‘Mixed messages, mismanagement and missed opportunities’
It is now 92 days since we learned of the first known case of Coronavirus in Scotland. On that day in March, Tony Banks and his team at Balhousie Care Group found themselves navigating a path that would try them like nothing before. Here, the owner and fo
THE news this week that a BBC survey found one in three Scots thought care homes had mishandled the coronavirus crisis was sobering – but not surprising. Reading that made me realise people don’t know the full story surrounding Covid-19 in care homes. And it’s about time they did.
We locked down our 26 care facilities on March 11, 12 days before the nationwide lockdown. The weeks and months since have been excruciating for relatives, frustrating and confusing for residents, and hellish for our staff. They’ve also been an operational and logistical rollercoaster – but without the good bits.
It’s been three months of mixed messages, mismanagement and missed opportunities by the Scottish Government, and the rate of Covid-19related care home deaths is one of the highest in Europe. Our Government leaders argue that this was unchartered territory, that they have done their best, that with hindsight they may have done things differently. I argue they had the power and knowledge to act much earlier to prevent the spread of this disease among our most vulnerable population.
Our extremely difficult decision to close homes – one of the first care home operators in the country to do so – was not taken lightly. Despite requests from industry bodies, there had been no clarity or guidance from the Scottish Government prior to March 11. We watched as coronavirus cases began to rise and realised we had to take matters into our own hands. We have a duty of care to our residents. It is our job to protect them.
On March 13, a number of local authorities asked us to help free up hospital beds by taking patient admissions from the NHS. We asked for the patients to be tested for Covid-19 before we took them and were told no. In at least one of our care homes we can directly attribute the first positive cases of Covid-19 to a new admission from hospital.
On May 21, Health Secretary Jeane Freeman said more than 900 patients were released from hospitals into Scotland’s care homes during the first month of the crisis – a figure not even close to her original claim of around 300. And the advice to us at that time was simply to carry out a risk assessment on the new resident admissions and isolate them for seven days (later extended to 14). This despite little being known about the virus and its symptoms. We may as well just have crossed our fingers.
Testing was promised but has simply not been delivered. It was 62 days between March 1 – the date of the first positive test in Scotland – and May 1 when the Scottish Government promised sample testing in homes without the virus, and testing of all residents and staff where there were cases. On May 18, the
Health Secretary announced routine tests for all 53,000 of Scotland’s care workers and admitted that care workers were the “prime vectors” of the virus. By then, 1,749 people in Scotland’s care homes had lost their lives to Covid-19.
Apart from testing delays, there has been massive inconsistency in speed and capacity across health authorities, and a shocking lack of awareness of this at Government level. Daily Government briefings promised testing for our staff and residents – but testing facilities were often unavailable or out of reach. And when public health officials promised to come to us, the testing didn’t always happen.
Between May 1 and May 15 – two weeks after the Government’s first promise on testing in homes with cases – two of our pleas to health officials went unanswered. We were told there was “not enough capacity” to carry the tests out.
The strategy from the Scottish Government was clear from the start: to protect the NHS. And it was successful. But at the expense of this, hundreds of care home residents have passed away before their time. And as we navigate this unholy mess there are police investigations into Covid-19-related deaths, procurator fiscal referrals, and an announcement from the Scottish Government that “failing” care homes face being taken under local authority control. I know I’m not alone in saying that private care home operators feel betrayed.
Infection control and other guidelines have come in thick and fast and are everchanging and conflicting. If you try to follow the thread of changes on the Scottish Government’s website, good luck.
Eleven weeks into this pandemic, our experience of working with six different local authorities and four health authorities tells us they rarely talk to each other. Their approaches and rules differ, and some of their requirements on our homes are wholly unreasonable. Panic among officials has risen in line with the rise in negative press surrounding care homes, and some of our relationships are strained.
I question why our health officials were not better prepared when we had the experience of several other countries to draw on.
Our staff are unbelievable. We came up with the phrase “Everyday Heroes” two years ago as part of an employee recognition scheme. Today, that couldn’t be more apt. We’re asking them to get to grips with new and changing guidance as they do their “day job” of being a family to our residents. They never complain as we issue them new rules on everything from the temperature to launder clothes, or what chemical to use on what surface.
Our heroes are sweating it out (literally – try wearing a face mask for 12 hours and you’ll know) while trying to keep spirits up among residents and themselves. And we’re more than aware of the impact it’s having on their wellbeing. Counselling lines and a hardship fund have been in place for them since almost the beginning.
The strategy was clear from the start: to protect the NHS. And it was successful. But at the expense of hundreds of care home residents who passed away before their time
Thankfully, Covid-19 cases and deaths at Balhousie Care stand at less than half the industry average and recovery rates have been remarkable (in one of our homes all residents affected have recovered). I’m convinced our swift action on closing doors and our strict policy on non-essential visits – which was only this week relaxed to include end-oflife visits – is an important factor, as are our high standards of infection control.
That said, we are not complacent – and nor should anyone be. There are lessons to be learned for everyone, and we all have a new normal to prepare for. On a practical level, we are taking extra precautions, including thermal imaging cameras for temperature checking and disinfecting foggers, plans for staggered visitor booking systems, PPE guidance for visitors, and designated meeting spaces.
But the crucial thing is this: we must have enough testing – for staff, residents and visitors, both antigen and antibody tests, and testing that isn’t just one-off but continuous. This is vital now to stop the spread and prevent a second wave.
The First Minister says she is “working hard to support the sector in every way”. Part of supporting is listening, yet nobody is asking us to share our experiences. Maybe this will come with a public inquiry. In the meantime, let’s get the whole care sector around the table and share the lessons we’ve all learned.
Let’s not forget the human cost of this pandemic. Every single person who dies is someone’s mum, dad, brother, sister, grandparent. They become our family when they move into our care home, and with the bonds that develop we really feel the loss of their death.
In their memory, and to protect the residents in our care today, we must learn from the mistakes of the past three months. That should include a full public inquiry. If not, we risk a second wave that could be substantially more aggressive and unforgiving than the first.
Tony Banks is chairman and founder of Balhousie Care Group
Balhousie Care Group operates 26 homes across Scotland with 940 residents.