An NHS hospital in Bristol discharged hundreds of untested or previously Covid-19 positive patients into care homes, an investigation has revealed.

Southmead Hospital transferred 213 untested patients into care homes in March and April without checking whether or not they were infected. 

Another 20 who had tested positive ‘at some point during their stay’ were sent to a care home without being re-tested prior to the move, meaning they could have still been infectious.

The findings, from a Freedom of Information (FOI) request by Bristol Live, give an insight into impact of chaotic guidance at the start of the pandemic. 

In March the NHS was keen to free up hospital beds for incoming Covid-19 patients, and the Government said testing was not necessary on discharge.

The decision has been now partly blamed for the huge impact the coronavirus has had on vulnerable people in care homes.

It is unclear how many patients with coronavirus were moved into care homes during the coronavirus crisis due to a lack of testing. The full scale of the problem will likely never be uncovered.

Southmead Hospital transferred hundreds of untested patients into care homes in March and April without checking they did not have the coronavirus

Southmead Hospital transferred hundreds of untested patients into care homes in March and April without checking they did not have the coronavirus

The FOI found Southmead Hospital, ran by The North Bristol NHS trust, discharged 171 untested patients in March.

This dropped to 42 in April, explained by new NHS England guidance that came into effect on April 16 requiring hospitals to test patients being discharged into care homes, and zero in May. 

The 20 patients who had tested positive ‘at some point during their stay’ were from March 1 to April 15 – before guidance changed. 

Those patients were not given a test before they were discharged, meaning those patients ‘cannot be said to have been positive when discharged’, the trust said.

It added that from April 16, patients who tested positive ‘were supported to remain in hospital for a further 14-day isolation period’ and on discharge provided with seven days of PPE. 

However, a further seven patients who had tested positive in the 48 hours before their discharge were transferred to care homes between April 16 and May 31.

REGULATOR FORCED TO INVESTIGATE SAFETY AT 50 CARE HOMES DURING COVID-19 CRISIS

Around 50 care homes were officially investigated by regulators during the Covid-19 crisis because of concerns they weren’t safe, it was revealed today.

Prime Minister Boris Johnson yesterday sparked a bitter row between politicians and care bosses after saying ‘too many’ homes weren’t following proper procedures.

Chiefs in the sector called his comments ‘despicable’, ‘cowardly’ and a ‘slap in the face’, and warned he had ‘picked a fight with the wrong people’.

But it has now emerged that dozens of care homes had people so concerned about the way they were acting that inspectors had to be sent out to check what was going on.

The Care Quality Commission, which regulates hospitals and care homes in England, received almost 1,000 reports about unsafe practices in homes across the country, The Telegraph reports.

Some forced staff to come into work while they had symptoms of Covid-19, others didn’t tell people when workers or residents had tested positive, and agency staff were sent to work in numerous different homes despite the risk of spreading the disease.

One Government source told the newspaper ‘some of these care providers are no angels’.

Britain’s care sector – which is privately run but linked to NHS hospitals and local councils – has been hammered during the pandemic and more than 30,000 residents have died either of coronavirus or from other causes.

Bosses have blamed a Government and NHS policy of sending hospital patients out into homes without testing them for Covid-19 for seeding deadly outbreaks in their facilities.

In Birmingham, the city council paid 16 care homes £1,000 each to take hospital patients who hadn’t been tested – some of whom allegedly had coronavirus – in order to free up bed space, the Birmingham Mail has revealed.  

This was made in agreement from the care provider ‘that the necessary infection control measures and resources were in place, including the provision of additional PPE’ where the resident was moving to.

Many care homes argued that they had struggled to procure adequate PPE during the pandemic. 

In response to the shocking findings, which are among the first to lay bare the scale of the care home scandal, North Bristol MP Darren Jones says the Government has ‘failed’ care homes.

He said: ‘Southmead Hospital and all of our health care providers have done an exceptional job saving lives in the most challenging circumstances. 

‘Care homes especially were failed by the Government.’

He criticised the ‘inadequate’ testing after the strategy has been lambasted by key figures for months.

Until April 15, the Government guidance said testing was a requirement only if the patients being discharged had obvious symptoms.

Official guidance said: ‘Negative tests are not required prior to transfers/admissions into the care home.’

Care home managers also complained that they had been ‘pressured’ into taking the patients, and families said their loved ones had been moved out of hospital like ‘sacrificial lambs’.  

It has since become clear that patients without symptoms of the virus (asymptomatic) are able to spread the infection to others.

And elderly people are more likely to show atypical signs of the virus without the usual cough and fever, including delirium and diarrhoea.  

NHS figures show 25,060 patients were moved from hospitals to care homes between March 17 and April 16.

But there is no national data to show how many of those patients had the coronavirus because testing was not accessible.

During the same period, care homes were crying out for more PPE to be supplied in order to protect both residents and staff from the infection.

There have been accusations the NHS was prioritised over care homes in terms of protecting it from being overwhelmed.

In May, Health Secretary Matt Hancock claimed Government had thrown a ‘protective ring’ around care homes ‘from the start’ – which has rattled chiefs in the care home sector. 

They have been further raged by Prime Minister Boris Johnson who appeared to shift blame onto care homes for their death toll surging into the thousands.

The Prime Minister had said during visit to Goole in East Yorkshire on Monday, July 6: ‘We discovered too many care homes didn’t really follow the procedures in the way that they could have, but we’re learning lessons the whole time.’

Sector bosses called his comments ‘despicable’, ‘cowardly’ and a ‘slap in the face’, and warned the PM he had ‘picked a fight with the wrong people’.

Mr Johnson refused to apologise for his controversial remarks after Labour leader Sir Keir offered him the chance during Prime Minister’s Questions on Wednesday. 

The Labour leader said the premier’s silence ‘rubs salt into the wounds of the very people that he stood at his front door and clapped’.

He added that the PM and Health Secretary Matt Hancock ‘must be the only people left in the country who think they put a protective ring around care homes’.

Care home residents make up almost 30 per cent of the total 55,000 deaths due to confirmed or suspected Covid-19 up until June 26, according to Office for National Statistics (ONS) data.

In Bristol, it rises to 48 per cent of the city’s 249 deaths.  

Bristol Live said it had also made an FOI request to Bristol Royal Infirmary. But the hospital had failed to respond in the 20-day limit.

MailOnline have contacted the trust (University Hospitals Bristol and Weston NHS Foundation Trust) for comment. 

A spokesperson said: ‘We have advised the requestor that it is our intention to respond to this request in full, but that it is unfortunately taking a little longer than usual to process and respond to FOI requests during the pandemic. The Trust is following the guidance published recently by the Information Commissioner’s Office (ICO).’

WHAT DID THE TRUST SAY? 

In response to the investigation, North Bristol NHS trust said, ‘in principle’, coronavirus-positive patients could still be transferred from Southmead into care homes if there were stringent infection control measures at the home. 

The trust’s chief operating officer Evelyn Barker said: ‘Sadly Covid-19 does disproportionately affect frail elderly people and there are many tragic cases of care home residents dying from this terrible disease.

‘Like all hospitals, when the huge wave of coronavirus was predicted to head our way in March and April, we urgently discharged medically fit patients so that we could care for everyone in need.

‘Based on the expert guidance at the time, we prioritised our then limited testing capacity for symptomatic patients and we only ever discharged people when our doctors believed it was safe.

‘We now know more about the risk of transmission before people display symptoms and the most recent studies have shown that much more transmission to care homes came from the community, rather than hospitals, as previously thought.

‘We supported care homes with PPE supplies when required and continue to work closely with our care home colleagues to keep residents and support staff safe.’

Care homes could ‘informally’ request an additional swab before discharge from April 16, the trust says. 

A Department of Health and Social Care spokesperson said: ‘Throughout the pandemic, our approach has been guided by the latest scientific advice, and it is because of the work we were doing to monitor outbreaks in care homes that they received advice on March 13 setting out actions to take around infection control and isolating residents or staff displaying symptoms.

‘To help further reduce the spread of infection in care homes regular testing for staff and residents has now begun, beginning with homes for over 65s and those with dementia before extending to all adult care homes.’

Bristol LIve said it had also made an FOI request to Bristol Royal Infirmary. But the hospital had failed to respond.

WHAT WENT WRONG FOR CARE HOMES? 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.

source: dailymail.co.uk

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