Care worker not using PPE due to Unclear advice by PHE may have infected client

An official investigation has found that a home care worker who did not wear protective equipment , as a result of weeks of contradictory government guidance on whether the kit was needed or not, may have infected a client with a fatal case of coronavirus.

A report into the death of an unnamed person by the Healthcare Safety Investigation Branch (HSIB), which conducts independent investigations of patient safety concerns in NHS-funded care in England, details the general confusion caused by the unclear, and often contradictory, advice on how much protection care workers visiting homes needed.

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The investigation, which was undertaken as a result of a complaint raised by a member of the public in April, shows that Public Health England published two contradictory documents that month. One recommended care workers making home visits should wear PPE but the other did not make any such stipulation. The contradiction was not cleared up for six weeks.

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The shambolic government guidance placed care workers and their extremely vulnerable clients at risk, according to Colin Angel, the policy director at the United Kingdom Homecare Association said on Wednesday, accusing the government of sidelining its expertise and publishing new guidance with little notice, sometimes late on Friday nights and, consequently, not always noticed by the target audience it was intended for.

The HSIB report said the care worker in question “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.”

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The National Care Association says it is ‘appalled’ that due care and attention was not given by the government to the risk of using out-of-date face masks in care homes.

About 819 people receiving home care have died of Covid-19 in England and Wales, according to official statistics.

“We were very sorry to hear of what happened and lessons have been learnt,” said Dr Éamonn O’Moore, PHE’s head of adult social care. “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.”

Angel said: “It has been consistently confusing for people who had to put it into practice … It has relied heavily on cross-referencing between different online documents, they were using unfamiliar and ambiguous expressions and the information we needed was dotted across the gov.uk website.

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“Because the guidance wasn’t clear, in the early stages, local councils, community health services and providers were having to interpret what they thought were the right answers. We have been worried throughout coronavirus that both people receiving care and the workforce would not be adequately protected by the correct use of PPE.”

On April 2 PHE and other public authorities issued general guidance which included PPE guidance for home care workers working with people in the “clinically extremely vulnerable” group, but separate primary guidance for home care provision issued four days later did not include the same said information. which did include PPE provisions needed for people in the “clinically extremely vulnerable” group which did include PPE provisions needed for people in the “clinically extremely vulnerable” group

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Rosamond Roughton, Director general for adult social care at DHSC, was the key contact for care home leaders and was tasked with beefing up the DHSC’s response to the pandemic.

Revised guidance by PHE on how to work safely in domiciliary care in England, which did include PPE provisions needed for people in the “clinically extremely vulnerable” group, did not, however, come out until 27 April .

Unfortunately, in another show of pernicious incompetence, the initial erroneous guidance, which did not include the proper home care PPE guidance, was not updated and remained on the gov.uk website until 13 May. In the meanwhile, the investigators looking into the Covid-19 death of the home care client alerted PHE to the safety risk.

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