A government plan to relieve packed hospitals by designating hundreds of care homes to accept Covid patients has fallen far short of its target, increasing pressure on the NHS.
Only 136 “hot home” social care facilities have been set up across England, despite the Department of Health and Social Care (DHSC) saying in October that up to 500 would be approved by the end of November to prevent beds being blocked in hospitals. They are mostly wings of care homes that use separate staff and separate entrances to prevent the virus from spreading.
There are now more than 29,000 people in hospital with Covid in England, and more than 3,800 are being admitted daily. But only 2,533 care home bed spaces have been found where patients who may still be infectious can be cared for without the risk of sparking fresh care home outbreaks, according to figures from the Care Quality Commission (CQC), which has been checking the safety of proposed locations.
In the absence of designated facilities, the NHS now wants the government to underwrite the risk of normal care homes taking in hospital patients who are ready to be discharged. With many care homes refusing to take Covid patients because insurers will not cover the risks associated with the virus, the NHS has urged the Treasury to effectively indemnify care homes against possible claims triggered by accepting patients.
“It’s imperative that care homes take patients that can be discharged safely in order to free up capacity [in hospitals] to deal with the huge numbers of Covid patients that require care,” said a well-placed NHS source. “You’d have to do this only with patients where there’s no risk of spread of Covid. And it mustn’t be seen as a dumping exercise. But it needs to happen, and urgently.”
It could cost the taxpayer between £600m and £800m, the Guardian understands, and the DHSC is understood to endorse NHS England’s view that accessing care home beds is vital to protect the NHS.
Fifty-eight council areas have not designated any facilities, although some have proposed NHS facilities such as community hospitals.
Without a deal on insurance, care bosses have said more designated settings are needed to ensure that care homes will not have to take in Covid-positive patients when it is not safe to do so.
“If people cannot be supported to leave hospital, whether that is by moving into a care home or having care at home, then the whole system will fail,” said Vic Rayner, executive director of the National Care Forum, which represents not-for-profit providers. “NHS saves lives, but so does social care, and it must be properly supported to ensure that it can play its vital role in making the whole system work.”
Rising outbreaks in care homes and growing staff absences are causing some providers to stop accepting new admissions.
The number of care homes in England that recorded a Covid infection in the last week of 2020 rose to 503, more than double the total a fortnight ago. Care managers are facing absences of between 11% and 50% of staff caused by positive Covid tests, according to a survey by the NCF.
Four residents died and 43 staff were infected in an outbreak at Oakdown House in East Sussex last month, its owner, Mike Derrick, told the Guardian on Monday. “The new variant seems to be so easily transmissible that once it is into a service, it spreads so quickly,” he said. “It’s so much more difficult.”
Derrick, who chairs the East Sussex Registered Care Association, said at least three other homes in his area had had serious recent outbreaks, and the local authority “has serious concerns about several homes every week”.
Last week it emerged that over the Christmas period, 13 residents died at Edendale Lodge care home in Crowhurst, East Sussex.
The CQC said it was in talks with the government “to address issues of capacity across the country, particularly in areas where there is a shortage or lack of designated settings”.
“It is our role to ensure that proposed locations … are safe for people with a confirmed Covid-19 test result to be discharged into,” said Kate Terroni, chief inspector of adult social care. “By rapidly inspecting and, where appropriate, approving designated locations … we are working to help combat the spread of infection and increase the number of people who can access care by ensuring that people can be safely discharged from hospital.”
A DHSC spokesperson said: “We have put in place enough designated care homes or NHS community settings to provide the small proportion of Covid-positive residents who require access to this care with the support they need, while protecting other vulnerable residents from the risk of infection.”