Scottish COVID-19 Inquiry|Impact hearing|Health and social care|26 March 2024 (morning session)
Shocking evidence. Independent Care Homes Scotland and Central Scotland care homes.
NB: Inquiry state Mary Rodgers which is incorrect. Real name is Mandy Rogers.
1.Independent care homes Scotland
The first four witnesses from Independent Care Homes Scotland (ICHS) are Mandy Rogers (Manager, Blenham House nursing home Edinburgh), Carol Anne Currie (Principal carer, Randolph Hill, Dunblane), Madeana Laing (Operations Manager and registered nurse at Beech Manor care home, Blairgowrie) and Peter McCormick (Managing Director Randolph Hill nursing homes).
‘‘The effect of lockdown and the pandemic on the residents was huge, they all felt very isolated and very lonely. After the pandemic, residents were not interested in going out and about…
..I feel that many residents faded away as the lockdown restrictions took such a huge toll on their mental health.’’
-First person account: Manager, semi-rural care home. Page 15 of statement
COVID-19 deaths
Below is the National Records of Scotland data made available for some of these premises which registered deaths ‘‘involving COVID-19’’ the first 15 months.
Testimony highlights
Anticipatory care plans and DNACPR
No medical care
During lockdown, from March 2020, many care home residents when ill with ‘COVID’ or NON COVID illness were cut off completely from all medical care and 90% admittedly in one home, were placed on ‘‘just in case’’ (end of life medications) by a GP without being seen and regardless of symptoms.
DNACPR orders
It is also stated by managers that during lockdown there was ‘a push on’ by the NHS to have DNACPRs in place and even Blanket DNACPRs were issued place in homes because residents ‘‘would not be going to hospital if they became unwell.’’ Families were not consulted. Complete bans on ambulances arriving at care homes is mentioned which was agreed to be without precedent.
‘‘The difficulty you then had was if the family member had said if my loved one becomes unwell (NOT specifically COVID related just with ANYTHING) and hospital treatment is required then that was then the challenge because you weren’t able to put them anywhere as NOBODY WOULD TAKE THEM.’’
‘‘People were still wanting their care escalted but were told by medical professionals they couldn’t get it.’’
-Madeana Laing
‘‘There was an impression there was a ‘‘‘PUSH ON’’ by the NHS to get more of these things (DNACPR) in place.’’
‘‘In one of our homes we received DNACRPs for all of our residents that hadn’t already got one in place.’’
‘‘There was a restriction in terms of access to care for people in care homes a decision that must have been made by the NHS. That was not a discussion held in the full public light.’’
-Peter McCormick
‘You need to look at who doesn’t have a DNR because they would now need to have one…they need to have one one because they won’t be able to goto hospital ..because they just didn’t want to take them.’’
‘‘Even when residents who did or maybe didn’t have COVID just became unwell it was very much a cut and dry…when you could CLEARLY SEE if they went to hospital they had a REALLY GOOD chance of IMPROVING of getting over what was making them unwell in the first place….it was almost like you were not playing god..it was just NO you can’t go but you could have got better if you’d been given the chance.’‘
-Madeana Laing
‘‘In your understanding the lack of ability to access an ambulance, paramedics or hospital was the reason for these DNACPR decisions put in place?’’
-Faryma Bahrami -Junior counsel to the inquiry
Reply-‘‘Yeah’’
-Madeana Laing
‘‘Had you ever previously experienced a time where every resident in your care home had to have this?’’
-Faryma Bahrami -Junior counsel to the inquiry
Reply-‘‘No’’
-Madeana Laing
‘‘In one case we were issued with a BLANKET DNACPRs for all of the residents..there would have been no discussion involved in that.’’
-Peter McCormick
Lack of healthcare. Preventable deaths. 90% of residents placed on ‘‘just in case’’ medication
Famlies raised concerns over DNR forms and their loved ones health being neglected by the NHS. Ms.Laing explains it was ‘‘quite a long time’’ before any residents were able to goto hospital, around 9 months. It is further explained this has likely led to many preventable deaths. It is described by Ms.Currie they had no GP visits for months and 90% of residents were eventually placed on end of life drugs.
‘‘Family members would become concerned after they had been ‘‘seen’’ by a GP why are they not going to hospital?’’
-Madeana Laing
Your impression was that a particular resident had a good chance of improving if they received hospital care but that wasn’t allowed..do you think that led to otherwise preventable deaths?
-Faryhma Bahrami
'‘I would like to think yeah some residents would have gotten better had they had the opportunity to go to hospital.’’
-Madeana Laing
‘‘Over a number of people it must have made a difference.’’
-Peter McCormick
'‘9 times out of 10 regardless of what the residents symptoms were they were prescribed ''just in case'' medication.'‘
‘‘We really, really struggled i think it was was months and months before we got a GP into our home.’’
-Carol Anne Currie
No ambulances
Care homes were informed ‘‘very sick’’ residents ‘with COVID’ would not be transferred to hospital as it would take too long for the NHS to disinfect ambulances.
‘‘When we did have very sick people who did have COVID …they couldn’t be taken to hospital because it would take too long to clean the ambulance…to disinfect it.’’
-Mandy Rogers
Handwashing harms
Frequent handwashing/sanitising led to staff severely damaging their skin.
‘‘There is mention of people’s hands starting to BLEED from hand washing so much.’’
-Faryma Bahrami
‘‘All our hands were BROKE OUT upto our ELBOWS.’’
‘‘Some of the staff actually had to wear dressings on their ARMS..it was very hard on the staff with RASHES and CUTS.’’
-Carol Anne Currie
Masks harms
Masks were detrimental to residents living with advanced dementia.
‘‘They can’t see your facial expressions, they don’t know who you are..we had some residents that didn’t know what we looked liked..they couldn’t remember our faces.’’
-Mandy Rogers
No xmas trees
Risk assessments required for using fans to cool residents and Christmas trees were banned.
‘‘We needed to have a risk assessment if we wanted to put a Christmas tree up…we were’nt allowed Christmas trees..in case it spread infection.’’
-Mandy Rogers
Garden visits
Care home staff were deployed as guards to monitor garden visits.
‘‘We had to re-deploy staff to be GUARDS to make sure people coming in were tested and not getting too close.’’
-Mandy Rogers
Asymptomatic COVID
Mandy Rogers tested ‘postive for COVID’ once but had no symptoms. 50% of her residents who ‘tested positive’ had no symptoms.
‘‘Far more people got COVID and survived it than succumbed to it….we had numerous asymptomatic COVID positives.’’
‘‘They only time i got COVID as through a mandatory PCR test and I WASN’T UNWELL at all.’’
‘‘You wouldn’t have known half of them (the residents) were positive.’’
Street visit
An extremely distressed resident who believed family had died only allowed to see loved ones out in the street.
‘‘We had to phone them to come and stand outside in the STREET so that she could see them through a window…she couldn’t speak to them or touch them or hold them.’’
No end of life visits
At end of life desperate families were not allowed to see loved ones and this was enforced by care home managers.
‘For me that was the hardest part…REFUSING relatives that were BANGING ON THE DOOR wanting to come in and see their loved one at the end and REFUSING them entry.’’
-Carol Anne Currie
Statement highlights
‘‘We were testing staff 3 times per week. Some had nosebleeds from the tests.’’
-Page 9
‘Resident’s activities and external stimuli were diminished during the pandemic or taken away altogether. This included the loss of the inward support formerly coming from the wider local community such as visits by school children. This, in combination with the visiting restrictions and difficulties narrated above, only served to further shrink and diminish the quality of life enjoyed formerly by residents.’’
-Page 12
‘‘Many of the Group homes came through relatively unscathed with (overall) annual mortality rates no worse than normal pre-pandemic.’’
-Page 22
‘‘Staff found birthdays and Christmas particularly hard. It was incredibly upsetting for them enforcing the rules and telling people they couldn’t come and see or be with their loved ones…
..It could be a residents last birthday and their children and grandchildren weren’t allowed to be with them.’’
- Page 24
‘‘I suffered from covid twice during the pandemic. The first time was absolutely fine, you had to isolate, there was no question of that. The first time I got Covid was roughly 2 and a half years after the pandemic started, maybe Autumn 2022.’’
-Page 26 -Principal Care Assistant, semi-rural care home
‘‘Testing at care homes didn’t come in until June 2020.’’
-Page 30
‘‘Public health did visits, they had to have all of the protective gear on like the people working in the home. They were quite brutal with care homes and picked up on small things like if there was a dirty mark under a chair rather than focus on the bigger issues. I think it was deflating for staff when we got the first report picking up on small issues, as the staff had done well..
..(we hadn’t had a Covid case till quite a while into the pandemic - about a year and a half).’’
-Page 30-First person account: Principal Care Assistant, semi-rural care home
‘‘Government Guidance was often issued addressed to Care Homes and Prisons.’’
-Paragraph 31
‘‘Operation Koper makes some staff feel like suspects in a criminal investigation. This surely cannot have been its intention and, although individual staff are often not placed under caution, they do not understand the distinction and they are not people who are accustomed to providing statements to police officers for onward transmission to Police Scotland.’’
-Page 35
‘‘At the start of the pandemic, the then Lord Advocate James Wolffe QC issued a direction that Covid-19, or presumed Covid-19, deaths did not require to be reported unless there was another substantive reason for doing so, noting that this was “consistent with the approach which had been taken in Scotland previously in relation to other significant outbreaks of infectious diseases.”
-Page 35
2.Cenral Scotland care homes
Introduction
The second testimony is from Central Scotland Care Homes Lissa Di Giacomo, Managing Director of 8 years at Oakminster Healthcare and Scott Finnigan Group General Manager of 7 years (Operations & Quality Improvement) Thistle Healthcare Limited.
Oakminster run 5 homes and accomodate 330 residents with 340 staff covering Glasgow city centre.
Thistle Healthcare run 10 homes and accomodate 750 residents with 1,000 staff covering mostly Lanarkshire and Glasgow.
The ‘‘CSCH’’ group in total operate 21 care homes throughout the Scottish central belt, with the majority concentrated in Lanarkshire and Greater Glasgow area. Occupancy of each home ranges from 24 to 106 of mostly elderly residents.
Testimony highlights
Decision to lockdown
Oakminster locked down it’s homes on the 12th March 2020 and Thistle on the 13th March.
‘‘I remember waching the news and seeing army trucks in Italy carrying deceased bodies from the villages.’’
External medical visits
During lockdown residents were denied access to in person healthcare services like GPs. Lack of physical assessment was extremely detrimental to their healt.
‘‘There was some services where all visitations just stopped…the majority of cases it moved to telephone assessment.’’
‘‘That physical assessment being missing had a HUGE impact.’’
PPE harms
Residents living with dementia were adversely impacted by the use of masks, gloves and aprons which increased their anxiety and fear. Managers believe there was no public health consideration about these harms for this group of people.
‘‘When you have what was a familiar face…when that person is going on with a mask on, gloves on, an apron on they can’t really work out who they are so it INCREASES their anxiety..it increases their FEAR if you like of what’s happening.’’
‘‘I think they were effected MOSTLY by this.’’
Primary impacts of restrictions
Managers refused to have any physical contact with their residents. ‘‘Cuddle curtains’’ were created to allow families to embrace. Adverse impacts of the lockdown on resident’s health was said to be ‘massive.’
‘‘I think not being with their family was almost as detrimental as the virus itself to their wellbeing.’’
‘‘Residents deteriorated as a result of the restrictions that were placed upon them.’’
‘‘The restriction of limited movement had a MASSIVE impact on people’s wellbeing.’’
Ladder ‘visits’
Some homes could not facilitate window visits. Families resorted to using ladders so they could see their loved one on an upper floor.
‘‘I was driving into one of our care homes and i saw a family...up a ladder at one of our windows.’’
Following the guidance
Care home managers and staff even if they did not agree with the guidance (1eg; supervising visits) they would would follow it anyway due to the consequences for them if a ‘positive COVID case’ was deteted.
‘‘Even though we may not necesarilly agree with it..we would follow it to the letter.’’
Operation Koper ‘major crime’
Managers discuss the implications of the ‘staggering’ increased workload due to Operation Koper. Both managers confirm COVID deaths registered from March-June 2020 could instead be the result of untreated chronic conditions and prolonged isolation. It is was stated the inability for medical care to be provided to care home residents during lockdown had extremely serious consequences for their health.
‘‘The manager sat at her desk and she opened an email and the subject was ‘‘Major Crime.’’
‘‘The numbers of people who died of ‘COVID’ are very SCREWED..Lots of people who just took unwell were classed as suspected COVID without any test being carried out.’’
'‘It seemed that other kinds of health conditions didn't exist during COVID and if you took unwell when you were living in a care home you were just automatically considered as being COVID positive.’
-Scott Finnigan
‘‘It was suspected COVID or COVID related where it may have been another underlying health condition.’’
-Lissa Di Giacomo
NHS discrimnation
Care homes lacked oxygen and ventilators. Residents were denied transfer to hospital when unwell which should be a basic human right.
‘‘Our residents were not being admitted to hospital which some may argue is a basic human right if you are not well and you need hosptial admission that you should be allowed to have that admission and not be discriminated against.’’
Statement highlights
‘‘Oakminster also reports a resident who passed away in February 2021. It is not known whether the resident had Covid-19 or not. The GP refused to attend because there was an ongoing Covid-19 outbreak within the home…
… The resident was prescribed end of life medication and passed away peacefully.’’
Oakminster believes that the resident should have seen the GP and been offered hospital admission but due to the outbreak in the home this was not an option that could be given to the resident or their family.’’
-Paragraph 35
‘‘Thistle also recalls several instances where..
…residents were refused admission to hospital…
..On one occasion, a paramedic and an A&E consultant jointly refused to take a resident to hospital with no reason given other than”clinical assessment.”
…On another occasion, a resident was taken to hospital in an ambulance by paramedics, however..
..upon arrival an A&E consultant refused admission based on their age, general frailty and having a DNACPR in place…
..The resident was returned to the care home and was placed on end of life care the next morning.’’
-Paragraph 37
‘‘The impact of this on the residents was that they were not receiving any medical services. GP visits, physiotherapists, dental care and foot care were no longer able to be delivered in person. Telephone consultations could take place, but they were not the same. This clearly reduced the overall quality of care that residents were able to receive.’’
-Paragraph 75
‘‘Sometimes they were unable to obtain the cells they needed as they could not get the swab far enough up the resident’s nose. The residents would often grab staff members’ hands to stop them. They clearly hated it and often did not understand why the test had to be done. The tests were invasive for everyone, but for those that did not understand why they were needed, the impact would have been worse.’’
-Paragraph 76
‘‘The common thread that runs through all of our group members' experiences of DNACPRs during the pandemic is that ..
..they felt like care home residents were simply written off…
..CSCH members found the issuing of blanket DNACPR instructions…
..to be inhumane and deeply concerning.’’
-Paragraph 83
Thanks for your attention.
Please help share this information.
End
Links:
X-link-1
X-link-2
Full video-Scottish COVID-19 inquiry-Impact hearing | Health and social care | 26 March 2024 (morning session)
statement-ICHS
statement-Central Scotland care homes
Where the care home residents were placed on ‘‘just in case’’ end of life medications was it noted exactly what those medications were and the dosage?