Facing up to mistakes to learn for the future
Audit Scotland today reports what the government in Scotland did during the first months of the Covid-19 pandemic to prevent the NHS from becoming overwhelmed. My analysis is this. They did the following -
Some overdue modernisations we should keep such as rolling out more digital consultations and having community hubs to support GPs.
Some overdue things that only cost money, such as increasing the workforce capacity which nurses and other unions had already been asking for.
Some regrettable but unavoidable things that will almost certainly have caused harm to patients, such as pausing screening and non-urgent treatment.
A thing that could have been avoided and turned out to have been unnecessarily quick and was predictably risky. This was almost 3,000 rapid discharges of untested patients from NHS hospitals into care homes from March 1 to 21 April. My view is that this last one definitely caused harm, but the government is keen to say it did not cause the harm. It was not responsible.
The government would want to avoid the idea that they caused harm. But the exodus happened because for years they have failed to plan the NHS to get older people out of hospital timeously. Capacity outside the hospital was found within weeks so why was it not used before?
The Audit Scotland report (para 29, p17) repeats the attempted evasion of government responsibility from the Public Health Scotland review of rapid discharges. Even though both say there were “significant issues with the data”. There should be significant issues with the conclusion that rapid discharge was safe. It must be challenged.
My issue* with the data goes on and on. You might not follow it in a brief blog but there’s a point. The mass ejection of mainly older people was only needed because delayed discharges had been allowed to build up. Of course it would be convenient for the health department if the problem lay not with what they did, but failures in the destination private care homes.
*The data and analysis
The study was observational i.e. they can show what appeared to happen but do not tell us what the cause was. It only examines association not causation. But they come to conclusions about cause and blame the care homes.
They find encouragement from the fact that a Welsh report gave the same result but on page 43 it says that they used the same methodology as Wales, so it is not surprising the results were similar.
The work did not include data submitted by the care homes themselves.
They attribute risk to big care homes without asking how many untested patients were put in bigger as opposed to smaller ones. They may have had a smaller viral load introduced into to their buildings from new residents.
They are not clear how deaths were counted as Covid-19 without testing, or whether dying without seeing a doctor was more or less likely in either setting
The only threat marker they use for large care homes is the number of non-residents coming into the care home, and they say that layout, design, staff rotas etc are likely to be important but were not examined with the data they had at the time
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