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.