One of Britain’s largest care home chains was forced to deny it would let staff work in multiple homes to protect residents from coronavirus after a letter to relatives suggested they might defy new Government rules.
Care minister Helen Whately insisted on Tuesday this system of working had been outright banned to stop care homes from being thrown to the wolves again, after tens of thousands of elderly residents died from the virus in spring.
Barchester Healthcare — which runs more than 200 homes and employs 17,000 staff across the country — sent a letter on Tuesday saying it was looking at ways to ‘limit’ staff working in homes, but stopped short of guaranteeing it would never happen.
A source admitted today that the letter was ‘worded badly’ and did ‘not convey how serious the provider was taking the guidance’.
Britain’s care sector was decimated during the first wave of the pandemic, in part because asymptomatic workers were allowed to freely move between care homes without being tested for the disease.
One furious woman, whose elderly mother is in a Barchester home in Cheshire, leaked the letter to MailOnline today after growing concerned her mother could once again be exposed to the virus, which preys on the elderly and vulnerable.
It comes after it emerged care homes will once again be asked to take in elderly hospital patients infected with Covid-19 to protect the NHS from being overwhelmed this winter.
The developments have sparked widespread fears lessons have not been learned from the catastrophic errors made earlier in the year, which led to more than 20,000 care home residents being killed by the virus.
Barchester Healthcare said it was looking at ways to ‘limit’ the practice but stopped short of guaranteeing it would never happen, in a letter sent to residents and their families (shown) on Tuesday
Care minister Helen Whately insisted on Tuesday this system of working had been outright banned to stop care homes from being thrown to the wolves again, after tens of thousands of elderly residents died from the virus in spring
Ms Whately, MP for Faversham and Mid Kent, told a Commons select committee on Tuesday that care homes would be banned from letting staff work in multiple homes.
She had been asked to give evidence about how the Government planned to throw a protective ring around the sector during the second wave of the virus.
Ms Whately said: ‘What we have done in the winter plan published in September, is to say now it is mandated. Staff must only work in one setting.
‘We have gone from the guidance setting to this must be the case. That is supported by the second round of the infection control fund to recognise the costs.’
Ms Whately claimed care home providers had been told last month about the rule-change as cases started to surge and a virus resurgence looked increasingly likely.
WHAT WENT WRONG FOR CARE HOMES DURING THE FIRST WAVE? A TIMELINE OF FAILINGS
FEBRUARY – SAGE scientists warned Government ‘very early on’ about the risk to care homes
Britain’s chief scientific adviser, Sir Patrick Vallance, revealed in April that he and other senior scientists warned politicians ‘very early on’ about the risk COVID-19 posed to care homes.
He said: ‘So very early on we looked at a number of topics, we looked at nosocomial infection very early on, that’s the spread in hospitals, and we flagged that as something that the NHS needed to think about.
‘We flagged the fact that we thought care homes would be an important area to look at, and we flagged things like vaccine development and so on. So we try to take a longer term view of things as well as dealing with the urgent and immediate areas.’
The SAGE committee met for the first time on January 22, suggesting ‘very early on’ in its discussions was likely the end of January or the beginning of February.
MARCH – Hospital patients discharged to homes without tests
In March and April at least 25,000 people were discharged from NHS hospitals into care homes without getting tested for coronavirus, a report by the National Audit Office found.
This move came at the peak of the outbreak and has been blamed for ‘seeding’ Covid-19 outbreaks in the homes which later became impossible to control.
NHS England issued an order to its hospitals to free up as many beds as they could, and later sent out joint guidance with the Department of Health saying that patients did not need to be tested beforehand.
Chair of the public accounts committee and a Labour MP in London, Meg Hillier, said: ‘Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences.’
MARCH – Public Health England advice still did not raise alarm about care home risk and allowed visits
An early key error in the handling of the crisis, social care consultant Melanie Henwood told the Mail on Sunday, was advice issued by Public Health England (PHE) on February 25 that it remained ‘very unlikely’ people in care homes would become infected as there was ‘currently no transmission of Covid-19 in the UK’.
Yet a fortnight earlier the UK Government’s Scientific Pandemic Influenza Modelling committee had concluded: ‘It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.’
On March 13, PHE advice for care homes changed ‘asking no one to visit who has suspected Covid-19 or is generally unwell’ – but visits were still allowed.
Three days later, Mr Johnson said: ‘Absolutely, we don’t want to see people unnecessarily visiting care homes.’
MARCH/APRIL – Testing not readily available to care home residents
In March and April coronavirus swab tests – to see who currently has the disease – were rationed and not available to all care home residents suspected of having Covid-19.
Government policy dictated that a sample of residents would be tested if one showed symptoms, then an outbreak would be declared and anyone else with symptoms presumed to be infected without a test.
The Department of Health has been in control of who gets Covid-19 tests and when, based on UK testing capacity.
MARCH/APRIL – Bosses warned homes didn’t have enough PPE
Care home bosses were furious in March and April – now known to have been the peak of the UK’s epidemic – that their staff didn’t have enough access to personal protective equipment such as gloves, masks and aprons.
A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’.
Adass said it was facing ‘confusion’ and additional work as a result of mixed messaging put out by the Government.
It said the situation around PPE, which was by then mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.
A shortage of PPE has been a consistent issue from staff in care homes since the pandemic began, and the union Unison revealed at the beginning of May that it had already received 3,600 reports about inadequate access to PPE from workers in the sector.
APRIL – Care home deaths left out of official fatality count
The Department of Health refused to include people who had died outside of hospitals in its official daily death count until April 29, three weeks after deaths had peaked in the UK.
It started to include the ‘all settings’ measure from that date and added on 3,811 previously uncounted Covid-19 deaths on the first day.
But in a letter sent by Barchester on Tuesday, the firm appeared to stop short of ruling out the possibility of some staff still being able to float between its homes.
The letter, signed by the firm’s chief executive Pete Calveley, was sent to relatives, patients and staff at its sites across the country.
It said: ‘We are constantly looking at ways we can limit risk of Covid-19 coming into our homes and hospitals, and have been discussing working arrangements with our staff to understand who is working in other care settings, and looking at ways we can limit this.
‘Needless to say every staff members’ case will be different, and it is important that we do all we can to support them to work in a way that suits their and their families’ needs, whilst keeping our residents and patients protected.’
Care homes in the UK are notoriously understaffed, with the public service union UNISON saying that as many as nine in 10 care homes were struggling to make up staffing numbers in 2017.
Care providers have increasingly become reliant on agency workers and staff on zero hours contracts — who are temporarily hired when staffing levels dip.
Public Health England says about 10 per cent of the care workforce are agency workers, who on average receive just £8.10 per hour – less than shop workers and cleaners.
Critics warn providers won’t be able to stick to the ‘one care home’ rule because they don’t have enough full-time employees.
This also runs the risk of staff on zero hours contracts going to work despite feeling ill because they are not guaranteed sick pay.
One woman, whose elderly mother is a resident in a Barchester home in Cheshire, told MailOnline: ‘Helen Whately said that was now banned.
‘I received a letter from Barchester Healthcare yesterday saying they were trying to limit that.
Pointing out that Barchester left open the possibility of staff working in more than one home, she suggested: ‘Barchester is either not following the rules or the Care Minister is misleading the Select Committee. Which is it?’
Barchester insisted it is following the new Government guidance and that all staff, including agency workers, will only be deployed to single designated homes.
Sources admitted the letter sent out on Tuesday was ‘worded badly’ and did ‘not convey how serious the provider was taking the guidance’.
A spokesperson for Barchester said: ‘We are following guidelines very closely and it is our policy that staff only work in a single designated home.
‘A letter has been sent to all staff members along with a self-disclosure form for all to complete and return detailing all their sites of work.
‘The letter detailed the need to restrict staff movement in and between our services and any other care settings. This is the case for both permanent and part-time/agency staff.
‘General managers at each home have also been briefed to make this clear and are working closely with any staff that have been working in other care settings to ensure that moving forwards they only work in one.
‘If staff choose to work in a non-Barchester care setting they will not also be able to work in a Barchester home for the time being.
‘Further solutions to ensure staff only work in a single designated home have included employing part-time staff on a permanent basis and block booking agency staff so they only work in our service.’
Department of Health bosses have written to care providers asking them to identify a group of designated facilities — either standalone units or zoned accommodation with separate staffing rotas that could take Covid-19-positive patients, to prevent the virus being spread among elderly residents.
Homes — still suffering from a lack of tests and PPE to contain coronavirus and protect staff — will be inspected by the Care Quality Commission (CQC) to ensure they meet infection control standards.
Councils will have to alternative accommodation for the residents to isolate in if a care home does not have appropriate facilities.
Ministers are aiming to create 500 facilities by the end of November and insist the move is aimed at preventing a second crisis in care homes.
But care bosses have accused ministers of playing with fire by purposefully allowing the virus back within touching distance of the exact people who should be shielded from it.
Councils have been asked to identify accommodation that could meet current and future winter demand and notify the CQC of these premises, ‘ideally’ by Friday or as soon as possible.
Vic Rayner, executive director at the National Care Forum, said: ‘Key questions around who will operate these services, how they will be staffed, what choice will patients have in relation to their discharge and critically how care for the multiplicity of needs will be managed in one setting appear to be still not settled.
‘Within 48 hours local authorities are being asked to identify these schemes – and then a rapid run around of designation will ensue.
‘The pressure on providers, authorities, regulators and people who are being discharged from hospital will be huge.’
The DHSC letter said it is hoped that every local authority will have access to at least one CQC designated site by the end of October.
The cost of these designated facilities is expected to be funded through the £588million discharge funding.
The letter, from the DHSC’s director for Adult Social Care Quality, Tom Surrey, reads: ‘Emphasis should be on commissioning standalone units or settings with separate zoned accommodation and staffing.’
The designated scheme does not apply to residents who contract Covid-19 in their care home, people using emergency departments who are not admitted, or people supported to live in their own home, it adds.
Local authorities have also been asked to ensure there is repeat testing, sufficient personal protective equipment (PPE), arrangements for staff isolation or non-movement, protection from viral overload, sickness pay and clinical treatment.
Mike Padgham, chairman of the Independent Care Group (ICG), said he would like to see the Government show more leadership so councils and providers are not left to ‘shoulder all the pressure on their own’.
He said: ‘First and foremost, it should certainly not be the case that homes are forced to accept Covid-19 hospital discharges, as may have happened last time.
‘They should not be put in such a position that they are forced to accept Covid-19 discharges as a means of survival.
‘The Government must provide financial support to homes so that survival and filling empty beds is not the sole reason homes decide to accept discharges. It has to be an issue that each home can decide upon, based on their own circumstances.’
Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said it is ‘absolutely essential that lessons are learnt from the first wave, to avoid a repeat of what happened previously’.
He continued: ‘Care providers remain under intense strain. For many, those experiences are now compounded by problems with the testing regime and uncertainties around funding, along with caution about taking on anything new or with greater risk.
‘Councils and care providers will work closely together to identify the most appropriate care homes, with the priority being that any measures must be designed to keep everybody, including both those who work in and receive care services, safe and to avoid the spread of infection.’