Advising with empathy and experience

Coronavirus and care home issues.

Care workers have been shocked by a document sent to GP practices by the Brighton and Hove Clinical Commissioning Group setting out guidance on how to cope with Covid-19 in care homes.

The Brighton and Hove Clinical Commissioning Group (CCG) is the local NHS management for an area of Sussex, which includes 35 GP practices and 98 residential or nursing homes.

The document says that many vulnerable people may not be admitted to hospital for treatment if they contract the virus, and directs all homes to "check they have resuscitation orders on every patient."

While it is not unusual for "Respect Forms" or Do Not Resuscitate orders to be discussed with elderly and vulnerable people as part of careful preparation for the end of life, one care manager who spoke to the BBC was deeply concerned that residents and families are being pushed to sign the forms.

Part of a suggested script from the CCG for GPs to use in conversations with residents and families, says: "frail elderly people do not respond to the sort of intensive treatment required for the lung complications of coronavirus and indeed the risk of hospital admission may be to exacerbate pain and suffering.

"We may therefore recommend that in the event of coronavirus infection, hospital admission is undesirable."

One Hove care home manager told BBC political editor, Laura Kuenssberg, that they felt “shocked and numb” after their GP told them: “none of your residents aged over 75 will be admitted to hospital".

Another told her: "We have been told flatly that it would be highly unlikely that they would be accepted into hospital."

NHS England has said that there is no national guidance that prioritises who can be treated in hospital.

The health trust, which includes the CCG, said that while: "agreeing advance care plans is a routine and important part of how GPs and care homes support their patients and residents, we recognise there may have been undue alarm caused by the interpretation of this particular guidance.”

When asked about a similar issue in Greater Manchester, at a Downing Street press conference, health secretary, Matt Hancock, said coronavirus patients living in care homes will not be refused admittance to hospital.

He said there were 2,029 spare critical care beds available in the NHS and their use would be based on clinical decisions.

He added: "It is not a blanket rule that people shouldn't go to hospitals from care homes. Hospital is there for people when they need it, when the doctors advise that they go."

But while it's not clear if similar guidance to that of the Brighton and Hove Clinical Commissioning Group has been sent out to homes in other parts of the country, there are concerns in the wider care sector, that without enough protective equipment, a relatively unseen part of the coronavirus crisis may develop behind closed doors.

Chief executive of MHA the UK's largest charity provider of care and accommodation for older people, Sam Monaghan, said: "While NHS staff are used to dealing with a high volume of end-of-life care, social care staff who develop close personal relationships with residents over months and years are not.

"As extraordinary as our colleagues across the UK are, they did not sign up to this but are doing their very best. They increasingly don't have the equivalent PPE to the NHS and we can't continue to accept that."

He added that care homes were: "struggling to even offer families the PPE to allow them to be with their loved ones at the end. Surely, as a society we can do better than this."