Engage: Following PM’s criticism of care homes what guidance was produced and when?

The Prime Minister has sparked anger among care providers after saying “too many” did not follow procedures properly during the coronavirus outbreak.

With some providers reporting up to 100 different pieces of guidance in as many days, it is unclear what specific procedures Boris Johnson was referring to.

Here is a timeline showing some key Government publications alongside developments in and affecting care homes.

February 10 – According to notes from a meeting held by the Scientific Advisory Group for Emergencies (Sage), experts believe that there is “a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks”.

February 25 – The Government publishes guidance which twice states it is “very unlikely” that people receiving care in a care home or the community will become infected.

But the start of the guidance says it is “intended for the current position in the UK where there is currently no transmission of Covid-19 in the community.”

March 5 – England’s chief medical officer Professor Chris Whitty tells MPs it is “highly likely” there is “community transmission” of coronavirus in the UK.

March 13 – The February 25 guidance is withdrawn. New guidance from Public Health England (PHE) advises care homes to review their visiting policy by asking those who are unwell to stay away and emphasising good hygiene for visitors. It says any review should consider the positive impact of seeing friends and family on residents.

Care home providers are advised to share their workforce between providers.

Residences are not expected to have dedicated isolation facilities but should implement isolation precautions when someone in the home displays symptoms of Covid-19.

Staff are not required to wear personal protective equipment (PPE) above what they would usually wear if a resident does not have symptoms.

March 17 – NHS Trusts are asked to “urgently discharge all hospital inpatients who are medically fit to leave” to help free up critical care capacity for those seriously ill with Covid-19.

Two days later Government guidance on hospital discharge service requirements is published detailing how this can be implemented.

If a patient has been tested for Covid-19, results should be included in documentation that accompanies the person on discharge, it says.

March 23 – Prime Minister Boris Johnson announces the strict nationwide lockdown is to begin, with people only allowed to leave home for essential reasons.

April 2 – Government guidance on the admission and care of care home residents says “negative tests are not required prior to transfers/admissions into the care home”.

It says all patients, asymptomatic or otherwise, can be safely cared for in a care home if guidance on infection control is followed.

The guidance also states that family and friends should be advised not to visit care homes, “except next of kin in exceptional situations such as end of life”.

April 15 – The Government publishes its action plan for adult social care, setting out its approach for controlling the spread of infection in the sector.

It confirms a move to put in place a policy of testing all patients prior to admission to a care home, and of testing all symptomatic staff.

Where tests are negative it still recommends isolation for 14 days.

It acknowledges some care providers will be able to accommodate confirmed Covid-19 patients through isolation strategies, while local authorities will be asked to find alternative accommodation for those providers that cannot.

In terms of outbreaks, all symptomatic residents will now be tested. Previously, this only applied to the first five symptomatic residents in each care home.

May 13 – Mr Johnson announces a £600 million package for coronavirus infection control in English care homes as he admits that the number of deaths among residents has been “too high”.

The ring-fenced funding, which also aims to cover homes’ additional staffing costs, comes with the condition that managers restrict permanent and agency staff to working in only one care home where possible.

May 15 – The Government publishes its care home support package guidance detailing the next stage of its plan to prevent and control Covid-19 in all registered care homes. This highlights the risk of asymptomatic transmission of Covid-19.

Health Secretary Matt Hancock announces his pledge for universal care home testing, saying “every resident and every member of staff in our elderly care homes in England” would be tested “between now and early June”. The Government later says its target is for all care homes with patients over 65 to have been offered tests by early June.

May 19 – The April 2 guidance is updated to add a loss of, or change in, normal sense of smell or taste (anosmia) as a symptom of coronavirus.

June 5 – Figures from the National Care Forum show more than a tenth of care homes it surveyed had not received coronavirus testing kits as of June 2.

June 19 – The April 2 guidance is further updated to bring it in line with the care homes support package announced on May 15, more than a month earlier.

The policy on visiting is being reviewed and will be updated “shortly”, the Government says.

June 25 – The Government says around 10,000 care home residents and staff in more than 100 homes in England will be repeatedly tested for coronavirus in a study examining patterns of outbreaks over time.

July 3 – The Government says all staff and residents in care homes for people over 65 or with dementia will be regularly tested for coronavirus from the following week.

Copyright (c) PA Media Ltd. 2020, All Rights Reserved. Picture (c) Yui Mok / PA Wire.