Showing posts with label CQC. Show all posts
Showing posts with label CQC. Show all posts

Monday, 3 August 2020

COVID-19 Panorama Programme and Community Integrated Care.

Last Thursday the Panorama Programme highlighted the care charity Community Integrated Care and how one of their home for dementia patients coped during the COVID-19 crisis. They lost quite a lot of their residents to the virus. 

Sadly Panorama did the usual lefty thing of Tory government bashing and tugging at heart strings. Plenty of emotional content and not much factual content. Let's have less of the "care workers crying in front of the camera" angle and more of the "fucked up confusion, changing the rules on a daily basis" angle instead.

The Panorama programme completely missed the reasons why care homes failed to prevent COVID-19 infections from getting inside.

In fact the programme blatantly showed on of the big issues during the crisis: whilst NHS hospital staff were doing full-on biological protection in what were effectively hazmat suits, care homes were left to deal with COVID-19 patients using just surgical masks, gloves and plastic aprons.

Where NHS staff were exiting COVID-19 wards and completely stripping off scrubs and PPE, the care home staff were wearing the same clothes walking from resident to resident.

It came as no surprise then that once testing had been established, the majority of care workers and residents in the home being filmed tested positive for COVID-19. The infection prevention was lacklustre at best. But homes can only follow official advice and use the equipment given to them. If they overstep their remit they can (and are) sanctioned. 

And this is where I am at odds with the Panorama programme: they didn't focus on the differences in advice and procedures between the NHS and care homes. Given there were dealing with effectively the same environment (working closely with a number of "patients", both infected and non-infected), why were the advice and infection control procedures so disparate?

The pictures on the news coming out of Covid wards at the time are chalk and cheese different between the advice given to care homes at the same time. 

The NHS had the resources available to protect staff (although there were issues even within the NHS) and patients. In the care sector people were just left to muddle through and deal with it as best they could.

The Panorama programme dealt with the subject of patients being sent to care homes from hospitals without covid testing and in some cases already infected patients being delivered to care homes which then went on to infect other staff and residents. Panorama dealt with the pressure that care homes were being put under to accept these patients, but nothing was said about practices, procedures and advice given to care homes. Yes, this was an issue, but only in limited cases.

In fact Community Integrated Care used common sense and instigated the full PPE policy (albeit only masks, gloves and aprons) and locked down care homes way before they were given official advice, which protected the majority of their homes from infection. The majority of their homes being infected from residents returned back to them infected from hospital visits.

The second thing the Panorama programme failed to investigate was the almost daily changes in official advice coming from official sources. I remember early in the pandemic, there was no advice for a number of weeks. Those homes that took it upon themselves to isolate and protect staff and residents fared best. Official advice at the beginning was woeful.

It was only when the horror stories came out of Italy of care home residents being left to die in abandoned homes that the government and their agents started to get their shit together and start offering advice. In one week the advice changed three times, such was the chaos around care. There was one change at least every week. And I've already blogged about the difference in advice given to different care sectors. Even though they may be doing the exact same job or type of care, residential care homes regulated by the CQC got more robust advice then other care sectors. The only difference I could see was that CQC regulated homes account for the stats about care homes that were being shown on the daily briefings. Unregulated care homes count as stats in the general population.

Other types of care such as domiciliary care or supported living were not given the same level of advice or support. My wife manages a number of homes that provide different forms of care. She was working to one set of guidelines for her registered home and a completely different set of guidelines for her other care homes. Despite them doing essentially the same job. That's how fucked up the advice was and still is.

And that's just advice. The debacle around getting hold of PPE is another saga entirely. Private care homes left out in the lurch, care homes in general left out of government initiatives and even when government -sponsored free PPE was available, the emails looked like a scam from some completely non-healthcare-related company.

The government deny care was an afterthought, but the evidence suggests otherwise.

But in my book, by concentrating on emotions Panorama spectacularly failed to score any point against the government. 

How's about playing back Chris Whitty's first few visits to the daily Covid-19 briefings when he went on about herd immunity when it wasn't a given there was any immunity against covid? How's about contacting care providers and asking for the emails that changed on almost a daily basis? How's about checking the difference between registered care homes and other forms of care?

And still the bollocks continue to be dropped: currently the plan is to test every care home worker for COVID on a weekly basis. Residents get tested every 28 days. 

Except currently not one testing kit has been delivered, so homes cannot meet the weekly target. Where's Panorama on that spectacular clanger?

It just shows that the BBC is run by children who fixate on one point and spectacularly miss attention to other details. They could have made one hell of a damning documentary if they had a clue about the subject they were filming.

Thursday, 30 April 2020

COVID-19: Changing Goalposts

The Mrs is currently scrabbling to comply with new guidelines released by the Care Quality Commission.

Over two months into the outbreak, the CQC has now issued an edict that registered care home workers should be wearing PPE at all times. Masks and gowns at all times and face shields when doing close personal care. Just like I was saying weeks ago.

The wife is now scrabbling to get supplies of PPE through from head office. She doesn't order it directly.

Of course if someone in the care home now contracts COVID-19 in between the edict being released yesterday and when the PPE actually arrives for use, guess who gets it in the neck?

Considering it was obvious two weeks ago and more that PPE should be worn as a barrier between carers and their clients, it's been a bloody long time coming. But of course the Mrs couldn't pre-empt any decision and buy PPE beforehand. She can only buy it now it's been deemed necessary.

Strangely it's only registered care homes. Other forms of care like supported living that work in exactly the same way are exempt from the PPE rules.

That's because they don't come under the CQC and any deaths are reported differently. They just get reported like deaths in the community.

Registered care homes count, (literally) because deaths are reported to the CQC and those statistics are collected by the ONS and are now starting to be reported on the news.

I can say quite cynically the deaths in registered care homes has shocked the government into action. Way too late.

It was quite obvious at the start of the COVID-19 outbreak that PPE should have been worn by carers as a barrier to them infecting care home residents and also a barrier to them being infected, as well as cross-infection between ill and healthy residents.

If it was good enough for hospital wards, it's good enough for care homes.

I hope the CQC will be taken to task on this.

I also hope it will show why the social care sector really needs to be classed as the same status as the NHS, if not absorbed into it.

Friday, 17 April 2020

CIVID-19: Key Worker Tests: Utter Stupidity.

Just received the email from the care quality commission about key workers self-isolating and who is eligible to get a test.

First off is the stupidly low number of test centres. They are:

Greenwich
Gatwick
Stanstead
Worcester
Midlands Metropolitan.

So, bit of a bugger if you're in Bristol or Keswick. You've got a very long drive. If you can drive. If you live in Cumbria, Northumberland, even in Devon, Lancashire or Yorkshire, you're going to be in the car for hours getting to the test centre. Maybe it's just a London virus and nowhere else in the country?

Second, the key worker is only tested if they or a member of their household is symptomatic.

Third, only workers in registered care homes are eligible for testing. No testing for workers in any other form of care like domiciliary care or supported living. The carers are going into these people's homes on a daily basis, in some cases shared accommodation that are just like registered homes, but don't require registration. #loophole.

We already know and have known for weeks that people can be spreading the virus without any symptoms. Figures out of China suggest that fourth fifths of those infected can be infected and asymptomatic, waiting for symptoms to occur is waiting way too late.

So really carers need to be tested on a regular basis to establish their viral status. Relying on symptoms emerging is bolting the door after the horse has bolted.

Key workers need to be tested either weekly or fortnightly regardless of symptoms. That way any asymptomatic spreaders can be removed from the system before they infect anyone they care for.

The CQC should have access to the latest covid-19 information, so they should know about asymptomatic spreaders and should update their policy to cope. It should have been updated at least 4 weeks ago when it was known that people can transmit the virus without symptoms.

As it is the advice looks like it was typed up two months ago, the test centres are too few and large swathes of the care sector are not included.

It's piss poor and should be better. People will die as a result of this, there can be no other outcome.