SAGE still probing links between hospital discharges and care home Covid outbreaks

MPs said care homes were "thrown to the wolves" in the pandemic last year
Photo: Owen Humphreys/PA Wire/PA Images

The government has pushed back its deadline to publish the findings of a review into links between hospital discharges and Covid-19 outbreaks in care homes.

In a document sent to the Public Accounts Committee yesterday, the Department for Health and Social Care said the government’s scientific advisory panel is still considering “relevant analysis” of the data on care home outbreaks and hospital discharges.

Last November, DHSC commissioned the care homes subgroup of the Scientific Advisory Group on Emergencies to issue a “consensus” statement on any links between the two.

The move came after outrage over the government’s policy of releasing patients from hospital to care homes without testing them for coronavirus early in the pandemic.

Guidance requiring patients to be tested before leaving hospital for care facilities was not issued until April 2020 – even though it was understood that the virus could be transmitted asymptomatically.

A June 2020 National Audit Office report found 25,000 people had been discharged to care homes without tests between mid-March and mid-April. A month later, a PAC report described the policy as “shocking” and committee chair Dame Meg Hillier said care homes had been “effectively thrown to the wolves”.

In a Treasury minute responding to the two reports in November, the government said it disagreed with the conclusion that releasing patients from hospital to care homes without testing them for coronavirus at the height of the pandemic last year was an “appalling error”.

It pointed to a paper from the SAGE care home working group last September that said there was “weak evidence on hospital discharge and modelling the impact of visitors does not suggest a dominant causal link to outbreaks from these sources”.

NHS England and NHS Improvement medical director Stephen Powis told PAC in October said the SAGE paper “provides the evidence that the committee requested”.

However, the paper added that studies had not ruled out any routes of infection, including hospital discharges, and said asymptomatic cases could mean routes of infection may be hidden “for a number of generations of disease”.

SAGE also stressed that the publication was the "best assessment of the evidence at the time of writing" and its conclusions may change as new evidence emeges.

The government said in its Treasury minute that it would ask the working group to “keep the emerging evidence on discharge under review” and would update PAC as further evidence became available. It set a target date to complete the work by spring this year.

In an update on that response yesterday, DHSC said SAGE had “reached interim conclusions” on the matter, but must now consider “relevant analysis” by Public Health England, NHS England and NHS Improvement that was carried out in the spring.

Last year’s PAC report also stressed the urgency of reforming the social-care system, saying the pandemic had “shown the tragic impact of delaying much needed social-care reform, and instead treating the sector as the NHS’s poor relation”.

It said the government must write to the committee by October 2020 setting out the specifics of its plan “organisationally, legislatively and financially, and by when, to make sure the needs of social care are given as much weight as those of the NHS in future”.

The November response said only that DHSC was “actively considering a range of proposals” and would provide an update on progress following the Spending Review.

It said it recognised “ever-increasing” pressures on the social-care system and had increased funding by £1bn a year to fund better staff, infrastructure and facilities. Subsequent select committee reports have criticised the government’s approach of offering stop-gap funding and said a major overhaul of the system is needed.

The update added: “The government remains committed to reform, is actively considering a range of proposals, and will bring forward a plan this year that address long-term challenges in the adult social care system.”

In yesterday’s update, DHSC said its response had “not changed substantially” since last October, adding only that it has now committed to bringing forward a plan for reform this year.

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