Covid Pandemic: Testing of Care Home Residents

Monday 6th March 2023 Lords Chamber

Commons Urgent Question

The following Answer to an Urgent Question was given in the House of Commons on Wednesday 1 March.

“The Covid-19 pandemic was an unprecedented global health emergency involving a novel coronavirus that we were still learning about day by day, even hour by hour. Even in those early days, the UK Government and colleagues in my department were clear that testing would be crucial. That is why the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), set ambitious testing targets to drive a true step change in the quantity of tests, because he knew that testing would be a vital lifeline until vaccines could be developed and proven safe and effective.

The importance of testing was never in doubt, and there was full agreement on that in every part of government, from the Chief Medical Officer to the Health Secretary and the Prime Minister. But in a situation where we had the capacity to test, at most, a few thousand each day, tough decisions about prioritisation had to be made. Those decisions were taken on the best public health advice available. Thanks in no small part to the bold testing ambitions driven by the Government, we were able to build the largest testing network in Europe.

I put on record my thanks to all those who worked tirelessly on this mission day and night, from civil servants to the NHS and, of course, our incredible social care workforce, who did so much to look after their residents. They all deserve our lasting gratitude.

The situation in our care homes was extremely difficult during the pandemic, not just in England but across the UK and, indeed, across the world. Because of the vulnerability of residents and the large number of people who come in and out of care homes, it is vital that we learn lessons.

It is equally vital that we learn those lessons in the right context. Selective snippets of WhatsApp conversations give a limited and, at times, misleading insight into the machinery of government at the time. The Covid inquiry is important so that we have the right preparations in place to meet future threats and challenges.”

19:33

[Baroness Wheeler (Lab)]

My Lords, we have heard much about the former Health Secretary’s thoughts via WhatsApp, but today’s Question is about care homes. The Government claimed early in the pandemic to have thrown a “protective ring” around care homes in response to the alarm bells that were ringing across the country about elderly, frail patients being transferred from hospitals without being tested for Covid. Tragically, over 17,000 residents lost their lives in the pandemic’s first year. Between the advice given by the Chief Medical Officer about the necessity of testing and Matt Hancock’s final decision to act, residents were left exposed and isolated, and staff put at risk.

The latest revelations will be deeply distressing for families up and down the country who lost loved ones. Why were care homes not urgently prioritised when the impact of Covid was there for all to see? Will the Government ensure that the Covid inquiry gets full disclosure of the texts, minutes and documents on this matter and receives whatever support it needs to report by the end of the year?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, for the record, noble Lords are aware of the Covid testing business that I set up at the beginning of the pandemic. We offered testing to the Department of Health and Social Care on a not-for-profit basis. That offer was not taken up and the business never had any government contracts. I wanted to make that clear at the beginning of my answer.

To answer the noble Baroness’s question on the Covid inquiry, the team is staffed to make sure that all the information that is needed is provided. Everyone agrees that we need to learn any lessons from what happened and that all the information that is available is brought to bear.

[Baroness Brinton (LD)]

Mr Hancock denies that he rejected Chris Whitty’s advice in April 2020 that everybody going into a care home should be tested. On 19 May, I said to the then Minister in the Lords:

“The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes … will be only ‘offered’ by 6 June.”


My noble friend Lord Rennard asked whether the Minister had heard the programme “More or Less” and the

“total demolition of the claim that 100,000 tests were being conducted each day”.—[Official Report, 19/5/20; cols. 1086-94.]

The following day, I said that

“Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well.”

The Minister said that

“we rolled out outbreak testing for all symptomatic care home staff and residents.”—[Official Report, 20/5/20; col. 1177.]

Two weeks later, I said that

“a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests.”—[Official Report, 3/6/20; col. 1417.]

We all knew what was going on at the time because we were being told by care homes and by the families of residents. Will the Government now apologise to the many families who lost loved ones as a result of the delay in getting full testing into care homes?

[Lord Markham (Con)]

It is to the regret of everyone that so many deaths were caused in care homes. That is something that I know everyone feels very deeply about. At the same time, the testing capacity was expanded very rapidly. As we know, at the beginning of the pandemic in mid-March, there was capacity for only 3,000 tests a day. At that point, the decision was made that they should go to NHS front-line staff. However, it was then rapidly expanded: on 15 April there were 39,000 tests, and by May there were about 100,000 tests a day. Obviously, at that point, the Government were able to expand the tests more fully to care homes.

Was that prioritisation right? That was the subject of the Gardner review but, clearly, the body that can decide best on whether the right decisions were made at the right time is the inquiry, with which everyone will co-operate fully.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what is so devastating in reading the Telegraph’s WhatsApp lockdown file is that it has confirmed that the most susceptible to Covid were victims of a lack of targeted testing in care homes, while the least at risk were hectored and frightened into getting tested to reach one government Minister’s self-set arbitrary targets. Will the Minister take back that we urgently need this public inquiry? Will it scrutinise the process of target-setting that lost sight of its original aim? Also, after the revelations that Minister Helen Whately raised concerns about the inhumane policies of separating people in care from their families—so lonely and distraught that they gave up—will the Minister support the Rights for Residents campaign to enshrine in law the right to maintain family contact in all care settings? It was not just the lack of testing that killed people but some of the policies too.

[Lord Markham (Con)]

We all agree that visiting should be allowed as much as possible. I know that the policy is that people can receive at least one visitor, but I know that there are also examples where that is not happening enough. It is very clear, from our side, that it is a priority that everyone should have visitation rights, because they are vital. Can we say that that will always be the case in every circumstance in the future? Well, clearly no one foresaw the pandemic, so this is one of those situations where we can never say so definitively, but we all firmly agree that visitation is a key part of people’s care and well-being.

[Lord Naseby (Con)]

Is my noble friend aware that I should declare an interest, in that my wife is a retired GP? In the period February-March 2020, it was very clear to those of us who were in contact with the medical services that things were not right in care homes. On 21 April 2020, I put down a Question—and I have a copy for my noble friend—which read:

“To ask Her Majesty’s Government what has been the COVID-19 testing policy for hospital patients that have been discharged to nursing and care homes over the last four weeks.”


That took us back to 23 March 2020. I got an Answer some three weeks later, which read:

“As outlined in the Adult Social Care Plan, published on 15 April 2020, any patient who moves from the National Health Service to social care will be discharged in line with the current NHS COVID-19 Discharge Requirements. NHS England and NHS Improvement published a letter on 16 April addressed to all accountable officers of all hospitals (public and private sector) working for the NHS and discharge teams outlining the new requirement to test patients being discharged from hospital to a care home.”


This did not answer the Question that I had asked about what had happened between the latter end of March and early April.

I recognise that my noble friend has only recently joined the Front Bench but, as far as I am concerned—I have taken a detailed interest in this—it is fundamental that we are honest. If things went wrong, as I am sure they did, they must come out in the public inquiry. I am happy to give a copy of my Question to the opposition parties, so that they do not have to scratch around to find it.

[Lord Markham (Con)]

Yes, it is vital that we understand exactly what happened when and that we learn lessons. I am sure we will see that some mistakes were made, and we need to learn from those. From our side, that was the whole point of setting up the Covid inquiry. We will ensure full co-operation.

[The Lord Bishop of London]

In advance of the outcome of the UK Covid-19 inquiry, which will take some time if it is going to be thorough, can the Minister tell us what attempt the Government have made to learn from how decisions were made during that period and to ensure that better decisions are made today?

[Lord Markham (Con)]

The first major finding was setting up the UK Health Security Agency, because of a feeling that the bodies that were there at the time were not best placed. That was the first learning. From that, things such as the 100-day vaccine challenge were set up to make sure that we are well placed should another pandemic occur. We have tried to learn lessons all the way through and have made sure that testing capacity is still in place, so that we are able to react quickly, and stocks are there. I like to think that sensible measures are being taken and that we are not waiting for the inquiry, but I am sure we will learn more as the inquiry is fully engaged and when it makes its own findings.

[Lord Allan of Hallam (LD)]

My Lords, the Government’s defence of their entire testing strategy has been that we should trust them but, based on all that we have seen of the former Health Secretary over recent months—far too much, would be many people’s reaction—can the Minister say whether he is a person who displays consistent good judgment or is he capable of making some quite serious mistakes?

[Lord Markham (Con)]

I do not know the said ex-Minister, so cannot comment on that. If we cast our minds back, it was a very pressurised environment in which lots of decisions had to be made very quickly. Mistakes were undoubtedly made as part of that. As to how we did overall, it is best for the inquiry to make findings rather than for me to give my opinion.

[Baroness Browning (Con)]

Can my noble friend confirm that, when the results are published, the contingency plan brought forward by the Government will include, quite clearly, what will happen with care homes in future situations? We are all concerned that this was very last-minute.

Can I ask my noble friend to reflect on my own circumstances? My aunt Vicky, aged 99 years and nine months, died in April 2020 in a care home that she had been in for some time. The death certificate said “Covid”. She was symptomless and not tested. When the family challenged it, it was changed to “died of old age”. I ask my noble friend to reflect on that.

[Lord Markham (Con)]

I am sorry for my noble friend’s loss, albeit one of too many losses in those circumstances. Yes, we absolutely need to learn the lessons around social care settings. Most people would accept that, of the many things that were done well during Covid, that was probably one that we would have done differently, in the early stages, if we had our time again. The Covid inquiry is all about making sure that we learn those lessons, going forward.

[Baroness Bennett of Manor Castle (GP)]

Following the question asked by the right reverend Prelate about what is happening today, I actually agree with part of the Government’s response, which referred to selective snippets of WhatsApp conversations. That is what we are hearing today. While we are waiting for the official inquiry, which will give us a clear, independent view of what happened, it is clear that there were big problems in our care homes. What are the Government doing today to look at the problems that continue in our care homes, particularly those associated with excessive profit taking and privatisation, particularly in homes under the management of hedge funds?

[Lord Markham (Con)]

I know that that is something in which Minister Whately is very engaged. The House has already seen some of the plans around social care and there is further work on discharge going on as we speak. I have spoken many times in the House about the need to resolve this, not just to make sure that the right care is in place for those involved but to free up hospital beds to improve the performance of the whole system.