The pandemic firestorm still burns in care homes. Untested residents and unprotected staff in this neglected private archipelago used to be out of sight and out of mind. But no longer. The government will not escape the ghosts of needless care-home deaths.
The Guardian’s Robert Booth last week revealed that the government rejected a radical plan by Public Health England to lock down care homes, move staff in and use empty Nightingale hospitals to isolate suspected Covid-19 cases. Research from the London School of Economics suggests that care homes have suffered 22,000 extra deaths. All staff and residents need persistent testing, but almost two-thirds of homes have had no staff tested yet, according to the Data Analysis Bureau.
Blame is cast in many directions: councils and care-home companies have turned up the volume of conflict with the NHS, though the sectors are supposed to be blending locally in integrated care systems. While many work well together, national representatives of the care industry are on the warpath.
Talk to Prof Martin Green, the spokesman for Care England’s larger care companies, and his charge sheet against the government is blood-curdling. “From the start the NHS was prioritised,” he says: the signs read Save the NHS and that’s what they did. “PPE was redirected away from care homes. Managers were told by suppliers their orders were requisitioned by the NHS.” He claims some areas had “blanket policies not to admit residents to hospital. I’ve seen the letters from GPs saying they will not admit residents, putting DNR (do not resuscitate) on their notes. Some refused to visit.” He says: “There was a clear instruction to empty hospitals in March and send people to care homes despite no testing for infection. I’ve seen patient notes altered to disguise infection.” Local hospitals deny it, protesting that care homes are trying to blame the NHS for their own failings.
Green attacks the government with gusto for “systematic ageism”. Indeed, at first the NHS was gripped by fear of the dying queuing outside, with no ventilators and overflowing morgues. There was whispered speculation about letting the over-65s go to save younger victims. That didn’t happen. But the NHS was only saved, Green alleges, because hospitals dumped the crisis on care homes. Exaggerated or not, with so many deaths the government rightly fears his allegations will stick.
Hot denials come from the NHS, with Hancock’s credulity-straining claim that he had tried to “throw a protective ring around care homes”. Chris Hopson, the head of NHS Providers, sprang to the defence of his hospitals: “Trusts invested considerable time and effort into protecting care homes and deeply resent the suggestion that they would knowingly discharge a [Covid-19] or suspected [Covid-19] patient into a care-home setting.” The problem, he says, was the lack of tests until mid-April so hospitals couldn’t know if they were sending the infected into care homes. Then he strikes right to the heart of the matter: “The scandal here is the repeated failure of politicians to solve our long running social-care crisis.”
The health select committee has been taking devastating evidence, eagerly chaired by Jeremy Hunt who fiercely challenged Boris Johnson over patients discharged to care homes at last week’s liaison committee. Downing Street is plainly rattled and infuriated by Hunt, suspecting him of leadership manoeuvres, should Johnson fall. Aides are drafting attack lines on Hunt’s six years as health secretary, highlighting his failure to prepare for a pandemic despite warnings, reports the Mail on Sunday. Many in the NHS are equally dumbfounded by Hunt’s reinvention as NHS champion, after willingly implementing the most brutal budgets in NHS history.
At the heart of the care-homes scandal is the government’s failure to reform social care’s ramshackle finance. The attempt sank Theresa May’s election campaign and there is no sign yet of Johnson’s promised “clear plan”. The NHS v care home row shows that both are utterly interdependent, yet can never meld while one is free, the other paid for by families or councils. Martin Green said to me revealingly: “Imagine the row if NHS PPE had been diverted to private care homes!”, unwittingly exposing the wicked issue: merging state and profit-making sectors is like oil and water.
In 1979 two-thirds of care was NHS- or council-run, but now 84% is for-profit. You can watch this bizarre market of care-home sales and takeovers in the trade magazine Health Investor or Knight Frank reports: the money and property enticed in private equity with funds in tax havens. But austerity has squeezed fees for state-paid residents, while family-run businesses are verging on bankruptcy as occupancy falls in this crisis: they protest that councils aren’t passing on emergency funds, stricken councils say they can’t pay.
After this, care needs to be renationalised, locally run with a single seamless NHS/care profession. Care beds are essential with over-85s doubling over the next 25 years. But the service needs to be free for rich and poor alike by the time they use it, to stop this financial conflict. There is no better time for brave reform, with care newly valued by all who have stood and clapped. The former Tory pensions minister Ros Altmann has slammed big care companies, “bought up by hedge-funders at knockdown prices, loaded with debt, tripling their money”. If they think they’re too big to fail, she says, “don’t bail them out, take them over”.
Johnson is no nationaliser. But families will not forgive the scandal of care-home deaths on his watch, left with tragic images of grandparents dying alone, feared to be without morphine or tranquillisers. Divorced from the NHS, private ownership of social care is a key reason why this horror is happening.
• Polly Toynbee is a Guardian columnist