In the early days of the pandemic the wider societal and political concern was the risk that the NHS acute sector would not be able to deal with a massive increase in patients requiring treatment for COVID19. It was at this time that there as a focus on creating capacity within NHS hospitals by ceasing routine non-essential treatments, by maximising the availability of respirators etc. At the same time there was a push to discharge individuals who were fit for discharge either to their own homes or to care homes.
In ordinary circumstances an individual is discharged when they are clinically fit. Before Covid19 this was often a process which was delayed as a result of the non-availability of care home beds. This was not because the beds were not available but because the funding from public authorities was not sufficient to enable these transfers to take place. Yet even before COVID19 there were circumstances where at best the eagerness of hospital discharge had led to a breakdown in relationships with the care home sector. The most commonly cited instance was where a clinician considered someone to be able to be supported in residential care, they were then discharged and within hours it was clear they required nursing not residential care. So, looking back from this position we have to be clear that the process of clinical discharge into care homes before Covid19 was one which was not always smooth and frequently problematic. As a result there was often a local distrust in the system.
Because individuals were not tested at the point of discharge, despite the requests of the care home sector at the time, there was a real concern that people who entered care homes might be infectious. Initially people were barrier nursed for a period of 7 days and later this was extended to 14 days. However, with growing knowledge about asymptomatic presentation and with the different ways which COVID19 presents itself in older people it is inevitably the case that regardless of the use of all appropriate PPE and protection measures being implemented that some people entered care homes and effectively ‘seeded’ the virus in the care home.
Dr Donald Macaskill, the CEO of Scottish Care states:
“Our intelligence from members throughout this pandemic has been that for many of them, despite undertaking stringent PPE and following the Guidance on barrier nursing at the time, the lack of testing at the point of discharge from hospital has negatively impacted upon the sector. It is the belief of many of our members that individuals showing no signs or symptoms were effectively moved into care homes which thereafter had outbreaks. Individuals may have been clinically fit for discharge but that did not mean they were virus free. The clearing of the decks of the acute sector failed to appreciate the pressure the care home sector was facing at the time.”