A plan to discharge Covid patients from hospitals into care homes without tests has been branded “madness” by care home providers who warned the move risks a repeat of last spring’s crisis, which was partly fuelled by pressure to relieve the NHS. The Department of Health and Social Care issued guidance that Covid positive patients in England who have been in isolation in hospital for 14 days “are not considered to pose an infection risk” and do not have to be retested. If they are not showing new symptoms or have had fresh exposure to the virus they can be moved directly to care homes from hospital. News of the strategy was first reported in the Guardian on Wednesday when NHS commissioners told care operators in Yorkshire that discharges could start happening directly in some cases “because we now know they do not pose an infection risk to other residents in a care home”. Care homes are demanding to see evidence to support that assessment in the light of rising cases of the new more transmissible strain of the virus. About 1,200 care home residents died from Covid in England in the first week of January and on Wednesday the NHS ordered GPs to rapidly accelerate vaccination of England’s approximately 400,000 care home residents to deliver all first doses by the end of next week. The latest discharge guidance comes amid an urgent need to free up space in the NHS, and the DHSC said it was clarifying an approach that had already been approved by its deputy chief medical officers and Public Health England.
“Our priority is to ensure everyone receives the right care, in the right place at the right time,” a spokesperson said. “We have been doing everything we can to protect care homes since the start of the pandemic, providing billions of pounds of additional funding, free PPE, infection control guidance, increasing staff testing and providing priority vaccines.” But Mike Padgham, chair of the Independent Care Group, which represents providers in North Yorkshire, said: “I can’t quite believe the government is thinking of doing this. How do we know [people being discharged] haven’t been exposed especially with this new virulent strain? It seems we haven’t learned from the first wave. We want to help the health service but people will be reluctant to accept discharges without the comfort of a test … It seems madness.” Rights for Residents, which represents families who use care homes, said its members were “terrified” by the prospect of hospital patients who have had Covid being discharged into care homes without a recent test. “My anger and frustration is that the government has had 10 months to plan for this,” said Diane Mayhew, co-founder of the group. “Care homes have closed and many are standing empty and would have the perfect infrastructure for discharge.” In mid-December, DHSC policy on discharges said everyone with a positive test result being sent from a hospital into a care home should first be sent to a designated facility set up specially to handle potentially infectious patients. This was described as an “important precaution to protect care home residents and minimise, where possible, the risk of infection”. However, only 136 of the so-called “hot homes” have been established after the government set a goal of at least 500 in October. The December policy also said infected patients who had been isolated for at least 14 days and were not showing new symptoms need not be tested but that “a clinical assessment should be made to determine subsequent onward movement”.
The new guidance says: “If these individuals have already completed their 14-day isolation period from onset of symptoms or positive test result and have no new Covid-19 symptoms or exposure, they are not considered to pose an infection risk. They therefore do not have to be retested and can move directly to a care home from hospital.”