COVID 19 Transfer of elderly patients to care homes: FOI release

Information requested

"1. Who authorised or mandated the transfer of elderly patients to care homes without adequate precautions?
2. How was this communicated and by whom?
3. What advice was given by the Chief Medical Officer, National Clinical Director, Chief Nursing Officer, or deputies regarding the transfer of patients?
4. Who decided what the level of testing was? 
5. What guidelines were in place and were they followed?"

Response

1. There was no “authorising” or “mandating” of the discharge of people from hospital. Each individual decision about whether, and when, a patient is ready for discharge is a clinical one, made by the clinician in charge of that patient’s treatment.

Where someone is most appropriately cared for after discharge is based on a multi-disciplinary assessment involving the individual and their family carers. In cases where a patient lacks capacity, an appointed guardian or carer with power of attorney, will be involved. If somebody is discharged to a care home it is because that has been assessed as the best place to meet their needs.

In March 2020 the Scottish Government issued guidance which stated that prior to people being admitted to a care home whether from hospital or the community, clinical screening should be undertaken of patients alongside a risk assessment to ensure sufficient resources including appropriate isolation facilities are available within the care home to support social distancing and isolation. The guidance recommended all admissions to be isolated for 7 days and if known to have contact with COVID patients for 14 days. Both clinical decisions around discharge and risk assessments are undertaken locally by health and social care professionals. There is no involvement of Scottish Ministers.

• On 21 April 2020 the Health Secretary announced that all admissions to care homes from hospital should be have a negative test for COVID-19 prior to admission to the home, regardless of symptoms unless it is in the clinical interests of the patient to be moved, and then only after a full risk assessment. Where a patient has tested positive for Covid two negative tests are required.
• This policy is reflected in both Scottish Government and Health Protection Scotland guidance for care homes.

2. As stated previously, there was no “authorising” or “mandating” of the discharge of people from hospital. All discharges were made based on the Guidance for step down infection control precautions and discharging Covid-19 patient from hospital to residential settings was published by Health Protection Scotland and made available online at http://www.nipcm.hps.scot.nhs.uk/.

3. Guidance from very early on in the pandemic (March) was that no patient should be transferred from a hospital setting if they were symptomatic or unwell and that prior to discharge every patients should have a clinical assessment.

4. Testing was more limited in the initial wave of the outbreak and was limited to symptomatic individuals – not to asymptomatic individuals prior to discharge. This changed from the 22 April 2020 so that no patient should be moved to a care home without a negative test – or two if they had COVID-19 infection. All guidance continued to be updated throughout the pandemic as evidence evolved and was consistent with World Health Organisation guidance at the time.

5. All of the above was in Government guidance at the time. Information on the testing of patients prior to discharge is available in the Public Health Scotland publication.

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