Intended for healthcare professionals

Letters Care homes after covid-19

Care homes after covid-19: the government needs a plan

BMJ 2020; 369 doi: (Published 27 May 2020) Cite this as: BMJ 2020;369:m2101
  1. Finbarr C Martin, emeritus geriatrician and professor of medical gerontology
  1. Population Health Sciences, King’s College London, Addison House, Guy’s Campus, London SE1 1UL, UK
  1. finbarr.martin{at}

I welcome Oliver’s plea that care homes are not forgotten (again) by the government after covid-19.1 But not forgetting will not be enough; the government needs a plan. Even if they had received prompt nationally coordinated support with personal protective equipment and testing, among other things, care home staff face particular challenges: scaling up medical supportive therapies while providing safe empathic hands-on care and psychological support, not least for residents dying without family involvement. The ability of many homes to step up to these challenges has been in stark contrast to the platitudes emanating from the government.

The care needs are complex. Care homes are not hospitals, they are not “the community,” they are not residents’ homes in the usual sense. Even “residential homes” are providing much more than social care. The 1980s policy narrative that outdated publicly funded and provided institutions would be better replaced with small homely private provision resulted in withdrawal of specialist NHS involvement, while the healthcare needs of residents became increasingly complex. The default response fell to primary care, with both advantages and inadequacies. Rightly, GP representative bodies regarded much of the work not to be typical primary care.

Recently, local NHS services have developed various project-type interventions, commonly funded to “protect local NHS hospitals” rather than partnerships to augment care homes’ efforts on care quality. NHS England has now prompted more systematic local engagement with its Enhanced Health in Care Homes Framework.2

Will this be enough? This is a major care sector fragmented not by default but by design. Do we know how best to accommodate—intellectually or organisationally—the various elements needed now and in the future? Despite decades of involvement as a clinician, researcher, and policy adviser, I think not. So, I support Bowman’s call for a national commission of inquiry to better understand how best to combine the present strengths into a sustainable national, but flexible, high quality care homes sector.3


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