The government needs to pay more attention to social care when planning for pandemics, Jenny Harries has told the Covid Inquiry.
The UK Health and Security Agency chief said one of the biggest lessons that should be taken from the pandemic is the need for “much better” systematic planning for how to support people with social care needs during infectious outbreaks.
“I don't think we can have a responsive health and wellbeing system if the value of social care is not recognised, the value of the workers is not recognised,” she said.
“As I look forward, planning for pandemics, the very same frail individuals who are sitting in residential care settings now, learning disabled, wherever they may be in the community, are the same people I need to reach each time there is an infectious disease incident. And so that should be much better planned for on a systematic basis.”
She also said social care workers “should have parity” and “that's not how it has been seen”.
Across the whole pandemic, there were 43,000 deaths of care home residents involving Covid in the UK, according to Office for National Statistics.
Harries, who was picked to lead the UKHSA a year into the pandemic, said there were also problems with the NHS and social care not being joined-up enough during the pandemic and that the system needs to be treated as whole.
“I do think there was a problem in the sense of ensuring, and I think I flagged this in my email somewhere, that the NHS and then social care should be seen as a total continuum.
"They are all part of the healthcare system. And sometimes one bit gets developed separate from another and looking back at some of these you can see the piece of NHS guidance pops out and then somebody else is trying to ramp up with it.”
'This sounds awful'
Harries was also asked during the oral evidence sessions about an exchange of emails with a senior official in the Department of Health and Social Care on 16 March, 2020, where Harries - then the deputy chief medical officer - said Covid-symptomatic hospital patients would need to be discharged into care homes.
Rosamund Roughton, who was director general for social care in DHSC, had asked Harries what the department’s approach should be in its shielding policy to discharging such patients into care homes, adding: “My working assumption was that we would have to allow discharge to happen, and have very strict infection control? Otherwise the NHS presumably gets clogged up with people who aren’t acutely ill.”
Harries responded: “Whilst the prospect is perhaps what none of us would wish to plan for, I believe the reality will be that we will need to discharge Covid-19-positive patients into residential care settings for the reason you have noted. This will be entirely clinically appropriate because the NHS will triage those to retain in acute settings who can benefit from that sector’s care. The numbers of people with disease will rise sharply within a fairly short timeframe and I suspect make this fairly normal practice and more acceptable but I do recognise that families and care homes will not welcome this in the initial phase.”
Asked about the email, Harries said this was not a “policy statement” but a “high level view” on what was a “very bleak picture”. Harries also admitted that the email “sounds awful” but she said was trying to explain “what the size of the problem might be”.
Harries said the email “isn't an invitation to be discharging Covid patients”. Instead, she said it was an explanation of what would need to happen if hospitals “overflow”.
“Otherwise there wouldn't have been places for other people from care homes to go in and be treated,” she added.
Harries' prediction largely came to bear, although without knowing if discharged patients had Covid or not. Some 25,000 patients were discharged from hospitals into care homes between 17 March and 15 April without being tested first, which led to the accusation that care homes were “thrown to the wolves”.
In the first wave of the pandemic there were almost 27,000 “excess deaths” in care homes in England and Wales compared with the 2015–19 average.
Harries said the “critical point” in the email exchange was the need to have “very strict infection control”.
Matt Hancock, who was health secretary during the pandemic, has repeatedly claimed that a "protective ring" was put around care homes at the start of the pandemic. But the High Court ruled last year that the policy of discharging untested hospital patients into care homes was unlawful.
The High Court said the government's guidance in the early stages of the pandemic on care homes was "irrational" in failing to advise that asymptomatic patients sent to care homes to free up hospital beds should be isolated for 14 days.
It was not until 15 April that the Department of Health recommended both testing and isolation for 14 days for residents coming into care homes.