Behind Closed Doors

What the covid inquiry heard about care homes

Dr Clare Craig

The shocking evidence heard in the Scottish Covid Inquiry about how people in care homes were denied dignity, love and ultimately life through withdrawal of healthcare during covid has now been echoed in England. Together held a panel discussion including the voices of whistleblowers who have not been heard and addressing fears that the inquiry will not join the dots on the evidence and that damaging new law will embed these practices if any kind of emergency is announced in future.

‘Generational Slaughter’

The mainstream media picked up on civil servant Alasdair Donaldson saying there had been a “generational slaughter” however this was framed as being due a virus and discharging residents from hospital who spread the virus. In his evidence Alasdair Donaldson was clear that “the Government public health response to Covid involved a series of catastrophic policy errors, and an overall system performance that was -- with notable exceptions -- a profound failure, perhaps the greatest Governmental policy failure of modern times.” There is some truth in that but it was not about the policy to discharge patients. Moving frail people is associated with a mortality rate and discharging them before they are well will increase that but the fact is that viral spread was driven by long distance aerosol transmission not close contact. Care homes that refused covid patients still had outbreaks and deaths.

All the measures that were introduced claimed they would “protect the NHS” but no-one seemed to ask what the NHS was for. It was surely for these vulnerable people who used the NHS most. The hospitals were so protected that many lay empty while healthcare was denied to those that needed it most. Of course excess mortality resulted.

The Inquiry did take evidence about blanket do not resuscitate (DNACPR) concerns and end-of-life medication practice.

The care home sector has the most vulnerable in our society and the rug was pulled out from under them in numerous ways:

1. Doctors refused to attend – giving the impression that the virus was catastrophic to health. The inquiry heard, “Our GP, I did a lot of video calls with them, it was hard to get them to come out… As soon as the Covid hit and we went into lockdown, we really struggled to get any doctors… They quickly started giving instructions over the phone and giving us more and more responsibilities in terms of how we needed to manage the residents.”

2. Many care home staff found reasons not to attend as a reflection of that attitude leaving the homes greatly understaffed

3. Visitors were banned so the care they offered was systematically removed at the same time as the role relatives play as advocates was denied. Residents felt abandoned, “Why is nobody coming to see me? And frightened. Some thought: is it a punishment? Where is everybody? Why have you done this to me?”

4. Blanket Do Not Resuscitate orders were issued on residents such that healthcare was denied to them – “paramedics were called out but, because [a DNACPR] notice was in place, they were not admitted to hospital”. Antibiotics, oxygen, face to face care from doctors and hospital admissions were all denied across the board.

5. It was assumed that anyone with respiratory symptoms had covid.

6. When care was sought carers were told “we don't take covid positive residents to hospital – order the end of life pack."

7. When residents died, their death certificates were completed virtually, by doctors who had not seen them in the lead up to their death.

In the words of Amanda Hunter, who is Together’s lead on social care “We have evidence from families and whistleblowers working in the care sector that care home residents and hospital patients were routinely denied antibiotics and other beneficial treatments during the covid era and that this led to deteriorating health and residents being placed on end of life pathways.”

The denial of care was not restricted to those who were otherwise dying. One extreme example was of a woman in her twenties who was in care for her epilepsy,

they wouldn't pin her collarbone when she broke it. And I just thought this is yet another example of the NHS seeing her as a second class citizen and although she has human rights under the Human Rights Act, these have been disregarded really. And you know, she was a healthy young woman in her twenties, apart from the epilepsy. And at that time, she was in better health than the rest of us. And I didn't see why I should agree to a DNA CPR for a healthy young woman in her twenties.

Compassion in Care’s Eileen Chubb read an anonymous care-worker whistleblower statement describing conditions during lockdown:

“There are not enough staff. Lots of people are sick and sometimes we have agency cover, but mainly we don’t. I reported how people were not being cared for. There’s not enough of us. No one could cope with this. The people we care for can’t do anything like pick up a drink. We have to do it for them and we can’t get to everyone. One person has not had a drink at all today since 7 this morning. Lots more people like that every day people calling, ‘Help me. Help me.’ I hate myself for having to walk past them. I hate this company for making me do this. I hate them for not listening to us. I love the people I care for, but I’ve had my shifts cut and I’m on a zero-hours contract – they call it bank staff. I had no choice but to say what was wrong. But I will always feel guilty about that because it meant I had to leave the people behind.”

No escape

In November 2020, a video went viral of retired nurse Ylenia Angeli (73) attempting to take her 97-year-old mother, Tina Thornborough, out of a Market Weighton care home – filmed and posted by her daughter, actor Leandra Ashton. Leandra said, “I don't know how to go mainstream with this, but it has to be human and it has to be truthful. And it also has to show that there can be a change.”

Ylenia Angeli was not the only one who was left unable to care for her own mother. Amanda Hunter went on to describe how her mother was “bedbound… unable to drink and eat… and… needed round-the-clock care.” When lockdown hit, “the quality of the care… plummeted.” She “deteriorated rapidly,” shrinking from “a size 12 to a size six,” becoming “skeletal.” Despite rare access “once a week for an hour,” families saw the “idiocy of the pantomime PPE” alongside a “dire lack of basic hygiene.” Amanda “fought with social services… for over a year” to remove her, but even with “lasting power of attorney,” she was “denied the right to bring my own mother home.” Instead, her mum was “moved to a nursing home nearer to where I lived” and “matters became worse.” After complaints, “my access was restricted,” and her mother was “evicted.” Before eviction, she “ended up in hospital where no visits were allowed,” and “after 7 days… the hospital put her on end of life.” Amanda “contested the prognosis,” waging a “seven-day battle in the courts” to get her “discharged to my care.” She “won the battle,” and her mother “lived another 14 months.”

Bullying

According to care-home operator Kath Blythe, a married couple who had refused the Covid vaccine were subjected to persistent pressure from visiting staff: “these two particular district nurses uh would come in every single day to badger them and go through, you know, you apart from one, you're the only others that haven't had the vaccine in this care home to the point where they asked if there was a double room vacancy in my Blackburn care home.” To escape the pressure, she said, they transferred temporarily to her other home – only for events to escalate: “as it turned out, we took them over and we got a visit by the police. These two district nurses had called the police uh and basically stated that they felt that .. there was a safeguarding issue and they had a duty of care. uh to make sure that these two people were okay. But by the time the police had got there, those two weeks had transpired and they'd gone back to Blackpool.” When challenged about the move, Blythe recalled being accused of facilitating their refusal: “we were told that we were aiding and abetting this couple and I said aiding and abetting what exactly? I said they have a choice. I said they have full capacity. If they don't want the vaccine they don't have to have it.” She added that, during their time in Blackburn, a different nurse persuaded them to accept vaccination: “what we weren't aware of was while they were in the Blackburn care home, they kind of got on very well with the district nurse in the area and you know she had a chat with them and she told them of all the benefits and even though she knew of their problems with their health, she managed to get them to have the vaccine. Well, all well and good, but within a 4 month period they were both dead, which was not all well and good.” She ended “I'm retiring. My time is done in care homes. I didn't sign up to kill off the elderly. And basically, that's what's happening. I don't want any more to do with it.”

The disabled

George Fielding, a disability-rights activist who said he helped found two care providers and delivered care during covid – argued that emergency policies devalued disabled people and erased their rights. He said: “you were all ranked on what condition you had, or whether you were medically vulnerable… your body and whether it worked or not and how it worked… is the only thing that supposedly was of value to you and as a result… disabled people’s lives were at the bottom… it got rid of choice, autonomy, rights, and dignities [of] those that most know why this society and our democracy needs to change, because it got rid of the platforms for people with disabilities to speak. Which is why it is incredibly crucial – incredibly crucial – that we’re here today.”

Silencing

HART and other groups with concerns around the covid vaccines were denied a voice during the vaccine module of the covid inquiry. Nevertheless we spent many hours writing extensive reports for the inquiry. These were not referenced by the module and have not been published.

Similarly the care home whistleblowers described how they invested many exhausting hours writing a similar submission describing it as “retraumatisting” and saying they were frequently left “sobbing”. Their submission included twenty case studies of deaths caused by end of life protocols. Like the vaccine module these statements were accepted but as yet have not been published.

Gloria’s Law and Anne’s law

The discussion ended with Amanda Hunter raising the issues of the proposed laws in England (Gloria’s Law) and in Scotland (Anne’s Law) which set in stone the idea that there are occasions when the most vulnerable should be denied access to the love and advocacy of their relatives. They guarantee visiting except during loosely defined “public-health emergencies” or when “necessary to control infection,” making rights subject to changeable guidance and a manager’s risk assessment under vague tests like “reasonable” and “proportionate.” Without tight definitions, independent review, and fast appeals, those carve-outs act as a standing off-switch that can reinstate blanket lockouts at a stroke.

Join the dots

Even if the UK inquiry does manage to take on board the abuses of Do Not Resuscitate orders, the denial of healthcare and the reckless use of end of life drugs there is still a question of whether they will join the final dots on this puzzle. One care home manager described how “other kinds of health conditions didn't exist during covid and if you took unwell when you were living in the care home, you were just automatically considered as being covid positive.” If every symptom was a covid symptom and then a covid death and there were excess deaths because of policy rather than a virus then the claims about how deadly the virus was will need to be scrapped and reassessed from scratch.