19 July 2021:
Today has been dubbed ‘freedom day’. People across England regain their freedoms after 16 months of restrictions impacting on everyday life, including where they can go and who they can meet. Yet, for people living in care, we fear very little will change. Visiting guidance for care homes has been reissued with minimal changes. There is no wholesale lifting of restrictions across care settings. Instead people in care face wholesale discrimination as pretty much the only group in England who will still be subject to restrictions on fundamental everyday decisions. Yes, the guidance is advisory but we know many care providers have been reading it as law.
The contrast between the lives of people in care and everyone else has become vast. With all restrictions lifted in the community, life will be able to return almost to normal. I could eat in a packed restaurant, jostle for a drink at my local pub, go clubbing. I could mix with as many people as I wish, having as much contact as I wish, with no mask, no social distancing. For people living in care, the guidance still prescribes what kind of visitors are ‘allowed’ and how much contact residents can have with them, even retaining “handholding is acceptable”. Although residents will now be able to have an unlimited number of ‘named visitors’, in reality this is likely to change very little as many homes are operating a booking system with strict time limits, in dedicated visiting rooms (which many people with dementia find too distressing). And if a resident needs an overnight stay in hospital, they will still be subject to a two week quarantine on return, which we know from our helpline is having a devastating impact both mentally and physically. The difference in treatment is astonishing.
The Government mantra of ‘data not dates’ now seems to have turned on its head to become ‘we must do this during the summer, no matter the data’. This dogged insistence on wholesale lifting of restrictions seems reckless in the face of rising cases, hospital admissions and deaths. The plan appears to be to keep people living in care locked down, while letting the rest of country get on with life and hope for the best.
But wrapping people in care homes up in cotton wool is simply not possible, desirable or lawful. Care homes are part of their communities. Care staff live in those communities, in households with people who are now free to mix with, dance with, hug as many people as they wish with no safeguards to control the spread of the virus. With cases rising in the community, the Government is putting people in care at risk by lifting all restrictions for the general population. Why not retain some of the simple safeguards on us all, to manage the virus, like face coverings? The Government has failed to give a convincing explanation for this and seemed desperate to press ahead with this grim experiment.
Care settings are people’s homes. People living in care have the same legal rights as the rest of the population to see their relatives and friends, get out and enjoy the summer, make choices about their lives. These rights are protected in law through the Human Rights Act, which sets out a framework for the Government, its agencies and care providers to make balanced, proportionate decisions about managing risk. Instead, the Government guidance for care homes leads the way on risk-aversion. Having put lives at risk during the first wave through policies like discharge from hospital into care without testing, the Government has swung dramatically to the other extreme, imposing severe restrictions on movements in and out of care homes for residents and their families. People in care have lived under more stringent restrictions, for far longer. For people already in a vulnerable situation, the harm has been devastating.
The guidance on visits in and out of care settings now needs a complete and urgent overhaul. It must start from a position of recognising care users’ rights, using the framework of human rights law to ensure any restrictions on those rights are necessary and proportionate. Infection and prevention control safeguards (such as testing and face coverings) should be built into that framework where necessary to ensure protection of those rights. A complete change in approach and language is needed in the guidance, to give leadership on ending the closed cultures which have taken hold in some care settings. Care staff need support on understanding and using their legal duties to balance risk and protect rights. This must run alongside a properly thought through strategy for reopening not only to relatives and friends, but also health practitioners, social workers, regulators and other professionals vital to protecting wellbeing. R&RA have been calling for this since June last year.
The country came together to fight covid. We should have come out of it together. The Prime Minister’s roadmap should have united us to manage covid in the long-term. Instead it has divided us in the most appalling way, by leaving behind the people hit hardest by lockdown.