Thread by @lewis_goodall

Spent the day in Oxfordshire talking to carers

They tell a tale of the mistakes of this crisis, how the differences between expensive care homes and more modest ones and good and bad companies help determine who lives and who dies for both residents and carers.

Thread.

Cumnor Hill House in Oxford they've had no deaths and only five positive cases. Residents are locked down in their rooms. But it's well staffed.

The cost is £1500 a week. £85000 a year.

That compares with around £500 a week in some northern local authorities.

They have lots of ancillary staff- including a hairdresser- every one of them trained in care. They've had lots of staff off isolating but they have back up when main carers go off. They pay decent sick pay, so they insist staff don't work through sickness and isolate.

They've sourced their PPE privately, at a cost of £28,000. Initially, they were offered only 500 disposable masks from govt supply. They took matters into their own hands. They now have supply for eight months.

That's the freedom resource gives you.

The Cumnor Hill CEO is in no doubt what difference it makes: "Of the cover emergency money govt has promised...it's nothing, councils are saying we’ll give you 2%...that's getting an extra box of masks, not enabling them to deliver really effective infection control procedures."

But it's not just about money.

Cumnor Hill locked down on March 12th- 3 weeks before govt changed guidance saying that care homes should do the same. CH chairman made that decision after seeing what was happening in Italy and Spain.

At the time, CQC tried to talk them out of it

Cumnor Hill was told by CQC that was this not in accordance with government advice- that social interaction was vital and it represented a deprivation of liberty. Care home CEO told me he was told "we would have to take out a deprivation of liberty order on all our homes."

In retrospect, this seems incredible

Although plenty of care homes did decide to lock down earlier, it wasn't until April 2nd that govt changed guidance to lockdown care homes.

Cumnor Hill CEO says it was a difficult decision at the time because of reaction of authorities

In matters where the home can't take matters into its own hands they're struggling, especially on testing. Manager says residents and carers keep hearing things announced from the podiums, like testing for all residents, phone the home but managers have no idea about roll out

Home kept enquiring about testing and passed from pillar to post between PHE/CQC/DHSC. In the end, only by name dropping their local MP and potential complaints did they get tests turn up the next day: "It shouldn't take that."

They're also still under huge pressure to take new Covid positive patients, which they're refusing to do.

But they do want to take their residents back but they're being held up in hospital. New rules mean a risk assessment has to be carried out before there's discharge

But many homes haven't had their risk assessment done yet. Which means Covid- residents are sat in hospitals and can't be discharged but every day there are at greater risk of being infected.

So guidance might allow covid+ resident with risk assessment but not covid- without.

Home manager also told me he's still under huge pressure to take new Covid positive patients, which he's refusing to do.

They've done something right. They've had no deaths and only five infections.

Across the county, I talked to another carer. Her testimony is shocking.

She has a different experience. Her care home is under resourced. Half their staff are off. They've had 15 deaths in her unit alone.

Staff have no time to properly care for residents

She told me her residents haven't been properly showered for weeks as there aren't showers in their rooms and there aren't enough staff to facilitate. All they can get is a bed bath.

One resident pleaded with her to help wash her hair. "She felt disgusting in herself, her hair was so itchy. She just wanted 5 mins and I had to say no because I had 6 or 7 to get up in an hour and that task isn't deemed essential."

The situation got so bad management at the home organised a "lock in" where staff worked and slept at the home for seven days to reduce transmission.

The staff were living and sleeping cheek by jowl- in rooms like this. They weren't giving testing on either end.

They were promised 24 staff to work round the clock, they got 10. They were working 18 hour days with 4 hours sleep: "It wasn't safe for us and it certainly wasn't safe for the very unwell people we were caring for."

The carers have had to make do with shocking PPE provision. Initially PPE was ok-they were given dust masks and gowns. Then lab coats. Then the lab coats ran out and they were asked for spare bedsheets which could be washed at the home. This has been supplemented with hairnets.

After the lock in, the carers weren't even paid properly that which they had been promised. The seven day lock in was described as 'traumatic" and something which will "need time to get over."

On testing, the system she describes is patchy: We have only been able to test 13 residents, 12 of those came back positive. 6 who tested positive passed away. 10 passed away and were not tested all had symptoms of COVID-19."

"Furthermore, testing has still not been offered to staff. Only staff who have been very unwell – some of whom hospitalised – have had access to testing because they were able to get it themselves. It was not done through the home."

She said management had been reluctant to roll out tests for fear of losing even more staff from their daily rounds.

The carer told me: "I've never heard the term 'lambs to the slaughter' being referred to so much. It refers to all of us, carers and those we care for. That’s how we feel." She's referring to both her individual corporate treatment and how the sector has been treated overall.

Despite losing so many residents, the home in question is likely to receive new covid+ patients soon because they have so many empty beds.

There are so many things to say about the care crisis, so many mistakes made and so many injustices. But principal among them might be inequity. There's no reason, at the end of life, someone should be better protected from this disease by the sort of home they're in...

...by how much they can afford to pay. But that is what's happening. It's a lottery of provision. Btw, it's not as if local authority places are cheap. The system just doesn't work.

And that's because politicians of every colour have failed to deal with this issue for years. Those who've tried (like Theresa May in 2017) get burnt.

It's simple, really. As one carer told me: "We don't value our old people and we don't value those of us who look after them."

And also to reiterate- there’s loads of modest care homes which do an incredible job and lots of expensive ones which don’t. This isn’t just about money. It’s one component, an important one but just one. There are still more structural problems which all homes are dealing with.

It’s a crisis not only of this government’s making but of many governments’ (and parties’) making. Of a rotten system and of poor practice in some homes. Right now though, in every home, those podiums in Whitehall and those speaking on them, feel very distant indeed.

End thread

My latest report on the care crisis from tonight’s @BBCNewsnight can be watched here: