‘We will need to discharge Covid patients into care homes’

A government medical chief advised the government in March 2020 that it would “need” to discharge Covid-positive patients back into care homes.

In an email shown to the Covid inquiry on Wednesday, England’s former deputy chief medical officer Jenny Harries wrote that discharging infectious patients would be “the reality”, even though families with loved ones in care homes “will not welcome” this.

"Whilst the prospect is perhaps what none of us would wish to plan for, I believe the reality will be that we need to discharge Covid-19 positive patients into residential care settings,” she told a top civil servant on 16 March 2020.

Ministers have been heavily criticised for not doing more to protect care homes, where more than 20,000 residents died in the first wave of the pandemic after many were discharged while still infectious. At the time, Matt Hancock claimed the government had put a “protective ring” around care homes but a document revealed by openDemocracy shows the government knew, at least by the autumn, that it had prioritised the NHS “at the detriment” of care homes.

Harries’ email sheds new light on the government’s awareness of the crisis in care homes at an early stage of the pandemic. In 2022, the discharge of Covid patients back into care homes without testing was ruled to have been illegal.

The message, sent in response to a top civil servant overseeing care homes asking for advice, continued: “This will be entirely clinically appropriate.

“The numbers of people with disease will rise sharply within a fairly short timeframe and I suspect make this [discharge of Covid-positive patients into care homes] fairly normal practice and more acceptable but I do recognise that families and care homes will not welcome this in the initial phase.”

Harries, who is now the chief executive of the UK Health Security Agency, defended the email, arguing it was a “high-level picture”.

“If people were not thinking through what the likelihood was in the rise in numbers of cases, I don’t think we [could] have sensible conversations about managing risks,” she said.

Harries was challenged on whether care homes had been given enough support, and whether the need to protect people inside care homes had been adequately communicated alongside her advice in the email.

“Guidance was updated very regularly, [but] I do think there was a problem which is I think that the NHS and social care should be seen as a total continuum, they are all part of the healthcare system, and sometimes one bit gets developed separate from another,” she said.

“I'm really keen to emphasise my email was a high-level view, so people were aware of what was kind of coming over the hill, but the hill was still a little way away.”

Harries’ email was a reply to Rosamond Roughton, who was the director general for adult social care at the Department for Health and Social Care at the time.

Roughton had asked: “When we introduce the shielding policy, what should our approach be to allowing patients to be discharged into care homes who are symptomatic of Covid-19?”

Roughton’s email continued: “My working assumption was that we would have to allow discharge to happen, and have very strict infection control? Otherwise presumably the NHS gets clogged up with people who aren’t as acutely ill.”

And she conceded it was “a big ethical issue for care home providers who are understandably very concerned and are already getting questions from family members”.

The Covid inquiry will dedicate an entire module to the social care sector, with public hearings due to be heard in spring 2025.

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