The Coronavirus CrisisThe Dysfunction Fuelling the UK's Care Home Epidemic
Former MP Paul Farrelly investigates how disjointed responses by turf-minded authorities in one English county reflect a nationwide pattern at the heart of the country’s nursing home crisis.
Set in four acres of landscaped gardens, beyond its Georgian façade, grade II listed Bradwell Hall traces its heritage back to a 15th Century yeoman’s house that was once the seat of one of the richest landowning families in North Staffordshire. It is now the county’s, and possibly the Midlands’, largest care home and one of the most stricken by the Coronavirus.
In the past three weeks, 24 of the 164 residents have died – eight confirmed with the virus, while the other 16, some with ‘pneumonia-like symptoms’, were simply not tested. In the same period last year, the toll in the near 190-bed home was just five.
It is a pattern, in my old constituency of Newcastle-under-Lyme, being repeated in care homes up and down the land. And it highlights, for many hundreds of families, the disjointed response to COVID-19 at its most heartbreaking.
“It’s a badly handled nightmare,” said a director of one of the area’s NHS trusts. “It all kicked off at Bradwell last month. But that was when no one, politicians or anyone else, wanted to know about care homes. Until now, their numbers have been ignored, to put it politely, or suppressed to put it more accurately, if that doesn’t sound too cynical.”
The latest figures, from the Office for National Statistics, put the number of Coronavirus deaths in care homes at 217 as of 3 April, against the tally of more than 14,500 in hospitals to date.
But Care UK, which represents the industry, puts the figure as “at least 1,400”, and even that may be wildly out. A London School of Economics study estimates that around half of Coronavirus deaths overall in Italy, Spain, France, Ireland and Belgium have come in care home settings.
The trouble is that, if Staffordshire’s ramshackle response is typical, as care home testing has been so slow, we don’t have the data to know and are only just now playing catch-up.
According to senior health and care sources, the local NHS – centred on the Royal Stoke University Hospital – has coped well until now.
Amid around 1,000 confirmed cases across the county, there have been just 99 fatalities at the hospital. And it still has vacant intensive care beds, plus spaces on wards, without drawing on hastily recommissioned, long fought-over community hospitals, including one barely a mile away from the Hall at Bradwell.
“Frankly, we’ve not seen the numbers we were expecting,” a hospital spokesperson said. “We’re testing staff. We have protective equipment and an agreement across the county in the NHS to share stock. But I can’t comment on care homes. We’ve not been involved in that.”
And there lies the nub. With the early focus on hospitals, the county’s three big NHS trusts have pulled together, and largely sidelined the six Clinical Commissioning Groups (CCGs) in the UK’s ‘purchaser-provider’ healthcare split. Care homes, meanwhile, have fallen to local authorities to take the lead and in Staffordshire, sources say, while way behind the curve, the county council has still aggressively staked its turf.
‘All planning for the first month was about enough ventilators and ICUs [intensive care units] and nothing else. The wider response, so-called ‘resilience’, is straight out of the cold war frankly, and this is not nuclear contagion,’ one senior local NHS source said.
“We were advised of the rapidly deteriorating situation at Bradwell Hall on 5 April. We directly offered them PPE [personal protective equipment] and staff counselling. However, we were told that the Incident Team at Staffs County Council were taking responsibility, supported by the council’s communications team. Essentially the NHS was told to back off.”
Operationally on the ground, key players liken the delays to the time lost nationally with the Government’s decision on 12 March to halt community testing in favour of so-called ‘herd immunity’, before the volteface 11 days later, enforcing lockdown and social distancing.
As in other parts of the country, Staffordshire’s ‘wider response’ is led by its SCG – Strategic Co-ordinating Group – borne out of civil contingencies legislation and chaired by the county council’s director of health and care, Dr Richard Harling, a former medic. It includes representatives of the police, fire service and the NHS, but during the crisis has had what one source politely termed a ‘shifting membership’, with key people included, then summarily excluded, as it seemingly fumbles to get a grip.
On the ground, too, there is legacy of different ‘multi-agency’ bodies, including the Strategic Resilience Forum (SRF), Local Resilience Forums (LRFs) and the Civil Contingencies Unit (CCU) and partners outside county hall struggle with all the acronyms.
Last week, as the nursing home crisis unfolded, one of the complaints confronting Health and Social Care Secretary Matt Hancock was that local authorities had yet to release much-needed emergency funds to the frontline. Indeed, Staffordshire only approved a £22 million injection into its ‘Coronavirus Battle Fund’ at a cabinet meeting on Wednesday. The move came just as Hancock, amid mounting criticism, announced his ‘right to say goodbye’ policy for relatives in care homes – amid a flourish of new, little green ‘care’ badges to put social staff on the same status as NHS nurses.
It came of little, belated comfort to homes like Bradwell Hall. The first Coronavirus cases there, one resident and a member of staff, were reported on 23 March, and the first death – of 86-year old great granddad Reg Amison – happened a week later.
A county council spokeswoman said that last week it had now delivered 3,000 sets of PPE to the nursing home, but relatives on the ground still report lots of make-do and mend.
“They’ve been in dire straits through lack of PPE. There are women at Bradwell even sewing things to put behind their ears, so the masks don’t cut,” one father of a care worker at the home said. “Eight deaths there have been confirmed by the hospital, but there’s been no thorough testing. That’s the problem with the county. Care homes have been left behind.”
Local families often have multiple members working across health and social care, the area’s biggest employer. But, like NHS staff for this article, they are reluctant to be named, for fear of the possible risk to their jobs. In one family, with one member ‘self-isolating’ with symptoms, a nurse at the Royal Stoke had been tested, but a care worker relative still had not.
The county council calls its ‘Strategic Resilience Group’ – yet another name to pop up in conversation – “a sort of Gold Command”. According to veteran local Healthwatch campaigner Ian Syme, however, it is definitely more “Dad’s Army”.
“It’s hopeless,” he said. “Bradwell Hall is now shut to new admissions and they are only now going to educate people about infection control. It’s a bit bloody late.”
Of Bradwell Hall’s 440 full- and part-time staff, 100 are now off work, ‘self-isolating’. This year it was fined £1,250 after the latest Care Quality Commission inspection, the second in a year, over continued breaches of safeguarding regulations. It ‘requires improvement’ across all inspection categories: safety, effectiveness, care, responsiveness and leadership.
Yet the local CCGs still commission places at homes like Bradwell for NHS continuing care, and have planned to put hospital discharge rehabilitation beds there, too. That’s part of an ongoing battle about care quality across the country, with the closure of community hospitals.
Calls to the nursing home about the current situation are being referred to the county council to deal with. At Stafford, the spokeswoman admitted the scale of the challenge and capacity issues: “At first, five people at care homes were tested, while hospitals are testing all. With 440 staff at Bradwell, 140 residents, all of them and their families, it’s a bit hit and miss really.”
Dr Harling, meanwhile, defended the limited testing as in line with Whitehall guidance. “Up until last Wednesday, Government policy was to test the first five cases in care homes. Since Wednesday, it is to test all,” he said.
As for local discretion in hotspots such as Bradwell Hall, he referred the issue to the local hospital and Public Health England (PHE), another of the plethora of agencies involved. As to why the Bradwell situation has been kept under wraps for so long, he declined to be drawn.
PHE was also contacted for comment about its role and actions, but did not respond.
Meanwhile, this weekend there are signs for some cautious optimism, despite scarcer supplies of PPE. Battles continue to rage, and to be won, in the local North Staffordshire NHS.
By unilaterally re-opening community hospitals, it has already fought off regional ‘command and control’ plans for Coronavirus patients to be sent, with vital staff, 50 miles down the M6 motorway to the new Nightingale hospital at Birmingham’s National Exhibition Centre. In all this, the Royal Stoke’s chief executive Tracy Bullock, sources say, has “played a blinder”.
And from this week, after first being pressed with Edgbaston – Birmingham home of the Midlands’ leading cricket ground – wider Coronavirus testing will now start at Stoke City’s bet365 Stadium, on the local A50 overlooking the Potteries, including care homes.
“We were working to a peak predicted around Easter,” said Tracey Shewan, spokesperson for the local CCGs and a former nurse, ready to be redeployed. “When testing first came out, it was to emergency areas, like A&E and ambulance crews, but we are now going to ramp it up. We will be testing all NHS and local authority staff, if symptomatic, or members of their family, if symptomatic too. From Monday, we will be testing them all.”
Of contact tracing, however – a key component of the response in other countries, like South Korea, Japan and Germany and vital to any lockdown exit strategy – there is yet no mention.
Paul Farrelly was the Labour MP for Newcastle-under-Lyme from 2001-2019 and is an ex-Observer, Independent and Reuters journalist