On 24 April I wrote to the Health Secretary concerning the transfer of potentially infectious COVID-19 patients from NHS settings into care homes, and the need to administer further protective measures to prevent this. 

Please find the full text below:

Dear Secretary of State

I write to you about the need to improve the guidance covering transfers from the NHS into care homes, and to improve convalescent capacity within the NHS to prevent infectious patients from being transferred.

As of a week ago, one of Newham’s care homes had lost fully 10% of its residents to COVID-19, and that only includes those who had a formal test. I dread to think what the figures will be by next week. Some of the issues that have caused our care system to be so vulnerable to outbreaks are now well known – PPE and testing shortages and priorities.

However, we will need to have further conversations about both the integration of our NHS and social care services, with regard to the number of transfers that have been made improperly and in a way that has fuelled the pandemic within community settings, and the increasingly high size and density of occupancy in care homes which make infection control extremely difficult. I understand that these more structural problems within the system may not be something you can remedy quickly within the span of this crisis.

Following discussions with the London Borough of Newham, I believe there are two steps that you could take within days, and which would help to further protect our care homes from further outbreaks and such appalling loss of life.

Firstly, while I appreciate that patients are now being tested for SARS-COV-2 before being transferred into care settings, and that if communication is good this would enable care providers to implement additional infection control measures, I believe that the guidance should be tightened still further. In my view, no-one should be being transferred to care homes if there is any risk that they have undiagnosed SARS-COV-2, or if they are in recovery but may still be infectious. Infection control is inevitably likely to remain far worse in care settings than within the NHS, and given the extreme vulnerability of most care home residents, I believe this step is necessary.

I understand that this would require the commissioning of additional convalescent capacity in many areas, to avoid a situation where the most specialised and resource-constrained facilities, namely ICU beds in hot wards, are taken up by patients who may no longer need that level of care, but who may still be infectious to others. I am told that local health authorities are looking at the creation of both ‘hot’ and ‘cold’ wards for patients on pathways to leaving hospital to avoid direct transfers into the care system. I urge you to look at this urgently, and if it is feasible, take action to enable greater convalescent capacity to be created across the country. This would in turn enable the guidance for transfers into the care system to be tightened without adverse consequences.

I note that Nightingale and other specialist capacity hasn’t got close to being full during this peak, recent very worrying reports about insufficient staffing notwithstanding. This suggests that there might be scope to convert part of the capacity within Nightingale and similar NHS facilities to a convalescent function.

I look forward to hearing from you.

Best wishes,

Lyn Brown

Member of Parliament for West Ham