A new report by NHS Providers shows how trusts have gone to great lengths to support care homes through the unprecedented challenges posed by the coronavirus pandemic.

The report, Spotlight on...NHS discharges into care homes, confronts and dispels the damaging and mistaken belief – deeply resented by trust leaders - that their organisations systematically and knowingly discharged COVID-19 patients to the home care sector.

Based on detailed conversations and feedback from trust leaders, it also highlights the many ways in which trusts have been working with local authorities and care homes to help them deal with the pressures posed by the virus.

It sets out in how in the crucial period between the publication of discharge guidance on 19 March, and the change in testing strategy on 15 April, the vast majority of patients discharged from hospitals did not go to care homes. Instead they were discharged to other settings such as community hospitals, or to their home with support from carers, as advised in the national guidance.

Faced in mid-March with the imperative to create additional bed and staffing capacity to treat patients who were seriously ill with COVID-19, trusts worked to agreed discharge arrangements with local health and care partners. Key considerations included:

• overall balance of risk to individual patients, given that hospitals are not a safe environment for recovery
• minimising moves for vulnerable patients
• the pressures on care providers – in some areas trusts redeployed therapeutic, nursing and mental health staff to support care.

 
It is important to remember that testing capacity during this period was very constrained, and there is still a lot to do to ensure the health and care sector has access to the volume of tests and the swift turnaround of results required.

Trusts consistently acted in accordance with the guidance, only discharging known or suspected COVID-19 patients to a care home if it had agreed it had the capacity to treat and isolate this type of patient.

Trusts consistently acted in accordance with the guidance, only discharging known or suspected COVID-19 patients to a care home if it had agreed it had the capacity to treat and isolate this type of patient.

   

The report says trust leaders responded quickly to the risk of discharging COVID-19 patients who showed no symptoms of infection into care homes, long before the government announced that they would have to test every single patient prior to discharge.

There are many more examples of the close and mutually supportive relationships between the NHS, local authorities and care homes in response to the pandemic. These include:

• supporting care homes and other providers with personal protective equipment (PPE)
• providing advice on care homes’ processes around infection control, PPE and segregating COVID and non-COVID residents
• enhanced clinical support for staff and residents
• opening up lab testing capacity to care homes as soon as possible

 
The deputy chief executive of NHS Providers, Saffron Cordery, said:
"The NHS has done everything it could to respond to the unprecedented challenge presented by coronanvirus.

"That includes working closely with colleagues in the care sector, building on longstanding relationships to provide much-needed support.

"It is a damaging and mistaken belief that trusts knowingly and systematically discharged COVID-19 patients into care homes.

"Health and care staff are doing their absolute best in incredibly challenging circumstances with the resources available at the time, so the blame game must stop.

Health and care staff are doing their absolute best in incredibly challenging circumstances with the resources available at the time, so the blame game must stop.

Saffron Cordery    Deputy Chief Executive

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"It will be for a public inquiry to establish why mortality in care homes has run so high.

"But we can see that the failures of testing to date and the supply of PPE have hit the care sector particularly hard and remain problematic.

It will be for a public inquiry to establish why mortality in care homes has run so high. But we can see that the failures of testing to date and the supply of PPE have hit the care sector particularly hard and remain problematic.

Saffron Cordery    Deputy Chief Executive

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"We also note the care sector's view that the government didn’t focus on its concerns sufficiently or soon enough, and that additional funding is taking too long to get to the frontline.

"Beyond that it has long been clear that the sector has suffered from years of underinvestment despite repeated government promises to resolve the crisis in social care.

"Trusts have, and will continue to support their colleagues in the care sector, reflecting our mutual dependence and shared determination to provide the best possible protection and care for those who use our services and the frontline staff who deliver them."