It was the end of a long day in March when Nicola Richards received the phone call she had been dreading.
Nearly two months after the UK’s first reported coronavirus cases had shown up in York, a resident in one of the care group boss’s homes down in Sheffield had suddenly developed a high temperature.
Within 24 hours, another resident was struggling to breathe. Two days later, the second resident had died and by Good Friday six more had passed away. By Thursday this week, 19 of the group’s nearly 200 residents were dead, 59 were infected and nearly half the staff were off work, fearing they too were contagious.
“It has been harrowing,” said Ms Richards, managing director of the Palms Row Health Care group. “You can’t prepare for the fear and anxiety it causes. We had one and then it was several and then it was 10-plus. It was awful.”
Four weeks after Prime Minister Boris Johnson locked the UK down, the frail residents of the country’s 11,300 care homes have emerged as the hidden victims of an overwhelmed, underprepared system plagued by shifting guidelines that some experts fear have had lethal consequences. Although the homes were quick to warn authorities about a shortage of protective gear and testing, they say their concerns were ignored as the virus began to spread.
“It was a mistake not to prioritise care homes from the start,” said Martin Green, chief executive of Care England, a charity which represents the large care home chains. “We knew the 430,000 people in care homes included some of the most vulnerable people.”
Nearly 11,000 more people than normal have died in care homes since the start of the outbreak, analysis by the Financial Times suggests, a far larger number than the latest official estimate of 1,043. The UK is not the only country where the virus has torn through retirement homes, where many residents already suffer from long-term health conditions, and shared dining tables and living rooms can make a mockery of social distancing rules. Inquiries into care home deaths have already begun in countries including the US, Canada, France, Italy and Spain, where residents were found abandoned or dead last month.
Up to half the coronavirus-related deaths in Europe are occurring in long-term care facilities such as nursing homes, the World Health Organisation said on Thursday, adding that “deeply concerning” data pointed to “an unimaginable human tragedy”.
Covid-19 has laid bare underfunded care systems across the world. But as the scale of Britain’s elderly care catastrophe emerges, it is clear that the sector spent far too long simply struggling to be heard.
As the virus was spreading to Britain at the start of the year, the largest UK care home companies knew from their employees abroad that they should start preparing fast. By March, some homes had begun to close their doors to visitors, upsetting families worried about leaving their elderly relatives alone.
But as shocking images from Italy’s overrun hospitals began to flash across TV screens, a more disturbing problem arose: a lack of face masks and other protective gear. Over Easter, the Association of Directors of Adult Social Services wrote to the government complaining that “shambolic” national delivery efforts had produced “paltry” supplies of essential kit to a care sector treated as an “afterthought”.
On the front line, care workers, many of them on low salaries, found themselves in alarming situations.
“I had staff in tears on a daily basis,” says Claudia Sykes, chief executive of a non-profit business in Kent that runs All Seasons, one of the many groups in the sector that looks after elderly people in their own homes.
She said workers were abused for turning up to see clients without face masks and other gear that had been almost impossible to locate.
“I had a member of staff literally driving around trying to get gloves and face masks from tanning salons, tattoo parlours and hair salons,” she says. “We’re now phoning schools to see if the kids will make protective visors for us. It sounds crazy but everyone is doing this.”
As colleagues reported being unable to get through to a national helpline number for protective kit, Ms Sykes resorted to arrangements an inner city drug dealer might recognise.
“One Saturday morning I was phoning everyone I knew saying: ‘Have you got any face masks?’ and this senior person in the NHS said: ‘Yes, I can get them for you. Turn up at this place and I’ll make it happen’. We’re watching The Wire at the moment and it really does feel familiar.”
As stocks of personal protective equipment, or PPE, dwindled, some claimed supplies were being diverted to the National Health Service. The Department of Health and Social Care denies this. However, it was clear that many care sector employees — and residents — were far back in the queue for one essential service: testing.
The head of one British care home group, who declined to be identified, told the Financial Times this week that authorities ignored his pleas for testing until a sixth resident had died in the space of four days in one of his homes. Even then, the home was only sent four testing kits for its dozens of residents — and none for his anxious staff.
“It was derisory,” he said, adding that the only confirmation he had ever had that his residents had tested positive for the virus had come unofficially from relatives of those who were hospitalised. “We’ve never actually had the courtesy of a phone call from the hospital,” he said. “We’re obviously not important enough to be told.”
Care homes were, however, constantly being told they were needed to help hospitals in the struggle to contain coronavirus. “As part of the national effort,” official guidance issued at the start of April said, the care sector had “a vital role” to play. This included accepting patients discharged from hospitals, “because hospitals need to have enough beds to treat acutely sick patients”.
“Some of these patients may have Covid-19,” it went on, but all could be safely cared for if the guidance was followed.
Care homes responded to the call, to the dismay of some residents’ relatives.
The London-based daughter of one resident said she had been “deeply concerned” to receive a letter from her father’s £1,000-a-week care home in early April saying the government had asked it to help free up beds in hospitals by taking patients who could have contracted the virus.
“The terrible and sad irony is that my father, who has mild dementia, is oblivious to the fact that higher powers are putting him and other elderly, vulnerable residents at risk by moving Covid-19 patients out of hospitals and into the home where he lives,” she told the FT.
Her fears were widely shared. A week later, she received another letter from the care home revealing that there had been a wave of concern and new guidance had now been issued. Residents were to be tested before admission, though as the home drily noted: “As is often the case we find that policy and reality are not entirely the same thing.”
‘Lip service’ guidance
Some care sector managers say a confusing series of shifting guidelines has dogged the care sector throughout the outbreak.
In Sheffield, Ms Richards from Palms Row said she had been overrun with emails on testing and PPE over the past two weeks. “We are swamped with information but none of it is concise,” she said. One email said the Care Quality Commission was going to start testing but another said local GPs would do it. “It’s a lip service exercise. They make these announcements but they don’t have any structures in place.”
The pandemic has magnified a longstanding sense of grievance that the care sector is an overlooked Cinderella service compared with the NHS. The latter’s central importance is hammered home relentlessly in the government’s three-word slogan, “Protect the NHS”. Millions of Britons come out on the streets to applaud NHS workers each Thursday evening.
This understandable focus may have had unintended consequences. “In the course of minimising an NHS problem, ministers and the NHS probably created more problems in social care,” says Sally Warren, director of policy at the King’s Fund and a former director of social care at the health department.
The health department said on Friday: “We have set out a comprehensive action plan to support the adult social care sector throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is being delivered to care homes and helping to minimise the spread of the virus to keep people safe.”
Part of the care home industry’s problems are structural and stem from the way it is funded. Unlike the taxpayer-funded NHS, which provides hospital care free of charge, nursing homes are means-tested and mostly run by private companies partly funded by local authorities that have suffered years of budget cutbacks. In recent years, some have failed to meet minimum standards of care while private equity-owned groups have been criticised for their short-term investment focus.
The NHS, which employs 1.2m workers, has received £6.6bn in emergency funding and had its debts written off during the pandemic. The care sector, which has more workers, is competing for a share of £2.8bn in emergency coronavirus funding for local authorities.
The differences between the two sectors is particularly stark when it comes to the pay and working conditions of their staff.
Many care workers get just over £90 a week in sick pay, so they struggle to afford time off. NHS staff get six months of sick leave on full pay.
This has helped the virus to spread through the 135-bed residence of one of the country’s biggest care home groups, said an employee from the chain who spoke to the FT this week. “When staff get symptoms, they don’t want to stay at home because the sick pay doesn’t pay the bills. So they come back to work and infect other residents and staff,” she said.
This worker has taken to giving herself a round of applause on Thursdays, when Britons emerge from their homes to clap for the NHS.
“I did — I clapped for myself,” she said, adding that unlike NHS workers she cannot jump the queues at supermarkets, where shop workers often earn more than she does.
“I thought, ‘I’m going to clap for myself because the NHS workers get £3 more than us an hour and we’re doing exactly the same job’.”
Additional reporting by Sarah Neville