Question:
Dr Cathy Winfield CEO of Berkshire West CCG on May 21 stated at the West Berkshire Health and Wellbeing board that the NHS were able to step up their critical care criteria at the Royal Berkshire Hospital by not testing patients discharged from hospital into care homes, and as a result West Berks have had 118 deaths of which 60 have been in their care homes.
My reading of her comments suggested that she now appears to have admitted that this policy was a mistake.
My question is, of all the fatalities in Wokingham’s Care Homes, how many were patients discharged from our hospitals and how many were not?
Minutes:
Question
Dr Cathy Winfield, CEO of West Berks CCG on May 21 stated at the West Berks Health and Wellbeing Board that the NHS were able to step up their critical care criteria at the Royal Berkshire Hospital by not testing patients discharged from hospital into care homes and as a result West Berks have had 118 deaths of which 60 have been in their care homes.
My reading of her comments suggested that she now appears to have admitted that this policy was a mistake.
My question is of all the fatalities in Wokingham’s Care Homes how many were patients discharged from our hospitals and how many were not.
Answer
Thank you for your question. Can I first extend my deepest sympathy to all those that have been effected by the deaths in care homes as a result of this virus. What has happened in Wokingham, and across the country, has been very difficult for many people. I’m sure there will be a national debrief with questions asked what has happened and what we can learn for future policies. Locally we expect we will be looking into this as part of the summer’s overview and scrutiny programme. Part of this will rightly look into the impact of the national guidance on hospital discharge and the absence of testing in the first part of the response.
Our care homes have worked tirelessly through this extremely difficult time to help support their residents and I would like to voice my thanks at their efforts.
It is important to note care homes in Wokingham Borough are usually run by private or voluntary sector service providers.
There are 52 CQC registered care home setting within Wokingham Borough; this includes both older people care homes (residential and nursing) and learning disability care homes.
95% of Wokingham Borough care homes inspected by the CQC were rated as ‘good’ or ‘outstanding’ prior to the outbreak (February 2020) of the virus.
It was possible that some care home clients caught the virus in hospital before being discharged, and as they were not tested before discharge, the appropriate isolation in care homes was not put into practice.
Wokingham Borough Council took ground-breaking action to help protect its care homes during the Covid-19 crisis.
Last month the Borough Council took the unprecedented decision to go against Government guidelines by refusing to take patients discharged from hospital into some care homes unless it was certain they did not have coronavirus. At the same time, the Council and partners across the health service have worked together to set up a ‘task force’ of specialists to work with care homes to make sure they were ready to cope with patients who had the virus.
The task force has now worked with all care homes and other care settings but worked intensively with 36 in order to make sure they can start to take hospital discharges again safely.
As with care homes across the country, those in Wokingham Borough have been coping with a very difficult situation during this crisis.
In the first period of the pandemic we became concerned that the situation in care homes was worsening, we lobbied our MPs and the Local Resilience Forum for increased testing of those being discharged and for those in homes and for improved supplies of PPE. We increased our support to local care homes, including providing emergency supplies of PPE and forming a task force focussed on going into homes to support with specific issues like detailed infection control advice
Despite this lobbying and support, Government guidelines continued to allow the potential discharge of patients with coronavirus into our care homes, so we took the decision to stop hospital discharge into our care homes unless the patient has tested negative and been without symptoms or our task force had made sure the care home could cope with positive cases.
This task force has now visited 36 care homes and we are now at the place where discharges from hospital can take place more safely into some of these homes. I would like to personally thank all care home staff for the immense effort they are putting in to keep people supported in the most difficult of situations.
The task force is just one way the Borough Council has supported care homes during the crisis. Other help has included:
· An improved funding deal for care homes we contract with plus ability to apply for additional temporary funding
· Help with supply of Personal Protective Equipment (PPE) – 386,000 pieces of PPE have been supplied to our care homes.
· Regular advice and guidance - over 400 calls to registered care homes
· Testing for staff with symptoms – more than 250 staff tested, plus others who have self-referred themselves for testing via the government website.
· Offer of access to staff in an emergency and Infection control hotline established
In addition to this, Wokingham Borough Council and the local NHS have worked well together to:
· Release hospital capacity to support infection control in care homes, and this has been successful – the NHS had not been overwhelmed in our area and there had been enough critical care capacity to treat all patients.
· By cohorting potential Covid patients and delaying discharges in some cases to allow the homes to be supported.
· The CCG Director of Nursing has coordinated a multiple agency response to support the homes with staff and patient testing, and infection control training. Homes were visited by the support team in priority order, as identified by Wokingham Council.
· All patients are now tested prior to discharge to care homes.
· Each care home now has a named clinical lead, usually a GP, and health care staff offer a weekly check in to each home and conduct multidisciplinary reviews of patients, including medication reviews.
The Council has worked with all partners to draw this into a care home support plan which is published on our website: https://www.wokingham.gov.uk/care-and-support-for-adults/care-and-nursing-homes/wokinghams-response-to-the-minster-for-care-regarding-covid-19/
The Council also publishes weekly Covid 19 data on its website https://www.wokingham.gov.uk/health/public-health-campaigns/coronavirus/ and this will also be discussed at this meeting. Up to the 22nd May, Wokingham has had 137 reported Covid 19 deaths of which 71 were in care homes and registered by a GP as having Covid-19 contributing factors. It is important to note that the Council and its partners only get death data from the ONS at the same time as the general public on a Tuesday. We then put this into a digestible report that is published every Friday. There a time lag on this information so the process of analysing this against hospital discharge data will take time to understand, but as I stated earlier this will be part of the overview and scrutiny process.