Yes, patients were discharged to care homes without Covid-19 tests

We’ve been asked by readers whether it was government policy on 19 March to send hospital patients back into care homes, without making it mandatory for them to be tested for Covid-19.

This is correct. There was no requirement to test all patients being discharged from hospital into a care home until 15 April 2020, though some trusts were testing patients before that date.

What did the guidance say?

On 17 March, NHS England and NHS Improvement wrote to trusts telling them to “expand critical care capacity to the maximum” by freeing up beds. This was to ensure the NHS had the capacity it needed to treat Covid-19 patients in the coming weeks and months.

To that end, trusts were told to postpone all non-urgent operations and to “urgently discharge all hospital inpatients who are medically fit to leave.” This included some inpatients who would then be discharged to a care home. 

NHS Providers, which is the association of trusts and foundation trusts in England, says: “NHS England and Improvement made this decision having just witnessed the health and care system in Northern Italy being overwhelmed by Covid-19 demand.”

Two days later, the Department for Health and Social Care (DHSC) and NHS England and Improvement published the discharge requirements in detail. 

There was no requirement to test everyone who was discharged to see if they were infected. The document said that, where applicable, Covid-19 test results should be included in the documentation that accompanied people who were discharged. 

On 2 April, the government reiterated in new guidance that “any [care home] resident presenting with symptoms of COVID-19 should be promptly isolated” but specified that “negative tests are not required prior to transfers / admissions into the care home.”

This was the situation up to 15 April, when the government published its adult social care action plan which said that trusts would need to test all patients prior to being discharged and admitted into a care home. 

This was required whether or not the patient had Covid-19 symptoms. 

The government acknowledged that some people may still be moved into a care home, while having the illness, as “some care providers will be able to accommodate these individuals through effective isolation strategies or cohorting strategies.” 

What actually happened? 

NHS Providers says: “Trusts were already testing patients and care home residents with symptoms wherever testing capacity allowed, but this capacity was not reliably and consistently available across the country before mid-April.”

However, Covid-19 can be spread by people without symptoms. Trusts said that, for a few days following 17 March, “small numbers of asymptomatic Covid-19 patients may have been discharged into care homes.”

Several trusts say they stopped that quickly and moved to a system whereby all discharges to care homes, regardless of symptoms were tested and isolated within care homes pending their test results.

So while the guidance didn’t require for patients discharged into care homes to be tested until 15 April, that doesn’t mean that it wasn’t happening. The testimony from NHS trusts seems to be that very few people discharged into care homes were reintroduced to the care home population without being tested.

NHS Providers said it spoke to a range of trust leaders to understand this, but it should be noted that this sort of testimony might not represent how all trusts behaved. 

Also, even if trusts did not ‘systematically’ and ‘knowingly’ discharge patients they knew or suspected had COVID-19 into care homes, as has been reported, that doesn’t close off the possibility that these discharges contributed to the disease spreading in care homes. 

For example, we know that care homes have struggled to get the adequate amount of personal protective equipment, meaning that even patients isolated in care homes may have been able to spread the disease into the care home more widely via an inadequately protected care worker.