Care home testing and shielding failures during coronavirus pandemic picked out by Committee

(Title Image: New Scientist)

Health & Social Care Committee
The Impact of Covid-19 on Health and Social Care: Part I (pdf)
Published: 8th July 2020

“The shock of Covid-19 has been so severe, it has shaken our very foundations. Yet, it gives us the chance to reset our course for the future. We can rethink how we support our vital yet fragile social care sector, and re-assess our approach to mental health, bringing services in line with those for physical health. This is the time to be radical, and significant changes for the better can be achieved if we grasp this opportunity.”
– Committee Chair, Dr Dai Lloyd MS (Plaid, South Wales West)

This is the first in what will be a series of reports from the Committee looking at different ways the coronavirus pandemic impacted health and social care.

It’s a long one, but these things always are and it has to be to get the full picture.

1. There were grave concerns over lack of PPE during March and April 2020

The distribution of Personal Protective Equipment (PPE) in Wales was organised by the NHS Shared Services Partnership and local government joint equipment stores.

Updated guidelines on the use of PPE in the care home sector in April 2020 led to confusion as some local authorities had already implemented the guidelines while others delayed by a week or more.

Towards the end of April 2020, a survey of doctors in Wales found that 67% felt they weren’t adequately protected and 60% had to buy PPE directly. During March, 74% of nurses raised concerns about PPE and more than half felt they were pressured into caring for patients without adequate protection. There were also worries that PPE wasn’t properly fitted.

In the care sector, the GMB union told the Committee the sector was completely unprepared for a pandemic, with many care workers using only gloves and plastic aprons. Care Forum Wales said PPE supplies were unpredictable, while other witnesses said suppliers resorted to only dealing with existing clients, which in the end resulted in English suppliers exclusively supplying English care homes.

In the early days of the pandemic, there were only days worth of PPE supplies in storage as opposed to weeks; this eventually changed to months worth of supply. The Welsh Government actively tried to obtain PPE from multiple sources, including domestic manufacturers, instead of relying on single sources (traditionally China and south-east Asian manufacturers).

Despite this, 90% of Wales’ PPE supplies are imported and the Welsh Government described the situation as “stable, but fragile”.

2. Access to tests improved as the pandemic went on, but there were big variations across Wales

While there was initial difficulty in accessing virus tests, the situation improved – albeit with significant regional differences, which were eventually addressed.

One of the biggest regional differences was test turnaround times, with just 36% of people receiving test results within 2 days in the north, compared to 59% in South Wales Central.

When it became clear that the original target of capacity for 5,000 tests a day by the third week of April 2020 couldn’t be met, the Welsh Government dropped it. The reasoning given was that lockdown was reducing the number of new cases overall – a view backed by the Chief Scientific Adviser, Dr Rob Orford.

3. Older people’s rights may have been violated during the pandemic due to the care home testing policy

The most controversial issue was the lack of testing in care homes. 28% of all Covid-19-related deaths in Wales happened in care home settings.

The official Welsh Government guidance in the early days was that virus testing was only required where a resident was showing symptoms. The result of this was that people were being discharged from hospital into care homes and neither they – nor the residents or staff in the home they were being discharged to – were testing for Covid-19.

Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth), said there was no evidence that releasing asymptomatic patients into care homes contributed to deaths. However, the WLGA called for patients to be tested twice before discharge to avoid “false-negatives” (a test result that says someone doesn’t have Covid-19 when they do have it – one of the arguments made against blanket testing).

The guidance, however, rapidly changed throughout the pandemic and by mid-May, routine testing in care homes (including staff) was authorised – though an initial restriction to care homes with 50+ residents was described as arbitrary.

The Older People’s Commissioner has called for the Welsh Government to be investigated by the Equality & Human Rights Commission for a possible breach of older people’s rights.

£40million has been made available by the Welsh Government to sustain adult social care services, but the sector was in a fragile state even before the pandemic. There was confusion over what precisely the funding was supposed to cover and concerns that, while welcome, it wasn’t anywhere near enough.

Additionally, there were fears that social care staff who test positive may not be able to afford to take time off work due to the low rates of UK statutory sick pay (£95.85-per-week).

Longer-term, the Committee called for reform of the social care sector and its funding model.

4. Shielding was poorly handled

One of the biggest cock-ups during the pandemic was the distribution of 13,000 shielding letters – advising people with serious pre-existing medical conditions to remain at home and avoid face-to-face contact with anyone – to the wrong addresses. This happened because a previous address of the targeted person was used and they subsequently moved.

Parkinson’s Cymru said there was confusion amongst clients over the support that would be available, while other witnesses criticised a lack of shielding instructions for people with learning disabilities and carers.

Additionally, some medical conditions were left off the list of those which would trigger shielding advice as an extremely vulnerable person – including motor neurone disease.

Local government was also only given three days notice that shielding exercises would take place, but on a more positive note, the WLGA said the response to the call for volunteers was “fantastic” – the only downside being a lack of co-ordination.

The Committee recommended the Welsh Government re-examines arrangements with supermarkets to ensure there’s sufficient capacity for online shopping and home delivery to meet demand during the winter.

5. “Track and trace” may be needed for a year or until a working Covid-19 vaccine is found

Tracking people with coronavirus system and tracing people they will have been in direct contact with is a key measure to suppress new cases of the virus and prevent a second wave.

In what’s probably the most positive part of the report, there was confidence that the system was operating effectively. Pilot programmes had enabled officials to fine-tune the contract tracing scripts and administration of test samples.

While there were few concerns about the number of tests that can be carried out, turnaround times – as mentioned earlier – have been a problem, with 85.6% of tests completed end-to-end within 48 hours (as of 21st June). Turnaround time is important because the sooner people know they have the virus, the sooner they/their household can self-isolate. The Committee recommended all tests to be turned around within 24 hours as soon as possible.

So far, 600 staff have been recruited (mainly from councils and health boards) for the track and trace programme. Though this may need to eventually increase to 1,000 people, due to the fall in new cases it may not be required. Additionally, a single digital platform for contact tracing is yet to be completely rolled-out though it is operational as of 8th June 2020.

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