Scottish COVID-19 inquiry Impact hearing |Health and social care|22 March 2024 (morning session)
The chief executive of Scottish care Dr.Donald Macaskill speaking about the ''CATASTROPHIC'' effects on residents due to healthcare withdrawal.
Introduction
Mr.Macaskill is the CEO of Scottish Care. He has a doctorate in theology, sociology and occupational psychology. Remarkably, also has a background in human rights and was an external adviser to the Scottish Human Rights Commission. Mr.Macaskill was recently elected as a Fellow of the Royal College of Physicians Edinburgh, however is not medically qualified.
Lockdown harms
In this segment Mr.Macaskill explains why he supported lockdowns. He explains how families were ‘used to’ lockdowns due to norovirus outbreaks which lasted no more than three weeks. NB: Severe COVID-19 lockdowns lasted over 12 months for care home residents and were sporadic for another year after and into 2022.
‘‘In April (2020) people like me questioned the appropriateness of lockdown with no end in sight..
..certainly into the EARLY months of the SUMMER we were seeing that this is causing MORE HARM to individuals..both families and to individual residents.’’
‘‘People were clinically deteriorating because of the absence of family and normal activity.’’
COVID symptons?
‘‘By April 2020, Scottish Care was starting to hear from in its members that the three main diagnostic symptoms of COVID-19 (continuous cough, high temperature and a fever) were not illustrative of how COVID-19 was presenting in older people.’’
-Paragraph 27 of statement
Fear over freedom
Mr Macaskill goes onto explain how some familes were less concerned about the threat from the virus than others yet he chose to side with those promoting fear not freedom.
'‘Knowing what we know now we ABSOLUTELY should have opened up care homes SIGNIFICANTLY earlier.’'
'‘The opening up should have been more trust based.'‘
Perverse guidance
Dr Macaskill explains that the guidance he was enforcing and ongoing throughout Scotland in 2020 was ''perverse''.
No care home transfers to hospital if unwell with ‘COVID symptoms.’
‘‘People had phoned ambulance and they refused to to take them to hospital..people had been taken to hosptial but consultants had refused to admit an individual because they came from a care home.’’
‘‘People were being prevented as citizens from exercising their right to receiving clincial care and support.’’
‘‘I had an incident YESTERDAY where the ambulance refused to transfer them to hospital.’’
Indemnity for NHS not care homes
In his witness statement Mr.Macaskill explains indemnity and insurance issues surrounding care homes throughout the pandemic and this made sure care homes kept their doors locked to visits.
‘‘The Scottish Government was not willing to indemnify care homes, as it did with NHS, in respect of liabilities connected with the pandemic. Had it done so, I believe that care homes would have been much more flexible when it came to visiting.’’
-Paragraph 37 of statement
‘‘Due to the risks faced by the social care sector during the pandemic, insurance premiums increased exponentially and a number of insurance companies withdrew their cover for the sector. A care home cannot continue to be registered unless it is insured.’’
-Paragraph 38 of statement
Further lockdown harms
Particularly upon dementia patients.
‘‘In addition to the restriction of visitors, for large periods during the pandemic care homes were prohibited from using their communal space to enable residents to socialise or engage in activities together. Care homes in normal times are vibrant normal busy locations, however, they became empty shells with no one congregating and chatting. This had a negative impact on residents' wellbeing especially those who were living with dementia and for whom the routine of normal activity was so fundamental.’’
-Paragraph 39 of statement
No clinical visits
Here Dr.Macaskill explains clinical visits were withdrawn in care homes.
'It was VERY widespread. One nurse described to me it was IMPOSSIBLE to get an allied health practitioner to come into a care home'
‘This restriction of clinical care was hugely damaging to residents with ongoing and developing clinical conditions and resulted in marked deterioration in the health and well being of residents.’
- Paragraph 86 of statement
‘‘The health and wellbeing of residents was impacted by the absence of speech and language therapists, physio therapists and podiatrists as well as dentistry and ophthalmology. Speech and language therapists in particular have an important role in care homes as they work with people with dementia to help them to continue to communicate and to help them maintain their ability to swallow.’’
- Paragraph 87 of statement
Health conditions like cancer and COPD were not well maintained and this was ''hugely damaging’’ to residents.
Operation Koper
With regards to operation Koper, Mr.Macaskill does not support this investigation for care homes nor the NHS, as front-line workers, nurses and managers are '‘frightened.’’
'‘I was interviewed myself by officers of Police Scotland.’'
‘‘The investigations associated with these reports became known as "Operation Koper"….its impact led to many skilled and experienced managers and staff leaving the sector.’’
- Paragraph 62 of statement
Further serious lockdown harms are explained by Mr.Macaskill especially on those with Dementia.
’’The impact of withdrawing support from people who had dementia in the community was catastrophic as it not only disturbed their routine but hastened their deterioration.’’
-Paragraph 70 of statement
‘Co-incidentally’ dementia is the most common pre-existing medical condition in deaths ‘‘involving COVID-19’’ in Scotland.
Hospital discharges
Also during the first lockdown people were discharged from hospital having received inadequate medical treatment.
‘‘Due to an urgency to discharge patients from hospital, there were also times when..
… residents who had been admitted to hospital were discharged back to their care home earlier than they would have been in normal circumstances and in conditions which would have ordinarily deemed them unfit for discharge.’’
- Paragraph 79 of statement
‘‘Many members of care home staff reported to Scottish Care a sense of `clinical abandonment' in the first phase of the pandemic…
…Many care homes struggled to access GPs and/or to get GPs to come into care homes to treat residents.’’
-Paragraph 85 of statement
This period is when excess deaths were highest.
Final statment remarks by Mr.Macaskill:
‘‘Had it been invited to participate at an earlier stage, I believe that Scottish Care could have helped the Scottish Government to foresee some of the challenges that arose in the care sector which would have helped to mitigate the subsequent impacts. I consider that it is essential that representatives from the social care sector are involved in future pandemic planning exercises.’’
End
Links:
Full video-YouTube-Scottish COVID-19 inquiry-Impact hearing | Health and social care | 22 March 2024 (morning session)
Full statement-https://www.covid19inquiry.scot/sites/default/files/ev-documents/sci-wt0189-000001.pdf
https://www.scottishdailyexpress.co.uk/news/scottish-news/police-begin-questioning-care-home-32108355
https://www.gov.scot/publications/excess-deaths-causes-involving-dementia-underlying-cause-scotland-2020-2022/pages/4/
https://medicalxpress.com/news/2023-11-lack-friend-family-dying.html