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Covid-19: Lack of testing led to patients being discharged to care homes with virus, say auditors

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2375 (Published 12 June 2020) Cite this as: BMJ 2020;369:m2375

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  1. Gareth Iacobucci
  1. The BMJ

Many patients in hospitals with covid-19 may have been discharged to care homes in March and April because of a lack of testing capacity at the time in England, auditors have reported.

The National Audit Office said that actions taken by the NHS to increase capacity meant there were enough beds and respiratory support nationally at the peak of the outbreak in April.1 Actions included postponing elective procedures, contracting with private hospitals to secure extra beds, and advising hospitals on 17 March to urgently discharge all inpatients who were medically fit to leave.

But the watchdog said that the government’s testing strategy led to some patients being discharged to care homes without being tested for covid-19 between mid-March and mid-April.

The NAO reported: “Due to government policy at the time, not all patients were tested for covid-19 before discharge, with priority given to patients with symptoms. On 15 April, the policy was changed to test all those being discharged into care homes. It is not known how many patients discharged to care homes had covid-19 at the point they left hospital.” Before the new policy of testing everyone before their admission to care homes was rolled out, around 25 000 people were discharged from NHS hospitals to care between 17 March and 15 April, the NAO said.

The auditors highlighted government guidance from 2 April that stated that care homes needed to make their full capacity available and that they could admit patients with covid-19. But it said there was a lack of data on “the extent to which care homes successfully isolated staff with confirmed or suspected covid-19.”

The NAO noted that testing of care workers with symptoms was not rolled out on 15 April. And it wasn’t until 28 April that all care home staff were eligible for tests, and the health department capped the daily number of care home tests at 30 000, to be shared among staff and residents. Testing of NHS staff with symptoms was also delayed but started on 27 March.

Until mid-April the government’s policy was to test no more than five residents with symptoms in any one care home. On 11 May the health department announced that, of around 400 000 care home residents, more than 45 000 had been tested by health protection teams. But it is not known how many residents have had covid-19, the NAO concluded.

Around 5900 care homes in England (38%) reported an outbreak of covid-19 between 9 March and 17 May, the NAO said. This peaked at just over 1000 homes in the first week of April, with some regions such as the North East more affected than others.

The NAO said it had also heard concerns from a range of health and social care organisations about the supply of personal protective equipment (PPE), with central sources up to mid-May meeting only around half of the modelled requirement.

Gareth Davies, the head of the NAO, said, “While we have not sought to evaluate government’s response in this report, our work raises some important considerations.

“Government’s ability to increase beds, ventilators, PPE, and testing has varied in part because of the number of other bodies, both national and international, with which it has had to engage. All of these issues need to be taken into account as the government plans for the later phases of the pandemic and future emergencies.”

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