Public Health England’s ‘confusing’ PPE advice may have led to vulnerable Briton dying from Covid-19 after carers didn’t know they needed to wear a mask and gloves to visit them, investigation claims
- Extremely vulnerable patient died after carers told they didn’t have to wear PPE
- Public Health England guidance was ‘confusing’ and ‘not visible’ at the time
- Protective equipment advice was hard to find during April – the peak of the crisis
- Investigation led PHE to change its online guidance and make it clearer
Public Health England (PHE) had to be pushed into making its coronavirus guidance clearer following the death of a vulnerable Brit who was visited by carers who were not wearing PPE.
Official guidance about when to wear personal protective equipment (PPE) were ‘confusing’ and ‘not visible’ during the peak of the UK’s outbreak, investigators say.
Independent watchdog the Healthcare Safety Investigation Branch has published a report revealing how it told PHE to make its advice clearer.
A member of the public complained to the HSIB after seeing someone who was shielding in April – during the depth of Britain’s crisis – die after they were visited by carers who didn’t wear protective equipment.
It emerged that the carers had not been told to wear PPE and Government guidance was so unclear at the time that they had been told they didn’t need to.
The report implies the patient got coronavirus from one of the carers, emphasising that they were not ill before the visit, but says ‘there is no way of knowing how the patient contracted Covid-19’.
The HSIB said there were multiple versions of advice about PPE online at the same time and PHE hadn’t made it clear enough which one to follow.
After being told about the patient’s death, PHE later changed its online advice to make it clearer which was the latest version.
Both PPE and PHE’s handling of the coronavirus crisis have been heavily scrutinised in recent months, with the Government slammed for not making protective equipment available for carers and PHE under fire for stopping swab tests in March.
Public Health England guidance now makes it clear that all carers should wear surgical masks, gloves and aprons every time they visit someone who is shielding, but this was not clear during the peak of the UK’s coronavirus outbreak, according to an investigation
‘Guidance that protects frontline workers and vulnerable patients needs to be as clear and accessible as possible and this is even more important in times of crisis,’ said Dr Kevin Stewart, medical director at the HSIB.
‘However, there are multiple guidelines for different care sectors and it is easy to see where confusion can occur as new updates overlap with older versions.’
PHE has come under scrutiny in this investigation for not having clear enough rules on what protective equipment carers should wear when around vulnerable people.
It now has a 28-page document on the gov.uk website outlining how home carers can protect themselves and their patients from coronavirus.
But in April, when the virus was killing hundreds of people per day, there were two versions of the guidance, the HSIB said.
And one of them, published on April 6, did not spell out what protective equipment should be worn when treating extremely vulnerable people who were shielding.
An update from April 27 says that carers should wear ‘a fluid repellent surgical mask, gloves and an apron’ in this scenario.
The previous version of the guidance did not offer specific advice, and the carers who visited the patient in the report did not wear PPE because they didn’t know they should.
Both versions were online at the same time and the older one did not contain a note to say it had been updated.
CARE BOSSES HIT OUT AT ‘SHAMBOLIC’ PPE SUPPLIES IN LEAKED LETTER
A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health in April saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’.
It raised concerns about testing in care homes, funding for the sector, and inadequate amounts of personal protective equipment (PPE) for staff, the BBC reported.
Adass said it was facing ‘confusion’ and additional work as a result of mixed messaging put out by the Government.
It said the situation around PPE, which is now mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.
The care sector, which looks after around 400,000 of Britain’s most vulnerable people, was being overlooked while officials focused on the NHS, Adass said as they raised fears of a ‘significant imbalance’.
The bosses added that they welcomed coronavirus swab testing for people working in social care but said it looked as it if it would be ‘rolled out without being given thought to who is going to be tested and what we are going to do with the result’.
The HSIB report said: ‘There was no straightforward way of navigating the gov.uk website. The guidance was not visible.’
As a result of this, the HSIB said, healthcare workers did not know what they should have been doing.
‘In the reported case,’ it said, ‘district nurses used PPE when delivering homecare.
‘However, other care workers did not use PPE and had been told this was not necessary.
‘The patient later died, and their death was confirmed as being Covid-19 related. The care visits occurred when the patient and other household member were not showing any Covid-19 symptoms.’
After the HSIB told Public Health England its guidance was confusing the government body took down the April 6 link.
Protective equipment for care staff was a contentious issue for months at the start of, and through the peak of, Britain’s coronavirus crisis.
Obsessed with protecting the NHS, Government officials were accused of overlooking the care sector and leaving it in the lurch while the virus spread wildly through homes and killed thousands of vulnerable elderly people.
A letter sent from the Association of Directors of Adult Social Services (Adass) to the Department of Health in April saw the care chiefs accuse a senior figure at the Department of overseeing a ‘shambolic response’.
It raised concerns about testing in care homes, funding for the sector, and inadequate amounts of personal protective equipment (PPE) for staff, the BBC reported at the time.
Adass said it was facing ‘confusion’ and having to do extra work as a result of mixed messaging put out by the Government.
It said the situation around PPE, which was by then mandatory for all healthcare workers, was ‘shambolic’ and that deliveries had been ‘paltry’ or ‘haphazard’.
The care sector, which looks after around 400,000 of Britain’s most vulnerable people, was being overlooked while officials focused on the NHS, Adass said.
They raised fears of a ‘significant imbalance’ between hospital patients and people relying on care in nursing homes or their own houses.
The bosses added that they welcomed coronavirus swab testing for people working in social care but said it looked as it if it would be ‘rolled out without being given thought to who is going to be tested and what we are going to do with the result’.
Dr Eamonn O’Moore, chief of adult social care at Public Health England, said: ‘We were very sorry to hear of what happened and lessons have been learnt.
‘We updated the links to the guidance clarifying the right one to use.
‘We continue to update and revise UK guidance informed by the evolving evidence, as well as listening to feedback from the health and care sectors on its appropriateness and accessibility.’
PUBLIC HEALTH ENGLAND’S CORONAVIRUS FAILINGS
Public Health England has come under fire for a number of its responses to the Covid-19 crisis.
Its directors have tried to divert blame, claiming that major decisions are taken by Government ministers in the Department of Health, but the body has been accused of being controlling.
These are some of the failures for which PHE has been blamed:
Stopping mass testing and tracing
On March 12 the Government announced it would no longer test everybody who was thought to have coronavirus, and it would stop tracking the contacts of the majority of cases to try and stop the spread of the disease.
As a result, Britain effectively stopped tracking the virus and it was allowed to spiral out of control.
Conservative MP David Davis said that was ‘precisely the wrong thing to do’.
Professor Yvonne Doyle, PHE’s medical director, told MPs in May: ‘It was a decision that was come to because of the sheer scale of cases in the UK.’
She added: ‘We knew that if this epidemic continued to increase we would certainly need more capacity.’
PHE said: ‘Widespread contact tracing was stopped because increased community transmission meant it was no longer the most useful strategy.’
Counting deaths inaccurately
It emerged last month that Public Health England had been counting coronavirus deaths by checking a list of people who had ever tested positive to see if they were still alive.
The cause of someone’s death, nor how long it had been since their positive test result, were not taken into account and the agency was accused of ‘over-exaggerating’ the numbers of people who were dying each day.
An investigation into the method by the Department of Health saw 5,000 deaths wiped from the UK’s official tally.
The statistical flaw was uncovered by Oxford University’s Professor Carl Heneghan and Dr Yoon Loke, from the University of East Anglia.
Matt Hancock has since brought the figures in line with Scotland and Northern Ireland, which only attribute deaths to Covid-19 if it occurs within a month of their diagnosis.
Lack of contact tracing capacity
Papers published by Government scientists on SAGE revealed that PHE only had the capacity to cope with five new cases a week on February 18.
Only nine cases had been diagnosed at the time.
PHE experts said modelling suggested capacity could increased ten-fold to 50 new cases a week — allowing them to contact 8,000 people a day.
SAGE said: ‘When there is sustained transmission in the UK, contact tracing will no longer be useful.’
Britain’s cases jumped started to jump by 50 each day at the beginning of March.
Pledged antibody tests in March
PHE’s Professor Sharon Peacock said on March 25 that the UK was on course to have antibody tests available to the public that month.
She confirmed the Government had bought 3.5million of the tests and was evaluating their quality.
They could be available to the public ‘within days’, she said at a Downing Street briefing.
Three months later, however, and they are still not a reality. Officials have since decided there are no tests good enough available, and there is no proof that the results will be of any use to the public.
Testing efforts slowed by ‘centralised’ lab approach
Scientists in private labs, universities and research institutes across the country said in April that their offers to help with coronavirus testing had fallen on deaf ears.
Only eight PHE laboratories and some in NHS hospitals were being used to analyse tests during the start of the crisis.
‘Little ship’ labs had tools to process tests and could have increased testing capacity rapidly if officials had agreed to work with them, they said.
But it took Britain until the end of April to manage more than 100,000 tests in a day. Germany had been managing the feat for weeks by utilising private laboratories.
PHE says it did not ‘constrain or seek to control any laboratory either public, university or commercial from conducting testing for Covid-19’.
It claimed that it requested officials changed testing methods in January to allow for any testing facility to conduct diagnostic tests.
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