Britain’s beleaguered care homes become next coronavirus epicentre

David Abbott

Britain’s overwhelmed care homes have emerged as the new front line in the fight against coronavirus. Care homes have struggled with a lack of testing and personal protective equipment (PPE) compounded by a multiplicity of data methodologies to count coronavirus-related deaths. 

Concerns have risen that the true breadth and depth of the crisis has been underestimated, with some care home operators claiming the population group is now the “new coronavirus epicentre”. According to provisional estimates from the Office for National Statistics (ONS), the total care home deaths in England and Wales linked to coronavirus since the start of the pandemic is 3,096, with a further 190 in hospices. However, these figures are disputed in some quarters with critics suggesting that the discrepancies over data methodologies have stymied clarity, awareness and action.

For example, the Care Quality Commission (CQC) counts suspected or confirmed coronavirus-related deaths notified by care home providers, usually within two to three days. On Tuesday 28 April, the CQC reported more than 4,300 deaths in care homes across England in Wales in the two weeks to Friday 24 April. By contrast, the Office for National Statistics (ONS), reported 2,050 coronavirus-related registered deaths in care homes during the 16th week of 2020 (week ending Friday 17 April); however, this figure is double the previous week and shows that one-third of all coronavirus deaths in England and Wales are now occurring in care homes. The National Care Forum (NCF), the adult social care sector trade body, suggested that more than 4,000 people may already have died in care homes across England and Wales due to Covid-19 before 13 April, modelled from a benchmark sample of its membership. Another forecaster has estimated coronavirus-related deaths in care homes in England and Wales at more than 7,000.

The Health Secretary Matt Hancock has announced that the government would begin including the number of care home deaths in its daily figures from 29 April. 

Care home residents are the most at-risk population group due to age, greater health frailty, and the inherent difficulty in observing social distancing in care home settings. All of which leaves the sector ill-equipped to handle the scale of the unfolding crisis. Chief among concerns is the adequacy and availability of personal protective equipment (PPE) in care homes. Increased provision of PPE and testing has been promised, but the pace of delivery to date has not met demand. Mr Hancock has also announced that testing will be expanded to all care home residents and staff in England from 29 April regardless of symptoms. Expansion of this policy to Scotland, Wales and Northern Ireland is expected to follow in line with geographic testing capacity expansion. 

At the national level, a better picture is still needed on PPE shortages in care homes to inform supply chain operators and keep pace with expected future demand. However, global demand for PPE is at unprecedented levels, with several countries banning exports intensifying an already extremely difficult challenge, as evidenced by the government’s recent deployment of an RAF aircraft to collect a delayed PPE delivery from Turkey. There have also been concerns over loss of service provision, particularly domiciliary care, as well as confusion over guidance on how to use PPE appropriately, according to the CQC. The government has pledged an “unprecedented shift in scale” in supply and distribution to the care home sector. From April 6, the government pledged to provide essential PPE supplies to 58,000 care homes, hospices, residential rehabs and community care organisations.

The CQC is leading the coordination of testing. The government claims there is testing capacity for every symptomatic social care worker. However, only 25% of eligible care home staff and 6.8% of domiciliary care staff have been tested to date, according to NCF data, while proximity to testing centres is also an issue. In addition, the movement of carers between care home settings, domiciliary care settings and other health settings is posing serious risks to staff and the vulnerable patients in their care. The crisis in UK care homes is common around the world. Governments in the US, Italy, Spain, France and Canada have launched inquiries into coronavirus preparedness and response in care homes.

In March the government provided £1.6 billion to local authorities to help finance their coronavirus response and support vital services, including adult social care. For private care home operators, the financial reality is expected income shortfalls as the collective quarantine takes its toll on a deeply interconnected economy which is struggling to come to terms with the all-consuming depth and scale of the pandemic on normal trading activity and emergency services.  

The UK private care homes sector is highly fragmented. There are an estimated 473,000 care home beds across the UK, according to Savills data, with the ‘big five’ private operators – HC-One, Four Seasons, Barchester, Bupa and Care UK – collectively operating 62,000 care beds, which is 12,000 fewer than five years ago. 

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