The care regulator has admitted failing to track vital details about scores of care homes that are being allowed to accept patients infected with COVID-19, while older and disabled people not yet infected occupy other parts of the same buildings.
The Care Quality Commission (CQC) has so far approved more than 150 care homes and other care facilities to be “designated settings” that accept recovering hospital patients who are still infected with coronavirus.
But analysis by Disability News Service (DNS) of a sample of the first 117 designated settings to have been approved shows most of them are existing care homes where part of a building has been assigned to receive patients recovering from, and still infected with, COVID-19, while other parts of the building continue to be occupied by older and disabled service-users not yet infected with the virus.
Many such settings care homes over two or three floors, with one floor set aside for patients with coronavirus.
According to the programme, devised by the Department of Health and Social Care (DHSC) last autumn to cope with an expected winter surge of coronavirus cases, some designated settings are “stand-alone units” where only service-users with the virus will be admitted.
But others are care homes “with separate zoned accommodation and staffing” for service-users with coronavirus, but other parts of those homes occupied by residents who are currently free from the virus.
The policy has been described as “abhorrent” by disabled activists, because it risks repeating the outcome of the scandal that occurred early in the pandemic, when hospital patients were discharged into care homes without being tested for COVID-19.
In a delayed response to a freedom of information request from Disability News Service, CQC has finally admitted that it has no idea how many of the designated settings it has inspected and approved have zoned accommodation.
This could make it harder for the care regulator to analyse how effective this type of designated setting has been in preventing infection of previously unaffected residents.
In the response, CQC said: “We do not have a set criterion for establishing or recording whether services are ‘stand-alone units’ or ‘zoned accommodation’, and we do not keep a central record of this.
“In each case the inspection report will contain a summary which will describe how the designated setting role is being delivered.”
Despite this lack of a “set criterion”, DHSC drew a clear dividing line between the two types of setting in a letter to social services directors (PDF) last October.
That letter said: “Emphasis should be on commissioning stand-alone units or settings with separate zoned accommodation and staffing.”
The DNS analysis of the first 25 care facilities in a list of approved designated settings provided by CQC suggests that 19 are clearly zoned settings; two are probably zoned; one is unclear; just two are clearly standalone; and one is probably a standalone setting.
This suggests that three-quarters (76 per cent) of designated settings are in zoned accommodation, and possibly as many as nine-tenths (88 per cent).
Among those analysed was a care home for up to 50 older people who need personal or nursing care, which had “identified the ground floor within the home to be the designated area”, which CQC said was self-contained and had en-suite facilities for each room.
Another was a two-storey care home for people over 65 who need personal or nursing care, where “the provider had adapted the top floor of the service and implemented safe infection control systems in line with current guidance”, with staff “deployed to work solely on the top floor of the service”, and “systems to ensure staff did not work in other health or social care services”.
A third home, for both younger and older disabled residents who need nursing or personal care, had, according to CQC, ensured that “isolation, cohorting and zoning had been successfully implemented across the service”, while CQC was “assured that this service met good infection prevention and control guidelines as a designated care setting”.
By 11 February, there were 157 CQC approved designated settings across 110 local authorities.
Manchester Disabled People Against Cuts (MDPAC) first raised concerns in September about the designated settings programme, after DHSC said in its adult social care winter plan that it was working on such a scheme with CQC.
An MDPAC spokesperson said: “Until we have disaggregated mortality data for care settings we will not know how bad a risk zoned care homes were, but the principle the government needs to understand is: your right to life is the same whether you live independently in your own home or if you live in a care home.
“If they cannot guarantee that right, we see it as further evidence of the need for independent living and separate dedicated COVID-positive care settings.”
Linda Burnip, co-founder of Disabled People Against Cuts, said: “The failure of CQC to keep important records about the use of care homes being used effectively as hospital wards is shocking.
“It is difficult to know what they are doing to safeguard disabled and older people during the pandemic but obviously very little.”
A spokesperson for the grassroots disabled people’s organisation Bristol Reclaiming Independent Living said: “It’s very concerning that the CQC do not keep a central record of which care homes have ‘stand-alone units’ or ‘zoned accommodation.’
“This is vital public health information that the Department of Health and Social Care should make easily available.”
He said it was “troubling that disabled COVID patients may have been discharged into accommodation without knowing what faces them.
“Once again, the whole exercise has been rushed. Clearly, the government has learned nothing from their own pandemic preparations over the last 10 years, such as Exercise Cygnus**.
“Neither have they listened to disabled people, who have warned of the dangers of repeating the fatal mistakes they made early in the pandemic.”
CQC refused to say how it justified allowing so many zoned settings, and not keeping track of how many of those it approved were zoned or stand-alone settings.
CQC also refused to say if it would carry out analysis of the difference in safety between stand-alone and zoned settings since the scheme started.
Instead, it issued a statement from Kate Terroni, its chief inspector of adult social care, who said: “It is our role to ensure that proposed locations for the designate scheme, which is an initiative led by DHSC, are safe for people with a confirmed COVID-19 test result to be discharged into.
“By rapidly inspecting and, where appropriate, approving designated locations for COVID-positive people being discharged from hospital into care settings, we are working to help combat the spread of infection and increase the number of people who can access care by ensuing that people can be safely discharged from hospital.
“Our IPC [infection prevention and control] inspections provide an assurance, whether the designated location is standalone or zoned, that the correct infection prevention and control measures are in place to keep people safe.”
DHSC refused to say how it justified allowing so many zoned settings, and whether it was happy that CQC was failing to keep track of how many services it approved were zoned or stand-alone settings.
DHSC also refused to say if it would now carry out analysis of the difference in safety between stand-alone and zoned settings, and whether it stood by its overall policy.
But a DHSC spokesperson said in a statement: “Our priority is preventing infections and outbreaks in care homes while ensuring that residents receive the right care, in the right place, at the right time.
“Since the start of this pandemic, we have worked closely with the sector and public health experts to make sure discharges happen in a safe and timely way.
“We have provided clear guidance to support safe admission to care homes, and to embed the Discharge to Assess model*, with our efforts backed up with over £1.8 billion of funding.”
** An exercise commissioned by DHSC in 2016 to assess the UK’s preparedness for an influenza pandemic
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