Coronavirus: 25,000 patients discharged into care homes without being tested, report finds

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Andrew Feinberg

White House Correspondent

Up to 25,000 hospital patients were discharged to care homes without testing during the height of the pandemic, an independent Whitehall report has established.

MPs from both parties condemned the findings from the National Audit Office (NAO), which also found that the government ignored calls in 2019 to stockpile personal protective equipment (PPE).

The NAO report established that, for an entire month, “medically fit” patients who did not display any Covid-19 symptoms were discharged without being tested. This policy, which sought to free up hospital beds for coronavirus patients, ran from 17 March and 15 April before it was changed.

“Due to government policy at the time, not all patients were tested for Covid-19 before discharge, with priority given to patients with respiratory illness or flu-like symptoms,” the watchdog said.

Jeremy Hunt, chairman of the Commons Health and Social Care Committee and a former health secretary, said “it seems extraordinary that no one appeared to consider the clinical risk to care homes despite widespread knowledge that the virus could be carried asymptomatically”.

Meg Hillier, chairwoman of the Commons public accounts committee, said care homes had been left at the “back of the queue” for both PPE and testing.

“Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences,” the Labour MP said.

It is not known how many of the 25,000 discharged patients were carrying Covid-19, but the NAO noted that, as of 17 May, one in three care homes had declared a coronavirus outbreak, with more than 1,000 homes dealing with positive cases during the peak of infections in April.

The North East was the worst affected region, with almost half its care homes reporting an outbreak by the middle of May.

The Department of Health and Social Care (DHSC) said it took the “right decisions at the right time”.

Plans to distribute PPE during the pandemic were also undermined due to the failure of officials to heed independent advice on the stockpiling of gowns and visors, the report established.

The New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), which was advising the DHSC, recommended in June last year that Public Health England (PHE) should increase its PPE supples and switch from glasses to visors.

In February, PHE had 41,500 pairs of gloves, 25,700 pairs of eye protectors and 156,000 facemasks. By the end of April, supplies for these items had been depleted, the report said.

“The department [DHSC] told us that the manufacture and supply of PPE has for many years been based on ‘just in time’ procurement and manufacturing principles,” it added.

Care homes were particularly overlooked in the distribution of PPE. Figures show that 8 per cent of gloves and 5 per cent of eye protectors from central stocks were directed to care homes.

Only health providers’ demands for face masks and clinical waste bags were met in terms of the modelled PPE requirements for the reasonable worst-case scenario during the outbreak.

The NAO also highlighted the “problematic” relationship between social care and the NHS.

“We have reported on successive efforts to integrate the two sectors: there have been 12 government white papers, green papers and consultations, and five independent reviews on integration over the past 20 years,” the report said.

“Going into the pandemic, meaningful integration was still to occur, however, and the lack of it has made responding to the crisis more difficult in a number of ways.”

Similarly, the number of bodies, both national and international, involved in acquiring PPE made the process of procurement more onerous, the NAO said.

Labour’s shadow health secretary, Jonathan Ashworth said the NHS had “entered the Covid-19 crisis exposed after years of under funding, bed cuts and with huge staff shortages”.

Susan Masters, a director at the Royal College of Nursing, said: “Without the extraordinary efforts of nursing staff across health and social care, the impact of Covid-19 could have been worse.

“But this report shows nursing staff were let down by a system ill-prepared to tackle this pandemic.

“Years of under-investment means social care was left exposed.”

A DHSC spokesperson defended the government’s handling of the pandemic and said it had stepped in to reduce care home transmission.

“We have been working tirelessly with the care sector throughout to reduce transmission and save lives and a result 60 per cent of care homes have had no outbreak at all, according to the latest Public Health England statistics,” the spokesperson said.

The spokesperson said the numbers used for judging PPE supply in the NAO report were “misleading”, stating: “The modelled PPE requirements presented in this report are theoretical worst case estimates – it is misleading to compare them to figures on centrally procured PPE which do not account for equipment supplied through other routes or existing local stocks.”