Coronavirus: Care workers 'shocked' by virus treatment guidance

The pressures of coronavirus are intense, and agonising in many different ways.

While the political focus has largely been about what is going on in hospitals, there is growing concern about some of the most vulnerable in our society, who live in nursing and residential homes.

The BBC has been passed a document sent to GP practices by the Brighton and Hove Clinical Commissioning Group - that's the local NHS management in that part of Sussex - setting out guidance on how to cope with Covid-19 in care homes.

There are 35 GP practices and 98 residential or nursing homes in that area.

The document spells out that many vulnerable people may not be admitted to hospital for treatment if they contract the virus, and directs all homes to "check they have resuscitation orders on every patient".

It is not unusual for "Respect Forms" or Do Not Resuscitate orders to be discussed with elderly and vulnerable people as part of careful preparation for the end of life.

But one care manager was deeply concerned that residents and families are being pushed to sign the forms.

The CCG guidance even provides a suggested script for GPs to use in conversations with residents and families - part of which says "frail elderly people do not respond to the sort of intensive treatment required for the lung complications of coronavirus and indeed the risk of hospital admission may be to exacerbate pain and suffering".

It goes on: "We may therefore recommend that in the event of coronavirus infection, hospital admission is undesirable."

One care home manager in Hove told me their GP had even told them "none of your residents aged over 75 will be admitted to hospital". They said they felt "shocked and numb" to hear that.

Another said: "We have been told flatly that it would be highly unlikely that they would be accepted into hospital."

And, remember, because of social distancing rules families are not being allowed in to be with their loved ones in their closing days if they fall ill.

NHS England is firm that there is no national guidance at all that picks and chooses who can receive treatment in hospital.

And the health trust which includes the CCG told me this morning that while "agreeing advance care plans is a routine and important part of how GPs and care homes support their patients and residents, we recognise there may have been undue alarm caused by the interpretation of this particular guidance".

And it says it will follow up with care homes to address concerns.

Asked about a similar issue in Greater Manchester, at Friday's Downing Street press conference, Health Secretary Matt Hancock said coronavirus patients living in care homes will not be refused admittance to hospital.

He said there were 2,029 spare critical care beds available in the NHS and their use would be based on clinical decisions.

"It is absolutely not a blanket rule that people shouldn't go to hospitals from care homes. Hospital is there for people when they need it, when the doctors advise that they go."

But while it's not clear if this kind of guidance has been sent out to homes in other parts of the country, there are concerns in the wider care sector that particularly without enough protective equipment, a relatively unseen part of the coronavirus crisis may develop behind closed doors.

Update

Sam Monaghan, chief executive of MHA, the UK's largest charity provider of care and accommodation for older people, has been in touch with a response to this story.

He said: "I am going to be frank, NHS staff are used to dealing with a high volume of end of life care, social care staff who develop close personal relationships with residents over months and years are not, to the same extent.

"As extraordinary as our colleagues across the UK are, they did not sign up to this but are doing their very best.

"They increasingly don't have the equivalent PPE to the NHS and we can't continue to accept that."

He added that care homes were "struggling to even offer families the PPE to allow them to be with their loved ones at the end, adding: "Surely as a society we can do better than this."