How could watchdogs fail so spectacularly to keep care home residents and staff safe? | John Beer


are homes are the focus of the Covid-19 outbreak in England and Wales. At least 40% of all coronavirus deaths have occurred in the very places dedicated to keeping people safe in their later years.

Such carnage points to a catastrophic failure at the highest level to protect care home residents and staff alike. The under-reporting of deaths, the lack of personal protective equipment (PPE) and testing available to staff, and the total focus on the NHS at the expense of the social care sector have all contributed to an estimated 22,000 deaths in care homes – places that government had originally advised were “very unlikely” to experience infection.

But how could care homes have been failed so badly, and what checks and balances should have been in place to prevent this?

Care homes in England are regulated by the Care Quality Commission (CQC). One of its key responsibilities is to carry out inspections and visits to ensure providers meet fundamental standards of quality and safety; however, as of 16 March, the regulator stopped all routine inspections to “focus on supporting providers to deliver safe care during the pandemic”.

While this might sound like a positive move, stopping inspections as the country locked down has left residents of care homes at heightened risk of abuse and neglect, particularly those in homes already designated in need of improvement or inadequate.

We at Hourglass (formerly known as Action on Elder Abuse) have campaigned for nearly 30 years to promote safer ageing in a society where older people are free from abuse. Before the pandemic, it was estimated that nearly two million people aged 60 and over suffer some form of abuse in the UK every year – a horrifying figure in its own right. But we could never have comprehended the level of neglect, indifference and failure by the state to protect so many older people as we’re seeing in this terrifying pandemic.

Calls to our confidential helpline relating to concerns over neglect have increased by more than 25% since the lockdown began. Family members of care home residents have reported being unable to speak to their loved ones for weeks at a time, and to being powerless to act even when they knew that homes were taking in new residents without testing or observing isolation periods.

The biggest issue facing care homes has been their ability to protect vulnerable older people from infection in spaces where outbreaks can prove devastating. Had the CQC continued its inspections, it would have been in a position to challenge cases where PPE was being diverted away from care homes to the NHS, and to aid struggling homes in their battle to secure tests for staff and residents.

Instead, care homes have effectively been left to fend for themselves.

On top of this, the CQC joined similar bodies in Wales, Scotland and Northern Ireland in refusing to publish detailed data on care home deaths, arguing instead for a need to “avoid confusion” and to protect “the privacy and confidentiality of those who have died and their families”.

Families and the wider public have a right to know when and where Covid-19 outbreaks are happening, and this lack of transparency is deeply troubling. Registered care homes are required to report the death of anyone using the service, meaning the CQC would have known from the start that mortality rates were increasing, and which homes were worst affected.

It would be unfair and inaccurate to lay all blame on one organisation. There are a number of watchdogs in England dedicated to ensuring good quality care and safely managed staff in the sector, but at this vital time all have failed to deliver.

The Health and Safety Executive (HSE) could and should have done more to raise the alarm on unsafe working conditions as staff struggled to care for residents. The chief coroner’s office should reverse its baffling decision to instruct coroners to avoid examining systemic failures in provision of PPE when conducting inquests.

And the health and social care committee should ensure its investigation into the management of the coronavirus outbreak is thorough and fair.

Many roots of the national failure to prepare for this pandemic lie in the under-funding and downsizing of health and social care services, much of which took place under the watch of former heath and social care secretary Jeremy Hunt. But with Hunt now chair of the committee, there is a potential conflict of interest. Perhaps in this case he should cede the chair.

Hourglass wants clarity on who is providing oversight to care homes at this crucial time. Care providers need to know where to turn for support and who will be responsible for rectifying failures to protect residents and staff.

The CQC, HSE, chief coroner’s office and select committee all have a clear duty to ensure that our loved ones are safe and well cared for.

They are supposed to be independent of government and where appropriate have a duty to hold those in power to account; but by every conceivable measure, they have failed. With more than 22,000 now dead as a result of Covid-19 in care homes alone, the public and grieving families deserve far, far better.

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