The Predictable Crisis

― Based on quality ratings at the outset of the crisis more than one quarter of Scotland’s care homes (those rated adequate or below) could have been expected to be unable properly to protect older people in the event of a pandemic.

― The Care Inspectorate does a professional job but has few enforcement powers and works inside a regulatory regime which is very limited in scope. As an example, in February they simply did not have the power to do what has now (eventually) been done at the Home Farm Care Home on Skye. The Care Inspectorate was incapable of brining Care Homes up to the standard required by the Covid crisis and poor quality care is embedded in the system.

― The result is that six out of ten care homes in Scotland have had a case of Covid and about 45 per cent still have a current case (as of Monday 18 May) – plus 7.4 per cent of care home staff have been absent with Covid compared to just 4.0 per cent of NHS staff

― All of what has resulted was accurately predicted in 2016 but calls to prepare were ignored. In particular there has been a continuing decline in trained medical staff and a rise in unfilled nursing vacancies (52 per cent of private sector Care Homes have nursing vacancies, compared to 15 per cent in the voluntary sector). There is no formal training for Infection Control for non-medical staff in Care Homes in the care SVQ.

― In 1993 the Community Care Act transferred responsibility for providing nursing care for Older People from the NHS to the private sector and for the first eight weeks of the crisis the Scottish Government was adamant that the the Providers (and not the Scottish Government) was responsible for protecting care home residents – until a mid-May U-turn. This effectively represented the privatisation of the responsibility for Older People in Care during the crisis and had the later U-turn been made at the
beginning many lives would have been saved.

― This meant that medical treatments which could have been delivered in Care Homes (such as the provision of oxygen) were not supported by the Scottish Government who left treatment to the discretion of private companies geared around property finance. In addition the nature of the deaths of Care Home residents was not taken to be a government responsibility and so the use of palliative measures (to make deaths as comfortable as possible) was also left to Providers. This almost certainly means many old people faced an absolutely unnecessarily uncomfortable and painful death. Health staff were not instructed to take the clinical lead in Care Homes until 17 May.

― In addition the mental wellbeing of residents was not made a priority, with people being locked in rooms alone for indefinite periods (as a result of Scottish Government advice), with some being told or knowing that they would be likely to die before seeing family members again. A Human Rights approach was not taken, and while individual Care Homes and staff will have done the best they can, no guidance on quality of life was provided.

― But the repeated updating of guidelines and the urgent steps taken to remove traces of the preceding guideline created a confusing impact – between 10 May (when revised guidelines issued two days earlier were withdrawn) and 15 May (when new revised guidelines were issued) there were no official Scottish Government guidelines at all.

― Private operators have extracted tens of millions of pounds of public money dedicated to care as private profit – and even more has been extracted by ‘flipping’ property which is effectively paid for by the public (the biggest profits in the care sector come from property and not from providing care).

― This is all exacerbated not only by the power of private providers and the way they have influenced the decision-making of successive Scottish Governments but also by prevailing management culture which, by emphasising ‘partnership working’, make criticism of the system almost impossible.