Care Homes (Covid-19 Hospital Patients)

– in the Scottish Parliament at on 18 August 2020.

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Photo of Donald Cameron Donald Cameron Conservative

1. To ask the Scottish Government what its response is to reports that 37 hospital patients were transferred to care homes after testing positive for Covid-19. (S5T-02313)

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Before I start, I take this opportunity to welcome Mr Cameron to his new responsibility.

Discharge decisions for individual patients are made by clinicians, based on each patient’s needs. If somebody is discharged to a care home, that should be because that has been assessed as the best place to meet that person’s needs.

As has happened in other parts of the United Kingdom, guidance on discharge and admission to care homes has evolved since the start of the pandemic as our understanding of the virus has developed. Current guidance sets out the steps that are to be taken to ensure that patients are screened clinically, so that people who are at risk are not transferred inappropriately.

Any individual who is being placed in a care home must be subject to an appropriate risk assessment and be isolated for 14 days. A testing regime is also in place to ensure that all care home staff are offered routine testing, and that people being admitted to a care home from either a hospital or the community are tested appropriately.

We have worked to make as much data available as is practical on a range of issues related to Covid-19, which is why I have today asked Public Health Scotland to work with boards to produce validated statistics and analysis on the number of patients who tested positive for Covid-19 and were subsequently admitted to a care home. That includes examining how many were assessed as being discharged when they were considered to be infectious, and the rationales that were in place for such a discharge, for example in the case of palliative care concerns.

Photo of Donald Cameron Donald Cameron Conservative

I thank the cabinet secretary for her words of welcome at the start. However, I have to say that it has taken months for the Parliament and the Scottish public to learn about those 37 patients who were sent to care homes. The First Minister has a broadcast every day and she did not mention it. We heard about those appalling mistakes—mistakes that possibly cost lives—only because of a newspaper investigation, which did not even include responses from every health board in Scotland.

How many Covid-infected patients did the Government send to care homes? More important, how many people were infected second-hand as a result of those colossal and potentially fatal mistakes?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The Government did not send people to care homes. As the First Minister and I have repeated, those are clinical decisions. Our national clinical director and our chief medical officer have consistently been crystal clear that the decision about where an individual goes on discharge is a clinical decision, following a risk assessment and in conversation and co-operation with a care home, if that is the place to which the individual is being discharged. It is entirely wrong to say that the Government sent people to care homes. We did not.

It is for individual health boards to determine whether they can respond, given the limits and cost of freedom of information provisions. Clearly, some boards decided that they could not. The work that I have commissioned today from Public Health Scotland will look across all health boards and will cover the robust validated statistical output and analysis that I have described. It will provide additional information about whether individuals were considered to be infectious at the point when they were discharged and, if they were, what the rationale was for that discharge decision.

Photo of Donald Cameron Donald Cameron Conservative

I am afraid that the cabinet secretary’s answers are wholly unacceptable. Nearly 2,000 people have died in care homes in Scotland from coronavirus—every single one of them an unspeakable tragedy. The Scottish Conservatives wrote to the Lord Advocate weeks ago, but we have still not heard whether he will investigate. Why do 2,000 bereaved families not deserve answers? Does the cabinet secretary agree that a public inquiry into the scandal should start immediately?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

It is not for me to comment on the Lord Advocate’s area of locus; I would simply say that, as I would have hoped that the member would know, the Crown Office has set up a unit to look at deaths in care homes. It will receive information and, where it considers it appropriate, it will investigate. The Crown Office will get on and do that job independently, as it should.

The First Minister has been clear, as indeed have I, that in due course there should be a public inquiry into all aspects of the handling of the pandemic, including, importantly, the issue of care homes. An inquiry would consider whether the guidance that was produced at various stages, based on the information and evidence that we had at the time, was appropriate and was implemented, and whether that guidance was properly updated as new evidence emerged, based on growing understanding of the virus, which is of course new.

These questions have been answered. There can be no doubt that I and this Government take very seriously the situation in our care homes, but I hope that, equally, there is no doubt that we have, at all times, acted with the best of intention and based on the information that was available at the time.

The Presiding Officer:

A large number of members want to ask questions on the issue.

Photo of Neil Findlay Neil Findlay Labour

Is no one accountable for this public health disaster, which I believe is due to neglect? The reality is that they could not get people out of hospital quickly enough. Many of those people had been in hospital for months and months, as long-term delayed discharge cases. The issue was not about the best clinical care but about clearing the decks of all those elderly people—our loved ones. I ask the cabinet secretary: who is responsible for that?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I have to disagree completely with Mr Findlay. I would never be so offensive as to describe clinical decisions as “clearing the decks”. I would never undermine the professionalism, skill and compassion of every one of the clinicians who work in our health service and, indeed, those in our care homes who are also party to the decisions about whether someone is admitted from hospital.

I really wish that Mr Findlay would not characterise individuals in that way.

I have made it clear that I am accountable for the decisions that I have taken as the health secretary. This Government is accountable for the decisions that it has taken throughout the pandemic, and, in the proper time, a public inquiry will look at all those decisions and judge whether we took the right decisions, based on the information that we had at the time, in the right way and updated them accordingly and whether the guidance and the decisions that we took were implemented appropriately. That is the right way to do it. It does not assist anyone to impugn the motivation of those who work in our health service and in care homes, all of whom are doing the best job that they can.

Photo of Emma Harper Emma Harper Scottish National Party

Is the Scottish Government aware of hospital patients in other parts of the UK being transferred to care homes after testing positive for Covid-19 from early on in the outbreak?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The answer is yes. In the four-nation discussions that I have with my colleague health ministers from the other three nations of the United Kingdom, we have discussed the issue and the guidance and its updating. Across the United Kingdom, we have wrestled with those challenges, as, indeed, have individuals and our counterparts in Europe and elsewhere. I will write today to my colleagues in Wales and Northern Ireland, and to Matt Hancock in the UK Government, setting out what I have asked Public Health Scotland to do and asking them to consider initiating a comparable exercise so that we can look across the UK’s four nations, learn from that and have comparable data across the country.

Photo of Alison Johnstone Alison Johnstone Green

In its response to this issue, Scottish Care said that there has been “a breakdown in relationships” between hospitals and the care sector because the “eagerness of hospital discharge” has resulted in individuals being placed in care homes when it was clear that they needed nursing rather than residential care. How does the cabinet secretary respond to that statement? What will she do to repair, strengthen and support those relationships and to ensure that the relationship between the care and hospital sectors is an equal one?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The first thing that I will do in response to what Ms Johnstone has said is ask Mr Macaskill from Scottish Care why, in the many meetings that he and I have, he has never raised that difficulty directly with me. I will then seek to understand what concerns him and what he and I together can do to resolve the matter. Looking forward, what we can do, should there have been a breakdown in the relationship between an individual hospital and a care home, is ensure that both understand their responsibilities. The care home has a responsibility to be confident that it can receive a resident into its care and meet that resident’s needs. If it does not believe that it can do that, it has a responsibility to be clear that it cannot, and alternative care must be found for the individual until it or another care home is ready.

Mr Macaskill is—helpfully and productively—a member of the recovery group that is working with me and a range of stakeholders on how we not only remobilise our health and social care services but ensure that the proper lessons are learned from the early days of the pandemic and that the proper planning is in place should we see an upsurge in cases as we enter autumn and winter.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I find it unbelievable that, all these months later, the Scottish Government still does not know the full extent of the tragedy. That is a devastating revelation. We now know that the Government was accelerating the movement of Covid-positive cases into care homes at the same time as the international community was screaming about asymptomatic transmission. We did not know how the virus was moving around in hospitals and our care homes had no PPE.

When the cabinet secretary talks about lessons learned, does she recognise that the only way for the Parliament and the country to learn those lessons is through an independent public inquiry, which she must commission now?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I believe that I have already answered the question about the need for a public inquiry. The First Minister has made it clear that there should be a public inquiry into every aspect of the handling of the pandemic and that, when the time is appropriate, she will commission such an inquiry. It will carry on and do the job that it is supposed to do.

I must correct Mr Cole-Hamilton in respect of PPE. In our care home sector, it is the responsibility of the private, independent and public sector providers to acquire PPE. When we knew, on 19 March, that their private supply lines were experiencing difficulty, the NHS and our national procurement service stepped in to ensure that there was a direct supply of the appropriate PPE, in volume and quantity, to care homes, and we have continued to do that where it is necessary. We will continue to do that for as long as it is required by the care home sector and other health and social care sectors.

Photo of Monica Lennon Monica Lennon Labour

I have listened carefully to the cabinet secretary, and I am disappointed that she has used the clinicians as a shield instead of taking responsibility for her Government’s guidance.

Care staff, the majority of whom are working class, low-paid women, were ringing the alarm about safety in care homes from the very beginning of the pandemic. Before the pandemic hit, the Government was well aware that there was a crisis in social care, especially in many privately run care homes that had had really bad reports from the Care Inspectorate. Why was it deemed safe to discharge Covid-19 patients to care homes that were not able to keep them and other residents and staff safe?

Does the cabinet secretary now accept that any patient who is known to have Covid-19 should not be discharged to a care home setting with other vulnerable people? Does she regret not acting sooner on the concerns of care staff and their unions?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I dispute completely the statement that I am using clinicians or anyone else as a shield. I have said more than once in Parliament—including today—that I am accountable for the decisions that I have taken. However, it is clear that the 13 March guidance—which was issued before the virus was in f ull community transmission—says very clearly that patients discharged from hospitals should be screened clinically. It is not me who screens them; it is for clinicians to screen those patients and to have those conversations. That is a simple statement of fact. It may not suit the argument that Ms Lennon wants to promulgate, but it is a statement of fact. I am certain that patients would not want me or any other politician to be screening them. That is not our job, and it is not the job that we are qualified to do. I am not using clinicians, care home staff or anyone else as a shield.

I am clear about my accountability and about the facts of the matter, which include that, from 2012, care homes were expected to abide by the “National Infection Prevention and Control Manual”, which includes basic infection prevention and control measures. We assumed that that was happening—the Care Inspectorate has a role in ensuring that that is the case. The guidance and PPE that we introduced were additional to that, to deal with the pandemic. As Ms Lennon now knows, residents are tested before entry into care homes, whether they are coming from the community or from hospital. That is a step to ensure that no one who is Covid-positive enters a care home unless there is a clinical reason—agreed between the hospital or the community and the care home—why that is the best place for that person to be. In those circumstances, as in others, they should be isolated for the appropriate length of time.

Photo of Graham Simpson Graham Simpson Conservative

The fact is that the cabinet secretary today has been hiding behind clinicians. She has repeatedly used the phrase “clinical judgment” and she is, in effect, saying that it was down to them. If people thought that it was okay to send patients who had tested positive into care homes, that was because of the guidance that was issued. Why will the cabinet secretary not take responsibility for that?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Quite simply, because Mr Simpson is wrong. It is a very long time since I had clinical training, but I am not shielding behind clinicians or using clinicians. It is a statement of fact that clinical assessment—whether it is about delayed discharge, what happens to someone who pitches up at A and E, or treatment once someone is suspected of having cancer—is a clinical decision, and rightly so. I will defend that on and on, and I will support clinicians in taking those decisions. That is what they are qualified to do, and that is where their expertise and compassion lie. That does not mean that I am not accountable for the Government’s decisions in these matters; it is a statement of fact, and I am very sorry that Graham Simpson does not like it.