The real story behind Britain’s Covid care home crisis isn’t what you think

The common answer is to blame the incompetence of the PM and the NHS. That isn’t the whole truth

Why did Britain end up with the highest Covid deaths in Europe? You will, by now, be familiar with the standard answer: a distracted and complacent Prime Minister didn’t focus until it was too late. He didn’t stop flights from China. Then, in a panic, he discharged Covid-infected pensioners into care homes, where the virus spread. Lacking the proper protections, the elderly were left to die – victims of government negligence. This hypothesis is simple and powerful. But it is also dangerously wrong, for reasons the Government had better start explaining.

The idea of a “patient zero” introducing the virus to Britain has been pretty much debunked. Hundreds flew in with the virus – and from all over the world. Studies show that most of our cases came in from France, Italy and Spain, with fewer than one per cent of infections coming from China. Stopping Beijing flights would have been pointless. As the Prime Minister suspected at the time, Britain was never going to be able to shut itself off from the world. His bigger mistake was to accept, at face value, advice that the NHS was about to be crushed by a Covid tsunami.

His advisory committee, Sage, drew up a scenario envisaging a huge need for NHS beds and ventilators – and, in general, demand outstripping supply eight times over. So the NHS decks were cleared, 30,000 beds emptied and patients discharged from hospital to care homes (most without a Covid test). But the tsunami never arrived. The hospitals were fine. The number of unused ventilators trebled, a third of beds stayed empty. And 22,000 died from Covid in care homes.

Those of us with reservations about the top-down manner in which the NHS is run will find this fits with our suspicions. The commissar gives the wrong order, thousands suffer. But that wasn’t the case this time. The NHS scaled up to a degree that would have been thought impossible a few months ago and cleared its beds by delaying non-urgent operations. And yes, 25,000 elderly patients were sent back to care homes between March and April – but this number was, if anything, smaller than the same period last year.

So what about the NHS then seeding the virus into care homes? If so we’d see a sudden boom in infections, but this didn’t happen. The Prime Minister was wrong to say that homes didn’t follow official advice: precious little was forthcoming. The full horror took weeks to emerge, in Britain and across Europe. For reasons that no one expected or (then) understood, the number of care homes with Covid present was small at first then grew rapidly over lockdown. Something else was going on.

It has been the same, awful story everywhere. Sweden didn’t lock down and has still had fewer deaths per capita than Britain (while taking a far smaller economic hit). But a failure to protect care homes led to most of Sweden’s Covid deaths. The figures here are quite striking: care homes look after three per cent of Britain’s elderly population but accounted for 41 per cent of our Covid deaths. Similar ratios can be found in Spain, France, Denmark, Israel and Portugal.

As a result, most of Europe is now asking what went wrong in care homes – and moving to a similar conclusion. It took ages to realise how many people are barely affected by Covid, carrying (and spreading) the virus without knowing it. Asking people to isolate if they had symptoms didn’t offer much protection. The more people coming in and out of the care homes, the greater the risk of infection. If those care homes don’t offer sick pay, the risk is greater.

Hong Kong banned care home visits pretty early on: it had learned from Sars. But British care homes were taking visitors for weeks after lockdown and, even after that stopped, agency workers drifted in and out, some working in multiple homes. The Government (belatedly) advised against this “where possible”. But for most homes it is not possible: they have no staff backup. Yet again, we see the problem in the British care home industry: a refusal to pay decent wages, a dependence on casual staff and a reliance on agencies that can provide low-cost workers.

Care homes that did things differently saw very different results. In France, a home near Lyon put its staff and residents into complete isolation for seven weeks, taking no one from outside. They had no Covid deaths. Valerie Martin, its director, said she went to such lengths because “my residents still have so much to live for”. She also had carers paid enough that they didn’t need a second job and were willing to be quarantined.

It has been a very different story here. An Isle of Skye care home found that 30 of its 36 residents ended up with the virus, six of whom died. It turned out to be shipping in workers, including one from Kent. A study published last week tried to explain the huge differences in how homes in England were affected. Residents looked after by agency workers were 58 per cent more likely to contract Covid. Those working in multiple care homes were more than twice as likely to carry the virus.

It might be shocking. But it’s not really surprising – given that this is the same problem we saw during the spread of superbugs like MRSA. Those lessons weren’t learned. Care homes argue, still, that their business model depends on being able to pay people less than supermarkets do. Their complaint about Brexit, even now, is that it makes it harder for them to import cheap labour and keep wages down. Their bigger concern should be what the Covid crisis has shown about their ability to protect those in their care.

Deciding what to do about care homes is, we’re told, high up on Boris Johnson’s list – but the more important point is what lessons can be learned now. If there is to be a second wave of Covid, it’s pretty clear what ought to happen: care home workers should be isolated and put up in a hotel if needs be. And – needless to say – forbidden from working from multiple homes.

It will cost, but looking after the elderly can’t be done on the cheap. The last few months have proved, yet again, the real price of low-cost care.