Ministers missed warnings that staff could spread virus between care homes

Ministers and Public Health England were warned in early April that staff working in multiple care homes could be unwittingly spreading coronavirus among the elderly – five weeks before the Government finally issued guidance restricting workers to one institution.

The Telegraph can reveal that the warnings were repeated by government advisers over the following weeks as data showed that three quarters of one home’s residents were infected with the virus, despite its managers having identified only two cases.

An official study conducted in mid-April found that symptomatic staff were self-isolating and being replaced by “bank” staff who worked at multiple homes.

Scientists also recommended effectively quarantining elderly patients in “intermediate” Nightingale-type facilities before transferring them back to care homes, but the idea was never taken up nationally.

Government advisers later concluded that discharging hospital patients back into care homes was an “important source” of infection.

The disclosures, in minutes of the Government’s advisory panel on respiratory diseases, reveal that the deputy chief medical officer privately warned ministers of the concerns following a meeting on April 9.

It raises fresh questions about why ministers and PHE failed to impose immediate restrictions on the movement of staff between care homes, as well as the discharge of elderly patients from hospitals. They also call into question Matt Hancock’s claim that “right from the start we’ve tried to throw a protective ring around our care homes".

Later minutes also show how scientists asked about “large-scale swabbing” of elderly patients in hospitals, only to be told by PHE that “this was to be done in a few hospitals” the following week, “but the focus to date has been on the front line”.

The panel also asked if there was a specific “taskforce” on protecting care homes from Covid-19, only to be told that the work was being shared between the NHS, PHE and Department of Health and Social Care (DHSC).

At least 19,394 residents died with coronavirus in care homes between March 2 and June 12, and it is believed thousands of others may have died as a result of the impact of the disease.

A recent analysis by PHE also warned that many care staff worked at multiple homes and may have transmitted the virus between them. In a meeting on April 9, the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) warned of the “apparent lack of success” of attempts to prevent the transmission of Covid-19 in hospitals and care homes.

Minutes of the meeting reveal that the advisers raised the issue of “staff working between different care homes” and said that outbreaks appeared to be occurring despite “an expectation that institutions would be the last to be infected if the correct shielding is in place”.

The meeting was attended by Prof Jonathan Van-Tam, the deputy chief medical officer, on behalf of DHSC. It was agreed that he would “feed back Nervtag concerns to DHSC about the number of outbreaks in care homes”.

In a subsequent meeting eight days later, PHE officials admitted that the “high numbers of outbreaks” were “primarily focused in care homes”. PHE representatives told the meeting that the body's guidance for care homes was “being updated, focusing on transmission within a home”.

But the minutes add: “Consideration still needs to be given on inter-home transmission driven by staff moving between homes.”

In the same meeting, scientists “asked about large-scale swabbing of care of the elderly and frailty units within hospitals”. PHE “noted that this was to be done in a few hospitals next week, but the focus to date has been on the front line”.

On May 1, Nervtag members stated that “more stringent measures are needed for nursing homes to improve shielding of highly vulnerable individuals”. Nervtag was also briefed on the findings of a PHE study of six care homes in mid-April.

“One of the homes had only identified two cases ... it was found that 75 per cent of the residents carried the virus and only 25-33 per cent were symptomatic. Approximately 45 per cent of the healthcare workers were also carrying the virus. It was noted that symptomatic staff were self-isolating and being replaced by bank staff, who moved through multiple care homes.”

DHSC’s guidance on controlling the spread of infection in care homes, published on April 16, made no mention of restricting the movement of staff.

It was another month before government advice said that, “subject to maintaining safe staffing levels, providers should employ staff to work at a single location”

A DHSC spokesman said: “It is our priority to protect care home staff and residents throughout this pandemic. Our guidance has always been informed by the latest evidence available at the time, and is regularly updated. On 15 May we published our care home support package which followed the latest evidence from PHE and recommended a range of measures care homes could take to limit the spread of the virus. This included limiting the movement of staff.”