Britain’s Covid-19 Care Home Cull

This article was originally published at Ebb Magazine here. Featured image by Ramona Sharples.

‘We did everything we could have done and we will carry on doing everything we can.’ This is how Boris Johnson characterised government policy on 26th January 2021, as Britain headed past the 100,000-death mark, with disabled people accounting for 60%. Bear this quote in mind as you read through this account of government actions towards care homes over the past year, and how care home residents account for between a third and 40% of deaths, yet they represent just 0.65% of the population. And that’s at least 10% of care home population culled, without even taking into account indirect causes of death; a study by the University of Manchester in November estimated that care home death toll was undercounted by 10,000. Journalist Julia Hartley-Brewer – citing official NHS England figures published on 19th November that 96% of Covid-19 deaths had ‘pre-existing health conditions’ and 92% were aged over 60 – concluded that the pandemic response has been overblown. After all, who cares about over-60s or those with pre-existing conditions? This is supposedly Britain’s ‘Greatest Generation’, yet more have been killed by Covid-19 than by the Blitz (which took approximately 32,000 lives).

Why is the British ruling class, exemplified by the likes of Julia Hartley-Brewer, so callous about the lives of our grandmas and grandads? Money, essentially. Those with non-standard bodies (and minds) slow down the production process and in various ways are a drain on profit for capitalists. They’re ‘unproductive’ as far as businesses are concerned. The ‘unproductive’ include the elderly and the disabled, and Britain’s ageing population has been a source of concern for its ruling class for a long time. The Office for National Statistics predicted that 25% of Britain’s population will be over 65 by 2066, and they already outnumber under 16s; a Times article from 2018 was headlined: ‘An ageing population is posing problems that Britain cannot ignore’; and in 2017, the Conservative Party tweeted, ‘There will be two million more people over 75 in the next 10 years – we to have a plan to deal with that challenge.’ Covid-19 presented the government with a convenient solution.

The government had already been killing the elderly for years through pension cuts, depriving them of heating funding (during the winter, the cold kills an elderly person every 5 minutes or so), while the disabled have suffered attacks (over 17,000 have died while waiting for benefits) through the bedroom tax, benefit sanctions, and austerity cuts to council services. The NHS has been decimated and left unfit for purpose and the disabled have been increasingly segregated into underfunded care homes and deprived of accessible housing. Segregation has intensified by allowing landlords to operate ‘no benefits’ prerequisites for tenants, reminiscent of ‘no blacks, no dogs, no Irish’, and care has been outsourced to (often untrained) volunteers as much as possible.

Care homes are, you’ll be shocked to discover, actually homes, not hospitals, and care staff are not necessarily qualified to nursing level – nor do they have adequate stocks of PPE at the ready. Care homes are places where people live; they have the right not to be exposed unnecessarily to a lethal disease. To give an insight into the horror of the situation: approximately 350 non-Covid patients died of thirst in care homes and hospitals during the first lockdown, let alone anything else. The British Medical Journal recent editorial characterised governments such as Britain as committing ‘social murder’ in their response to the pandemic. Friedrich Engels first described this in 1845:

‘When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live — forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence — knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual; disguised, malicious murder, murder against which none can defend himself, which does not seem what it is, because no man sees the murderer, because the death of the victim seems a natural one, since the offence is more one of omission than of commission. But murder it remains.’

The government didn’t send hitmen in with guns to massacre care home residents, but that doesn’t mean it isn’t a form of murder. Here’s how it happened.


Discharge and legislation

On the 27th of May, Boris Johnson – famed around the world for his honesty – declared ‘it’s just not true that there was some concerted effort to move people out of NHS beds into care homes.’ The NHS reserved 1800 beds in care homes right at the start of the pandemic and proceeded to discharge 25,000 patients between 17th March and 15th of April in England (plus about a thousand each in Wales and Scotland). Most weren’t even tested and, of those that were, patients who tested positive were discharged anyway (7 in Hull, 20 in Bristol and so on, 20% of care homes admitted patients with Covid-19 positive tests).

The government published guidance on 2nd April, titled ‘Admission and Care of Patients during Covid-19’, which stated:

‘the care sector also plays a vital role in accepting patients as they are discharged from hospital… Some of these patients may have Covid-19, whether symptomatic or asymptomatic… Hospitals around the country need as many beds as possible to support and treat an increasing number of Covid-19 cases. This means the NHS will seek to discharge more patients into care homes for the recovery period’.

No concerted effort, indeed. A Sky News survey of care homes found 70% of care homes felt pressured to take Covid-19 patients.

From April 15th, care homes received the formal ability to demand a test and reject Covid-19 patients, however, local councils replied by threatening to withhold pandemic funding unless they took patients in. Leading voices in the care sector also revealed that the £600m fund from the government actually prevented them spending the money on PPE for staff. Guidance was updated on September 16th reiterating that care homes should still be prepared to take Covid-19 positive patients from hospitals.

While the door was forced open to care homes, the door to hospitals was slammed shut. NHS hospitals were often operating a ‘no admissions’ policy for care home residents. The reason given for all of this was to prevent the NHS reaching capacity. Yet the Nightingale hospitals created specifically to deal with Covid-19 treated barely a trickle of patients, and then were largely kept ‘in hibernation’. The Nightingale hospital in London Docklands was arranged to have 4,000 beds, opening in early April, but the 7 hospitals across the entirety of England admitted hardly any patients at all (about 50 in London and approximately 100 in Manchester), and only briefly before they were put into ‘hibernation’ with potential capacity of several thousand beds and costing tens of millions in maintenance. Moreover, the NHS did not near capacity at any point; Alex Thomson of Channel 4 news tweeted on 14th April: ‘Govt policy is to push recovering Covid hospital patients into care homes because NHS needs beds. Odd since no major hospital seems to be full and vast Nightingale field hospitals lie all but empty’.

Further to this, the fact that the government felt it necessary to grant legal immunity to health services and local authorities providing care for disabled people with the 2020 Coronavirus Act on 25th March and essentially suspend the legal duty to meet the needs of the disabled, could be considered a smoking gun. When discussing these facts with various people I tend to get the response: if this were true, there’d be a huge outcry. Well, let’s hear it from the government’s own ministers and MPs. Ros Altmann, former government minister, said care home residents ‘are being abandoned like lambs to the slaughter.’ She told Today:

‘They are left without protective equipment, they can’t find it, or testing even if they request it, it’s not always given to them. They haven’t got the staff they need … and they feel that the NHS has kind of left them in the lurch. GPs are not coming into the care homes in the way that they used to and some are finding if people need to be hospitalised either that tends to be very difficult or if people are sent to hospital they are sent back very quickly and there are no tests so they don’t know if these people are infecting others in their care homes.’

Tory MP Geoffrey Clifton-Brown characterised government approach to care homes as a ‘pretty reckless policy.’ Even Jeremy Hunt attacked his own government and a cross-party public accounts committee reported on 29th July that the Department of Health and Social Care (DHSC) had continued with the policy ‘even once it was clear there was an emerging problem’, and the chair (Meg Hillier MP), said ‘our care homes were effectively thrown to the wolves, and the virus has ravaged some of them.’

In response to criticism, Health Secretary Matt Hancock simply stated that it was not illegal. Boris Johnson shifted blame onto the care homes themselves: ‘We discovered too many care homes didn’t really follow the procedures in the way that they could have.’ However, they followed the procedure of accepting Covid-19 positive patients as a fait-accompli – this is what caused the death toll. Labour provided zero opposition and their Five Point Plan in September didn’t even mention the seeding of the virus among those most vulnerable to it.


Floating cover staff, inspectors, and testing

The virus was further spread by allowing floating cover staff to move between different care homes, according to a study using genome tracking by Public Health England (PHE). Conducted from 11th to 13th April, results were known since – at the latest – the end of April, but weren’t circulated to care homes until weeks later. During this time at least 2,500 people died in English care homes. A report as far back as 2018 from flu pandemic planners warned ministers about controlling ‘cross-infection’ from such frontline temporary care workers.

A further document by PHE in 2019 regarding flu pandemic prep urged operators to avoid moving staff between homes and floors, yet the DHSC’s plan published on 16th April refrained from giving this same guidance which is so crucial in saving lives. In November The Telegraph reported that the government still hadn’t stopped agency workers from ‘roving’ across multiple sites, yet the spread of infection in care homes accounted for 82% of multiple outbreaks in the four weeks prior to the 8th of October, according to PHE.

In August the Care Quality Commission was repeatedly denied testing for its inspectors, a further risk of spread between 500 care homes planning to be inspected over a six-week period. The care sector trade union, GMB, predicted that inspectors would spread the virus ‘like wildfire’ through care homes: ‘we can’t comprehend why the government would deny inspectors access to testing.’ Technically, care staff have been eligible for tests since 28th April 2020, but the DHSC capped the daily amount of care home tests at 30,000 (both staff and residents). Tests were outright denied to people with learning disabilities and autism in care homes. Government guidance from the 15th April and updated on 14th May stated: ‘you can only get tests if your care home looks after older people or people with dementia.’ By the June 6th deadline for testing all care sector staff, the government had only managed about a third.


DNRs & frailty scale

At the beginning of the pandemic a ‘frailty index’ was created by the National Institute for Health and Care Excellence (NICE) to assess viability for critical care – those scoring above five on a scale of nine would be considered potentially disqualified from critical care. That included the ‘moderately frail’ – the patients who need help with complex tasks like financial management, transport, or heavy housework. NICE were soon forced to make U-turn on their advice for the NHS to deny disabled people treatment, but only after threats of legal action from disability groups. This index didn’t have a huge amount of time to do much damage, but is nevertheless another major indication of intent. The use of ‘Do not attempt resuscitation’ notices, on the other hand, functioned in a similar way, but were unable to be stopped in their tracks.

DNR notices waive the patient’s right to life. Typically these are signed by doctors in consultation with patients or failing that, their families, in situations where it’s in the best interests of the patient, in terms of minimising suffering, for them not to be resuscitated. One in ten care homes were told to place blanket DNRs on their residents or found that decision was taken by NHS staff without consultation with patients or their families, a report in August by Queen’s Nursing Institute found. Other patients were given DNRs as soon as they caught Covid-19. Some care homes delayed calling ambulances because of the DNRs. Residents ‘felt pressured to agree to an advance Covid-19 care plan that stated they would stay at home without treatment if they contracted the virus.’

GPs across the country were writing to vulnerable patients advising them to fill out DNR forms in order to prioritise more able-bodied cases of Covid-19. One GP in Somerset recommended that autistic adults in care homes needed DNRs and another in Scarborough tried to apply it to an 11-year-old boy with cancer. Between July 2016 and December 2018, 19 hospital patients who died had ‘learning disabilities’ or ‘Down’s Syndrome’ given as the reason not to resuscitate. Turning Point, a learning disability care provider, stated that it had received an ‘unprecedented’ number of unlawful DNR orders for its patients. Hancock promised to ‘take action’ on wild use of DNRs, only after threat of a judicial review on 14th July. Yet, as late as October a press release by Amnesty International stated,

‘The horrifyingly widespread use of [Do not attempt cardiopulmonary resuscitation] orders for care home residents is one of the most deeply disturbing scandals of the pandemic. There’s no doubt that this was a violation of residents’ human rights and could have caused avoidable deaths… As we speak, countless do-not-resuscitate orders may remain in people’s files. Many of these people could fall ill in the coming months… It is also imperative that mechanisms are urgently put in place to ensure that there is full awareness across the health and social care sector that do-not-resuscitate orders must never be interpreted as meaning a person should not be transferred to hospital or receive other types of medical treatment.’

Furthermore it was found that around two thirds of people with underlying conditions (such as diabetes, high blood pressure, respiratory issues like asthma) were denied care during the pandemic.

It doesn’t matter to what extent this was premeditated and fully deliberate. Whether the government actively wanted to kill residents or simply didn’t consider them worthy of keeping alive is moot; the outcome is the same: social murder. A massacre, in fact. The government does have a motive, it had the means and it had the opportunity. They’ve tried to maintain plausible deniability, and this will be accepted by those who are in the habit of whitewashing Britain’s crimes and murderousness even in the face of overwhelming evidence. The crimes of Britain are legion and include, pointedly, use of germ warfare to commit mass murder and even genocide (using disease against Native Americans and First Nations in what is now the USA, Canada and Australia, and then between 1940-1979 tested biological weapons, including anthrax, on its own citizens in Britain, affecting the elderly in particular). The Conservative Party openly talked about the elderly and the disabled as posing a problem and a financial burden, before the government actively funnelled a lethal virus into care homes which house the very people most vulnerable to the disease. They deprived them of testing, protective equipment and other essential resources. They allowed floating cover staff and inspectors to exacerbate the spread, denied residents access to hospitals and forced DNRs on them. Case closed.

With special thanks to Prolekult, whose dedicated ongoing research of this issue has been fundamental to the writing of this piece. Make sure to watch their incredible documentary on this topic: Camps of Dependence.

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