Revealed: the secret report that gave ministers warning of care home coronavirus crisis
A secret government report that said the UK was not prepared for a pandemic and forewarned of the Covid-19 crisis in care homes is being published by the Guardian.
The report is based on the findings of a government simulation of an influenza pandemic, codenamed Exercise Cygnus. It concluded starkly that Britain was not adequately prepared for a flu-like pandemic’s “extreme demands”.
The 2017 report is likely to raise questions over whether ministers ever implemented key recommendations pertaining to the care home sector.
It contained 26 key recommendations, including boosting the capacity of care homes and the numbers of staff available to work in them. It also warned of the challenge facing homes asked to take in patients from hospitals.Asked recently about the report on Exercise Cygnus, the health secretary, Matt Hancock, said he had been assured by officials at the Department of Health that “everything that was recommended was done”.
However, Martin Green, the chief executive of Care England, which represents the largest independent care home providers, said concerns raised by the exercise about the social care system’s ability to handle patients discharged from hospitals and the need for the largest private care providers to increase capacity were not raised by government agencies with his members.
“It beggars belief,” Green told the Guardian. “This is a report that made some really clear recommendations that haven’t been implemented. If they had put in place a response to every one, we would have been in a much better place at the start of this pandemic.”
Covid-19 has swept through the UK’s care homes, killing 6,686 people up to 1 May in England and Wales, in some cases claiming dozens of lives in a single facility. Operators have been beset by shortages of essential personal protective equipment (PPE) to protect staff and limit the spread of the virus among residents who are by definition the most vulnerable to the disease.
With a third of all Covid-19 deaths so far being recorded in care homes, Boris Johnson told parliament on Wednesday: “There is an epidemic going on in care homes, which is something I bitterly regret.”
The government has kept the Exercise Cygnus report secret since it was first circulated in Whitehall three years ago, and has resisted growing calls for more transparency, which culminated in the announcement of a legal case to force ministers to release the findings. However a copy was leaked to the Guardian, which is publishing the document in the public interest.
The report, marked “Official – Sensitive”, is being published in full, although names and email addresses of government officials have been redacted.
Public Health England ran the Cygnus exercise in October 2016, coordinating more than 950 people, from Department of Health ministers to teams of local emergency planners and prison officers, to test the UK’s response to a new global pandemic, envisaged to be influenza.
The exercise included four dummy meetings of Cobra, the government’s emergency response system, over three days, as ministers and officials were tasked with imagining the UK was facing the peak of infections.
A report on Exercise Cygnus was produced in July 2017 and sent to all major government departments, NHS England, and the devolved administrations of Scotland, Wales and Northern Ireland.
It stated as its “key learning” that “the UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nationwide impact across all sectors”.
The report recommended that a comprehensive “pandemic concept of operations” be created and that NHS England should conduct further work to prepare “surge capacity” in the health service.
It explicitly recommended that the social care system needed to be able to expand if it were to cope with a “worst-case scenario pandemic”, and that money should be ringfenced to provide extra capacity and support to the NHS.
It also said the Department of Health should consider bringing back “recently retired nurses and care workers to deal with the extra strain on the system”. Such staff could be involved in “vital tasks”, it said, including “opening up more distribution points for personal protective equipment (PPE) and working on essential communications to the public”.
Concerns were raised about the ability of the social care system to “provide the level of support needed if the NHS implemented its proposed reverse triage plans, which would entail the movement of patients from hospitals into social care facilities”.
During the coronavirus crisis, care homes have been asked to take recovering Covid-19 patients, leading to concerns that they may spread the infection if not properly isolated and treated, which is not always possible in care settings.
When Hancock was asked about Exercise Cygnus on 28 April, on LBC radio, he replied: “I asked my officials to go back when this first came up in the press a few weeks ago and check that everything that was recommended was done and that’s the assurance that I got.”
However, senior figures in the care sector are raising questions about whether the recommendations pertaining to the care sector have been implemented in full.
Vic Rayner, the chief executive of the National Care Forum, said: “The sort of plan you might anticipate coming from these recommendations has not been evident in terms of a national or local government approach. They might have done this planning behind the scenes, but they haven’t involved the care providers.”
The report states that the Association of Directors of Adult Social Services, whose members commission care services, should be involved in developing a way to assess surge capacity in social care during a pandemic. However, the Guardian understands the association was not asked to do so.
Care England’s Green said the recommendations for expanding capacity and staff levels were not discussed with providers following the 2017 report.
“Nobody has ever had that conversation with us,” he said. “Care England has been talking about providing extra capacity for years. We have been telling them that we have capacity and people don’t need to be in hospital. But we have got nowhere.”
In response to a freedom of information request by the Guardian last month, the Department of Health and Social Care (DHSC) refused to publish the report on Exercise Cygnus, claiming that it would “prohibitively impact the ability of ministers to meet with officials and external stakeholders to discuss ongoing policy development”.
The report on at least one similar previous exercise, Winter Willow, has been published without controversy. Last month solicitors at Leigh Day announced that an NHS doctor had instructed them to pursue legal action against the DHSC to try to force the release of the report.
Moosa Qureshi, whose case is being crowdfunded, argued there was an “exceptionally strong public interest in the publication of the report given the lessons and recommendations are directly relevant to the system and procedures that have been developed”.
A government spokesperson said that lessons from Exercise Cygnus had been learned and continued to be considered.
“The UK is one of the most prepared countries in the world and, as the public would expect, we regularly test our plans. What we learned from previous exercises helped us to rapidly respond to this unprecedented global crisis,” the spokesperson said. “We have followed a science-led action plan designed at all times to save lives and support our NHS.
“Our planning helped prevent the NHS being overwhelmed and means we are now moving past the peak of the virus.”