Radical... NHS_Training_in_Primary_Care_General_Practice

‘Outbreaks of infectious disease can be particularly challenging to manage in care homes. Residents may have dementia or other conditions that make isolating them particularly challenging and infection control, outside a hospital setting, is difficult’

… so says the Health Foundation, trying to unscramble the numbers and trends on deaths in care homes.  Their trends and deductions are important.  Their observations worth focussing on.

Reading between the lines, are they hinting; it’s too difficult for care homes to manage Covid?

Monday lunch-time, BoJo implied care homes hadn’t done a good enough job.  By tea time, Number 10’s press office cobbled together a nonsense about; 

‘…care homes didn’t do what they were supposed to do because they didn’t know what they were supposed to do, so how were they supposed to do it.’

… I suppose that made sense to them.  The rest of us just supposed it was another Bojo gaff.

Or was it?  Could the care homes have done better?

To be critical of the performance of the care home sector implies the people working in it have not done a good enough job.  That’s not right.  

I’m full of admiration for the lovely people, some of whom lived in tents, for weeks, putting a ring of canvass around their residents, to keep them safe.  It’s selfless and heroic.  They succeeded despite the system.

Was it wrong to discharge the frail to care homes, untested?  Less than 3% of the 33,000 discharges went to care homes.  Untested because scientists said it was safe.  Anyway, the DH/PHE didn’t have sufficient test capacity.

The ONS, Vivaldi study, reported about half of care homes had infections.  The other half didn’t.

Twenty percent of residents tested positive as did 7% of the staff.

Common factors emerged;

  • Staff infection; higher where there was reliance on bank or agency staff.
  • In care homes where staff had sick-pay; lower levels of infection in residents.
  • Where staff infections higher; resident’s infection rates were higher.

You can see where this is going… 

You could deduce infection control wasn’t, universally, good enough, or beyond the scope of a care home.  

You might say, they didn’t have enough PPE.  On the other hand, these are privately run businesses, they take on the responsibility of looking after yer-granny, why didn’t they have contingency stocks of their own.

You could say HMG was slow to crank-up testing.  Or, you might say, Amazon and Ocado arranged testing for their staff, why not care-homes.

You might point out, some care homes have had no infections, others, side-swiped… and then ask; if some can do it, why not all.

Is it right to say these are care homes, not nursing homes, we expected too much.

All this points to a sector that needs… well, call it what you like, support, help, shaking-up, sorting-out, a fix.

At one end of the scale; former head of the CQC, chair of Health Education England, David Behan’s, HC-1 care homes.  They pay their chief executive £800,000 a year.  They’ve lost 863 residents and three staff to the virus.  Their operating company, HC-One Ltd, made a £6.5m loss in 2018 but paid out an estimated £40m in rent, to offshore firms.

It’s legal, but is it right?

Other end; care-homes run by husband and wife teams, on shoe-string fees, which is all local authorities can afford.

It’s happening, but is it right?

Nine things to think about;

1.  Given the shifting demographic, have the abilities of care homes been pushed to their limits.  Do we actually want to up-skill, for fully supported-living homes.

2. Money, but not, in my view, for David Behan, to send overseas.

3. Privately funded residents pay as much as £12k a year, more than local authority funded residents.  A national tariff makes sense.

4. Registration and national training standards for all care-home staff.

5. No care home registered without a 24/7 nursing presence.

6. Resilience testing for organisations and a three month stock of PPE for emergencies.

7. Regular staff testing and vaccination, arranged and paid for by the companies.

8. Transparent national data-sets on infections, illnesses and untoward events.

It’s a start… number nine?  

The radical Aneurin Bevan, in 1948 saw healthcare needed; consolidation, quality controls, mandatory training, organisation, equity of access and a funding structure that works for people, not companies.  He gave us the NHS, by..

… nationalising the fragile healthcare infrastructure.

Now, in 2020, nationalise the fragile care homes sector, give us a National Care Service… think like a radical.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.