Revealed: Government knew it had prioritised NHS ‘to detriment of care homes’

The UK government knew as early as September 2020 that its desire to free up hospital beds in the early stages of the pandemic had been “to the detriment” of care homes, openDemocracy can reveal.

It is one of a number of explosive admissions in a highly secret Covid “lessons learned” review document that was released tonight following a two-year transparency battle between the Department of Health and Social Care (DHSC) and openDemocracy.

Ministers have publicly maintained they “threw a protective ring” around adult social care and “specifically sought to safeguard care homes” even after losing a high-profile court case last year over their failures. But behind closed doors, the department admitted the “operational response centre” (ORC) at the heart of the government’s Covid response had prioritised hospital capacity and failed to fully understand social care.

“The unprecedented speed with which this new virus emerged inevitably focused attention primarily on how the NHS would be able to cope,” reads the draft document, which is marked “OFFICIAL SENSITIVE”. “This prioritisation of the protection of hospital capacity, without adequate acknowledgement of key interdependencies, was to the detriment of ASC [adult social care].”

The review also reveals the precarious staffing levels of the ORC itself as the disease crept towards Britain. As late as February 2020, 37% of shifts in the unit – also called the “incident response team” – were unfilled because civil servants who had received special training for emergencies could not get permission from their bosses to be released from regular work.

The DHSC carried out the review, dated September 2020, “as an informal, internal-only” overview of the first wave of the pandemic.

It used a “mixture of interviews with senior figures”, including “stakeholders” outside the department, and a survey that received 276 responses from across the DHSC. According to the DHSC, the review was not intended for publication, was not finalised, and “remains in draft form”.

Under the heading ‘Organisation’, the review says staff worked slower because the department did not have the right software: “The lack of a collaboration document management system, such as SharePoint or Google Drive, impacted teams’ ability to work at pace.”

In a passage that is likely to catch the eye of data privacy campaigners, the review also criticises Foundry, the controversial database software provided to the NHS by digital giant Palantir – saying even health secretary Matt Hancock was unable to use it.

“There is no single departmental overview of the range of available [DHSC] datasets, their origins, ownership and structure and the governance arrangements relating to access to those datasets,” the review states. “NHSE created the ‘Foundry’ data sharing platform to partially address these issues but staff (and the Secretary of State) experienced access issues and its utility as a central resource was limited.”

Palantir initially offered its services to the NHS for just £1, openDemocracy investigations revealed at the time, but subsequently won contracts worth £22m after getting its foot in the door. openDemocracy successfully sued the government over the deal and secured a vow that it would not work with the CIA-backed ‘spy tech’ firm again without consulting the public – a promise that was not kept.

The ‘lessons learned’ review also reveals that documentation about key early decision-making may not exist – something that is likely to create a headache for the official Covid-19 inquiry, which began taking evidence this week, as well as the government itself, which has already been hauled over the coals for its refusal to release unredacted information.

“Due to the dynamic situation,” the document says, “complex discussions were sometimes taken in senior meetings without a formal submission to set out accountability. While this assisted decision-making at pace, it meant there was not always a clear audit trail for rapidly evolving strategy.”

Care homes

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.

Respondents to the survey criticised “glaring omissions in strategic direction of integration and preparedness” within the sector, “meaning that the social care system was not able to respond to a major health emergency”.

Indeed, some said they had not anticipated that the government would need to have a centralised role with care homes at all, assuming – wrongly – that the largely privatised care sector would be “responsible for their own response” to Covid.

The review also admits that putting a hold on routine care home inspections by the Care Quality Commission watchdog “removed one of the department’s lines of sight into ASC [adult social care] and limited its direct knowledge of what was happening on the ground”.

The DHSC says in the document that it “would have benefitted from a fuller understanding of the response by Asian countries (recognizing the contexts are very different) earlier in our planning, which might have enabled us to start to build testing systems earlier in January 2020”, but does not go into detail about what information officials lacked, or why it was unavailable. It also notes there was an “absence of a unified leadership for Test and Trace” at the start of the pandemic, but again stops short of going into detail.

On the subject of personal protective equipment (PPE) such as masks, gowns and gloves, the review recommends “more rigorous… vetting of PPE suppliers” in future. During the pandemic, the government set up a so-called ‘VIP’ lane for suppliers of the kit – a separate channel for politically connected firms.

But PPE supplied through the government’s VIP lane was three times more likely to be useless to the NHS than normally procured PPE, according to analysis by openDemocracy. The total value of contracts awarded to suppliers through the high-priority lane was £1.7bn. Some £4bn of unusable PPE bought by the government in the first year of the pandemic later had to be burnt.

The existence of the ‘lessons learned’ review was first revealed by HuffPost UK in May 2021. The DHSC refused openDemocracy’s request to see a copy, but the information rights watchdog – the Information Commissioner’s Office – ruled in our favour. The DHSC initially appealed against the ruling, threatening to take the ICO to court, but has now handed it over.

The ICO held that there were “significant public interest arguments in favour of disclosure”.

A Department of Health and Social Care spokesperson said: “We have always said there are lessons to be learnt from the pandemic and we are committed to learning from the COVID-19 Inquiry’s findings which will play a key role in informing the government’s planning and preparations for the future. We will consider all recommendations made to the department in full.”

openDemocracy hopes to cover every day of the UK Covid inquiry. It’s a huge undertaking, but we can do it with your support. Please click here to make a donation.