Sorry, no, could you explain this to me again? The Scottish Government sent untested patients into care homes to protect them from Covid? And when they did test someone and they had Covid they sent them to care homes anyway. Because no-one new about pre-symptomatic transmission. That’s the official Jeane Freeman line… and it makes no sense.
All of this information is telling me nothing at all about practice, behaviour and attitudes during the pandemic, but it is absolutely filling me in on the intensity of the ‘save our skins’ operation which has been undertaken since, all to come up with some plausible explanation for what on the face of it is clear negligence.
So let’s get into this a little. The first thing doing that requires is to look at why this is such a terrible issue, one that deserves more respect. In June 2020 I was sent a long article by care expert Nick Kempe. I read it and I told him that it was too important to drop only as an article and could he write it up as a policy paper. He did that over the weekend.
I’ve edited countless policy papers over the years, but this is the only one which caused me to break off work because of the tears. What I learned was horrific. In the last 30 years residential care has become another side shoot of the wealth management and equity investment beanfeast. Care homes became cash cows for private businesses, as much because of endless property deals as because of fees.
And whenever that happens you can be 100 per cent certain that standards will drop. There is too much bad data to cover here – for example, one in three care homes are classified by the Care Expectorate as ‘high risk’. There are more high-risk care homes in Scotland than low-risk ones.
There were 7,086 complaints against private care homes last year of which over 700 were upheld. The rates of complaints in private, for-profit care homes is three times that of public sector care homes – which is a worry because 77 per cent of care beds in Scotland are in the for-profit sector.
But these are just complaints right, nothing big? Not exactly: “Issues have included poor health, welfare and safety, filthy living conditions, residents going weeks without being washed, unsafe food and drink intake, missed hospital appointments, and mismanagement of medicines. Some incidents led to injuries and even death.” Jings.
Elderly people were just left to gasp horribly with dreadful flu-like symptoms until they couldn’t gasp another breath or their heart stopped from the pressure
Hardly surprising, because five out of the six care home groups which are the big players in the private sector which runs the vast majority of care home beds in Scotland are owned in off-shore tax havens. They lobby relentlessly (Scottish Care is their lobbying body) to the extent that they tried to stop you finding out how many people died of Covid in their care homes altogether.
And the Scottish Government tried to help them cover this up, because this is another one of those areas where the public sector is so hollowed out that it can’t deliver services other than through the private sector, so it starts to treat the private sector like part of the government.
Which means none of the above is being overstated – quite the contrary, the Care Inspectorate is a pushover. It almost never issues sanctions on a care home, even if it has issued a string of compulsory enforcement orders which went ignored. Hell, they didn’t even bother investigating complaints during the pandemic.
This is all really important to understand in relation to Freeman’s evidence. This privatised care model (like every privatised model) operates on the basis of cutting any corner that doesn’t get you imprisoned. Care homes used to have a good cohort of properly-trained medical staff as part of the team, but those cost money. Now the ratio of medically-trained to only personal-care-trained staff has swung overwhelmingly away from medical expertise.
That means these care homes cannot provide any comprehensive medical care – most staff can’t even give you an asprin without supervision. I cannot do more than emphasise this as strongly as possible; there was next to no medical care in care homes when these patients were decanted. No proper palliative care, no ventilators, no medicines. (Incidentally, there was no protective equipment for staff either.)
You need to stop and think about that for a moment – almost anywhere you could be during the pandemic you had some kind of access to proper medical care, unless you were sent to a care home. I’d be interested to know how many people were sent back to a hospital, because that would indicate an attempt not to just use that care home as a death room for someone.
The number will be negligible. What actually happened is that these elderly patients (often with dementia, often with no real understanding of what was happening to them) were locked in rooms where they barely saw a human most of the time and were denied access to any loved one or familiar face (or any face at all given the masks, which isn’t going to help a confused elderly person).
Once locked in that room they were left to die an often horrible death, often with next to no palliative care at all. They were just left to gasp horribly with dreadful flu-like symptoms until they couldn’t gasp another breath or their heart stopped from the pressure. It was this that cause me to have to take a break to deal with my tears.
Back to Freeman’s evidence then. If there was one overwhelming message that even the Care Inspectorate couldn’t underplay during the pandemic it was that infection control in many if not most care homes was nowhere near fit for purpose. Whatever the risks of cross-infection in an acute bed in a hospital, you can’t say there isn’t serious infection control.
To ‘protect’ these elderly people they were forced out of a medical environment with strong infection controls into a non-medical environment with weak infection controls – you see why I’m not buying this?
And there is proper medical care in a hospital where there almost certainly isn’t in a care home. Ms Freeman’s evidence states that to ‘protect’ these elderly people they were forced out of a medical environment with strong infection controls into a non-medical environment with weak infection controls. You see why I’m not buying this?
And if the purpose of this was to protect these elderly people from getting Covid, why were they sending Covid-positive patients there too? To protect them from what? Or were they just part of a bulk deal?
What I can’t take (I really can’t take) is this idea that no-one knew about pre-symptomatic transmission at the time. There were medical journal articles raising concern of clear suggestions of pre-symptomatic transmission in January 2020 – this meta-study identified nine separate articles in medical journals on the subject by the end of March 2020.
But let’s not muck about here – the first warning from the World Health Organisation about asymptomatic transmission was in January 14 2020 and was raised again on 4 February. By 24 February the Lancet was publishing research which suggested there was asymptomatic and presymptomatic transmission and it was NHS guidance by 3 March having been discussed by Sage (which no Scottish Government minister attended) in February. This ‘we didn’t know’ claim was fact checked out of existence a long time ago.
By the time Scotland was booting Covid-positive cases into care homes this was no longer a contested proposition. So when Freeman says she was advised otherwise I would very much like to know who provided that advice, what form it was in and to see that advice.
Because what it looks like to me is there is a three-part strategy. First, cry and make a big deal about how hard this has been on you. Second, mumble crap about protecting people and all the things you didn’t know. Third, blame it on an unnamed adviser, presumably Catherine Calderwood. Her unspecified medical condition which is preventing her from giving evidence may be sincere, but that doesn’t make it any less convenient.
This reeks of a coordinated defence position being prepared. If Freeman didn’t know the medical advice when she was the Health Secretary in charge of a pandemic, that is disgraceful. If she was getting advice 100 per cent contrary to the real advice the grown-ups were given, we need to see it and know who gave it. Calderwood has form (see the WHO link above to check out more on her ‘testing is a distraction’ comments).
The reality is that the chances that Freeman’s defence is honest seem slim to me. These patients were not transferred to protect them but to free up notional beds based on some consultants PowerPoint presentation of a spreadsheet or something.
But we will never know, because they either systematically destroyed records of these decisions or didn’t record them at all – and of course the next thing they did was to engage in a cover-up operation via Public Health Scotland.
All we learned yesterday was how Scotland’s governing elite plan to avoid responsibility. I find their plan unconvincing. At the bottom of the list of priorities is true remorse for the unnecessary suffering of an old lady with dementia who spent her last, panicked hours gasping for breath alone in a locked room with no idea what was going on.
- This article has been corrected after publication. I’d mis-phrased the sentence on the big six care home operators in a way that implied that they between them operated the big majority of care homes, but they’re just the biggest players in a private sector which runs the big majority. And I’d transposed Scottish Care into Care Scotland. Sorry about that.