Carlaw, Sturgeon, Crosslet care home and Richard Leonard.
Bill Heaney REPORTS ON FIRST MINISTER’S QUESTIONS
More than 900 patients were discharged from hospital to care homes in March before compulsory testing was announced on 21 April, which is far more than the SNP government previously suggested, according to Conservative leader Jackson Carlaw.
He asked First Minister Nicola Sturgeon if she now knows the total number of patients who were discharged from hospital to care homes without being tested and if she is satisfied that, during that time, the government did everything that it reasonably could do to protect care home staff and residents.
The FM replied: “We have already published the figures for February and March. The figure that Jackson Carlaw gave was for March. The figure for April will be published in a few days’ time, on 2 June.”
She added: “Two things have been suggested about care homes, both of which are serious and legitimate points. One is that we should not have discharged older patients from hospitals to care homes and the second is that we should have tested more before doing so.
“I absolutely see why, with everything that we know now, people would look at those things and ask why that was done. However, I invite people to look at the situation that we faced at the time.
“On the first of those issues, older people who are what is called delayed discharges do not of course need to be in hospital—even in normal times, it is not in their interests to be there.
“However, at the time that we are talking about, we were waiting for a tsunami of coronavirus cases to enter our hospitals. We should remember the scenes that we were seeing from Italy at that time.
“It would have been unthinkable to leave older people there in the face of that, as it would have put them at huge risk. I am sure that many of them would have died in those circumstances, and I think that I would be getting asked different questions right now.
“Secondly, on testing, at that time, the advice was that people who did not have symptoms were not likely to spread the virus and that testing people without symptoms was unreliable. Indeed, that latter point is still a concern to an extent.
“If we apply what we know now to the situation then, of course we might now take different decisions, but when we faced those decisions, we had to act on the information that we had and, based on that information, we did everything possible to protect older people.
“There were risk assessments of people leaving hospitals and of course there was guidance to care homes about isolation. On that issue as on everything, we continue to adapt our response as our knowledge continues to develop.”
The Tory leader persisted: ” The First Minister has just confirmed that elderly people were taken out of hospital and put into care homes without being tested, but can she confirm whether it is the case that even people who were ill and displaying symptoms of the disease were removed from hospital and returned to care homes?”
Ms Sturgeon said: “I never forget that, when we cite the statistics, we are talking about real people and real individuals—each day when I read out the grim statistics that I am required to read out, I take the time to remember, as I always will do, that behind each and every one of those statistics is a human being who is being grieved by their loved ones.
“On the issue at hand, obviously, it is not possible for me to comment on individual cases when I do not know the full circumstances, but anybody who has lost a loved one to the virus will understandably have questions and, in the fullness of time, we will want to try to answer all those questions as far as we can.
“However, the guidance that was issued at the time made clear that clinical risk assessments should be carried out of the patients who were being discharged from hospital.
“Nobody who had symptoms of coronavirus, and certainly nobody for whom the clinical assessment was that they should continue to be in hospital, should have been discharged.
“The risk assessments are required to be done by clinicians and professionals, but the guidance that was in place was clear and should have been followed very carefully, as all guidance should be followed, whether it is to hospitals or to care homes.”
Labour leader Richard Leonard also tackled the FM on care homes: “Back on 5 March, I asked the First Minister about the challenge of delayed discharge in the light of Covid-19.
“We now know that the Government rushed to discharge almost 1,000 vulnerable patients from hospital in the month of March alone, and we have seen the devastating consequences of that in Scotland’s care homes. At the time, the First Minister told me that there would be “an intensive focus on ensuring that we can discharge people appropriately”—[Official Report, 5 March 2020; c 15.] but right up until 22 April, the Scottish Government’s guidance on the discharge of patients from hospital into care homes stated: “individuals being discharged from hospital do not routinely need confirmation of a negative Covid-19 test.”
He added: “Just yesterday, a nurse who works at a care home told me ‘We had several residents who came from hospital. None of them knew they were going to a nursing home, so when they arrived, we contacted their next of kin, who didn’t know they were going to a nursing home either. It was all one big mess.'”
Does the First Minister now accept that her intention that people would be discharged appropriately was not met? Why did she allow the policy to remain in place for so long, he asked the FM.
She replied : “It is true that we now have different advice on the testing of asymptomatic or pre-symptomatic people but, at that time, two things were different. First, there was a view that it was not likely that people without symptoms would spread the virus. Secondly, there was concern about the lack of reliability of testing people without symptoms; to an extent, that latter concern still exists.
“We have developed our approach to testing and to other things as the evidence and the advice have changed. We cannot apply hindsight and change what we knew at the time. We could operate only on the basis of what we knew and with absolutely the best of intentions. I challenge Richard Leonard’s assertion that we “rushed to discharge … patients from hospital”.
“I regret, more than Richard Leonard might ever be able to know, every single person who has lost their life in a care home as a result of the virus. Again, however, this is where hindsight comes in.
“If we had not tried to get older people out of hospital, they would potentially have been exposed to the virus in hospital and many of them would have died. In those circumstances, Richard Leonard and others would undoubtedly have asked me, ‘With the benefit of hindsight, why didn’t we try to get older people out of hospital?’
“There are no easy choices when we face such decisions. What we have to do is make the decisions based on the best evidence and information that we have. That is what we did. We put in place the guidance that I have mentioned, and we have continued to adapt our approach as our knowledge has developed.
“We will continue to do that every step of the way, and we will continue to be—as we have been all along—open and transparent with the Parliament about the decisions that we are taking and the reasons for those decisions.”
Richard Leonard said: “I have said and we have said repeatedly, you should listen to the World Health Organization, which said, ‘Test, test, test.’ It has been saying that since March. Sadly, the result is the consequences that we see in our residential care homes. “The crisis in our care homes might be linked to the release of those hospital patients who had not been screened, but it has not stopped there.
Castleview care home in Castlegreen Street, Dumbarton.
“Every day, the Government’s data shows that there are more new Covid-19 infections in even more care homes. The number now stands at over 5,500. That is as many as one in six residents, with over 60 per cent of all care homes in Scotland reporting at least one case. Let us be absolutely clear that the crisis is not yet under control.
“Last week, the Scottish Government announced regular testing for care home staff, but the Royal College of Nursing is warning today that Scotland is lagging behind. I ask the First Minister once again how many care home staff and residents have now been tested and when all those staff will finally have access to regular testing.”
Ms Sturgeon replied: “Testing of care home staff will be an on-going process, because it is not enough to do it once; we have to do it regularly. We will publish data, as we have done, on testing as we go along when we are certain that that data is robust and is able to be published.”
But the Labour leader was not content. He said: “The situation is urgent. We know that flawed Government guidance led to the discharge of untested patients into care homes, and we know that flawed Government guidance meant that care home residents were not transferred into hospitals when they were ill.
“We must not make the same mistakes again. This time, the guidance must be right. “