Care homes have, without doubt, shown us the ugliest face of Covid-19. And yet, I wonder, when the inevitable enquiry comes, will the medical profession be honest with itself, bold enough to look inwards and discuss the thought process and actions which sprung forth?
There were decisions being made around residents of care homes very early on that terrified and saddened me. Of all of the medical decisions that I have witnessed in this pandemic, the approach to the elderly and care home residents has literally given me nightmares.
I listened to Matt Hancock tell journalists at the daily briefing that there no blanket rule to refrain from escalating care home residents care to hospital if needed or to put in place DNARs. And I know that wasn’t true. I don’t know if he was lying or just didn’t know. But he wasn’t right.
I had conversations with colleagues who described elderly patients who likely had Covid and were deteriorating and so they were ‘being made comfortable and difficult conversations had with relatives’. I had online discussions with colleagues asking why they didn’t send the patient in to hospital. There was a strong chorus of disbelief that I would even ask such a question. Replies along the lines of: ‘Really? You think a frail 82-year-old would do well on a ventilator?’ I was roundly mocked. I doggedly made the point that the stats were still strongly in favour of that 82-year-old surviving and they may just need oxygen support. Not everyone needed a ventilator. What if it were your mum? Your grandpa?
Were we all so blinded that we bought into the idea that this particular patient cohort would take a ‘valuable’ bed?
I was sent copies of the ‘frailty score’ which was being used as a delineator of who should and shouldn’t be sent to hospital. That the CCG were handing down instructions on just this very issue. And of course, the CCGs felt supported by the NICE guidance on using the frailty score for deciding who gets critical care.
I was reading tales of GPs who were instructed to go to their care homes and put in place DNAR forms across the majority of residents. And we are seeing reports of Midazolam prescriptions doubling in care homes during lockdown.
We now have firm evidence of the excess cancer burden caused by knee-jerk and blanket decisions that closed departments and withdrew treatments. I can’t help but feel that we will uncover the same regarding blanket decisions about care home residents and who should and shouldn’t be escalated to hospital in Covid.
And now I’m left with almost identical questions all over again. Who has the right to make the decisions for individuals whom were not necessarily ready to die, who would have wanted hospital treatment given the choice, even a ventilator if it came to that? And I don’t think for a second that any colleague made these decisions glibly or easily, but I do wonder at the value we place on someone who is ‘frail’, who is elderly, who lives in a home, who has dementia. I know this virus represented unprecedented times; decisions were made quickly; the Government did a great job of terrifying the nation, from members of the public though to doctors.
Did we then make unpalatable decisions in the midst of this terror? Were we all so blinded in the headlights of Covid, by the Government message that the NHS was/would be overwhelmed, that we bought into the idea that this particular patient cohort would not do well, would take a ‘valuable’ bed and therefore they must therefore stay put?
Whatever the answer, we must find it, learn from it, hear from the victims’ relatives and maybe even apologise. We must reflect to learn.
Dr Renée Hoenderkamp is a GP in London
