Care Homes - Excess Deaths April 2020: FOI release

Information requested

Information relating to Scottish Government response protocols during the coronavirus pandemic:

1. In spring 2020, the Scottish Government made the decision to move elderly patients within Scottish hospitals into Care Homes – to make space for a potential wave of SARS-COV2 infected inpatients. Can the Scottish Government confirm whom was responsible for making this decision – was the decision taken by the First Minister, Health Secretary or the Chief Medical Officer?
2. In April 2020, 2,724 deaths were recorded within Scottish Care Homes. This represents 1,646 more deaths than average for April, an increase of 153% on the five-year average. Can the Scottish Government confirm what was the cause of death of those 2,724 people and what was the main cause of the excess deaths?
3. Of the 2,724 deaths recorded in Scottish Care Homes In April 2020, can the Scottish Government confirm how many of those deaths had ‘Do Not Resuscitate’ orders (DNR)?
4. During April 2020, the use of the palliative care drug benzodiazepine (Midazolam) was reported to have doubled within the Scottish Care Sector. Can the Scottish Government confirm how many of the 2,724 care home residents that died, had been treated with benzodiazepine within 14 days of their death?
5. NICE guidance document NG163 was published in April 2020 to provide guidance to care staff on managing coronavirus symptoms, especially during end of life care. How many of the 2,724 deaths in Scottish Care Homes in April 2020, were caused as a result of the treatment protocols outlined in NG163? Did the treatment protocols cause more unnecessary deaths than lives saved?

Response

1. The decision about whether, and when, a patient was fit for discharge was a clinical one, made locally by the clinician in charge of that patient’s treatment.

Where someone was most appropriately cared for, after discharge, was 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, was involved.

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 fit for discharge and risk assessments were undertaken locally by health and social care professionals, with the rights and needs of patients being central to the decisions made. There is no involvement of Scottish Ministers in those decisions.

2. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested, because National Records of Scotland (NRS) are responsible for vital events statistics in Scotland, including deaths. This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

However, you may be interested in Table 8b of NRS’ finalised deaths involving COVID-19 data for 2020 from the Archive. This table provides weekly deaths, including excess deaths, registered in care homes in Scotland by underlying cause of death.

If you have any further queries regarding these statistics you may wish to contact NRS directly at statisticscustomerservices@nrscotland.gov.uk who may be able to help you.

3. The Scottish Government does not hold this information. National Records of Scotland (NRS) are responsible for vital events statistics in Scotland, including deaths where the cause was related to COVID-19. The information they hold is restricted to that recorded at death registration and therefore they do not hold sufficient detail to identify where a person had in place a do not resuscitate order. This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

4. The Scottish Government does not hold this information. National Records of Scotland (NRS) are responsible for vital events statistics in Scotland, including deaths where the cause was related to COVID-19. Whilst NRS do hold toxicology information for some deaths, it’s not routinely collected for deaths unless the death is suspected to be drug-related and it is referred to the Procurator Fiscal. This would not apply to the majority of care home deaths and therefore NRS won’t hold toxicology information for all of these deaths. This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

5. The Scottish Government does not hold this information. National Records of Scotland (NRS) are responsible for vital events statistics in Scotland, including deaths where the cause was related to COVID-19. The information they hold is restricted to that recorded at death registration and therefore they do not hold sufficient detail to identify where a death was caused as a result of the treatment protocols outlined in NG163. It is therefore not possible to determine whether treatment protocols caused more unnecessary deaths than lives saved. This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

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