Human rights group Amnesty International has demanded an immediate independent public inquiry into the handling of care homes during the coronavirus pandemic, after a report found that thousands of older people were effectively “abandoned to die”.
The Amnesty report found that a series of “shockingly irresponsible” government decisions led to violations of older people’s human rights, including the right to life, the right to health and the right to non-discrimination.
An investigation by the group’s crisis response team found that the death toll in England’s care homes was “entirely avoidable”.
And it raised particular concern about the misuse of “do not attempt resuscitation” (DNAR) orders, after witnesses gave evidence that local GPs and clinical commissioning groups had requested their insertion into residents’ files on a blanket basis.
Interviews with care home managers and staff uncovered accounts of a “complete breakdown” of systems in the first six weeks of the crisis, with the government ordering the discharge of 25,000 people from hospitals into homes in order to clear NHS beds, including some who were infected with Covid-19.
Care homes reported delays in receiving guidance, difficulties sourcing personal protective equipment (PPE) and an inability to access tests, despite having to manage infected patients released from hospital.
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The report – entitled As If Expendable: The UK Government’s Failure to Protect Older People in Care Homes during the Covid-19 Pandemic – found that between 2 March and 12 June some 28,186 “excess deaths” were recorded in care homes in England, with over 18,500 residents confirmed to have died with coronavirus during this period.
Amnesty International UK director Kate Allen said: “The government made a series of shockingly irresponsible decisions which abandoned care home residents to die.
“Discharged without being tested, thousands of older people were sent to care homes at great risk to themselves and other residents and to staff.
“The appalling death toll was entirely avoidable – it is a scandal of monumental proportions.
“As the country faces a second wave of coronavirus, we urgently need a full independent public inquiry into the care home scandal, so that lessons can be learned and lives protected, before any more lives are lost.”
Several care home managers told Amnesty that they had no coronavirus in their homes until they received patients discharged from hospital.
The manager of a care home in Yorkshire said: “Because of what we’d witnessed in Spain and Italy, we stopped visitors on 28 February and got PPE. We had no cases until 28 March when a resident was discharged from hospital with Covid.”
Despite it being known early on in the outbreak that older people were particularly vulnerable to the virus, the government “failed to take measures” to protect England’s 400,000 care home residents, the report found.
Up until 13 March – two days after the World Health Organisation declared Covid-19 a global pandemic, Public Health England was advising that “there is no need to do anything differently in any care setting at present”. On 17 March, the government ordered the discharge of 25,000 patients from hospitals into care homes, said the report.
And as late as 2 April – the same day that the WHO confirmed the existence of pre-symptomatic cases of Covid-19 – the Government reiterated its guidance for hospital discharge that “negative tests are not required prior to transfers / admissions into the care home”.
Donatella Rovera, Amnesty International’s senior crisis adviser, said: “It is as if care home residents were seen as expendable. Despite thousands of empty beds they were de-prioritised when it came to getting access to hospital care, and had blanket ‘do not resuscitate’ orders imposed on them without due process.
“Such abuses are deeply disturbing. It is imperative that lessons are learned so that the same mistakes are not repeated, and that those responsible for such disastrous decisions are held accountable.”
The 50-page report also detailed complaints that multiple residents were denied access to GP visits or hospital admission, with doctors offering consultations only by phone or video call. And it said that provision of testing was still “far from adequate” despite a promise in July of regular tests for care home.
It raised concern about blanket bans on visitors, regardless of individual patients’ circumstances, quoting one woman who said she had been unable to see her elderly mother for six months and been told by email that she would “only be able to visit when she is dying”.
Amnesty has launched a campaign for a full independent public Inquiry into the pandemic, with an interim phase starting immediately focusing on older people in care homes.
It also called on the government to order a review of the use of DNAR forms, ensure full access to NHS services for care home residents, make regular testing available to care homes residents, staff and visitors and ensure that restrictions on visits are tailored to the best interests of individual residents.
Responding to the report, a Department of Health and Social Care spokesperson said: “Our position has always been clear that it is completely unacceptable for ‘do not attempt CPR’ decisions to be applied in a blanket fashion to any group of people.
“This has never been policy and we have taken consistent action to prevent this from happening.
“From the start of the pandemic we have been doing everything we can to ensure care home residents and staff are protected.
“This includes testing all residents and staff, providing over 228m items of PPE, ring-fencing over £1.1bn to prevent infections in care homes and making a further £3.7bn available to councils to address pressures caused by the pandemic – including in adult social care.”
