Public concern about Coronavirus drops sharply, but it remains the biggest issue facing Britain

 From IpsoMori - interesting to see poverty and inequality moving up in the list of concerns.

The March 2021 Ipsos MORI Issues Index records the first significant drop in concern about Covid-19 since June 2020.The proportion who name the coronavirus as a big issue for the country has fallen from 72 per cent in February to 49 per cent this month. One third see the pandemic as the single biggest issue (34%), a decrease from almost six in ten last month (57%).

 

While economic concern has held steady, there has been a fall in the proportion of the public naming Brexit as an issue. This month 26 per cent cite the UK’s exit from the EU as a worry, the joint-lowest score for this issue since the vote to leave in 2016 (concern was also at this level in April 2020). This month’s score is seven percentage points lower than last month – and half the level of concern recorded in December 2020 (60%).

 

There has been an eight-percentage point increase in mentions of the NHS as a big concern: 24 per cent mention it as an issue. Fieldwork occurred between 5 and 11 March, covering the period when the Government announced a one per cent pay rise for NHS staff.

 

Other issues that have risen significantly from last month include Poverty and inequality (up 6ppt since February), education (up 4 ppt), unemployment and immigration (both up 3ppt),

 

 

 

 

While concern about Coronavirus has fallen across all groups since last month, there is a distinct pattern by age, with older and younger Britons now significantly less concerned than those in the middle age brackets. The proportion mentioning the pandemic as an issue stands at 44% among 18-34s, 59% among 35-54 year olds, and 43% among the over 55s. By contrast, in February these figures were 70%, 76% and 72% respectively.

 

Those aged 65 and over are among the least likely to mention the pandemic as a big issue; 39% do so, meaning it is their joint-top concern alongside the economy (also 39%).

 

 

Imperative that Brent Scrutiny Committee seeks answers on US takeover of Brent GP surgeries at Wednesday's meeting

 

 

The main agenda items tabled for Wednesday's meeting

This blog has reported the huge concerns of local councillors, Barry Gardiner MP, Brent Patient Voice  and Patient Participation Groups over the takeover of two GP surgeries in Brent by a US company. The concerns have been echoed across London in a joint letter by London borough chiefs to Matt Hancock.

One of the main issues is the alleged lack of due diligence by Brent CCG in coming to the apparent decision to back that takeover and the fact that the decision (it it wasa decision) being made in a private session.

Surely then it is incomprehensible that the only vehicle that the Council has to holding the Brent CCG to account, the Community and Wellbeing Scrutiny Committee, does not have  this as an item on its Agenda (above).

One can only hope that councillors will put such an item on the Agenda under Any Other Business in accordance with Standing Order 60.  

Many questions were left unanswered or unsatisfactorily answered at  Wednesday's meeting of the PPPG LINK this is a chance for Scrutiny to really do its job.

The battle against privatisation of Brent GP practices is going on right now

Brent CCG is discussing the takeover of two Brent practices t and appears unlikely to oppose. Join HERE

Nan Tewari has put this forward to the meeting which has just  started:

The PCCC of Brent CCG wishes to NOTE that in ratifying the consent as recommended by Officers of the North West London Collaboration, a number of events have occurred since the PCCC gave its in principle consent to the change of control of AT Medics Ltd in its Part 2 meeting in late 2020.

(a)   The 18 Feb 2021 letter confirming ‘change of control’ letter is written by Samantha Jones [CEO, President and Director of MH Services International Holdings (UK) Ltd] who became the new CEO, President and Director of AT Medics on 10 Feb 2021.

(b)   Samantha Jones’ statement that <the existing AT Medics GP directors remain actively involved at an executive level in the business> may give rise to adverse inference in its inaccuracy, and for the avoidance of doubt should be amended to correctly refer to 'the former AT Medics GP directors..........'. 

(c)   All the AT Medics GP directors resigned their directorships on 10 Feb 2021.

(d)   The AT Medics assurance questionnaire answer on 3 Dec 2020 on the question of staffing or management changes that may take place as a result of change of control, is a straightforward description of the standard TUPE status of the former GP directors and cannot be represented as being a specific ‘assurance’ of any other nature.

(e)   Information of public interest relating to Operose Health Ltd and MH Services International Holdings (UK) Ltd, deriving from Companies House financial records, that has come to the attention of the PCCC and its non-voting, Brent Council representatives, is summarised below.

 

As at 31 December 2019, the holding company for the UK group which Operose Health Ltd is part of, MH Services International Holdings (UK) Ltd, had creditors falling due within one year of nearly £49m (£48,999k).

It owed Centene Corporation £37.8m at the end of 2019, and then notes that it received a further £13m in 2020.  These debts are unsecured, but repayable on demand.

Its accounts (audited by KPMG) have been prepared on the basis that the UK group is a "going concern".  This is because Centene has advised “that it does not intend to seek repayment of the amounts due at the balance sheet date, for the period covered by the forecasts.”  Those financial forecasts only go up to 31 December 2021, and the accounts note that there is a risk that those forecasts may not be met.

The Director who made all the statements in connection with the holding company accounts to 32 December 2019, and signed them off, is not one of the company's UK resident directors, but Tricia Dinkelman.  Her address is given as Centene Plaza, 7700 Forsyth Blvd., St Louis, Missouri, MO-63105.

That is also the address of Centene Corporation, which is a US company registered on the New York Stock Exchange, reg. 42-1406317.

The money which the UK group owes to Centene Corporation has not come directly from Centene, but via its Delaware registered "affiliate", MHS Consulting International Inc.

The business model policies that are set in the accounts of the group holding company, MH Services International Holdings (UK) Ltd, indicate an intention to close non-profitable parts of its business.

From We Own IT

Nearly 50,000 from all across the UK have signed the petition asking health chiefs to kick Centene out of NHS GP practices - amazing! Will you join us for an hour tomorrow to take the next steps to win this campaign to protect our NHS? We've got a plan - now we just need your help to make it happen! Please join us whether or not your GP surgery is directly affected. Can you join the online organising meeting at 6:30pm on Thursday, 18th March?

Sign up for the organising meeting

A US healthcare profiteer, Centene, has recently taken over 49 NHS GP practices. This is terrible news for the NHS. Millions of Pounds will be syphoned out of those GP practices in shareholder profits and the care people receive will suffer greatly as a result.  The pay and conditions of GP surgery staff (including GPs) could likewise suffer, which would affect morale and therefore patient care. And, this could lead to more of our local GP practices being closed down for not being profitable. Wherever you live and whether you are currently affected, this matters to you because Centene could be coming to your neck of the woods soon. Local health authorities (CCGs) have the power to terminate Centene's primary care contracts and kick them out. We need to force the authorities to take that step.

Grants available to Brent communities & organisations wanting to tackle health inequalities

 From Brent Council

Grants from £1,000 to £25,000 are being made available to individuals and organisations with innovative ideas and solutions to tackle the impact of COVID-19 and health inequalities.

The Brent Health Matters Programme – a joined up approach from Brent Council, NHS partners and the community to tackle health inequalities has launched its Community Grants Scheme this week.

Health inequalities are avoidable, unfair and systematic differences in health between different people. The pandemic has not only exposed long-standing health inequalities, but in many cases made them worse.

Cllr Neil Nerva, Brent’s Cabinet Member for Public Health, Culture and Leisure, said:

The fund is now open to submissions from individuals and organisations that have ideas and solutions to reduce the disproportionate impact of COVID-19 in the short term, and more broadly tackle health inequality issues in the longer term.

An individual can bid for up to £1,000, with a higher threshold of £2,000, whereas an organisation can look to secure up to £15,000 in funding, with a higher threshold of £25,000. The higher threshold would require the bidder to demonstrate how they will deliver significant impact in a single ward or impact across multiple wards.

The launch of the grants will complement other elements of the Brent Health Matters programme that have already led to some real examples of acting on feedback from the community. This includes the launch of a health and wellbeing telephone advice line that has been launched as a pilot for the whole of the borough through to April, with the potential for it to be extended.

Cllr Nerva added: 

Any Brent resident can now speak to locally based NHS staff to ask any non-clinical questions about health and social care. They will be helped with signposting to relevant support and assisted to access the right services. Residents can also receive advice on how to better manage their health conditions.

The Advice Line is available on 020 3114 7185, 10am to 3pm, Monday to Friday.

To find out more, including how to apply for a Community Grant, go to www.brent.gov.uk/brenthealthmatters

URGENT: Brent TUC launch petition to stop closure of Wembley Ambulance Station

 

Sign the petition to Garrett Emmerson, Chief Executive London Ambulance NHS Trust SIGN HERE

Public Health Directors: Government misjudgement in lifting too many restrictions, too quickly will risk spike in Covid19 cases and deaths

I am publishing below the full text of the statement by the President of the Association of Public Health Directors on the proposed lifting of restrictions. LINK


COVID-19 has already taken a huge social and economic toll on our nation – and the reality is that it will continue to do so for some time.

We are at a critical moment. We need to weigh up the balance of risks between easing restrictions, to enable more pupils to return to school, more businesses to open and more social connections to happen, with the risk of causing a resurgence of infections.

Directors of Public Health are increasingly concerned that the Government is misjudging this balancing act and lifting too many restrictions, too quickly.

This is a new disease; evidence is still emerging and there is much uncertainty. However, based on what is currently known, several leading scientists and public health experts have spoken out about a string of recent national policy announcements affecting England which project a degree of confidence that many – including ADPH members – do not think is supported by the science.
Over the weekend we have seen signs that the public is no longer keeping as strictly to social distancing as it was – along with this, we are concerned that the resolve on personal hygiene measures, and the need to immediately self-isolate, if symptomatic, is waning. A relentless effort to regain and rebuild public confidence and trust following recent events is essential.

At a local level, Directors of Public Health (DsPH) consider that honest and open dialogue with their communities is integral to effectively containing COVID-19 and managing outbreaks. That focus must be echoed at the very top of Government.

The Government has set five tests, each of which must be regularly reviewed as restrictions are adjusted and eased. Here is our current assessment:

Firstly, the pressure on the NHS – and those that tirelessly and expertly work within it – has been significant but it has been able to cope with those who unfortunately need hospital treatment for the effects of COVID-19. The number of people in hospitals with COVID-19 is falling, and beds are available for those that require them.

Secondly, there must be a sustained and consistent fall in the daily death rate. While the first peak in deaths has passed, the downward trend is slow – particularly in care settings. Deaths are a measure of what happened roughly two weeks before – the effect of easing measures now will only become evident in two weeks.

The critical debate is about the third test – ensuring the rate of transmission of the infection continues decreasing to manageable levels (taken to mean R being well below 1). The rapid and multiple ways in which measures are being eased is likely to make it difficult to judge the cumulative impact on R.

As we saw in March, R can go above 1 in a very short space of time – and once it does it can take many months to bring it back down. The room for manoeuvre is tight.

The fourth aspect, ensuring supply of tests and PPE is able meet future demand, remains an enormous challenge. PPE manufacturing and supply chains are stronger, but shortages are still being reported and it is not clear that supply can meet new demand as different parts of society, public services and the economy open. While testing capacity has undoubtedly increased, we are not yet confident that the current testing regime is sufficiently effective in getting the priority tests done and the results to where they are needed to enable swift action.

Finally, the fifth test. A second peak cannot be ruled out – whether it will overwhelm the NHS is an important question to ask. But perhaps the even bigger one is, do we really want the same number of deaths again? The scale to date represents an unimaginable tragedy and we must do everything possible to limit further loss of life.

The ADPH has argued that an effective contact tracing system is vital to keep R consistently below one. We set out a ‘Statement of Principles’ to outline what needs to be in place to make this work. A huge effort is underway to establish such a system. We would pay tribute to valued colleagues at Public Health England, who have built on the contact tracing work they conducted at the start of the pandemic – and Dido Harding and Tom Riordan who have shown great energy and leadership in recent days. We also welcome the new Joint Biosecurity Centre to support action based on intelligence and there are welcome signs that local knowledge, insight and capabilities are more widely understood and recognised by the Government.

As ever, the ADPH will continue to be as constructive as possible and as challenging as necessary.

But, let’s be clear, the NHS ‘Test and Trace’ programme is currently far from being the robust operation that is now urgently required as a safeguard to easing restrictions. Directors of Public Health are working at extraordinary pace to develop Local Outbreak Plans. The ADPH will shortly be publishing a briefing paper setting out the guiding principles needed to shape – and implement – them. It is important to recognise that these plans will largely build on the health protection duties that DsPH already have. The work that has been going on throughout this pandemic, including managing outbreaks in settings such as schools and care homes and support for vulnerable people, continues day in and day out.

DsPH have proved themselves capable and ready to take on this leadership role and will develop and deliver local plans with the support and collaboration of local government colleagues and PHE regional teams, as well as the NHS, third sector and business.

Now is the time for steady leadership, careful preparation and measured steps.

The ADPH is calling for full implementation of all Phase 2 measures to be delayed until further consideration of the ongoing trends in infection rates and the R level gives more confidence about what the impact of these will be. There also must be a renewed drive to promote the importance of handwashing, social distancing and self-isolating if symptomatic, positive for COVID, or a contact of someone who is. And, additional assurance is required that the NHS Test and Trace System will be able to cope with the scale of the task.

The risk of a spike in cases and deaths – and of the social and economic impact if we have to return to stricter lockdown measures – cannot be overstated; this needs to be understood not only by the public but also by the Government.

GP's 7 point plan to reduce death toll in care homes

NHS GP Dr Gero Baiarda an NHS GP at the Clarence Medical Centre in Windsor in this  opinion piece reveals how a GP’s role in keeping elderly care home residents well has become near-impossible, due to decisions made by national and local government, and what must be changed to reduce the number of elderly residents dying prematurely, or unnecessarily.  (Source:
 GPDQ -GP on demand service)

Setting the scene

At the beginning of this crisis, the UK public was informed that those most at risk were the elderly and anybody with an underlying health condition. 

It is likely that this information was intended to reassure the majority of the population who do not land in either of these camps. However, if you were on a mission to identify a sector of our community to which both categories were not only relevant, but were concentrated in one static location like a quarantined cruise liner, you would have to look no further than the UK’s residential or nursing homes.

Unsurprisingly, we learned last month that the number of elderly care home residents who have died from Covid-19 was possibly as much as five times higher than the Government’s official estimate.  When you figure that up until that point, only the first five suspected cases in every care home setting were being formally tested in order to identify an outbreak, it seems likely that even this is an underestimate.[1] 

Further compounding this low number of recorded deaths was the fact that official figures excluded long-term care home residents with Covid-19 who were admitted to hospital and subsequently died. New data published in the BMJ on the 29th April now states that there were 4,343 deaths from Covid-19 in care homes in England and Wales in just a fortnight.

However, with the poor access to testing that is still a reality for many elderly care home settings, the numbers could be higher still. In fact, research by London School of Economics academics suggests that if the UK follows international trends, care home deaths from Covid-19 could be closer to 50% of all UK cases. This would be in line with the figures emerging from Ireland, France, Italy, Spain, Portugal, Ireland, Belgium, Norway and Canada, where the national proportion of total Covid-19 deaths is reported at between 33 percent and 64 percent.[2] 

Further supporting this hypothesis are figures from the Office for National Statistics which show that deaths from all causes in care homes rose by 48.5% in a week compared to a 10% increase (from 8578 to 9434) in hospital deaths during the same time frame, and an 11% increase (from 4117 to 4570) in deaths in private homes. Today we learn from official statistics that nearly 10,000 care home residents, or 26% of all cases, have died from Covid-19 in the UK since the crisis began, but that the true figure could be as much as 43,000.

As measures are introduced this week by the Prime Minister which will see tens of thousands returning to work, and a pathway to eventual relaxation of lockdown, it appears that deaths in this sector are still largely going overlooked. Below, I seek to provide a clear insight into why this has happened, what the current situation is, and what might be done to address the care home crisis that is continuing largely unchallenged. 

Why have the numbers of Covid-19 deaths in care homes been underestimated?

1. Inadequate testing 

• During a crisis in which even symptomatic frontline NHS workers have struggled to access testing, it is easy to see how elderly care home residents have been placed very far down the pecking order. And yet, without adequate testing of every symptomatic resident, how are we ever going to get close to the true number of deaths in UK nursing homes that have arisen from infection with Covid-19?

• The human impact of insufficient testing goes far beyond the repercussions of inaccurate statistics. Care workers with symptoms must isolate at home until they test negative, which then leads to fewer workers assisting more of the residents, with the inherent heightened risk of infection for all involved.

•  The UK government’s recent statement on easing lockdown measures has not clarified whether visiting elderly care home residents is now fully permissible. Elderly residents with symptoms who have not been tested are routinely isolated and no longer permitted visits from family members. Some of these residents will be in their final days of their lives for reasons other than Covid-19, and yet will not be allowed the comfort of having loved ones come visit them. In short, without adequate testing taking place on site, we often do not know what we are dealing with, and residents are still dying without saying goodbye in person.

• Family members play such a crucial role in end of life scenarios. Without their presence, the emotional strain on family and carers alike can be unbearable. A negative viral antigen test would help ease this enforced isolation and afford some dignity to our elderly in care homes, not to mention closure for their loved ones.

Any bereavement is hard enough, but can be unbearable when we are denied the fundamental right to say goodbye. 

2. Data Lag

• Deaths take time to register and appear on official statistics, especially in the current locked down climate.  According to the Department of Health and Social Care, it takes at least 11 days for deaths in care homes to enter the official data, with death registration taking a minimum of five days.

• The official UK Covid-19 death toll only started to include deaths outside hospitals a few weeks ago. As of the 15th April, Public Health England’s official figures claimed that there were only 3,084 care homes in England with confirmed cases. A month later, the official death toll for care home residents is 10,000.

• As recently as four weeks ago, the Office for National Statistics was still suggesting that 85 percent of all UK Covid-19 deaths were occurring in hospitals. Clearly, there was no way of corroborating this figure when there had been so little effort to gather accurate data from care homes. The new figures suggesting that 26% of all Covid-19 deaths have occurred in care homes is very much at odds with this earlier suggestion.

• World-renowned statistician, Sir David Spiegelhalter of the University of Cambridge, suggested on the 1st May 2020 that the incidence of  Covid-19 deaths was higher in UK care homes than hospitals. He continued that, although the Prime Minister suggested that we were over the peak in the UK as whole, deaths in care homes were yet to peak. His predictions appear increasingly to have the ring of truth.

What is perpetuating the crisis?

       1.       Lack of adequate planning and testing

• Care homes are as much on the frontline as General Practice, yet no contingency was put in place for this foreseeable situation. There is still no significant plan in place for how medical attention and testing should be delivered. We knew all along that the elderly and those with underlying health issues were the two most vulnerable groups.

• As of the week ending 19th April, only 505 care home workers had received Covid-19 tests in comparison to nearly 48,000 NHS staff and their families.[4] Even late last month, three quarters of more than 200 providers contacted by the BBC said none of their staff had been tested for the virus.

• What access is being offered is often far too distant for many carers to reach. Care home staff are being invited to testing sites sometimes 100 miles from their location. On site testing for residents and carers alike would seem the logical solution.

2. Inadequate medical input 

• The central principle of the practice of medicine is, ‘First, do no harm.’ Because of this, many medical colleagues have ceased the regular review of care home residents which, up until the crisis struck, occurred weekly. GPs are overwhelmed by fear of contaminating elderly patients with an infection from which they are never likely to recover.

• GPs have also known for months that care homes are hotbeds of Covid-19 infection. GPs and carers alike are then left in a situation where, if they do what every instinct suggests by attending to the sick elderly, they run the considerable risk of not only becoming infected themselves but also passing the virus on to their families at home. This fear is compounded by an often-inadequate supply of PPE at homes.

• The result has been massively decreased rates of GP visits to care homes, with telephone consultations taking their place, or video call if the home has technology in place. Residents and carers alike are feeling forgotten and abandoned. There have been moves within recent weeks to move to UK-wide remote ward rounds done over video-link. Some GP practices have delivered this kind of review throughout the crisis, but there has only been patchy provision of this sort of service throughout the UK as a whole.

3. Elderly care home residents are not being admitted to hospital

• Aside from emergency situations in which paramedics are called, GPs bear sole responsibility in the community for making the decision whether to admit patients to hospital.

• Although GPs are informed when their local hospitals are at maximum capacity, they are not usually made aware when occupancy crises have eased to more manageable levels,  and have tended to assume that hospitals are always full to the brim. In fact, many A&E departments throughout the UK are reporting record-low attendances.

• Subsequently, GPs do not have enough up-to-date information to make an informed choice as to whether they are seeking admission for an elderly and vulnerable patient to a hospital that is already straining at the seams. When all variables are considered, it may sometimes present less risk to the patient to stay at home. The fear that many GPs have had is that the elderly patient they choose to admit to a hospital with limited resources would be side-lined for younger patients seriously ill with Covid-19 who face a higher realistic chance of survival and recovery. There are only so many ventilators, and the famous ‘R Figure’ we have heard so much about in recent weeks is only just teetering below 1.

• Even if the GP does decide that the best place for the patient is in hospital, it is often the case that residents, their carers’ and family members are extremely reluctant to agree to admission for fear of contracting and dying from Covid-19 once admitted.

• There have been numerous reports of Clinical Commissioning Groups (CCGs) urging GPs and care home managers to ensure they have do-not-resuscitate orders (DNR) signed by their residents. This is often interpreted as a licence to avoid admission and allow nature to take its course at home.

4. Rapid, unsupported, and disconnected discharge from hospital

• On 17th March, NHS England wrote to hospital bosses and advised them to seek to actively discharge patients to free up 15,000 acute beds for people with Covid-19.

• Many of these patients were elderly, and part of the recommended guidance for effective discharge included giving patients the direct telephone number of the ward from which they had been discharged. They were urged to call if they need further help or advice rather than contact their GP or visit A&E.

• Many of those discharged have kept slavishly to this advice and continue not to seek any further medical help whatsoever even 2 months down the line.

5. Little or no PPE

• Personal Protection Equipment has only really been prioritised for hospital use since the crisis began, with even GP surgeries struggling to access adequate supplies, let alone care homes. However, it is close to impossible to care for elderly residents without subjecting both them and staff to considerable risk of cross-infection without it.

• PPE ideally should be changed prior to each new interaction with a resident, but scarce supplies in most care homes will not allow this. Carers are left to treat residents with little or no PPE or wearing the same gowns and masks for multiple patients. Spend a few minutes on social media and you will easily find care home staff sharing their experiences of washing their PPE each night before their next shift.

• Unlike any other frontline service, care homes are still required to pay VAT on any PPE that they manage to source. They are often also having to source this equipment privately and at exorbitantly inflated prices, something that is unsustainable for any period in view of the cash-flow crisis many of these homes are facing.

• Almost certainly because it is such a scarce and expensive resource, many care workers report that PPE is being locked away and rationed; they are being advised that they either do not need to use it because residents do not currently have viral symptoms, or that they should make gowns and gloves last all week. This puts residents and staff at risk. UNISON’s PPE alert hotline has received more than 3,500 messages from scared employees since it was established stating that they are worried for their residents, themselves, and their families.

       6. Care home staff sick, isolating or too scared to work

• Some carers are so frightened of contracting the virus that they are refusing to work, while others with symptoms but no access to testing are self-isolating.

• It should not be forgotten that this was a sector that already faced problems with recruitment because of low pay and long hours. The addition of considerable personal risk to life has led to some carers abandoning the role altogether.

• This means that the same high workload is now being shared between far fewer carers, which increases the risk of exposure to the virus for residents and care home workers alike. The same carers, often in inadequate or unchanged PPE, are having to deal with more residents in less time within the same working day.

7. No requirement for testing before admission to a care home

• UK Government guidelines suggesting new residents to care homes are tested for Covid-19 prior to their admission have only recently been put in place and are not being consistently applied. They are not even a universal requirement throughout all UK home nations, with Scottish care homes still permitting admission to residents without testing as recently as last week. Other elderly UK residents are still being admitted with the understanding that they will receive a test within a few days of arrival. This allows more than adequate opportunity for rapid spread within the home at which they arrive.

• This allows a clear avenue of infection into otherwise safely contained homes, especially when cash-flow is such a major issue for so many residences.

• It is inevitable that some of these new residents will be carrying the virus whether they have symptoms at the time of admission, or not.

What should be done? Here is a 7-step approach to reducing the death toll in the UK’s elderly care homes: 

It is often said that the mark of a civilised nation is how we treat our most vulnerable. The UK is failing our elderly and ‘at risk’ groups and, up until this week, was not even gathering the data that would prove this. There are six simple measures that should be taken to remedy the situation.

1. Adequate PPE - Care home staff are as much at risk as frontline clinicians in A&E, and yet are on a fraction of the salary. They should be afforded the same level of access to PPE protection without care homes facing the financial sanction of having to pay profiteers exorbitant prices or VAT to the Government.

2. Adequate Testing - All care home residents and staff demonstrating symptoms should have near instant access to testing. In the case of carers, this would allow them to continue to provide much-needed support, and in the case of residents, this would allow them to continue to draw comfort from their families if they test negative yet are ailing. Care homes could then set about isolating to their rooms only those who test positive.

3. Access to dedicated care home medical teams - Full PPE Hot Hubs and Hot Car visiting services dedicated to the treatment of patients with proven or suspected Covid-19 have popped up all over the country. There is no reason that similar dedicated provision could not be provided for care homes. This would provide considerable support, reassurance and comfort to residents, their families, and their carers alike.

4. Regular symptom checking - The Government suggested last month that all residents should be assessed twice a day for Covid-19 symptoms including cough, shortness of breath and a high temperature. This is all well and good, but there was no simultaneous pledge for provision of adequate PPE and access to rapid testing, something that would be indelible to such checks taking place safely. However, it is feasible that dedicated care home health teams could provide this service if they were established across the UK.

5. Improved, more regular communication between CCGs, GPs and hospitals - this would enable GPs to understand what capacity hospitals have when making important decisions regarding hospital admissions. The discharge procedure should also be reverted back to normal, meaning the GP is updated and can continue to provide care themselves or through the Hot Hubs and Hot Car visiting services.

6. Accurate Data - It is easy to ignore what we cannot see. The Government pledged on April 28th to publish accurate data on Covid-19 deaths in care homes alongside those occurring in hospitals. This data will include figures from the ONS and the CQC. Since 10th April, care homes have also been required to notify the CQC within three days of any resident deaths due to confirmed or suspected Covid-19 cases.  This is a very recent development and we are now many months into the crisis.

7. Integrated Health and Social Care provision - This crisis has taken the UK government and NHS infrastructure completely unawares, and we need to take steps now to minimise the chance of any future recurrence. Care homes feel detached and isolated because they really are very separate from other UK health and care provision. This has left them inadequately supported in terms of training and a consistent and reliable supply of PPE. This deficit in structuring was highlighted in an editorial published in the BMJ last month which suggested that, “The current emergency has exposed once again the need for a universal integrated health and social care service.”

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[1]  https://www.bbc.co.uk/news/uk-52289607

[2] (https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/?subscribe=success#blog_subscription-3).

[3] https://edition.cnn.com/2020/04/21/uk/uk-death-toll-coronavirus-statistics-gbr-intl/index.html

[4] https://www.mirror.co.uk/news/politics/coronavirus-tests-been-given-only-21865558

[5] http://www.pulsetoday.co.uk/clinical/clinical-specialties/respiratory-/hospital-patients-discharged-early-to-free-up-beds-told-not-to-contact-gp/20040506.article