Coronavirus (COVID-19): framework for decision making - overview of public engagement

7. Options for resuming care and support for those most affected by the current restrictions

Footnote^[14]

This chapter deals with wider health and social care and how the NHS can best return to delivering important routine care. The best use of capacity, both to respond to the pandemic, and in terms of adapting it to wider health issues, is considered. There are also specific concerns about how care homes are supported and protected. Discussion focusses on:

• The wider health impact of living in lockdown
• Wider health services
• Care homes

Wider health impact of living in lockdown

The wider health impacts of lockdown were widely discussed by respondents. Mental health strains were continually described by many across a number of topic areas. Difficulties associated with being isolated and unable to see friends and family were discussed at length. Some discussed how social restrictions had negatively affected health behaviours such as physical activity and diet, which could impact the number of people who are 'overweight' or 'obese'. Others felt that some groups might be particularly susceptible to substance misuse at this time.

Wider health services

There was widespread support on the platform for the resumption of a greater range of health services. Concerns were expressed about many of the public who were balancing Coronavirus (COVID-19) health priorities with non-virus related priorities. It was felt that many were missing out on vital care and were at greater risk if they missed opportunities to seek support or routine treatment and screenings. Others described not seeking help for less threatening but uncomfortable or painful conditions.

"Many people with life threatening or long term conditions are being discouraged from contacting medical authorities by the constantly repeated death toll figures & projections. In addition many clinics have been cancelled leaving those previously receiving treatments in limbo including cancer patients, diabetics with sight issues or ulcers and those in chronic pain without support etc. Covid 19 is not the only serious threat to life & limb but has been allowed to overwhelm other medical services to the serious risk to many."

This was also true of wider health services such as dental services, physiotherapy, audiology and psychiatry that many felt could resume with the appropriate PPE.

There were also concerns about the impact on pregnant women and new parents. Many were concerned that they were unable to get support from wider friends and family that they would usually call upon. Others were concerned that pregnant women did not have access to the routine support usually available, e.g. midwifery services and health visitors. Respondents also said partners should be able to attend routine scans, appointments and labour wards - with PPE in place.

Respondents also gave ideas for how existing services could be concentrated in the current situation. Facilities such as NHS Louisa Jordan were advocated as somewhere where Coronavirus (COVID-19) patients could be treated to maintain safety at other facilities and as a way of freeing up space to clear the backlog of elective operations and routine screening. A variation on this suggestion was to split hospitals into Coronavirus (COVID-19) facilities and hospitals for patients without the virus, which might reduce transmission and improve uptake of services.

Care Homes

Overall, there seemed to be a widespread view that, as one of the contributors put it, "the pandemic is still very much rife in our care homes" and that action and resources are needed to limit the number of infections and deaths in care homes. One contributor called for two separate strategies for care homes and for the general public, noting that the lockdown will be causing more and more frustration with the general public, especially when it is believed a large number of cases are within the care home community.

There was quite a widespread feeling that the approach for keeping care homes safe has so far been a failure. One contributor wrote that although the issue of Coronavirus (COVID-19) hotspots in care homes was identified very early in this pandemic, there has been no progress in resolving it.

"Too little has been done and too late. Human-to-human transmission has been known about for weeks if not months. Protection of care home residents now needs to improve massively to combat against this and […] other existing and unknown infections."

Other commentators recognised that this would nevertheless be a difficult task, first of all because of the claimed limitations and effectiveness of testing.

Yet others seemed to doubt whether care homes, which are often privately run, can enforce the regulations required and some called for action to ensure compliance, including taking care homes into public ownership.

There were calls for more extensive testing in care homes or selective testing of workers and tradespeople:

"Now that more testing capacity is available, every resident and every care worker associated with every care home in Scotland needs to be tested to get a baseline on the scale of the care home issue. No worker or tradesperson should be entering a care home unless they have been tested immediately prior and shown negative, and have isolated since their most recent test. The consequences for the residents are too high to wait for the first case in a care home before taking action. The understanding of transmission is sufficiently developed to justify the above action under the precautionary principle."

A number of other suggestions appeared across various posts on how to keep care homes free from Coronavirus (COVID-19). These included:

• Setting up changing rooms in the car parks for staff to change out of home clothes into a clean uniform kept on site and appropriate PPE. Post-shift uniforms should be bagged (in scrub bags) and laundered onsite
• Isolate staff in care homes as soon as a Coronavirus (COVID-19) case was confirmed in a care home and replace those staff with a new team
• Reduce staff changeover in care homes to minimise risk of virus transmission
• Supplying more PPE to care homes
• Supplying mobile testing units to care home to detect Coronavirus (COVID-19)
• Moving 'spare nurses' from all our intensive care units to care homes, mobilising student nurses, volunteers, civil servants and public servants who are not working at full capacity to help in care homes

At the same time it was noted that many of these measures could increase pressure on care home staff, who some respondents believe are already over-worked and under-paid.

There was a separate idea which emphasised care homes "need to look at ways to facilitate short periods of contact."

"Otherwise many older people will die, miserable and alone having never seen their family again. If they do not die from covid, then it will be due to medical conditions related to stress and bereavement."

One other respondent noted that the Danish care system was able to facilitate socially-distant meetings with families in care home gardens. Still others believed that lockdown of care homes hadn't prevented the virus entering care homes and that visitors could also isolate or wear appropriate PPE.

One contribution noted that not all care homes cater for the elderly and that some are for adults with learning disabilities who are physically fit and healthy (thus arguably not a high risk Coronavirus (COVID-19) group), and therefore rules for no mobility out of care homes could be relaxed for them, especially if the care home is in remote setting.