Care homes: Link between hospital discharges and Covid outbreaks not ruled out

A link cannot be ruled out between patients being discharged from hospitals to care homes without being tested for Covid-19 and later outbreaks at those care homes, a newly updated report from Public Health Scotland (PHS) has said.

Wednesday, 21st April 2021, 1:46 pm
Updated Wednesday, 21st April 2021, 6:40 pm

These discharges increased the likelihood of Covid outbreaks by 27 per cent, according to a best estimate from PHS.

Thousands of elderly patients were discharged from hospitals to care homes in the early months of the pandemic to free up hospital beds, in a move the Scottish Government later admitted was a “mistake”.

A report from PHS released in October last year found no statistical link between discharges and later outbreaks, but the report’s presentation was criticised by the Office for Statistics Regulation (OSR) following a number of complaints.

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The finding of “no statistical evidence” that hospital discharges were associated with care homes, which was later directly quoted by First Minister Nicola Sturgeon, was “inconsistent”, the OSR said.

PHS has now released a revised report, which also found no statistically significant link, but the body added: "Due to the uncertainty observed, we cannot rule out a small effect, particularly for those patients who were discharged untested or discharged positive.”

Five discharges to five care homes were found to have possibly caused a Covid-19 outbreak, while five further discharges had an “uncertain association” with an outbreak.

From March to May last year, 3,061 patients were discharged from hospital to a care home without a Covid test, according to the new report.

This increased the risk of an outbreak in those care homes by 27 per cent.

Some 110 patients were moved after a positive test, which PHS estimates increased the risk of outbreaks by 17 per cent, although due to the small sample size this figure is not as reliable.

In the 30 days after their hospital discharge to a care home, 154 people tested positive – 3.5 per cent of all people discharged who had not previously tested positive.

Some 675 people died within 30 days of discharge, 14 per cent of the total, and Covid was associated with 22 per cent of those deaths.

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William Jolly, whose father died in a care home in April last year after having been discharged from hospital, called the handling of the matter an “absolute disgrace”.

He reacted in “horror”, he said, to “self-congratulatory” comments that there had been no link between the discharges and outbreaks.

Around 3,300 deaths in care homes have been linked to Covid-19, according to National Records of Scotland.

Opposition parties responded to the updated report with further calls for a public inquiry into care home deaths.

Scottish Labour health and social care spokesperson Jackie Baillie said the Scottish Government had “catastrophically failed” in its duty of care.

“Despite the claims of the First Minister and the health secretary, it is clear that the discharge of Covid positive patients into care homes led to people’s lives being put in danger,” she said.

She added: “Thousands of care home residents lost their lives to this dreadful virus and many thousands more were put in danger.

“The Scottish Government has catastrophically failed in its duty of care – this wasn’t ‘taking the eye off the ball’, this was a colossal and deadly failure of judgement. Those responsible must be held to account.”

Scottish Conservative Health Spokesman Donald Cameron said: “This report confirms that our care homes bore the brunt of the devastating effects of this pandemic due to decisions taken by SNP ministers.

“While the First Minister said previously that there was no statistical evidence to back up the claims that discharges led to outbreaks in care homes, it is clear our most vulnerable individuals were put at increased risk as a result of this policy.”

Scottish Liberal Democrats leader Willie Rennie said: “I warned at the time about the danger of admitting untested residents into care homes, but the government insisted it was doing the right thing.

"Families have been treated to a long-standing exercise in spin and duplicity as ministers sought to minimise their role in the most tragic saga of this sorry year.”

Care home size is much more strongly associated with increased risk of outbreaks, with larger care homes more at risk.

Early this month health secretary Jeane Freeman told the BBC podcast Political Thinking with Nick Robinson: “We didn't take the right precautions to make sure that older people leaving hospital and going into care homes were as safe as they could be and that was a mistake.

"I think our failures were not understanding the social care sector well enough.”

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