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Daphne Havercroft: Covid-19: How the NHS protects itself by neglecting the elderly

This is an article by Daphne Havercroft. In 2015 Daphne retired from a career as a senior project and service delivery manager for a global IT services corporation. She has seen and experienced the very best of NHS care, delivered by skilled and caring health professionals, and also the worst of the NHS, particularly its leaders’ callous attitude towards the elderly, which has been exposed for all to see during Covid-19. Her Twitter account is @DaphneHavercro1, and her blog can be found here.

On 14th March 2020 (it seems ages ago), the Telegraph published an article about the coronavirus outbreak by Health and Social Care Secretary, Matt Hancock, in which he said, “Our goal is clear. The over-riding objective is to protect life”, and “our strategy is to protect the most vulnerable”.

Five days later, on 19th March, the Government published its Covid-19 Hospital Discharge Requirements describing the process for doing exactly the opposite of what any sensible person would do if they wanted to protect vulnerable, elderly people.

The process is to protect the NHS by dumping vulnerable, elderly people from hospital back into the community, either to their own home or to a care home, without any proper assessment of the risk of them introducing Covid-19 into the community or the risk to them of acquiring the infection in the community and without ensuring that carers have access to adequate Protective Personal Equipment (PPE). Pages 18 and 19 of the document reveal that the local commissioner for NHS and Social Care Equipment is responsible for ensuring adequate stocks of PPE.

Covid-19 has not suddenly forced the NHS to neglect the elderly to protect itself. It does it all the time. Many people like me, who have supported an elderly relative with multi-morbidities through hospital discharge in normal times, know that the NHS deems elderly people admitted to its hospitals to be ‘bed blockers’, a social care problem, and it can’t get shot of them fast enough.

The Care Quality Commission (CQC) published a report in July 2018, the same month that Mr Hancock was appointed to his current position, in which it said of England:

The NHS and social care are two halves of a whole, very often providing support for the same people. We must create an environment that drives people and organisations across health and social care to work together, rather than driving them apart.

This is stating the obvious. Expensive quangos like the CQC are good at that. Unfortunately they are not so good at protecting elderly, vulnerable people.

Matt Hancock is the Secretary of State for Health and Social Care. If he was serious about a strategy to protect the most vulnerable he would not have waited to write about it until March 2020; he would have acted on the CQC report in July 2018 by creating a culture that enables leaders across English health and social care organisations to work together, both in normal times and during a pandemic.

Instead Mr Hancock has spent nearly two years allowing the NHS to continue to protect itself at the expense of the elderly, by writing them off as a social care problem and failing to ensure that their health needs are properly planned for and effectively delivered in the community across the whole of England. This includes provision of compassionate, palliative care for those naturally approaching the end of their life, regardless of Covid-19.

Apparently Matt Hancock, whose declared “over-riding objective is to protect life” doesn’t understand that some elderly people with multi-morbidities approaching the end of life and  with a poor quality of life, might not want to survive Covid-19 if they catch it, but they do want decent palliative care that, in the words of the World Health Organisation, “provides relief from pain and other distressing symptoms”, and “affirms life and regards dying as a normal process”, and “intends neither to hasten or postpone death”.

The years of NHS neglect of the community health needs of the elderly have come to the fore during Covid-19, particularly with the plight of those in care homes. These people have been deprived of family contact, even when they are dying. Some of them have died in homes with no registered nurses on the staff, trained and qualified to deliver end of life medication to relieve suffering and distress.

We will probably never know the truth about the physical and emotional harm caused to elderly, sick people by the NHS’s neglect of their community health needs in normal times and its abject failure of contingency planning to protect them from undignified and distressing deaths during the Covid-19 pandemic.

Will the aftermath of the Covid-19 pandemic prompt Matt Hancock to belatedly act on the CQC’s July 2018 report to create a culture that finally breaks down barriers between health and social care? Genuine culture change requires replacement of those leaders in health and social care who can’t, won’t, or can’t be bothered to deliver, by leaders who can and do deliver, including getting PPE to the people who need it at the time they need it.

Looking at Mr Hancock’s performance, I do not have confidence that he has the capability and maturity to sort out this mess.

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14 thoughts on “Daphne Havercroft: Covid-19: How the NHS protects itself by neglecting the elderly

  1. Given that the public finances have been ruined I think it’s unlikely they’ll sort this out in future if it requires more money for social care. But there will probably be some kind of window dressing that doesn’t deal with the underlying issue.

  2. “…he would have acted on the CQC report in July 2018 by creating a culture that enables leaders across English health and social care organisations to work together, both in normal times and during a pandemic”.

    While I quite agree with the general thrust of this admirable article, I take exception to this particular recommendation.

    The only people who can “create” cultures are microbiologists, working with bacteria in Petri dishes. With creatures consisting of more than one cell, culture is difficult – approaching impossible – to “create” or change, or even influence.

    The Concise Oxford English Dictionary defines culture as:

    culture
    n noun
    1 the arts and other manifestations of human intellectual achievement regarded collectively. Øa refined understanding or appreciation of this.
    2 the customs, ideas, and social behaviour of a particular people or group.
    3 Biology the cultivation of bacteria, tissue cells, etc. in an artificial medium containing nutrients. Øa preparation of cells obtained in such a way.
    4 the cultivation of plants. Ø[in combination] denoting cultivation or husbandry: aviculture.
    n verb Biology maintain (tissue cells, bacteria, etc.) in conditions suitable for growth.

    ORIGIN
    C17 (denoting a cultivated piece of land): the noun from French culture or directly from Latin cultura ‘growing, cultivation’; the verb from obsolete French culturer or medieval Latin culturare, both based on Latin colere (see cultivate).

    In this context, I take it to mean “the customs, ideas, and social behaviour of a particular people or group”. That is precisely what laws and government edicts are powerless to change. Indeed, there is an ancient legal principle that laws had better conform to customs, because if they don’t it is the customs that will win.

    A closer analysis reveals that “leaders” won’t work together if they don’t want to; and they won’t want to unless there is something in it for them. (See “Yes, Minister”, passim).

    More generally, it is a glut of “leaders” that causes such problems. Left to their own devices, the rank and file would never dream of doing such crass and absurd things. It’s when empire-building and career nourishment set in that you get truly psychotic behaviour.

  3. Hasn’t a large part of the problem been that they split Social Care from Healthcare and made it the responsibility of local authorities? This might have been a good idea if they hadn’t simultaneously taken funding from local authorities, leaving them unable to provide the services properly. This has meant that many care homes were taken over by the private sector and the results have been plain to see.
    Another thing this highlights is that, whatever the enormous efficiency problems with the (theoretically) unprivatised NHS, many care homes are yet another example of the private sector providing abysmal public service.

  4. “The process is to protect the NHS by dumping vulnerable, elderly people from hospital back … to a care home, without any proper assessment of the risk of them introducing Covid-19 into the community …”

    Early on, on several blog comment threads, I remarked that we must expect “a slaughter” in the care homes. That was before I learned that the NHS had the daft policy you describe.

    But the daftness has not been restricted to the NHS. Apparently the same folly has been perpetrated in several other places, most conspicuously by Governor Cuomo of New York. Now Cuomo may be a nasty piece of work but nobody thinks him a fool.

    So what explains multiple outbreaks of “stick ’em back in the care homes before it’s safe to do so” disease? I rule out the potty conspiracy theories going the rounds. But such a correlation of folly needs some explanation. Simple panic?

  5. In all the articles about the NHS, good & bad, I’ve seen no mention of private medicine. There are many smallish private hospitals, from perhaps 10 – 20 beds, well staffed and equipped. Have any of these dealt with CV19 infections? Are there any figures about their numbers?

  6. The decisions to dump infected elderly people back into care homes is such a travesty and an injustice I can’t help thinking there must be scope for a legal challenge or prosecution. So many people have died needlessly from this. Their families must have a legal case for some kind of class action against both the government and the NHS. And it have the additional benefit of exposing the absurdity of the entire Covid19 lockdown plan.

  7. You might well be right Cheezilla, but part of the truth is that we as a society don’t want to pay for it to be any better.
    It is a consequence of living in bankrupt country, that has been selling off the family silver and chipping away to balance the books for most (in not all) of my adult life. This includes raising taxes from 38% of a person earnings in 1980 to 52% today. – All taxes taken into account.

    I shudder to think how this situation will be affected by the economic ruination that lies ahead.

  8. I have heard that their services were bought in – so little private medicine dome either.

    Others may know more.

  9. Except government edicts as themselves forms of social behaviour have no source than the culture which produced them. NHS / Welfare / Environment are as ‘cultural’ as Trousers / Trafalgar Square / Fish ‘n Chips.

    But you’re on the money with ‘glut of leaders’, too many chiefs… Best understood by Conquest’s Third Law of Politics, that ‘the simplest explanation for the behaviour of any bureaucratic organisation is to assume that it is controlled by a cabal of its enemies.’

    In other words the NHS operates at the expense of providing medical services, which are a kind of add-on. It’s the same with learning in respect of universities, and state education generally. E.g. a large proportion of NHS and education bureaucrats do nothing more than measure each other’s performance re Diversity / Carbon / Women etc. Nothing to do with education / health whatever. It gets a mention in Hector’s book whose theme is the culture of the modern university. Perhaps the police are the most glaring example right now…

    Conquest was a Sovietologist, and we should also understand the British state as a bureaucratic organisation. Which means civil society in the service of the state, epitomised by ‘our NHS’ which people are not only expected to cheer but to die for. Mrs T was on similar ground when she said ‘no such thing as society, only men and women and their families’.

    What she meant was that in common parlance the state was being assimilated with society, which is to say the role of the family and neighbour being usurped by state sponsored professionals. What she didn’t or couldn’t anticipate was the extent to which commercialism would also dissolve those relationships in the absence of God / religion, understood as a principle of membership as much as a moral code.

    My mother used to do meals on wheels for the WRVS (Womens Royal Voluntary Service). But those were the days when you could own a home and rear a family on a single income even though we were supposed to be ‘poorer’, ‘the economy’ being ‘socialist’.

  10. My thoughts exactly.
    And not only the care home residents. The government also suspended consultations, screening, diagnostics and treatment across all areas of medicine in order to ‘protect the NHS’.
    Result? Excess deaths, not attributable to Covid-19, are through the roof!
    A lot of lawyers will be touting for business after this.

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