Welsh Government incompetence ‘responsible for multiple Covid deaths in care homes’

Martin Shipton

The Welsh Government’s incompetent handling of the impact of Covid-19 on care homes resulted in many elderly and vulnerable people suffering lonely avoidable deaths in unnecessary pain, the UK Covid Inquiry has been told.

Addressing the Inquiry on behalf of the Covid-19 Bereaved Families for Justice Cymru group, solicitor Brian Stanton said: “A letter from March 2020 to vulnerable patients in Wales … informed them that it was unlikely that they would be offered hospital admission, that they certainly would not be offered a ventilator bed, and they were encouraged to complete a DNACPR [Do Not Attempt Resuscitation form] so that, and I quote, ‘your friends and family will know not to call 999’ and so that ‘scarce ambulance resources can be targeted to the young and fit’.

“This letter was roundly condemned for its lack of sensitivity, but it is in fact an accurate reflection of what happened to many elderly and vulnerable people in care homes. The letter promised, ‘we will not abandon you’, but abandonment was exactly what was being communicated and it raises the question: how on earth were elderly and vulnerable people considered expendable in this way?

“Through the awful experiences of care home residents and their families we are provided with a microcosm of everything that was wrong with the pandemic response in Wales, and with a system that allowed many elderly and vulnerable people to suffer lonely avoidable deaths, in unnecessary pain without appropriate medical treatment.”

‘Horrified’

Mr Stanton said the group’s members were horrified to have learned just how dangerous care homes were during the pandemic, with the people most vulnerable to infection locked down in the least safe environments in the country, with excess deaths at over 100% in the peak months of the pandemic and death rates following infection as high as one in three.

He said: “These dangers were well understood within Welsh Government, and a published statement of Heléna Herklots (the Older People’s Commissioner for Wales) describes a meeting on May 28 2020, with the Chief Medical Officer for Wales, Sir Frank Atherton, who when asked whether ‘care homes were safe’ replied ‘that if he was working at home, he would take a relative into his own home from a care home’.

“For such a statement to come from the most senior Welsh Government adviser on matters relating to health, is a damning indictment on the safety of care homes in Wales and Ms Herklots was so concerned about the situation that in the same month she referred the Welsh Government to the Equality and Human Rights Commission for investigation. The Commission found that ‘a number of decisions in the Covid-19 response may have resulted in failures to adequately protect the right to life, including decisions about hospital discharges, admissions to care homes, prioritisation of testing and access to necessary healthcare and treatment.’ “And their report states that: ‘Representative groups have described how the combination of decisions in the pandemic response either ignored care home residents or treated them as expendable’.

Areas of concern

Mr Stanton went on to list seven specific areas of concern:

1. Deaths and infection rates in care homes in Wales: “Many deaths of care home residents in Wales were not diagnosed or recorded as caused by Covid-19 because of the lack of available testing and because the symptoms were not recognised. In these circumstances, the group considers it a reasonable position to attribute all excess deaths within care homes in waves one and two as Covid-19 related deaths.

“A report of the Technical Advisory Group in Wales identified a 12% increase in excess deaths in Wales in all settings in 2020, against a five-year average. Terrible though this data is, it was even worse in care homes. In 2020, deaths in Welsh care homes increased by 26% (more than double the increase in the general population). And in the peak months of waves 1 and 2 excess deaths were at or over 100%.”

2. Failures of preparation and to learn lessons for improvement, including between waves 1 and 2. “The appalling circumstances in which so many vulnerable people lost their lives is a direct consequence of the lack of preparation and capacity within the health and social care system in Wales, in particular a lack of hospital capacity; a lack of testing capacity; and insufficient quantities and types of PPE.

“Despite the size of the social care sector and the increased vulnerability of care home residents to infectious diseases, the UK and Welsh pandemic planning exercises gave almost no consideration to this vital area of preparedness. Shockingly, many of the planning exercises do not even mention social care at all.

“According to the ONS report of 11 May 2021, among English regions and Wales, the highest proportion of care home deaths in wave two was in Wales, which supports the view of the group that there was a complete failure to learn the harsh lessons of wave one. The huge loss of life in wave 2 was not inevitable, but the continued disregard for the safety of elderly residents sealed the fate of too many.

“The Welsh Government’s primary concern and first instinct is always reputation management at the expense of candour and learning lessons. This tendency is offensive to the bereaved and prevents them from gaining closure, and it is most clearly evident in the next and third section.

3. Testing failures. “A comprehensive testing regime is essential for controlling known high levels of nosocomial infection in care homes, yet testing policy in Wales was a catalogue of chaos and reactionary decisions. On April 8 2020 Wales rejected the need for a negative test prior to hospital discharge based on a claimed lack of testing capacity. However, the average number of untested patients discharged to care homes for the remainder of April was just 10 per day, equating to 1% or less of available testing capacity. Despite the incredibly serious risk of seeding infections within vulnerable communities, it was decided that this tiny number of tests could not be spared. Worse, and adding insult to injury, Wales wasn’t even close to using its full capacity in this period, for example just 57% of available tests were used on April 20.

“Routine testing was not introduced in Welsh care homes until May 16 (almost three weeks after England on April 28). However, in their oral closing in Module 7, the Welsh Government maintained that there had been no delay, and that it was not until ‘new’ advice was provided by SAGE on May 12 that the case for routine testing was made out. The Cymru group does not accept this position – it was well known that Covid-19 was spreading within care homes asymptomatically at levels of 50% from at least April 3 (the date of the CDC report). And SAGE meetings (at which the Welsh Government were represented) warned of the dangers of nosocomial asymptomatic infection on no fewer than seven occasions between April 14 and May 7, including on April 16 at SAGE 26 that testing is an important part of controlling transmissions in hospitals and care homes, and on April 23 at SAGE 28, that a testing strategy to reduce the spread in care homes is required.

“Meanwhile in Wales the former First Minister [Mark] Drakeford was making bizarre statements in the Senedd on April 29 and May 6 that there was no clinical value in routine testing in care homes.

“Moving forward to the second wave, in December 2020, as the situation worsened, the Welsh Government reversed its testing strategy and actually reintroduced the practice of discharging hospital patients into care homes without a negative test. Covid deaths in care homes had at this time increased from 21 in October 2020, to 217 in December 2020, and nearly doubled in January 2021 to 417. This backward step demonstrates reckless disregard for the safety of elderly vulnerable people, and is a glaring example of the inability of the Welsh Government to learn from its mistakes.

“Against this background of dithering, false statements and U-turns, it was difficult for bereaved families in Wales to hear the explanation offered by Mr Drakeford, in his recent oral evidence in Module 7 that: ‘We planned first and then we announced. And sometimes that makes us look like we were doing things later than was happening elsewhere, but I believe that our method was more effective.’

“The Cymru group believes that the real reason for failing to introduce routine testing in care homes was not scientific uncertainty but a lack of testing capacity and concerns about the impact on staffing levels, both of which were the responsibility of the Welsh Government, and for which ‘the science’ made a convenient scapegoat.”

4. The failure to take a precautionary approach: “The lack of regard for the dual risks of asymptomatic and airborne transmission and the absence of a precautionary approach is evident within the announcement of the former Minister for Health and Social Care, Vaughan Gething, on March 16 2020 that no PPE was required if a patient or health care worker in social care did not have symptoms of Covid-19. and that higher levels of PPE were ‘unlikely to be needed’ in a social care setting.

“Despite the lack of protection provided, the Welsh Government was well aware of the risks, for example, on March 24 2020 in the Senedd, the former First Minister, Mark Drakeford warned about the risk of asymptomatic transmission to vulnerable people.

“These are complicated issues, but in short, the group’s position is that there was sufficient scientific knowledge from the very outset of the pandemic that the virus may transmit at high levels asymptomatically, and via aerosols, to have necessitated much greater focus on preventing nosocomial infection within extremely vulnerable care home communities through adequate PPE, comprehensive testing regimes, and other IPC [Infection Prevention and Control] measures, particularly ventilation. The failure to do so undoubtedly contributed to high levels of nosocomial infection and deaths.”

5 Inadequate PPE and IPC guidance: “The Welsh Government became responsible for the provision of PPE to care homes on March 19 2020. By May 7 2020 (seven weeks after the arrangement began) only around two thirds of the social care sector’s PPE needs were being met by the Welsh Government.

“There was also a failure to provide the right type of equipment, with IPC guidance dictated by the inadequacies of the PPE stockpile and the limitations of PPE procurement rather than by considerations of safety.

6. Suspension of vaccinations in care homes. “A major concern of the Cymru group is the decision of the Welsh Government to intentionally delay the provision of vaccines to care home residents, contrary to the advice of the Joint Committee on Vaccines and Immunisation.

“Given that the fatality rate for an unvaccinated care home resident may have been as high as 1 in 3 and that the benefits of vaccination were so significant and pronounced, it beggars belief that any responsible government should have sought to delay this provision, as the Welsh Government did.

“The reason for the delay that placed so many people at unnecessary risk of death was the failure to procure the necessary refrigeration despite knowing of this likely requirement since August 2020. Another glaring failure of preparation and further evidence that older people in care homes in Wales were deprioritised.

7. The failure to provide appropriate medical treatment, medicines, and equipment. “The Inquiry is going to hear from witnesses and has other evidence before it of appalling neglect, including:

The routine application of Do Not Attempt Resuscitation notices.

The removal of in person consultations – which disproportionately impacted elderly residents of care homes.

The outrageous refusal to provide hospital treatment, an example of which is detailed within the witness statement of Helen Hough, who describes an ambulance team refusing to take a resident to hospital and their instructions that they were not supposed to transport anyone from a care home.

And the fact that care homes were not equipped to provide oxygen therapy and good-quality palliative and end-of-life care which led to many residents enduring unnecessary suffering, of which the Inquiry has many harrowing accounts.

Mr Stanton concluded with the words of north Wales care home owner Helen Hough, who wrote an email to the Welsh Government on May 4 2020 stating: “I do hope, when this is over, this is all thoroughly investigated, because I and many other managers will be stating what a diabolical shambles this is in Wales.”