Social care…

Social care... Training Primary Care - NHS - GPs

How’s yer granny?  Mine liked a port-n-lemon, shortbread biscuits, dripping sandwiches and played the piano, in a pub.  

Good old gran.  Have you got a gran?  Is she safe?  Where do you think she might be safe?

In a care-home, with people of her own age and experience, looked after by the super-well-intended… or…

At the top of a tower-block, depending on food parcels, the pharmacy delivering her medications and a twice a day phone call; ‘How you doing Gran?’

If the data is to be believed, it looks like the tower-bloc might just be safer.

Deaths, in care-homes, from any cause have increased by 99% since the start of the outbreak.  The front-line of the Battle-of-Covid 2020, is now in care-homes.

  • Four Seasons Health Care reported a 79% increase in deaths in two weeks, bringing its toll to 286, 
  • The UK’s largest private provider, HC One, of which the former boss of the CQC, David Behan, is now the executive chair, announced a 50% increase in deaths in 10 days, to 616. 
  • Bupa, revealed it had lost well over 200 residents with confirmed or suspected coronavirus.

If, as BoJo announced in his comeback speech, the ‘tide is beginning to turn’, he should know… it’s still a riptide in care-homes.

Yesterday, England and Wales recorded 4,343 care-home coronavirus deaths in a fortnight.

Just where is safe for Gran?

I have nothing but admiration for care home staff, some of whom have left their own homes and are locked-down, with their clients, living in care-homes, some in tents, under siege.

Passion for the job, commitment to their work and vocation in their veins.

However, I have questions… would it be wrong to ask…

Is the inability of the care-home sector, to cope with CV-19, a reflection of a failure of regulation?  Care-homes, unlike nursing homes, are not required to have clinical input, the type of which may have improved infection control and clinical governance.  

Being able to operate a care-home, legally, without this level of cover, points to the need for legislation to end the artificial boundary between nursing and care.  Change regulation and licensing requirements.

Was it an error on the part of the DHSC to assume the privately run care sector would be robust enough to manage the epidemic themselves?  Were they left to their own devices?  Should the DH+ have intervened with the same robust response the health sector initiated? 

Is it reasonable to require, care home companies to have businesses continuity and epidemic emergency plans in place and their own reserve supplies of protective equipment, without looking to the DHSC for supply?

Is it reasonable for care-home companies to provide on-site testing, for their staff, as have Ocado, Amazon, ABB and others?

Is it a fact that the Covid-collapse of the sector means the CQC has been inspecting for the wrong things.  For instance; 48% of home care staff leave after less than a year in the job, and 73.5% leave within two years… isn’t that a quality indicator?

Is it reasonable to assume that low-waged and high-churn staff cannot be adequately trained, beyond basic induction. 

Many care-homes are subsidised by private client’s fees, paying, sometimes >double the rates local authorities pay, for the same care.  That is inequitable?  What part has funding played in the care-home Covid response?  

The Daily Mirror reported; HC-One Ltd made a loss of £6.5million in 2018 but the group perfectly legally, paid an estimated £40million in rent to offshore companies in the group.

The care-home business is vulnerable, fragmented, pressured, regulated for the wrong things, sometimes exploited.  Much like health services in 1948.  

Final question, the sector is highly fragmented, probably, in many cases, not viable and open to manipulation…  

... is the answer a fresh start?

Nationalisation and a proper Department of Health and Social Care?

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Reproduced at by kind permission of Roy Lilley.