A duty of care

One Saturday night, early on in the lockdown, we binged our way through the second series of Ricky Gervais's brilliant After Life, his customary awkward moment-inducing dark comedy about a widower struggling with the loss of his wife. One of its many sub-plots is that of Gervais's character, Tony, and his bittersweet, will-they-won't-they relationship with his father’s care home nurse, Emma. This storyline is laid over the top of Tony's dad, Ray, gradually disappearing into the tangled mists of dementia. With apologies in advance for the spoiler, when Emma tells Tony that his father has died, I was instantly silenced - transported back to the identical call I received from my brother on a Sunday morning last August. The subsequent scene in Ray's care home, as he lay motionless in bed, took me back further, to the sight of my own father, finally at rest.

Dad's passing was my first up-close experience of death. Older relatives had died before in my lifetime but even in the case of my grandfather, who died when I was 15 (and had been my only living grandparent), I was somewhat distanced from his ultimate demise, due to him ending his days in a care facility my family felt it best that I avoided. I remember the day he died, though, looking out of my west-facing bedroom window and seeing a theatrically symbolic shaft of sunlight breaking through the cloud over where my grandfather had been living. 

With my dad's death, however, I'd seen it coming in real time. At 90, when he went, he'd had a 'good innings', as they say, but his later years had been blighted by prostate cancer and, ultimately, Alzheimer's, along with a suite of ailments associated with them both. Dad died in the care home he'd been a resident of for the year or so since a hospital stay the previous summer, after which it was concluded that it was no longer safe for him (or for my mum) to return to home. While tragic, he died 12 months later with some dignity and at apparent peace (although I later learned of the gorier, scatological detail of what his carers had to deal with as Alzheimer's gradually destroyed the wiring connecting his mind and his body. Their professionalism and their stoicism will remain with me forever). 

Ten months, almost to the day of my father's death, care homes could not be any more on the frontline of consciousness. Nearly one third of all COVID-19 deaths in the UK have occurred in care homes. The growing suspicion is that care patients and care staff have been the country's cannon fodder in the battle against the coronovirus, with a chronic lack of testing and widespread shortages of PPE, plus the knowing release from infected hospitals of patients back into care homes, almost guaranteeing asymptomatic transmission of the deadly bug. Damningly, the first independent report into the care sector's preparations for the pandemic has concluded that care home residents were, scandalously, "an afterthought". I can't speak for how my dad's facility in Kingston has fared, but if it's anything like thousands of others across the country, I shudder to think how he and his fellow residents would have survived. The National Audit Office report has revealed that 25,000 hospital patients were discharged into care homes as the pandemic reached its peak in the UK, with one in three homes suffering outbreaks of the virus. The report points to a lack of testing of hospital patients being discharged into or back into care homes as major cause of the infections that have wreaked tragedy amongst some of our oldest and most vulnerable citizens.

Meg Hillier, the former journalist who is now an MP and chairs the House Of Commons public accounts select committee, said of the report: "Care homes were at the back of the queue for both PPE and testing, so only got a small fraction of what they needed from central government. Residents and staff were an afterthought yet again: out of sight and out of mind, with devastating consequences." This, the report said, was nothing new, highlighting the "problematic" relationship between the NHS and the social care sector. "We have reported on successive efforts to integrate the two sectors," the report said, citing the numerous reports, consultations and independent reviews on this over the past 20 years. "Going into the pandemic, meaningful integration was still to occur, however, and the lack of it has made responding to the crisis more difficult in a number of ways," the report added, highlighting a lack of data and the most critical factor of PPE from government stockpiles not being released to care homes - including only 20% of gowns, 33% of eye protection and 50% of aprons that had been identified from scenario planning as being needed.

What leaves a bitter taste in my mouth is that while the government has been bragging about the record time it took to build the NHS Nightingale hospitals, and Health Secretary Matt Hancock boasting of his own achievements in reaching testing targets (which peaked, then fell back, and as at time of writing, his much vaunted test-and-trace app is still not fully operational...), care homes and carers have been making the ultimate sacrifice. It's almost as if this was planned that way. We've read  heartbreaking stories of carers succumbing to COVID-19 with their patients, bravely sacrificing their own lives to be with those they've devoted themselves to, rather than being at home with their families. 

My recollection of Dad's care team is one of a group of remarkable patient individuals, dealing with the weirdness and the grim hazards as car mechanics deal with engine grease and oil. And, yet, it's taken weeks of attrition before the government would even recognise the death rate in care homes as part of the official statistics of COVID-19 infections. Figures show that care home deaths tripled between the end of March and mid-May, passing the 7,000-per-week mark at a time when the national total was still only 21,000. Now it is above 40,000. Throughout this period the official advice has changed: on 19 March the NHS guidance was that: "unless required to be in hospital, patients must not remain in an NHS bed". On 2 April, the rules on discharging to care homes were clarified, saying "negative [coronavirus] tests are not required prior to transfers/admissions into the care home". By 15 April, the government said all patients discharged from hospitals would be tested for coronavirus. Now, more than 14,000 care home residents with coronavirus have died in England and Wales alone.

As much as life in my dad's care home resembled the Cuckoo's Nest, I can't stop thinking about the team who looked after him for those 12 or so months or, indeed, those people who lived there. Those carers brought dignity to my dad in his final days, even when his own body was denying him of dignity.