The costly mistakes made with restrictions in health and social care

If a hospital or care-home does everything perceived to be helpful in stopping the spread of the virus, they will be free of any other kind of scrutiny.

From New Year’s Day, a particular NHS trust in the North of England suspended visits for patients. Given the extent to which coronavirus has been able to spread amongst the most vulnerable in hospitals and care homes since the pandemic began, enhanced infection controls are rational under the circumstances, and a core tenet of focussing protection upon those vulnerable to a bout of severe Covid-19 disease.

Also, sensibly, there are exceptions to the visitor ban. Women in labour can have a birthing partner. Children in emergency departments, children’s wards and neonatal units can be accompanied by a parent or caregiver. Patients with dementia, a learning disability, or who require a carer generally are also exempt. A negative lateral flow test is required to enter the hospital, but otherwise these scenarios appear to have been properly considered when devising the rules.

And yet, when a relative of my friend went to visit their mother (a dementia patient) on New Year’s Day, as they had been doing for the preceding week, they were refused entry. Despite the exemptions, clearly articulated on the Trust’s website, the staff said they were exercising caution and using their discretion to block the visit.

My friend’s relative tried again the next day when more senior staff were in attendance. They had no better luck having spoken to two people in roles of responsibility. The management were so worried about escalating Covid cases, nothing else, such as patient well-being, could supersede that obsession.

My friend’s distressed and helpless relative said:

“Since mother isn’t aggressive or doesn’t disrupt their system, they’re happy to leave her un-engaged and on her own regardless of the devastating long-term consequences. I’ll keep you posted of any developments, but the situation is looking terrible”.

The problem is, no matter how many deaths from heart problems, cancers, or dementia we have, the only health problem that the public sphere seems to care about is Covid-19. If a hospital or care-home does everything perceived to be helpful in stopping the spread of the virus, they will be free of any other kind of scrutiny.

A significant amount of death caused by Covid-19 has been due to nosocomial infections. In a single week in December 2020, when fatal infections in Britain were at their peak, almost one in four cases that required clinical treatment, were likely to have been caught in hospital. Almost a third of fatalities in the first wave took place in care homes.

The Government made things worse for those most vulnerable. Spooked by the thought of ICU capacity being exceeded many times over in the Spring of 2020, the panicked measures involved clearing out hospitals as fast as possible to make space for the presumed swarms of Covid-19 patients. This involved discharging large numbers of sick and elderly people back to their residential homes, filled with other sick and elderly people, without testing them first. Scottish GP, Dr Malcolm Kendrick described it as “scandalous”.

Not only did the Government fail to protect the residents of care homes, but as the journalist and broadcaster Peter Oborne has pointed out in his book The Assault on Truth, Johnson and his cabinet have repeatedly lied about it (Peter Oborne, The Assault on Truth, Simon & Schuster, London, pages 84-89).

The leader of the Labour Party, Kier Starmer, raised in the House of Commons in May 2020 that Government advice until March 12th, 2020, had been that it was “very unlikely that people receiving care in a care home will become infected” (Hansard, HC Deb, 13 May 2020, vol 676, col. 240.). Johnson replied that “It wasn’t true that the advice said that” (Ibid). Guidance published on February 25th had advised explicitly what Starmer had asserted; Johnson was wrong. Starmer has since asked him to correct the record in Parliament, but Johnson has neglected to do so.

The Prime Minister also claimed that care homes had been locked down on March 13th, having been commanded to only permit essential visits. An investigation conducted by Reuters found that there was “no evidence” of this, a finding that was supported by numerous care home providers. The Prime Minister told the House of Commons on May 13th, 2020, that there was a system of testing people going into care homes from March onwards (Ibid). This was emphatically untrue. Testing had been introduced on April 15th, 2020.

By the summer Johnson was blaming the care homes. “Too many care homes didn’t really follow the procedures as they could have” he said. The House of Commons Public Accounts Committee rightly described the transfer of 25,000 untested individuals from hospitals to care homes as a “reckless” and “appalling error”.

Can one blame a manager of a care home or hospital if they are now over-zealously applying visitation rules? The Alzheimer’s Society correctly asserts that blanket bans on visits for dementia patients are unacceptable. Government guidance now states that visiting must be supported and enabled whenever possible. So, to an extent we can lay blame on the doorstep of the hospital refusing my friend’s relative entry to see their mother.

Yet, given that the Prime Minister sought to blame health care providers for the failure of the Government to effectively execute a shielding policy, one can understand why they are jumpy. These mistakes have a cost. In this case, a confused and lonely dementia patient locked in solitary confinement, wondering why their children haven’t turned up.