Date of prep: December 2020
Prescribing information and
adverse events reporting
For healthcare professionals only
At least 78 older people were discharged from NHS hospitals to Scottish care homes after testing positive for covid-19 in the early months of the pandemic, a new report has found.
Public Health Scotland said that just 650 of the 3,599 people discharged from care homes between 1st March and 21st of April were tested for covid-19. Eight in ten people discharged were never tested.
Of those tested, 78 received a positive result while in hospital before being discharged to a care home.
However, the report does draw a link between the risk of outbreaks and the size of a home.
Nicola Sturgeon insisted that the report found no statistical relationship between hospital discharges and outbreaks in care homes.
But Scottish Care, which represents different social care providers, said:
“We should have initiated testing for all discharges much earlier than we did. The report makes it clear that there are real benefits from this testing process.”
CEO Dr Donald Macaskill described the report as “only part of the story” because it misses the experience of frontline care workers who believes hospital discharges led to the virus being introduced in their care home.
The report covers discharges that took place as hospitals attempted to free up capacity ahead of an anticipated surge in covid patients. At the time there was no requirement to test patients before sending them to a care home.
Advice changed on the 21st April to specify residents should receive two negative tests before discharge and that any new admissions to care homes should be isolated for 14 days.
Between this date and the end of May more than 90% of patients discharged to care homes were tested. Although the majority tested negative, 278 tested positive.
However 45 of these patients did not get a negative test result prior to their discharge, the figures suggest.
More than three-quarters of the 1,084 care homes in Scotland received a resident from hospital between March and May.
Just under half of the 4,482 covid-19 deaths in Scotland have happened in care homes.
Responding to questions today, Nicola Sturgeon said: “One of the things that the report does seem to find which is the most significant factor in outbreaks was the size of care home.
“That is not blaming care homes and it is not blaming staff it is simply recognising that bigger care homes, there are perhaps more interactions, there is perhaps more of the risk of community transmission getting into the care homes, so we have to think about how we work with and support larger care homes to better mitigate that.”
The First Minister added: “Let me be clear that this does not say that hospital discharge in all circumstances was not a factor at all, it just says that it wasn’t a statistically significant one.
“That doesn’t take away from the need for us to learn about what did happen in care homes so that we can make sure we make the changes that are designed to minimise and mitigate that for the future.”
The issue of hospital discharges rose up the agenda after a Sunday Post investigation found dozens of patients who had tested positive for covid were sent from hospitals into care homes near the beginning of the pandemic.
The true figure was thought to be higher as not all NHS boards responded to requests for information from the newspaper.
UK scientific advisors have previously said that outbreaks in care homes cannot be pinpointed to one single cause, with one top Scottish medic telling healthandcare.scot they were “complex and multi-factorial” and likely to be different for each facility.
Dr Macaskill of Scottish Care said:
“At the start of the pandemic all the emphasis was on the preservation of the NHS. Our politicians and medical advisors stood in front of posters which read ‘Protect the NHS’.
“The care home sector and its workforce played its part in that protection, and can be assured that in the majority of instances that support through enabling people to come home or be admitted, was not a significant risk factor for outbreaks.
“However, we need to ensure that where people are convinced there was a direct relationship between discharge and outbreak that this belief needs to be investigated.”
Dr Macaskill added: “Some of our members and staff who work in care homes in a few cases believe that Covid-19 was introduced into their care home community as a result of discharges. I hope the researchers can take some time to listen to the experience of staff in care homes where there have been significant outbreaks.
“At the moment we have one side of the story, what is missing is the frontline experience of our care sector and its staff, the voices of those who received care and their families.”
by Henry Anderson
Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.