Revealed: The scale of "hasty" move of elderly from hospital to Scots care homes over coronavirus

The overview from Professor David Bell of the University of Stirling, a member of the International Long Term Care Policy Network, talks of failings through lack of testing, and not taking into account whether care homes were properly prepared.

Professor Fiona McQueen, Scotland's chief nursing officer has admitted people arriving in care homes from hospital do "not necessarily" have results to Covid-19 tests.

Concerns about human rights failings came as official data reveals that in February and March over one in three patients (1500) on delayed discharge were moved to care homes and 2,800 went home.

READ MORE: Covid-19 crisis: the real story -  Scots care home industry body warns of new virus shift and testing fails in damning analysis

Papers from the health board, NHS Greater Glasgow and Clyde, confirm there were 22 ward closures across 11 Scottish hospitals in March and April because of coronavirus.

And analysis of official NHS data between February and March 2020 shows the number of patients who had delayed discharges fell by 28% as demand for beds soared during the pandemic..

Last month Health Secretary Jeane Freeman indicated the cut went further while hailing a "significant effort" with a drop of “around 600” delayed discharges in April – a reduction of more than 60% in two months.

Professor Bell, who has had a long-standing academic interest in the economics of social care, in a new analysis on the "remarkable turnaround" says the new figures provide "clear evidence of the imperative to clear hospitals prior to the pandemic" but questioned the wisdom.

He added: "Those moved away from hospital will have been accommodated in care homes or in a domestic setting.

"It is likely that these arrangements were made in haste with probably the laudable motive of protecting patients from the virus."

Prof Bell said the pattern of delayed discharges this year "deviated from recent experience" with a "gradual upward trend in delayed discharges from mid-2017 onward, a marked rise during January and February 2020 and then an even more marked decline during March".

Prof Bell added: "The principal reason for reductions in delayed discharge "was likely associated with a desire to remove patients who were potentially vulnerable to Covid-19 away from hospital settings."

He highlighted "failures" in the process including "not testing those discharged to care homes, not considering how well-equipped care homes were to deal with residents who were potentially carriers of Covid-19 and not understanding the challenges facing care home staff".

He told the Herald that the failures might have been the reason for Covid becoming so rampant in Scotland's care homes.

But he said further research was needed. That would examine if the process "caused more problems by placing some people with Covid infections in settings where they could infect others. It would also examine if exposed frail people to more risk than they would have faced in hospital.

The latest delayed discharge census over the reasons for continued delayed discharges till May 2020 shows that the completion of care arrangements (35%), waiting for availability of care home places (23%),awaiting community care assessments (17%) and awaiting funding (2%) made up the continued delays.

The rise in so-called bed-blocking bucks the trend of previous years, when charities including Age Scotland had been concerned about a rise in delayed discharges and called for a review of health and care provision across the country.

Adam Stachura, head of policy and communications at Age Scotland said of Prof Bell's analysis: “We know that a longer than necessary stay in hospital can actually be detrimental to someone’s health and the sky high levels of delayed discharge experiences before this crisis have been a result of the appropriate social care package not being available to them. It seems remarkable that when there is a will to get people out of hospital, there is a way."

"The big question is has this move been the safest one for the individual? We really hope it has been. It will be interesting to know how many of these moves to care homes have been permanent and if the views of the individual and their families were taken into account.

“It demonstrates just how interlinked health and social care is and whether there has been enough focus on the importance of social care during this crisis. The pressure on social care and care homes over the last two months in particular has been huge and demonstrated that they are very much at the front line, perhaps not always with the resource they have needed.”

Across Scotland around 68,000 people receive home care support, 34,000 are residents in care homes and 125,000 are employed in these services.

While yesterday there were 2,363 deaths in Scotland from coronavirus, care homes continued to account for the majority of deaths recorded in the last full week – 54%. Cases of the virus have been reported in 60% of Scotland's care homes, with a total of 5,635 residents affected.

On March 13, when there were 85 confirmed cases of Covid-19 in Scotland, the health secretary wrote to executives across the health sphere saying that it was "imperative that care homes continue to take admissions if it is clinically safe to do so".

She advised that in some cases they provide a "safe alternative to more acute settings, including hospital care".

It echoed advice circulated alongside the letter from the then Chief Medical Office Catherine Calderwood who said: "The long term care/residential care sector is vital to the wider health and care system and it is essential that it continues to function in a safe and effective way as it provides a safe and appropriate alternative in some cases to more acute settings such as hospital care.

"There are situations where long term care facilities have expressed concern about the risk of admissions from a hospital setting. In the early stages where the priority is maximising hospital capacity, steps should be taken to ensure that patients are screened clinically to ensure that people at risk are not transferred inappropriately but also that flows out from acute hospital are not hindered and where appropriate are expedited."

On April 21, the health secretary in announcing expansion of testing said that Covid-19 patients discharged from hospital to a care home should have given two negative tests before discharge.

In May, the Scottish Government was forced to withdraw guidance for care homes two days after publication apparently because of the issue.

The guidance stated that for patients who have been in hospital for non-coronavirus related treatment, and are not showing any symptoms, “a single test is sufficient”, no more than 48 hours before being discharged.

The guidance added: “The patient may be discharged to the care home prior to the test result being available.

"The patient should be isolated for 14 days from the date of discharge from hospital. Risk assessment prior to discharge from hospital should be undertaken in conjunction with the care home.”

Health Protection Scotland interim guidance on testing published on May 14 outlined extending testing to residential care homes in three scenarios, including as a measure to support outbreak investigations, but accepted there was "unlikely to be adequate physical or laboratory test capacity" to extend the testing "hence some local NHS board level prioritisation will be necessary".

Plans to extend coronavirus testing to all care home staff were announced by the Health Secretary on May 18. Jeane Freeman said all care home staff in Scotland would be offered routine tests in a bid to curb following evidence from health officials that workers were the main vectors of the disease.

Before that, guidance in March said that people admitted to care homes should be isolated in their rooms for 14 days.

At the end of March, Nicola Sturgeon said there was a target of reducing cases of delayed discharge by at least 400 – or 25% - from the baseline of March 4.

“This reduction is of course good in itself – people should not be in hospital for longer than they need to be.

"But it is also of course a very important part of our efforts to increase NHS hospital capacity as we start seeing more cases of Covid-19.”

In response to the analysis, the Scottish Government spokesman referred the Herald to a statement made by Nicola Sturgeon last week in relation to the Covid-19 crisis.

It said: "I absolutely see why, with everything that we know now, people would look at those things and ask why that was done. However, I invite people to look at the situation that we faced at the time.

"If we apply what we know now to the situation then, of course we might now take different decisions, but when we faced those decisions, we had to act on the information that we had and, based on that information, we did everything possible to protect older people. There were risk assessments of people leaving hospitals and of course there was guidance to care homes about isolation.

"Nobody who had symptoms of coronavirus, and certainly nobody for whom the clinical assessment was that they should continue to be in hospital, should have been discharged in that way. The risk assessments are required to be done by clinicians and professionals, but the guidance that was in place was clear and should have been followed very carefully, as all guidance should be followed, whether it is to hospitals or to care homes.

"If we had not tried to get older people out of hospital, they would potentially have been exposed to the virus in hospital and many of them would have died."