Massively Underprepared
15 May 2020
Massively unprepared – or were we?
Today I have listened to three stories directly from Providers of numerous deaths, in quick succession, once the dreaded COVID-19 was through their front doors. All three stories trace back to failed discharges from hospital. Whether this is due to incompetence, confusion, or botched testing I guess no one will ever know – there are far too many stories for any authority to have the resource to investigate every case.
It left me thinking though. How did we get here?
Having grown up hearing pharmacy talk and then care home talk around the dining room table, I am one of the lucky ones. We have been through “issues” within the services that we have had to fix; we have had infection outbreaks and learnt our lessons on how important infection control is and how to erect a barrier – quickly.
As I hear the blame laid at the door of government agencies in meetings everyday, I find myself questioning why the level of knowledge within the sector is so varied.
Yes, it is true, without the equipment we could not do what we need to do, but it is also true it is not all about PPE. Each service must have an infection control strategy; well trained staff that know how to implement it; and champions that understand the risks and how to flex the strategy to mitigate presenting risks immediately.
Why has this gone to badly wrong?
Looking at our “system” the specialism of infection control sits under each CCG. Local Authorities, at least in the area Evolve operates, do not have infection control leads. The CCG holds contracts with nursing homes, and complete contract monitoring visits only with nursing homes. Under the residential contracts we do not seem to get any infection control visits or questions.
CQC inspect infection control under Safe. I am sure lots will be said about the depth of inspection in this area – but their job is to inspect – not to advise.
So where then is the residential home supposed to accumulate the knowledge required within the area of infection control, when an outbreak hits because of a failed discharge. Why are we suddenly speaking to residential homes about barrier nursing – they don’t have nurses on site.
This leads us to the District Nursing Teams – they are the nurses tasked with clinical oversight in residential homes – I wonder what their advice has been to the providers?
One view expressed in a recent provider forum by a commissioner was – but this is their business. This is what residential homes do, why don’t they know?
What ever the answer, the catastrophic failure to prevent outbreaks in homes across the country will require questions to be asked. Uncomfortable questions for all of us. Why?
Because at the end of the day hundreds, no thousands, of older adults and their families, have been failed by the very system that was meant to protect them.
The very notion of which keeps me lying awake at night.
Shrien Dewani
Director, Evolve Care Group