'Shockingly irresponsible' government risked care home lives and violated human rights says Amnesty

“Shockingly irresponsible” government decisions put care home residents' lives at risk and led to violations of their human rights, Amnesty International has said.

An investigation by the human rights group has concluded ‘care home residents were effectively abandoned in the early stages of the pandemic’ by being denied their right to life, right to health and right to non-discrimination.

Amnesty International has published findings in its 50-page report - 'As If Expendable', which highlights failings such as the government’s decision to discharge 25,000 untested hospital patients into care homes, the roll-out of Do Not Attempt Resuscitation (DNARs) forms, GPs refusal to enter care homes and the denial of care home residents’ right to NHS services.

The organisation has called for an independent inquiry into the COVID-19 pandemic with a focus on care homes to start immediately. It also wants to see current ‘restrictive’ guidance on care home visiting to be changed.

’Appalling death toll entirely avoidable’

Kate Allen, the director of Amnesty International UK, said: “The Government made a series of shockingly irresponsible decisions which abandoned care home residents to die.

“Discharged without being tested, thousands of older people were sent to care homes at great risk to themselves and other residents and to staff. The appalling death toll was entirely avoidable - it is a scandal of monumental proportions. As the country faces a second wave of coronavirus, we urgently need a full independent public inquiry into the care home scandal.”

Guidance said negative tests for hospital discharges was not needed

In three months 18,562 people living in care homes died with COVID-19, the report highlighted. Care homes told Amnesty about government delays when it came to giving guidance, difficulties accessing enough PPE and no testing for COVID-19-infected patients who were discharged from hospital.

The damning report highlighted how the government failed to protect care home residents. Until 13 March, Public Health England advised care homes: 'There is no need to do anything differently in any care setting at present'. On 2 April, the government reiterated its guidance stating: ‘Negative tests are not required prior to transfers/ admissions into the care home’.

A manager of a care home in Yorkshire told the human rights body: “We stopped visitors on 28 February and got PPE. We had no cases until 28 March when a resident was discharged from hospital with COVID.”

Discriminatory DNARs

Amnesty International now wants the government to have a 'thorough review' of Do Not Attempt Resuscitation (DNAR) forms in care home residents’ care plans and medical files.

Care home managers have told Amnesty that GP surgeries and clinical commissioning groups (CCG) were requesting they should insert DNAR forms into residents’ files as a blanket approach.

Amnesty has discovered a group of six Sussex CCGs issued DNAR guidance on 23 March to 35 GP surgeries and 98 care homes. The document instructed them to: “Search your clinical system for any care home patients who do not have a resuscitation order recorded (either ‘not for’ or ‘for’ resuscitation) and put appropriate orders in place”.

The guidance also related to hospital admission and asked GPs to ensure “patients who do not already have a ‘do not convey to hospital’ decision are prioritized and have one in place”.

GPs refused to enter care homes

Amnesty received evidence of GPs refusing to enter care homes and only being available for phone or video consultations, regardless of a sick resident’s symptoms and even in the case of end-of-life support.

A senior staff member in a large care home group informed Amnesty in September: “GPs and district nurses have not come into the majority of our homes since the beginning of the pandemic. Not even to carry out essential work.”

Residents denied access to hospitals

As well as face-to-face access to a GP, residents’ right to NHS services (general medical services and hospital admission) were denied. Care home staff and relatives told Amnesty that sending residents to hospital was discouraged or refused.

As the Nightingale Hospital in London and others around the country were created in readiness for COVID-19 patients and had empty beds, hospital admissions for care home residents fell dramatically during the pandemic. There were 11,800 fewer admissions during March and April compared to previous years, according to official figures.

The son of a care home resident who died, said: “From day one, the care home was categoric it was probably COVID and he would die of it and he would not be taken to hospital.

“He only had a cough at that stage. He was only 76 and was in great shape physically. The care home called me and said he had symptoms, a bit of a cough and that doctor had assessed him over mobile phone and he would not be taken to hospital.

“Then I spoke to the GP later that day and said he would not be taken to hospital but would be given morphine if in pain… He died a week later.”

Amnesty now wants care home residents to have full access to NHS services.

Lack of testing and diverted PPE

The human rights group's report also highlighted care homes’ struggle to get testing to prevent COVID-19 infections. The introduction of regular testing for homes was not announced until 6 July. Amnesty wants to see regular testing made available to care home visitors, as well as to care home residents and staff.

A Durham care home manager who spoke to Amnesty in mid-August said testing provision was still inadequate: “We’ve been all over the shop. There was some testing for care staff and residents, but I’ve no idea what the next few weeks will look like.”

At the start of the pandemic, care homes struggled to find personal protective equipment (PPE) and some informed Amnesty that supplies had been reserved for the NHS. A care home manager in Norfolk said: “[In March] we tried to order PPE. We were getting in touch with our usual suppliers, but they were saying ‘we can’t give them to you, they’re on order for the NHS’.”

The Amnesty report attacked initial government advice in March which was against the use of PPE 'if neither the care worker nor the individual receiving care and support was symptomatic'.

Should not be blanket restrictions on family life

The human rights group's report has highlighted the ‘devastating impact of isolation’ on residents during lockdown which caused with less movement, decreased cognitive function, loss of appetite and a reduced will to live. Amnesty's report has stated care home residents must not be subject to blanket restrictions on their private and family life.

It wants to see government guidance for visits to ‘put the best interests of the residents at the centre’. It calls for restrictions based on individual risk assessments, taking into account all measures including more frequent testing for care workers, residents and visitors.

A family member told Amnesty: “I have not been able to visit my poor mum for six months. She is bed-bound and is on the first floor so window visits have not been possible. I have been informed [by the manager] by email ‘that I will only be able to visit when she is dying’.”

Vic Rayner, executive director of National Care Forum, who has already warned depriving residents of visits risks them 'giving up hope', said: “This report from Amnesty makes hard reading".

The NCF director highlighted "urgent action" was required to "overhaul the guidance about visiting in care settings".

"It is absolutely essential that the Government’s approach now and in the future ensures that policy guidance, effective resourcing (including PPE), and plans for action are always created in equal partnership with the care sector. The gap between rhetoric and reality must end now.”

Care home residents were seen as 'expendable'

Donatella Rovera, Amnesty International’s senior crisis response adviser, said: “It is as if care home residents were seen as expendable.

“Despite thousands of empty beds they were de-prioritized when it came to getting access to hospital care, and had blanket do not resuscitate orders imposed on them without due process. Such abuses are deeply disturbing."

Ms Rovera said it was important "those responsible for such disastrous decisions are held accountable".

Amnesty International is urging everyone to ‘take action’ by signing its campaign petition that tells Health Secretary Matt Hancock ‘to protect people living in care homes and ensure this doesn’t happen again’.

Professor Martin Green, chief executive of Care England, which represents care homes, said: "There have been a lot of mistakes made but what is important is that lessons are learned. Never again must adult social care be the under dog; there needs to be parity between the NHS and adult social care.

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