Scottish COVID-19 inquiry impact hearing|Health and social care|22 March 2024 (morning session)

Dr.Donald Macaskill. Chief Executive of Scottish Care speaks of catastrophic adverse impacts on care home residents health due to COVID restrictions.

Introduction

Dr.Macaskill is the CEO of Scottish Care. He has a doctorate in theology, sociology and occupational psychology with a background in human rights and was an external adviser to the Scottish Human Rights Commission. Dr.Macaskill was recently elected as a Fellow of the Royal College of Physicians Edinburgh, however is not medically qualified.

‘‘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. Members said that they suspected that other symptoms such as delirium may be evidence that an older person had COVID-19.’’

-Paragraph 27 of statement

’’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

Testimony highlights

• Dr.Macaskill explains why he inititally supported lockdowns and explains how families were ‘used to’ lockdowns due to norovirus outbreaks which lasted no more than three weeks.

Note: Severe COVID-19 lockdowns lasted over 12 months for care home residents and were sporadic for another year after and into 2022. 1

‘‘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.’’

Fear over freedom

• Dr.Macaskill goes onto explain how some families 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 was ''perverse''.

• No care home transfers to hospital if residents unwell with ‘COVID symptoms.’

‘‘I was dismayed and distressed..

‘‘People had phoned ambulances 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 had come from a care home.’’

‘‘People were being prevented as citizens from exercising their right to receiving clincial care and support.’’

‘‘I had an incident..perversely YESTERDAY where a provider contacted me somebody had an injury in the care homes the ambulance refused to transfer them to hospital.’’

Further lockdown harms

• Particularly serious 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

• Dr.Macaskill explains clinical visits were withdrawn in care homes.

• Health conditions like cancer and respiratory disease COPD were not maintained and this was ‘’hugely damaging’’ to residents.

• Care staff could not obtain approporiate medical care for residents.

'‘It was VERY widespread (no extenral clinical visits). One nurse described to me that it was IMPOSSIBLE to get an allied health practitioner to come into the care home.'‘

‘‘This is a population with MULTIPLE co-morbidities..the least we owed them was the ability to have their other health conditions maintained whether that was cancer or COPD or ANY other respiratory condition.’’

‘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

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.’'

Police investiation prohibitive to release restrictions

• Operation Koper meant care homes visiting continued to be heavilly restricted as consequences of ‘COVID’ outbreaks were more serious.

‘‘Operation Koper was a DEADENING of flexibility and from my experience was the singlular event which caused harm during the summer months to the care home sector.’’

‘‘Care homes became terrified that they would be prosecuted in the event that a resident died of COVID-19 had they not followed guidance to its letter.’’

-Paragraph 35

‘‘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.’’

‘‘The fear and stress from Operation Koper is still ongoing within care homes as the police continue their investigations into care home deaths. I believe this operation to be wholly disproportionate and damaging.’’

- Paragraphs 62 and 63 of statement

Statement highlights

‘‘It was of course traumatic for families to be separated from their loved ones, and the impact of this is incalculable…

..However, it should not be forgotten that staff also found enforcing such restrictions distressing.’’

-Paragraph 32

Indemnity for NHS but not care homes

• Dr.Macaskill explains indemnity and insurance issues surrounding care homes throughout lockdown 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

‘‘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

Impacts on Dementia

• Those harmed the most from the restrictions were living with Dementia.

The restrictions and guidance that were put in place had a significant impact on individuals withdementia. The guidance produced for care homes during the pandemic did not fully or adequately take into consideration the experience of someone living with dementia in a residential care setting. Such guidance was not subject to appropriate equality and human rights assessment and instead a one size fits all approach was adopted.’’

-Paragraph 65

‘‘It is extremely challenging to isolate a resident with dementia to their room as they often like to pace and may have a set route that they take each day. This is a form of pattern behaviour, which is common to those with dementia. Disturbing this can cause the individual significant distress and lead to neurological harm.’’

-Paragraph 66

‘‘Activities usually arranged in care homes had to be cancelled. Such activities are not only for entertainment or socialisation but often are designed to help with the cognitive function of those with dementia... .

.The withdrawal of these often contributed to the cognitive decline of residents with dementia.’’

-Paragraph 67

Barrier nursing/Hospital discharges

• ALL hospital transfers treated as ‘COVID’ and isolated for 2 weeks.

‘‘Due to the trust deficit and the absence of testing for new or returning residents, as an organisation Scottish Care advocated that all individuals entering a care home should be treated as if they were COVID positive and therefore barrier nursed for an initial fourteen days, if possible.’’

-Paragraph 75

‘‘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

‘‘The practice of care home staff being strongly discouraged from seeking to transfer COVID positive residents to hospital remained.’’

-Paragraph 84

‘‘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

Witnessing deaths

• Distressing.

‘‘ Staff were often with residents when they died and have referred to COVID deaths as being distressing for the individual and, as a result, distressing to witness.’’

-Paragraph 101

‘‘I am aware of instances in which care home staff attempted suicide as a result of the stress and pressure they were put under during the pandemic.’’

-Paragraph 103

Thoughts

Those admittedly harmed the most from the punishing and discriminatory lockdown restrictions March-May 2020 then died the most ‘involving’ a novel disease.

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