Did Matt Hancock’s negligence lead to Covid seeding into care homes because patients were not tested before being discharged? This was one of Dominic Cummings’s more potent charges and it brings back memories for me because I spent a chunk of last summer looking into this. In my line of work, the success rate for stories is quite low: investigate five avenues and you’re likely to find four dead ends. So you end up with a lot of data and research that’s never used, because the original premise doesn’t hold up. I was (and remain) critical of much of government policy on Covid response: it seemed horribly plausible to me that panicked NHS discharges were behind the staggering care home death count. It ought to be easy to prove, I thought. I was right to think there’s plenty of data, as I built the picture my theory collapsed.
When lockdown happened, all kinds of crazy and dangerous things took place. The NHS prepared for a hospital tsunami that never arrived. Sage M modelling suggested 59,000 ventilators would be needed – cue a mass panic and £570 million spent finding 30,000 of them. They were not needed. At the peak of the first wave, half of NHS hospital beds lay empty. Demand for ventilators dropped (far) below that of a normal Easter and that the number of unused ventilation units trebled. Meanwhile, 22,000 died from Covid in care homes. One well-connected health figure told me at the time that ‘the care homes will be the new killing fields,’ and that we were looking in the wrong place.
At the time of the NHS discharges, the formal advice was that there was no such thing as asymptomatic Covid – so it was assumed that a patient who had no symptoms probably didn’t have the virus. Tests were also quite hard to come by. Cummings said that Matt Hancock assured the Prime Minister that patients would be checked for Covid-19 before being discharged – and that when Boris came out of hospital he was shocked to find this did not happen. Amidst the chaos, did Hancock promise something he could not deliver? I’m all too prepared to believe that. We know that the 2 April official advice was that “negative tests are not required prior to transfers / admissions into the care home.” But the big question is: did the NHS send Covid into care homes when the elderly were discharged?
The figures, on their own, suggest there’s something worthy of investigation…
But correlation is not causation. If the NHS had seeded the virus into care homes you’d expect to see Britain – with its pensioner-discharging NHS bureaucracy – stand out amongst countries for care home deaths as a share of all Covid deaths. But the below chart (source here) shows that, while care home deaths were a tragedy, ours were not proportionally bigger than other countries.
If the virus was seeded into care homes by agency staff, then you’d expect to find correlation between care home deaths and Covid in the community. The does appears to be the case globally:-
And then – to me, one of the most surprising factors – figures suggest no more patients were discharged in April and May than normal (about 25,000). The figures suggest that empty NHS beds were due to the drying up of admissions, not a surge in expulsions. There have been several studies into this since, trying to identify what went wrong: the NHS discharge ‘seed’ theory was the prime suspect, for the above reasons. But this theory did not stand up to scrutiny in genomic studies. PHE has now released a study saying that fewer than 2pc of Covid deaths in care homes were linked to hospital discharges.
Again, this doesn’t exculpate Matt Hancock from telling the Prime Minister one thing and doing another. Or from the shameful failure to protect care home patients more broadly. But if we stand any chance of working out what went wrong in care homes, we need to be frank about the theories that stand up – and the ones that don’t. We are left with the hypothesis that, in most cases, agency workers seeded the virus – in a way that didn’t happen in care homes with live-in staff. It could well be that, yet again, we have seen the real cost of cheap care.