November 24, 2020

Delays to Covid-only care home plan could strand patients, warn England health chiefs – The Guardian

Covid patients could be left to languish in hospital and block NHS beds amid delays in setting up “hot” care homes dedicated to receiving them, health chiefs have warned.

A plan to reduce care home coronavirus outbreaks by setting up “hot homes” to receive infected people discharged from hospital is running late after dozens of councils missed a government deadline to nominate locations.

By the end of October every area of England was supposed to have at least one facility approved for Covid-positive discharges, the government pledged last month. It was part of an attempt to prevent a repeat of the spring pandemic, which killed more than 18,000 residents after thousands of patients were discharged into care homes without tests.

But as hospital admissions with Covid continue to rise, only 67 out of 151 local authorities have one set up, according to figures from the Care Quality Commission (CQC).

NHS Providers, which represents NHS trusts, said the delays were adding to discharge problems, causing increasing patient stays and a growing number of “super-stranded” patients.

“While the new discharge requirements are well-intentioned and aimed at protecting the most vulnerable in care homes, the challenge of implementing the changes has created blockages across mental health, acute and community beds,” said Miriam Deakin, the director of policy and strategy at NHS Providers.

“Trusts are telling us that a combination of insurance and CQC assurance approvals for the new designated spaces are adding delays.”

The shadow care minister, Liz Kendall, said the shortfall presented a threat to the NHS. There were already nearly 15,000 people in hospital with Covid and the daily rate of admission was the same as on 20 April.

“The lack of places to discharge patients isn’t just bad for them but also for the NHS, which desperately needs all capacity to treat Covid patients and bring down the huge backlog in cancer and other waiting times,” she said. “The government must set out what it will do to ensure places are available in every part of the country as a matter of urgency.”

The instruction to set up designated care settings for people discharged from hospital with coronavirus came from the Department of Health and Social Care (DHSC).

It had already updated guidelines on the admission of Covid-positive patients, which now state that no care home will be forced to admit anyone if they are unable to cope with the impact of the person’s Covid-19 illness. If they refused, it would be the local authority’s responsibility to find alternative accommodation.

Some care homes and councils are understood to have faced difficulties securing affordable insurance and finding suitable facilities.

Tuesday’s figures showed 46 councils in England have not nominated a potentially “Covid-safe” facility for inspection by the CQC. This included 25 councils that said they would not take part in the scheme but would make alternative arrangements, understood to include using community hospitals.

As of 13 November, only 74 “hot homes” have been set up and approved, with 936 beds. Councils proposing alternatives, such as working with NHS facilities, report having identified just over 700 beds.

Kate Terroni, the chief inspector of adult social care at the CQC, said: “It is our role to ensure that proposed locations for the designate scheme, which is an initiative led by DHSC, are safe for people with a confirmed Covid-19 test result to be discharged into. By the end of November we will have completed 500 infection prevention and control inspections, including at all approved designated locations.”

The DHSC was approached for comment.