Richard North, 18/05/2020  
 


When Michael Gove was challenged on yesterday's Marr Show about the government's stance on care homes, few would have expected the minister to roll over and tell the truth. They were not disappointed.

What is interesting in a macabre sort of way, therefore, was to see how Gove evaded the questions and the skill with which he stretched the truth way beyond breaking point – and yet managed to get away with it.

The issue at large, of course, is the way patients were dumped on care homes in order to clear the decks for Covid sufferers, thereby spreading the infection into the care sector.

Specifically, on 19 March, NHS hospitals were instructed to discharge 15,000 patients to make room for the expected "surge" of Covid-19 patients, anticipating that about half of these would need support from health and/or social care.

Gove's "defence", to say the very least, is disingenuous. He does not deny that this happened. Rather, he claims that "the number of people being discharged from hospitals into care homes has been falling throughout this crisis and has been far less this year than last".

Needless to say, the point is irrelevant, so Marr comes back to him, asserting that the problem related to "the people who were in that position right at the beginning". Some of them, he said, "were infected with Covid-19 and you put people who were infected with Covid-19 out of hospitals and into care homes and you knew that was happening".

Unfortunately, Marr – as so often – misses the point. He does not refer to the instruction to the NHS hospitals on 19 March but instead refers to "government guidance on two care homes", current until the 15th of April. This read: "Some of these patients admitted to a care home may have Covid-19. Negative tests are not required prior to admissions in care homes".

"That", says Marr, "was a terrible mistake", but it is not the relevant point, and it lets Gove off the hook. "Well let me say three things", Gove counters. "Firstly on testing we've significantly increased the number of tests so that tests are now available for all those who are symptomatic in care homes".

Secondly, he says, "our guidance has altered over time but that is as a result of our scientific understanding of the virus changing over time". And then he has a "third thing". The critical point, says Gove "is, the decision as to whether or not a patient is in a hospital or in another setting, a care home or home is a clinical decision".

Developing that point, he argues: "it is often the case that for a patient it will be far better for them – they will receive better care if they are in a care home than in hospitals".

Marr makes a half-hearted counter, asking whether they might not be "infecting other people in the care home as a result?", but Gove thinks he's on a winner: "The key thing", he says, "is a clinical decision is made both about the patient and about the infection risk".

In hospitals, he adds, "there is also a risk of infection as well, as we know, and hospital beds are there for people who require a particular type of intervention because they have an acute problem, so it is a difficult judgement to make but it is one where the clinician is in the lead". That's his key defence – blame avoidance: "it wasn't me guv, it was them clinicians".

Had Marr been better prepared, he might have cited the 19 March instruction. It starts:
This document sets out the Hospital Discharge Service Requirements for all NHS trusts, community interest companies and private care providers of acute, community beds and community health services and social care staff in England, who must adhere to this from Thursday 19th March 2020.
This is a direct instruction to NHS trusts, which goes on to say that: "Implementing these Service Requirements is expected to free up to at least 15,000 beds by Friday 27th March 2020, with discharge flows maintained after that". It adds:
Acute and community hospitals must keep a list of all those suitable for discharge and report on the number and percentage of patients on the list who have left the hospital and the number of delayed discharges through the daily situation report.
This is unequivocally a direct instruction – there is no clinical judgement involved. Hospitals are given no choice. They must clear the decks. The choice of the individuals may be up to the clinicians, but the numbers are not in question.

But Marr fluffs it. Apparently unaware of the instruction, he chooses a different point. "I don't dispute that it's difficult", he says, "but when you say clinicians are in the lead, Ministers were warned back in 2017 in the Cygnus Exercise that this was going to be a problem". He continues:
The government's own assessment of this said there’s going to be a problem in the care home sector if take during a pandemic people out of hospitals and put them into care homes. And the care homes may not be able to cope – as they have not been able to cope. All of this has been proved. Ministers knew about it ahead of time.
Gove is now off the hook. "Well, this is the reason why we have had fewer people being discharged from a hospital into care homes this year", he says, "40 percent fewer. That’s one of the steps that we've taken".

Marr gives it another half-hearted push: "It doesn't matter how many if they've been infected with Covid-19 when they go into the care homes", he protests. But Gove is home free: "No, no, this is the key thing. 40 per cent fewer overall", he says, "and at the same increased investment in the care home sector of the kind that I mentioned, 3.2 billion pounds".

In full flow, he boasts: "And at the same time deliveries of personal protective equipment, and at the same time an increase in the provision of the tests so that we now have more tests in this country than any other European country".

It goes on a little longer, but it's all over bar the shouting. Gove's final throw is that, "if we look at the proportion of people in the UK who've died in care homes, that is significantly lower than the proportion of people in European countries who've died in care homes".

Sadly, this is not the first time we've commented on the uselessness of Marr, but this time he has sunk to new lows – as has the BBC. The sheer amateurism of his approach and his lack of preparedness are a stain on the corporation and the continual use of a supposed "star" who is clearly not up to the job.

But then the media generally have lost it. Even when they manage to produce something of value, they fail to give it the prominence needed, and effectively throw the game.

In this context, we have the Guardian preening itself for its "exclusive" on Covid-19 and hospital infection. "Up to 20 percent of hospital patients in England got coronavirus while in for another illness", it declares, adding, "Some infections were passed on by hospital staff who were unaware they had Covid-19".

The upshot of this extraordinary situation is, effectively, that up to 6,000 of the 30,000 hospital deaths recorded in this epidemic have, in one way or another, been caused by hospitals – and that is without adding the deaths in care homes which must be attributed to the hospital discharge policy.

Such matters should be on the front page of every newspaper, the "breaking news" that, in this epidemic, the biggest single cause of infection, the most deadly killer of all is the hospital system. But this is by no means the main concern of the media. It gets far less attention than the idiots who are out each week to clap.

Thank you media. Forgive us if we don't applaud you.

Also published on Turbulent Times.






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