On a doorstep in the suburbs of north London, three-year-old Ayse picked up a tissue to wipe away her grandmother’s tears - tears for one more victim of the virus.
Credit: Reuters UK. Breaved grandmother comforted by child
The little girl was waiting for her mum, Sonya Kaygan. Her grandmother hadn’t broken the news that Kaygan, 26, who worked at a nearby care home, was dead, one of over 100 frontline health workers killed by the coronavirus in Great Britain.
The grandmother, also called Ayse, spoke through sobs. “Why? Why?” she repeated. Why couldn’t she visit the hospital to say her goodbyes? Why did so many die in her daughter’s workplace? At least 25 residents since the start of March, of whom at least 17 were linked to the coronavirus. It was one of the highest death tolls disclosed so far in a care home in England. And why did Kaygan and her colleagues resort to buying face masks on Amazon a month ago, protection that arrived only after she was in hospital?
A Reuters investigation into Kaygan’s case, the care home where she worked, and the wider community in which she lived provides an intimate view of the frontline of Britain’s war on the coronavirus. It exposes, too, a dangerous lag between promises made by Prime Minister Boris Johnson’s government and the reality on the ground.
Even as the government was promising to protect the elderly and vulnerable from the deadly virus, local councils say they didn’t have the tools to carry out the plan, and were often given just hours to implement new government instructions.
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Policies designed to prevent hospitals from being overwhelmed pushed a greater burden onto care homes. With hospitals given priority by the government, care homes struggled to get access to tests and protective equipment. The elderly were also put at potentially greater risk by measures to admit only the sickest for hospital treatment and to clear out as many non-acute patients as possible from wards. These findings are based on documents from government agencies seen by Reuters, interviews with five leaders of local authorities and eight care home managers.
It is too early to reach final conclusions about the wisdom of these policies. Still, staff and managers of many care homes say they believe the British government made a crucial early mistake: It focused too much attention on protecting the country’s National Health Service at the expense of the most vulnerable in society, among them the estimated 400,000 mostly elderly or infirm people who live in care homes across Britain.
The government summed up that policy in the slogan “Protect the NHS.” The approach gave the country’s publicly-funded hospitals priority over its care homes. A UK government spokesman defended the strategy. “This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice.”
The effects of this approach have been felt desperately in Elizabeth Lodge, in Enfield, north London, where Kaygan worked.
The first coronavirus test of a resident of the Lodge only took place on April 29. That was 34 days after the first suspected case at the home, said Andrew Knight, chief executive of residential services at CareUK, a private company which operates the home. It was also 14 days after Matt Hancock, the UK health secretary, pledged tests would be available to “everyone who needs one” in a care home.
“The government’s response on testing has come way too late to have any meaningful effect on keeping the virus out of our homes,” said Knight, the CareUK executive, in a statement to Reuters.
So far, at least 32,300 people have died in Britain from the coronavirus, the highest toll in Europe, according to official UK data processed by 2 May. Out of those deaths, more than 5,890 were registered as occurring in care homes in England and Wales by April 24, the latest date available. These figures don’t include care home residents who were taken to hospital and died there.
Many care home providers believe the figures understate the number of deaths among care home residents because, in the absence of testing, not all are being captured. During the 10 weeks prior to the outbreak, including the height of the flu season, an average of 2,635 people died each week in care homes in England and Wales. By April 24, that weekly death toll had risen to 7,911. According to Reuters calculations, the pandemic has resulted in at least 12,700 excess deaths in care homes.
“I think the focus early on was very much on the acute sector,” or urgent hospital treatment, “and ensuring hospitals were able to respond in an effective way,” said Graeme Betts, acting chief executive of Birmingham City Council, which oversees the UK’s second-biggest city.
“And I think early on care homes didn’t get the recognition that perhaps they should have.”
Helen Wildbore, director of the relatives and residents association, a national charity supporting families of people in residential care, said while it was right for the initial focus to be on protecting the NHS, “I think it has taken too long for the government to turn its attention” to vulnerable people outside hospital. “I think it’s fair to say that the sector has felt like an afterthought for quite a long time.”
Jeremy Hunt, a former Conservative Party health secretary and now chairman of the House of Commons health select committee, advocated banning visits to care homes by friends and family from early March, advice that wasn’t followed. Speaking to Reuters, he drew a parallel between the UK’s response to the coronavirus and the way it deals with peak winter demand for hospital services.
“What happens with any NHS winter crisis is the focus of attention immediately switches to the hospitals and dominates the system’s thinking,” he said. “Many people in the social care sector told me exactly the same thing happened with COVID-19.”
The government spokesman said protecting the elderly and most vulnerable members of society had always been a priority, “and we have been working day and night to battle coronavirus by delivering a strategy designed to protect our NHS and save lives.”
Born in Northern Cyprus in 1993, Sonya Kaygan had come to the UK after studying English. She settled in Enfield, a north London borough of 334,000 people with a large community of Turkish origin, and one particularly hard-hit by the virus pandemic.
Kaygan lived with her mother and together they looked after her child. Both worked in different care homes: She worked night shifts and her mother worked the day shift. Kaygan’s monthly wages for three or four weekly 12-hour shifts added up to a take-home pay of about £1,500 - just short of the monthly rent of their home.
By the time a “lockdown” was imposed by the prime minister on March 23, the virus was spreading fast and Kaygan was beginning to feel sick. “She started feeling a bit uncomfortable,” her uncle Hasan Rusi said. “She had a temperature and was coughing. It might have been a cold, it might be a virus.”
Established plans drawn up by the government for dealing with a flu pandemic had always been clear that care homes could be a place for infection to spread. But on February 25, Public Health England, a government agency overseeing healthcare, stated it “remains very unlikely that people receiving care in a care home or the community will become infected.”
The guidance was widely reproduced on care home websites and stayed in force until March 13. It meant that few care homes restricted visits and few families withdrew their relatives from homes. No plan was put in place for testing staff. A government spokesman said that advice “accurately reflected the situation at the time when there was a limited risk of the infection getting into a care home.”
On March 12, the government shifted from what it termed a “contain” to a “delay” phase, after the World Health Organisation declared an international pandemic. The UK now focused efforts on mitigating the spread of virus through the general population, allowing “some kind of herd immunity” to develop, as the chief scientific adviser, Sir Patrick Vallance, explained on BBC radio on March 13. But, said Vallance, “we protect those who are most vulnerable to it.”
David Halpern, a psychologist who heads a behavioural science team - once nicknamed the “nudge unit” - advising the UK government, had expanded on the idea in a separate media interview on March 11. As the epidemic grew, he said, a point would come “where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease.”
Nonetheless, Reuters interviews with five leaders of large local authorities and eight care home managers indicate that key resources for such a cocoon approach were not in place.
There weren’t adequate supplies of protective equipment, nor lists of vulnerable people, they said. National supply chains for food were not identified, nor was there a plan in place to supply medicines, organise volunteers, or replace care staff temporarily off sick. Above all, those interviewed said, there was no plan for widespread testing in vulnerable places like care homes or prisons, let alone an infrastructure to deliver it.
On March 23, Johnson announced another shift in strategy, replacing the mitigate-plus-cocoon approach with a broader lockdown. Schools, pubs and restaurants were shuttered, sport cancelled and everyone was told to stay at home.
For local leaders, caring for the most vulnerable became increasingly challenging. Typically, they said, new plans were announced in an afternoon national press conference by a government minister, with instructions to implement them, sometimes the next day, arriving by email to councils later that night. Ministerial promises, handed off to the councils, included drawing up a “shield list” of the most vulnerable, delivering food to them and organising and delivering prescription medicines. Even plans for using volunteers were announced nationally, without taking account of volunteer infrastructures that many councils had in place.
“From our vantage point, it sometimes looked like policy made up on the hoof,” said Jack Hopkins, leader of Lambeth Council in south London, an early hotspot for the virus outbreak. Local councils knew they had to act quickly, but there was no dialogue about how things should happen. “It felt very much like government by press release, with local government left to pick up the pieces,” Hopkins said.
It was the same experience in Birmingham, which was also hit hard by the virus. Betts, the council’s chief executive, wants to avoid dishing out criticism in a situation that is “new for everyone.” But, he said, “it did make it quite challenging from a local authority perspective, when, you know, the prime minister says at 5 pm or 6 pm that something’s going to happen. Eleven o’clock or midnight you get some guidance on it, and you’re meant to be off and running in the next day.”
The most acute problem identified locally early on was the shortage of adequate personal protective equipment (PPE) for NHS and care home staff. Yet Jenny Harries, England’s deputy chief medical officer, declared on March 20 that there was a “perfectly adequate supply of PPE” for care workers and the supply pressures have been “completely resolved.”
Five days later, Johnson told parliament every care home worker would receive the personal protective equipment they needed “by the end of the week.” This didn’t happen, and more than a month later, the government’s chief medical officer conceded publicly that shortages remained.
According to Nesil Caliskan, leader of Enfield Council, early statements that local shortages were caused by distribution difficulties proved to be a “downright lie.” The government simply didn’t have enough kit, she said.
The government didn’t respond directly to claims that it gave false assurances or insufficient time and support to councils to implement ministers’ instructions. A spokesman said an alliance of the NHS, industry and the armed forces had built a “giant PPE distribution network almost from scratch.” Councils had been supported with £3.2 billion in extra funding to support their pandemic response, he said, and 900,000 parcels of food have been delivered to vulnerable people.
DO YOU WORK FOR THE NHS?
Three days into the lockdown, on 26 March, the nation was urged to stand at their doorstep or window on a Thursday evening and applaud the NHS. Boris Johnson, by now already infected himself, led the cheering on the first occasion.
For some workers in Enfield, the chants left them uneasy. Working 12 hours shifts for barely £9 per hour, below the non-statutory London Living Wage of £10.75, they wondered if those cheers for caregivers were also meant for them.
“I’m one of them,” one care home employee, who asked not to be named, recalls telling her 12-year-old daughter as her neighbours clapped. The daughter teased her: “Oh, Mummy, they don’t talk about you. They talk about the NHS. Mum, do you work for the NHS?”
The caregiver replied: “No. But it’s the same. We care for people.”
The caregiver was one of three workers who recounted their experiences at an Enfield care home run by a firm called Achieve Together. Each described how, after a patient was sent to hospital on March 13 and confirmed to have the coronavirus, staff were issued with thin paper masks. After a fortnight, staff were told the masks should be saved for dealing with patients with symptoms, and they were taken away. And although several staff developed symptoms and had to isolate, no tests were available. A spokesperson for Achieve Together said staff had access to “more than sufficient supplies of PPE, including face masks and face shields, which are supplied and worn directly in line with Government advice.”
One night, caring for a resident with a lung infection who hadn’t been tested, she’d worn a thin blue surgical mask as she performed close-up procedures like feeding him and brushing his teeth.
The day she spoke to Reuters, April 24, health secretary Matt Hancock had reiterated to the BBC that tests were available for care workers. But for now, none was available for this care worker. Her only option was a drive-through centre, but she had no car.
“I want to be checked and really want to be checked as soon as possible,” she said. “If I had the choice.”
The spokesperson for Achieve Together described the health and wellbeing of residents and staff as “our absolute priority.” Staff and residents were tested “when the Government made testing available.” The company did not specify when those tests took place. It declined to comment on details of the home, citing a need to protect patient privacy.