As Scotland’s health secretary hints that our system of social care is in need of a fundamental review, the country’s leaders are being urged to look at the tragic case of Home Farm care home in Portree as a clear example of where things have gone wrong.
At the nursing home, where 10 have died since a major outbreak of coronavirus was confirmed in the last week of April, operators HC-One were last week subject to a court action to strip them of their care licence.
But while a sheriff in Inverness accepted the operator’s pleas that there had been recent improvements, and deferred a decision on the licence until 10th June, calls are growing to shore up the legislation which regulates private care home giants like that which runs Home Farm.
Jeane Freeman, the health secretary, has said that the outbreak had “shone a light” on areas that needed improved.
And for the families devastated by what has unfolded at Home Farm and other Covid-ridden care establishments across Scotland, the action can’t come soon enough.
Fay Thomson, whose sister Meg has been a resident at Home Farm for the past four years, felt authorities lacked power to step-in and properly address concerns.
Although NHS Highland was providing temporary help in Portree, she fears that handing back full control of the home to HC-One could bring a return to the problems which led her family to lodge a complaint last year.
Fay Thomson made a complaint about her sister’s care last year.
She said: “The care inspectorate are diligent in their inspections, but if their recommendations are not met, they are simply carried forward until the next time. It could rumble on and on.”
Mrs Thomson’s sister has Alzheimer’s and the family’s complaint centred on a decision to remove the one-to-one care that she had been receiving between May and October last year.
“It was taken away because of staff shortages, but we felt this was placing her at risk,” she said.
“We had previously been very satisfied with her care. She had a wonderful person with her. Because of staff needs elsewhere she was taken away, and there was no one else in place.”
The care inspectorate recognised the complaint.
In January inspectors found that requirements to address staff shortages, which in turn were having a knock-on effect on hygiene standards and infection control procedures, had not been met.
As the lethal consequences of Covid-19 became clear – with 69-year-old Meg one of 30 residents to test positive for the virus – inspectors returned.
And on the 14th of May the Care Inspectorate, after identifying “serious and significant concerns about the quality of care experienced by residents”, submitted a court application to cancel HC One’s licence to operate.
While the action was welcomed, it also raised fears that the home could be closed.
“At the moment NHS Highland is shoring up HC-One,” Mrs Thomson added. “It would be fine if that situation continued, but it may not sustainable.
“The home can’t close – it would be a disaster if that were to happen. But we can’t return to the situation where it is operated by the same people who have already shown that they have struggled to manage it safely.”
As the West Highland Free Press reported this week, a staff member blew the whistle on a string of concerns over practices at the home in the weeks running up to the Covid-19 outbreak.
MSP Kate Forbes said recently that NHS Highland were “in effect” running the home, though Mrs Thomson said the current, but temporary, manager is an employee of HC-One.
She urged greater transparency, and for the most recent care inspection report, as well as the partnership agreement reached between HC-One and NHS Highland, to be made public.
With over 5,600 cases of suspected Covid-19 reported in Scotland’s care homes, the government has now confirmed new emergency measures for swift intervention if care residents are being put at serious risk.
Though the Care Inspectorate can apply to a sheriff to cancel the registration of a service where it has concerns regarding life, safety and wellbeing, the new proposals would also permit an emergency order to appoint a health board or local authority to intervene and run care homes for up to 12 months.
As the Scottish parliament gathers evidence for an enquiry into the response to the pandemic, and with a view to long-term reform, it is being told to look to Skye.
Evidence that has gone before Holyrood includes a submission which described the handling of Covid-19 within Scottish care homes as “the single greatest failure of devolved government since the creation of the Scottish Parliament”.
Financial interests have been prioritised over the needs of older people... paying more to current providers won’t address the issues without fundamental reform of regulation and contracting. Nick Kempe
Nick Kempe, formerly Glasgow City Council’s Head of Service for Older People, said the Care Inspectorate does a professional job but has few enforcement powers and works inside a regulatory regime which is “limited in scope”.
In February, when intervention might have saved lives, “they simply did not have the power to do what has now (eventually) been done at the Home Farm,” he added.
He said the problems stretch back to the early 1990s and the Community Care Act which transferred responsibility for providing nursing care for older people from the NHS to the private sector.
He adds: “Health care capacity has been stripped out of the Care Home sector over the last 25 years and this helps account for the scale of the current crisis.
“Financial interests have been prioritised over the needs of older people and that paying more to current providers won’t address the issues without fundamental reform of regulation and contracting.
“Care homes require significant increased staff capacity and skills, along with improved access to NHS Services, if they are to be able protect older people from Covid-19 and future pandemics while respecting their rights and delivering person-centred care.”
Mr Kempe’s research also highlights the complex company structure of HC-One.
He said the company has property with leasing costs worth over £36 million, and it uses various financial instruments – such as sale and lease back arrangements and inter-company loans – to extract cash.
His submissions states that parent firms are registered in Jersey and the Cayman Islands, and though the company has a reported debt of over £260 million, its top director is paid more than £800,000 a year.
Meanwhile, back in Portree it took political pressure to get the company to agree to give employees who had tested positive for Covid-19 access to full pay while they were off sick with coronavirus.
Workers at Home Farm had initially been forced to rely on statutory sick pay of £95.85-a-week after testing positive and being signed off.
This story was also published by the West Highland Free Press. Cover photo: West Highland Free Press.