Thread by @C4Ciaran

Did we learn the lessons of the first wave?

Care homes in England 'under pressure' to accept COVID positive patients.

I've been told 'it's a disaster waiting to happen.' Read on..

https://twitter.com/Channel4News/status/1306642076101218315

Channel 4 News has seen a leaked contract which calls on care home providers to accept patients who are COVID-positive from hospitals.

The contract, from Trafford Council in Greater Manchester, outlines how eligible care homes will receive COVID-positive patients within just 2 hours of the patient being identified by the hospital as ready for discharge.

The leaked contract sets out terms for the “Rapid Discharge” of patients from hospital, and states that “some of these patients may have COVID-19, whether symptomatic or asymptomatic.”

There was a huge political row over discharging COVID-positive patients to care homes earlier in the pandemic.

England's Health Secretary Matt Hancock said he'd thrown a 'protective ring' around care homes.

UK government guidance updated on September 16 reiterates that care homes in England should be prepared to accept COVID-19 positive patients from hospitals.

Guidance in England expressly permits discharging COVID+ patients to care homes"

“As part of the national effort, the care sector also plays a vital role in accepting patients as they’re discharged from hospital...

“Some of these patients may have COVID-19.”

There was also a row in Scotland over discharging patients with COVID to care homes.

The guidance in Scotland is now very different from England's and requires patients to test negative twice before being discharged from hospital to a care home.

England's guidance states that care homes will not be forced to admit COVID-19 patients.

But with cases rises and winter coming there are warnings it may become "commonplace."

Leading Clinician Professor Adam Gordon told @Channel4News that discharging patients from hospital to care homes was “accelerated and escalated” in the early months of the pandemic and that it could happen again in line with the latest UK Government guidance.

Prof Gordon ran a COVID ward. He says:

“If we see similar pressures on the hospital sector this time around then it will be commonplace under the current guidance that people who are COVID positive will be discharged back into care homes.”

Data from the Office for National Statistics reports that there were 15,501 COVID-19 related deaths in care homes in England and Wales up to 4 September.

Prof Gordon says "we’re still waiting on conclusive evidence about the role patients going from hospitals into care homes played in spreading infection during the first pandemic..."

"But in the absence of evidence, it’s clear there’s two possible approaches." Essentially the Scottish approach and the English approach.

Can't care homes just say no to COVID+ patients?

A worker at a national care home provider (who asked not to be identified) told @Channel4News there was “pressure” from local authorities to take patients, including those carrying the virus.

Which brings us back to those contracts and the leaked contract seen by @Channel4News

Source at a National Care Provider:

“They're aiming now for patients to be out of hospital into a care home within a few hours from the decision to discharge them. That process used to take about a week.

“We have contracts with local authorities for block beds and you have to have a very good reason to reject a referral..."

“Ethically and operationally it’s difficult to refuse a patient who’s arrived in an ambulance at the care home door as many could die from the back and forth.

“There is an expectation and pressure to accept all patients.”

The insider said current problems with testing in the UK meant care homes could not know whether the virus was circulating in the home after accepting COVID positive patients.

“When you're bringing COVID positive patients into a care home many will die. We have strong procedures to prevent the spread, but this virus is extremely contagious.

“We are relying on the testing system to help keep our residents and staff safe..."

“We have staff and vulnerable residents who are being put in danger.

Care homes may not be safeguarded and no one in Government seems to care.”

In Wyncourt Care Home, Altrincham, there's a memory tree.

It bears the names of residents who have passed away.

This year they added two more names to the tree. It followed a COVID outbreak they believe was seeded by a positive patient being discharged from hospital.

Wyncourt Care Home is run by Sue, who says she would not take a COVID-positive patient from hospital again.

"Relatives want to know that I’m keeping these people safe as much as I can. That's having staff tested. And not brining in potential risk."

Sue says the current testing system is "shocking".

She's waiting six days for results to return which she says means her staff could be carrying the virus without their knowledge in the meantime.

Sue is pleased the government is pledging more than £500m for infection control at care homes in England.

She hopes to get money to hire more staff and avoid the risk of hiring in.

Infection control is now high stakes in England's care homes welcoming COVID+ patients from hospital.

Top clinician: "the English guidelines place the onus on the care home to ensure they can safely isolate and support that person with COVID in the care home setting."

Prof Gordon says “Care homes are not hospitals. They are designed to be homes and in many instances care home staff are not healthcare professionals who in the past have had really in-depth training in infection control..."

“If you were to be absolutely belt and braces about this, you might choose to isolate patients in an NHS setting until such time as they were confirmed to be COVID negative.”

Trafford Council says care homes can refuse patients. It says the wellbeing of patients being discharged is its primary concern. And the alternative would be to leave them in hospital with a higher risk of infection.

Statement:

Care homes "under pressure" to accept COVID positive patients.

Full story here: channel4.com/news/revealed-…

Big thanks to @luciajwalker and @althomsonC4

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