Care homes have become coronavirus graveyards – but who is to blame?

Older people in care homes make up at least a sixth of the total coronavirus-related fatalities in the UK. How did we get here?

Government incompetence has most often been blamed for the deaths of thousands in care homes. ​The government’s repeatedly updated guidance issued to care homes was never going to stop the spread of Covid-19 in those settings. Combine that with a time-lag in reporting the number of deaths, and one can see why the public were arguably kept in the dark about the scale of the problem until recently.

Elderly people in care homes now make up at least a sixth of the total coronavirus-related fatalities in the UK.

How did we get here? There have been many warnings about the risks.

Since 2005, the government National Risk Register repeatedly identified that a flu-like pandemic would be the most likely disaster to happen. They knew it could come and they set out plans to protect us.

In 2012, the government’s Pandemic Influenza Preparedness Team produced the Health and Social Care Influenza Pandemic Preparedness and Response document. Until late February 2020, the 78-page guidance for health and social-care chiefs was the go-to guide for “how health and social care organisations should plan for, and respond to, flu pandemics”.

It gives a devastating warning about the potential impact of pandemic flu: “Care homes may find that difficulties such as staff shortages, resident illness, death, and transport problems all coincide over a prolonged period during a pandemic. Infection rates can be particularly high in group-living environments, such as care homes, so residents may need more help with personal-care tasks and more may be in need of end-of-life care.”

It correctly identified that having large numbers of frail, elderly people in one place with a new coronavirus would lead to significant fatalities.

Fast forward to this February, and the evidence supported this. Analysis from China showed that one in six of those over 80 years old who contracted Covid-19 died.

On 3 March, Boris Johnson announced that widespread transmission of Covid-19 was “highly likely” and launched his coronavirus action plan. This warned that “there could well be an increase in deaths arising from the outbreak, particularly among vulnerable and elderly groups”.

Despite the government issuing this action plan and warning of Covid-19 becoming widespread, it also had new guidance for care homes. It was the direct opposite of its own expert advice and the warnings from the government action plan.

“It remains very unlikely that people receiving care in a care home or the community will become infected,” the guidance stated. “There is no need to do anything differently in any care setting at present.”

The guidance was withdrawn on 13 March, but it had provided a window for Covid-19 to find a foothold in care homes. If that didn't buy Covid-19 enough time, then the government's replacement guidance, which is still “being reviewed”, would certainly in my opinion have massively encouraged the spread among care home residents.

“Care home staff who come into contact with a Covid-19 patient while not wearing PPE (personal protective equipment) can remain at work. This is because in most instances this will be a short-lived exposure, unlike exposure in a household setting that is ongoing.”

A care home staff member who feeds, dresses, washes and bathes someone with Covid-19 can carry on working in the care home with other vulnerable residents, yet in a hospital they would need full PPE.

In Scotland, if I pop to Tesco I should wear a face mask; but, according to this guidance, getting up close and personal with a Covid-19 sufferer before heading to see the frail elderly person in the next room is fine. In my view, there are only four possible reasons why care homes would be given these new sets of guidance.

First, politicians U-turned on the advice of their own experts because they didn’t think Covid-19 would affect older British people. Yet the action plan proves to me that the government was aware of the risk to our elderly.

Second, the Department of Health and Social Care forgot about care home residents or how susceptible they were to illness. Again, this seems implausible since they purposely issued the new care home guidance that addressed this demographic.

Third, the Scientific Advisory Group, with a nudge from the government, decided to downplay the risk in order to encourage the herd immunity strategy and “if that means some pensioners die, then too bad". However, the government says this is a highly defamatory fabrication, with quotes from meetings that are invented.

This leaves one explanation – my personal belief – which the government denies. It is that the guidance was given to care homes in order to free up beds in an attempt to protect the NHS from the threat of becoming clogged with recovering Covid-19 patients.

Let me explain my thinking. A functioning NHS is critical to managing Covid-19. On 3 March, the government announced plans to help with the incoming influx of the infected and also plans to build mortuaries to manage the dead. They also need plans to house the recovering.

As the prime minister has demonstrated, recovering from Covid-19 is hard.

For a survivor in their seventies admitted to hospital but now recovering, it can be a massive challenge and require months of care.

These individuals may be too sick to be discharged to their home, but too well to remain in a hospital bed, especially when there is massive demand for them for new Covid-19 inpatients. Care homes are ideal for recuperation. And, if the NHS did its job well, there would be hundreds, possibly thousands, needing this longer-term care.

The increase in care-home fatalities frees up enough space for recovering patients to be transferred from NHS beds and allows hospitals to have enough capacity to treat the next wave of Covid-19 patients.

This argument sounds heartless, but I believe this is what has happened. In such a brutal crisis, these are decisions that are planned for, as some see it, in order to protect the NHS.

There should be honesty from the government on this. Was it just an oversight? It seems unlikely to me. We need to know why care homes have become graveyards.

Richard Stokoe lectures at the University of South Wales on planning for disasters and civil contingencies and on strategic leadership

In response to this article, a Public Health England spokesperson said: “We have always been clear that certain groups, including people aged over 70, are at higher risk of serious complications from Covid-19. The initial advice accurately reflected the situation at the time when there was no community transmission, meaning there was a limited risk of the infection getting into a care home.

“Once there was evidence of widespread transmission and we moved into the ‘delay’ phase, new guidance was immediately put in place. Any suggestion that we said that infections in care homes would be unlikely in the current phase of the outbreak is wrong.”