Discharge of hospital patients into Kettering care home ravaged by Covid was ‘not the safest’ and devised during 'time of panic’
A nurse quoted in the newly published safeguarding review said that ‘care and compassion had gone out the window’ at the care home where 19 residents died during the first lockdown
In the first published version of this article on November 16 we said the Northamptonshire CCG had not apologised to families for what had happened. This was incorrect and the apology is now included in the story below. NN Journal apologies for the error.
By Sarah Ward
A review into what happened at Temple Court care home in Kettering has found the process by which hospital patients were rapidly discharged into the home was ‘not the safest’, devised at a ‘time of panic’ and that opportunities were missed to step in sooner.
19 residents died between the months of January and May 2020 at the Amicura Ltd owned care home, which had taken in 23 patients from the county’s two hospitals between March 19 and April 3 during a period of rapid discharge on orders of the Conservative government.
Days after agreeing to admit all the new residents the home’s manager went off sick herself and did not return. Patients who remained in the home until May 12 - when the local authority and regulator the Care Quality Commission decided to close the home - were severely neglected, often not having been fed or washed properly and cut off from their families.
As one family member told the review:
“I don’t know what the scene [in the care home] was like when almost half had died. What had he [their dad] seen and experienced, it must have been Bedlam?”.
The safeguarding review, which was published this week, sheds a light for the first time on what other agencies outside of the care company, such as the health board, adult social care and public health were doing during the period, when residents were succumbing to the new virus which had locked down large parts of the world. The independent reviewer, former police detective Heather Roach, found that while the care company had overall responsibility for care of the residents, ‘there were shortcomings in the part played by others.’
Before the pandemic
The care home had been rated as requiring improvement in 2019 and was under review by the CQC. In January of 2020, two months before the national lockdown began, the CQC had received a safeguarding complaint about the care home, citing a lack of staff and the following month a whistleblower had also contacted the regulator with similar concerns.
However when in mid March the county’s two hospitals began to discharge patients into care homes, on national orders in an effort to free up beds in advance of an anticipated upsurge of Covid patients, Temple Court ‘received one of the highest number in the shortest period’.
Patients were not always being tested for the virus before they were moved out and in total 233 people were discharged into the county’s care homes from hospitals. The review reports that just over 6,000 people were moved out of the hospitals to make space between March and April.
The process of discharge was coordinated by the Local Resilience Forum Hospital Transfer Cell - which was made up of staff from health and adult social care.
The report says the impact of the discharge into care homes was not monitored sufficiently:
“The impact of this particular national policy was significant and whilst successfully achieving the overall aim of freeing up bed space the impact upon other parts of the health and social care service was not monitored sufficiently by the local emergency response structure or the senior management within the care home.”
It also found during a series of interviews and events with the public bodies involved that the discharge had safety issues:
“Practitioners attending the learning event told the review that there were limited options for patients leaving acute hospitals in that they could either return home with family support or be put on the “Discharge to Assess” pathway into a care home setting for further assessment. It was suggested that up to 95% of all patients’ discharges went to care homes when not all should have done. A number of families spoken to as part of the review were also expecting their relative to be discharged home. It was felt by practitioners that the process developed was not the safest but had been designed at a time of panic.”
Altogether Temple Court received 15 patients from Northampton General, six from Kettering General and two from community hospitals.
However the Care Home Selection Healthcare, which had been commissioned by the county’s Clinical Commissioning Group since 2016 to broker discharges from hospitals into care homes, told the review it did not receive any information or ‘soft intelligence’ to indicate safeguarding concerns about the home had recently been reported.
After the manager had agreed to take in the additional 23 residents she then went off sick herself in early April.
The report says:
“Many of the existing residents at the care home were frail and suffered from dementia, therefore doubling the capacity at the home in around two weeks appears to have put a significant strain on the existing staff resulting in their inability to provide basic care. However, the basic provision of nutrition, hydration and personal care had all featured in action plans prior to the pandemic hence there is likely to be a predisposition to similar issues re-occurring.”
Conditions worsened when the manager went on sick leave and agency staff were taken on to fill in gaps by other staff who were isolating.
Agency staff told the review they were unable to access care plans and so patients were not being cared for according to their needs.
But while all this was going on a ‘rosy picture’ was being painted to families who called to speak to their relatives. They were not being told of deaths of other patients or how the virus had infiltrated the care setting.
The report says:
“Amicura Limited accept that their communications with relatives was poor and there simply were no staff available to deal with the family contact. They have since reviewed this aspect and incorporated it into their pandemic response plans.”
The home had also not reported the outbreak to public health as it should have done, or told the CQC of any deaths.
The report contains several upsetting accounts of how people had died.
One woman was particularly distressed when her husband, 90, died with a full beard. Prior to that he had shaved twice a day for most of his life and had asked for an electric razor for his birthday, which had been taken to the care home but remained unused.
Another family found their mother in a skeletal state, with bags of uneaten food at her bedside.
Presents that had also been dropped into the home by relatives, unable to step over the threshold, were also found unopened in an office. One family member who went to collect belongings after their relative died, picked them up in black bags from the front door and overheard staff laughing inside.
A nurse who was sent in by the local authority and the CCG said ‘compassion and care had gone out of the building and an example she provided was that on VE Day there were no celebrations, and the residents were fed with chicken nuggets.’
The review states that the county only had two quality improvement nurses (QIN) involved in monitoring the care homes, who were employed by the clinical commissioning group.
One of the nurses had contacted the home on March 28 to check they had the information about how to report cases. The manager said there was one resident with symptoms and everyone was self isolating. Three days later the manager emailed the nurse to say a resident had been taken to KGH with symptoms and emailed again three days later to say one resident had been admitted to hospital and had sadly died.
There was then no evidenced contact until two weeks later. The independent reviewer says there were missed opportunities between April 3 and 9 to recognise a problem and for the Covid 19 emergency response system ‘to take supportive action sooner’.
The review says:
“On 20th April 2020 the deteriorating situation within the home was identified following a call to the home by one of the QINs. She was informed that the manager was off sick, the clinical lead shielding and other senior staff absent. The QIN escalated concerns to Amicura Limited’s area manager and operations manager. She was informed that nursing support was awaited from one of the other care homes. Arrangements were put in place for a deputy manager to attend the care home on a daily basis, which commenced on 22nd April 2020.
“Amicura Limited state that the deputy manager began supporting the care home from 17th April 2020 and that the Operations Manager had visited the care home on 9th April 2020. Between those dates Amicura Limited say that there was regular contact with the home including by phone with the area manager, as well as email contact with various managers. No specific evidence has been provided to demonstrate direct contact with the care home in this period.”
On April 29 the health protection team went into the home to give infection control training and the next day the QIN visited. By this date, 13 residents had died. Many of the 39 remaining residents did not have a care plan.
The report says:
“Between 1st May to 12th May 2020 the Local Authority, CCG and the CQC worked collectively to develop a clear action plan to drive improvement with the care home however it became apparent that the improvements were not being made and advice was not being acted upon.
“The CCG had developed the concept of a Health Tactical Team, and this was deployed into the care home on 3rd May 2020 as it was apparent that there was a need for clinical oversight to increase quality and safety. The individuals forming the team stated that their role was one of support to the care home and not to take over the day-to-day management of the service. An initial movement of ten residents from the care home was made due to the individuals being clinically unwell and following a decision on 11th May 2020 the remaining residents were also moved to other accommodation.”
Conclusion of the review
The 52 page report found:
“. . there was room for improvement in terms of the quality monitoring of the service provided by Amicura Limited and the care home, by the Local Authority and CCG which could have been achieved in a more joined up approach in relation to collation of all available information. This should include safeguarding concerns and soft intelligence.
“. . . it appears to the author that the admission of large numbers of patients in a short period of time in pursuance of the national approach to free up bed space created additional pressures for the care home.
“There was a lack of oversight of this process from the senior managers within Amicura Limited and within the Local Resilience Forum (LRF) arrangements. The number and speed of discharges into the care home was inappropriate and there does not appear to have been any consideration given to the previous CQC inspection rating of “Requires Improvement” when determining the volume and specific needs of patients being discharged to the care home.”
The reviewer made ten recommendations to the health and adult social care bodies as well as the CQC including better communication between themselves and monitoring of care homes providers. There were also recommendations of how public authorities could help care home providers drive-up quality.
Following the review Toby Sanders, Chief Executive, Northamptonshire ICB said: “Our thoughts continue to be with the families and loved ones of everyone affected by the tragic events at Temple Court Care Home at this very difficult time.
“The review recognises the events that took place during the early stages of the pandemic. At that time there was a national directive to free up hospital capacity by discharging medically fit patients to alternative care settings. This was also at a time so early in the pandemic that patients were not routinely tested prior to discharge due to limited testing capacity at that time.
“This led to a rapid discharge of patients to care homes, and while the majority of care providers kept the residents in their care as safe as they could during this difficult time, the care provided by Amicura Limited at Temple Court Care Home fell well below the standards we expect. They have since been prosecuted for failing to protect residents from avoidable harm.
“We acknowledge that despite the pressures during this period, there was more we could have done to proactively contact care homes across the county to ensure they had the support they needed, and for that we are sorry.
“Since the review partners across our system work much more closely together and there are more opportunities to share information and concerns about quality of care, and we have clear pathways in place to escalate and swiftly act on any concerns if needed.”
Amicura was fined £200,000 after being prosecuted by the CQC for a series of failings earlier this year.
A spokesperson for the company said: “We have apologised unreservedly to everyone affected by the failures of our systems and processes in the early stages of the Covid-19 pandemic.
“Following these events, we immediately set about learning lessons about what went wrong and committed to making significant improvements across the company to ensure that our residents are always safe, supported and well-cared for. Our focus has been on implementing measures which will always prioritise resident wellbeing by improving service provision and accountability, strengthening governance and oversight, and supporting our home managers in their development.
“It was also important for us to understand exactly why standards deteriorated so dramatically at home which had undergone significant investment in people and equipment, had made huge progress, and had scored 92% in a report by NHS Nene CCG only a couple of months earlier. This was not previously a failing home and was very much fit for purpose.
“With the benefit of hindsight, we recognise now that whilst we felt at the time we were acting in the national interest and supporting the NHS by accepting patients discharged from hospitals into care homes under Government policy at the start of the Covid-19 pandemic, this actually placed incredible strain on our team – leaving many of them overwhelmed, exhausted and themselves ill with the virus.
“The combination of these factors left the home disproportionately reliant on the use of available agency staff, with very little opportunity to adequately train them on our policies and procedures and had a significant and detrimental effect on the running of the home and the care provided to our residents.
“We recognise these factors were unprecedented, but that does not excuse what happened and we know we must do better in the future. We are fully committed to our journey of continuous improvement and remain determined to deliver the best possible care for every resident.”
I was the journalist who first reported what was happening at the care home back in May 2020. I had been contacted by a family member of a resident who was concerned they were not getting answers from the care company and had become worried for their father who they had not been able to see.
My subsequent reports, which revealed the shocking numbers of deaths, were for many affected families the first time they became aware their relative was not the only person who had died at Temple Court.
The cover up of the true scale of the outbreak and the deaths that were occurring is detailed in the report. While on a phone call to the home one family member overheard a staff member telling the person he was speaking to to ‘say nothing’ when he questioned about deaths. One relative claimed a CQC staff member had told them to stop asking questions ‘as it was not helpful’.
As we will all no doubt remember, the pandemic was an unprecedented, harrowing time for many. But I would argue that for those in care homes, cut off from their families and friends, cared for by staff, who were themselves often scared and risking their own lives to do the jobs (for wages which were paltry considering the responsibility), who bore the brunt of the handling of the pandemic.
The protective ring that the then health secretary Matt Hancock says was put around care homes across the country was non-existent, rather the virus was in many cases unwittingly planted into the care homes due to a lack of testing. There was not enough PPE, many settings were being staffed by agency staff, who were not familiar with the place or its residents.
Altogether more than 140 people in Northamptonshire died in care homes with Covid in the first lock down, but as the review finds, Northamptonshire was not an outlier in the number of care homes deaths that occurred.
For me this will always be a stain on our nation; an injustice to those who died and is I imagine unbearable to the families who suffered loss.
As the report itself says those who died at Temple Court were ‘remarkable people who should have spent their twilight years being properly cared for and treated with the utmost dignity.’