People or politics, who are we protecting?
'Seen something? Say something.' is the Scottish slogan to protect adults at risk of harm, so why were those who saw harm in care homes during lockdowns dismissed or ignored when they said something?
Same storm, different boats accurately describes the events of 2020 onwards. Lockdowns were a welcome opportunity for many people to step off the treadmill of life but for others, especially those who lived on their own, isolation due to the cancellation of all sources of social contact and support was akin to a prison sentence. Small businesses struggled and thousands were forced to close with a subsequent rise in deaths by suicide.
Care homes were subjected to their own sets of rules with restrictions continuing long after they were lifted for the rest of the population. Care homes are already chronically understaffed so the removal of relatives and other services who provide invaluable scrutiny on care standards was a predictable recipe for disaster that should have been recognised and avoided.
Unknown to most due to scant reporting on mainstream news, the Scottish Covid-19 Inquiry (running at a cost in excess of £30 million with no projected end date or budget) has laid bare the stark reality of what went on behind the closed doors of care homes. While failing to explore fundamental questions about the necessity of Covid-19 interventions, a wealth of evidence has been gathered about the detrimental impact of the government’s response to Covid-19 in the first part of the Scottish inquiry which has focussed on health and social care.
These distressing testimonies give witness to the profound neglect of care home residents, many of whom were denied necessary medical care or given untimely end of life medications which hastened death, assisted by blanket approaches to DNACPRs (Do Not Attempt Cardiopulmonary Resuscitation). Many died as a consequence of isolation and loneliness, unable to understand what was going on and believing they had been abandoned. It is now widely recognised that the majority of care home deaths attributed to Covid-19 were most likely due to what has been termed ‘confinement disease’.
Why was this allowed to take place over such a prolonged period when Scotland has a robust legal framework which could and should have been used to protect care home residents; the majority of whom are frail with a diagnosis of dementia or some other cognitive or sensory impairment?
The Coronavirus Act 2020 changed or suspended many safeguards, particularly in relation to the role of attorneys and guardians. However, the Adult Support & Protection (Scotland) Act 2007 (ASPA), which has a similar but more robust function and infrastructure than the Care Act 2014 in England, was unaffected. Indeed, the ASPA was enhanced with an amendment to recognise that covid infection could create a new situation of risk for adults.
The ASPA provides a framework to support and protect adults who are unable to safeguard themselves, their property or rights from harm. Harm can take many forms and may or may not be intentional; physical, psychological, sexual, financial, neglect or self-neglect. No category of harm is excluded simply because it is not mentioned in the Act, such as institutional harm which may prompt large scale investigation to identify if there is some failing or deficit in the management of the establishment or in the environment.
The ASPA has a robust infrastructure which ensures that all health and social care staff and other agencies such as the police, ambulance and fire and rescue services are aware of their responsibility to recognise and report harm. Each of Scotland’s 32 Local Authorities has a multi disciplinary Adult Protection Committee which oversees the functioning of the Act and these committees are overseen by a National Strategic Forum hosted by the Scottish Government. This robust infrastructure gives priority to adult protection and ensures that all health and social care staff (and the public) are aware of their responsibility to recognise and report harm of which there is no threshold and absolutely no exemptions. Reporting all harms, irrespective of personal bias, is essential to recognise patterns of harm which again may prompt large scale investigation and of course a resolution to whatever is causing the harm.
The first release of adult support and protection data in Scotland was published in May 2023 and includes data from 2019/20-2021/22. Even prior to the issue of formal data collection, it was known that harm was most likely to take place or be reported to be taking place in a person’s own home followed by care homes. With a notable rise in referral rates, the data raises a red flag with the drop in ASPA investigations taking place in care homes over the lockdown period when care home residents were being subjected to life threatening harm. There were 1,184 investigations in 2019-20 dropping to 884 in 2020-21. Unsurprisingly large scale investigations also fell in 2020-21 at a time when they were most required. However, in the same period, investigations in people’s own homes rose, which is telling of the removal of scrutiny and access to care homes.
This vital information is given scant attention in the analysis of the data in the Scottish Government’s own statistical report and also in a report published in May 2023 by IRISS, Adult Support & Protection, Everyone’s Business; a document intended to raise awareness of adult support and protection but fails to acknowledge the detrimental impact of lockdowns in care homes.
Isolating frail older people and denying them access to essential medical care and treatment was obviously going to cause serious harm. Why then were these harms missed, dismissed or ignored, even when changes to the ASPA actually prompted recognition of increased risk? Was everyone so confident in the effectiveness of infection prevention and control measures that they failed to see when they were causing harm? Indeed, if they recognised harm at all, did they consider it to be ultimately beneficial for both the individual and the greater good so failed to recognise it as harmful? Even when neglect resulted in severe injury or death?
From early 2020, the Scottish Government and Scottish health and social care organisations were alerted to ongoing and potential harms to care home residents as a direct result of covid-19 management measures. CEOs of health and social care organisations mainly agreed that harm was being caused but were either unwilling or unable to take action because organisations didn’t seem to have the authority or governance to challenge government policy.
Regardless of individual opinion on the necessity of the interventions that were imposed on care homes, the health and social care workforce should have been encouraged to say something when they saw something was wrong. Referrals and subsequent investigations should have soared which in turn would have alerted government ministers to the serious nature of harm occurring in care homes. Had this been done, the atrocities as documented here could have been avoided rather than regretted with hindsight. Instead, those who raised the alarm on harm were censored and silenced, cancelling any opportunity for open and balanced debate.
The Scottish inquiry has fairly given a voice to those who were harmed but it’s unlikely that either inquiry will be interested in asking why the health and social care workforce caved to politically motivated policies with no evidence base, over our normally robust legal framework, professional standards and codes of ethics. Not to mention common sense.
From my own perspective, working in the field, it was made extremely clear to me that any deviation from, or questioning of, 'the rules' which were in spirit and practice upheld every single time (daily) the then First Minister of Scotland announced how "heavy" her heart was, was not to be countenanced. I did my individual best by recording in my work notes every occasion when it was obvious to me that a person was suffering because of the restrictions. As far as I am aware none of my colleagues did the same. From what I've seen since, the swallowing of social work into a much larger corporate mentality was accelerated by the events of 2020-2022.
Thank you for a very informed and interesting article. No one in the nursing and care homes set out in 2020 to cause harm to the people in their charge, but it did happen. Following orders blindly can lead you down a path of destruction when the orders themselves are bad, it coming from the government and our health institutions in a so called "emergency" seemed to supersede any protection laws so they were toothless in safeguarding the victims. The majority of people just blindly followed the orders given to them by their government and health institutions, all of this was so insidious because it came under the guise of "health care" and "infection control" and it was wielded with no mercy onto the elderly especially in care and nursing homes. There was no compassion, no humanity instead the orders were cold, callous and inhuman which caused the most damage to vulnerable people. The engineers of this pandemic travesty knew exactly what the fallout of their actions would be.