The Covid-19 new case count must be much lower than it is now, with a sustained downward trend (82%)

Extensive arrangements for testing and contact tracing must be in place (77%)

Scientific or medical evidence shows that it is safe for children to return to school (84%)

Covid-19 testing for all children and staff at your child’s school is conducted (67%)

With an aspiration to open schools more widely in less than three weeks from now, the Prime Minister is squandering a great deal of parental goodwill.

The NEU has supported the lockdown, but the past few days have revealed the Government’s garbled approach to the next phase. In his haste to use schools as a symbol of recovery, the Prime Minister has merely succeeded in revealing the incoherence at the heart of his strategy. His ‘sketch’ must be redrawn.

Now that the Prime Minister has set himself on a course out of lockdown, he needs to act fast to reassure unions, school staff and parents that when schools do open it will only be when our shared and widespread concerns for personal safety are fully met.

1. Inadequate testing 

• During a crisis in which even symptomatic frontline NHS workers have struggled to access testing, it is easy to see how elderly care home residents have been placed very far down the pecking order. And yet, without adequate testing of every symptomatic resident, how are we ever going to get close to the true number of deaths in UK nursing homes that have arisen from infection with Covid-19?

• The human impact of insufficient testing goes far beyond the repercussions of inaccurate statistics. Care workers with symptoms must isolate at home until they test negative, which then leads to fewer workers assisting more of the residents, with the inherent heightened risk of infection for all involved.

•  The UK government’s recent statement on easing lockdown measures has not clarified whether visiting elderly care home residents is now fully permissible. Elderly residents with symptoms who have not been tested are routinely isolated and no longer permitted visits from family members. Some of these residents will be in their final days of their lives for reasons other than Covid-19, and yet will not be allowed the comfort of having loved ones come visit them. In short, without adequate testing taking place on site, we often do not know what we are dealing with, and residents are still dying without saying goodbye in person.

• Family members play such a crucial role in end of life scenarios. Without their presence, the emotional strain on family and carers alike can be unbearable. A negative viral antigen test would help ease this enforced isolation and afford some dignity to our elderly in care homes, not to mention closure for their loved ones.

2. Data Lag

• Deaths take time to register and appear on official statistics, especially in the current locked down climate.  According to the Department of Health and Social Care, it takes at least 11 days for deaths in care homes to enter the official data, with death registration taking a minimum of five days.

• The official UK Covid-19 death toll only started to include deaths outside hospitals a few weeks ago. As of the 15th April, Public Health England’s official figures claimed that there were only 3,084 care homes in England with confirmed cases. A month later, the official death toll for care home residents is 10,000.

• As recently as four weeks ago, the Office for National Statistics was still suggesting that 85 percent of all UK Covid-19 deaths were occurring in hospitals. Clearly, there was no way of corroborating this figure when there had been so little effort to gather accurate data from care homes. The new figures suggesting that 26% of all Covid-19 deaths have occurred in care homes is very much at odds with this earlier suggestion.

• World-renowned statistician, Sir David Spiegelhalter of the University of Cambridge, suggested on the 1st May 2020 that the incidence of  Covid-19 deaths was higher in UK care homes than hospitals. He continued that, although the Prime Minister suggested that we were over the peak in the UK as whole, deaths in care homes were yet to peak. His predictions appear increasingly to have the ring of truth.

• Care homes are as much on the frontline as General Practice, yet no contingency was put in place for this foreseeable situation. There is still no significant plan in place for how medical attention and testing should be delivered. We knew all along that the elderly and those with underlying health issues were the two most vulnerable groups.

• As of the week ending 19th April, only 505 care home workers had received Covid-19 tests in comparison to nearly 48,000 NHS staff and their families.[4] Even late last month, three quarters of more than 200 providers contacted by the BBC said none of their staff had been tested for the virus.

• What access is being offered is often far too distant for many carers to reach. Care home staff are being invited to testing sites sometimes 100 miles from their location. On site testing for residents and carers alike would seem the logical solution.

2. Inadequate medical input 

• The central principle of the practice of medicine is, ‘First, do no harm.’ Because of this, many medical colleagues have ceased the regular review of care home residents which, up until the crisis struck, occurred weekly. GPs are overwhelmed by fear of contaminating elderly patients with an infection from which they are never likely to recover.

• GPs have also known for months that care homes are hotbeds of Covid-19 infection. GPs and carers alike are then left in a situation where, if they do what every instinct suggests by attending to the sick elderly, they run the considerable risk of not only becoming infected themselves but also passing the virus on to their families at home. This fear is compounded by an often-inadequate supply of PPE at homes.

• The result has been massively decreased rates of GP visits to care homes, with telephone consultations taking their place, or video call if the home has technology in place. Residents and carers alike are feeling forgotten and abandoned. There have been moves within recent weeks to move to UK-wide remote ward rounds done over video-link. Some GP practices have delivered this kind of review throughout the crisis, but there has only been patchy provision of this sort of service throughout the UK as a whole.

3. Elderly care home residents are not being admitted to hospital

• Aside from emergency situations in which paramedics are called, GPs bear sole responsibility in the community for making the decision whether to admit patients to hospital.

• Although GPs are informed when their local hospitals are at maximum capacity, they are not usually made aware when occupancy crises have eased to more manageable levels,  and have tended to assume that hospitals are always full to the brim. In fact, many A&E departments throughout the UK are reporting record-low attendances.

• Subsequently, GPs do not have enough up-to-date information to make an informed choice as to whether they are seeking admission for an elderly and vulnerable patient to a hospital that is already straining at the seams. When all variables are considered, it may sometimes present less risk to the patient to stay at home. The fear that many GPs have had is that the elderly patient they choose to admit to a hospital with limited resources would be side-lined for younger patients seriously ill with Covid-19 who face a higher realistic chance of survival and recovery. There are only so many ventilators, and the famous ‘R Figure’ we have heard so much about in recent weeks is only just teetering below 1.

• Even if the GP does decide that the best place for the patient is in hospital, it is often the case that residents, their carers’ and family members are extremely reluctant to agree to admission for fear of contracting and dying from Covid-19 once admitted.

• There have been numerous reports of Clinical Commissioning Groups (CCGs) urging GPs and care home managers to ensure they have do-not-resuscitate orders (DNR) signed by their residents. This is often interpreted as a licence to avoid admission and allow nature to take its course at home.

4. Rapid, unsupported, and disconnected discharge from hospital

• On 17th March, NHS England wrote to hospital bosses and advised them to seek to actively discharge patients to free up 15,000 acute beds for people with Covid-19.

• Many of these patients were elderly, and part of the recommended guidance for effective discharge included giving patients the direct telephone number of the ward from which they had been discharged. They were urged to call if they need further help or advice rather than contact their GP or visit A&E.

• Many of those discharged have kept slavishly to this advice and continue not to seek any further medical help whatsoever even 2 months down the line.

5. Little or no PPE

• Personal Protection Equipment has only really been prioritised for hospital use since the crisis began, with even GP surgeries struggling to access adequate supplies, let alone care homes. However, it is close to impossible to care for elderly residents without subjecting both them and staff to considerable risk of cross-infection without it.

• PPE ideally should be changed prior to each new interaction with a resident, but scarce supplies in most care homes will not allow this. Carers are left to treat residents with little or no PPE or wearing the same gowns and masks for multiple patients. Spend a few minutes on social media and you will easily find care home staff sharing their experiences of washing their PPE each night before their next shift.

• Unlike any other frontline service, care homes are still required to pay VAT on any PPE that they manage to source. They are often also having to source this equipment privately and at exorbitantly inflated prices, something that is unsustainable for any period in view of the cash-flow crisis many of these homes are facing.

• Almost certainly because it is such a scarce and expensive resource, many care workers report that PPE is being locked away and rationed; they are being advised that they either do not need to use it because residents do not currently have viral symptoms, or that they should make gowns and gloves last all week. This puts residents and staff at risk. UNISON’s PPE alert hotline has received more than 3,500 messages from scared employees since it was established stating that they are worried for their residents, themselves, and their families.

• Some carers are so frightened of contracting the virus that they are refusing to work, while others with symptoms but no access to testing are self-isolating.

• It should not be forgotten that this was a sector that already faced problems with recruitment because of low pay and long hours. The addition of considerable personal risk to life has led to some carers abandoning the role altogether.

• This means that the same high workload is now being shared between far fewer carers, which increases the risk of exposure to the virus for residents and care home workers alike. The same carers, often in inadequate or unchanged PPE, are having to deal with more residents in less time within the same working day.

7. No requirement for testing before admission to a care home

• UK Government guidelines suggesting new residents to care homes are tested for Covid-19 prior to their admission have only recently been put in place and are not being consistently applied. They are not even a universal requirement throughout all UK home nations, with Scottish care homes still permitting admission to residents without testing as recently as last week. Other elderly UK residents are still being admitted with the understanding that they will receive a test within a few days of arrival. This allows more than adequate opportunity for rapid spread within the home at which they arrive.

• This allows a clear avenue of infection into otherwise safely contained homes, especially when cash-flow is such a major issue for so many residences.

• It is inevitable that some of these new residents will be carrying the virus whether they have symptoms at the time of admission, or not.

1. Adequate PPE - Care home staff are as much at risk as frontline clinicians in A&E, and yet are on a fraction of the salary. They should be afforded the same level of access to PPE protection without care homes facing the financial sanction of having to pay profiteers exorbitant prices or VAT to the Government.

2. Adequate Testing - All care home residents and staff demonstrating symptoms should have near instant access to testing. In the case of carers, this would allow them to continue to provide much-needed support, and in the case of residents, this would allow them to continue to draw comfort from their families if they test negative yet are ailing. Care homes could then set about isolating to their rooms only those who test positive.

3. Access to dedicated care home medical teams - Full PPE Hot Hubs and Hot Car visiting services dedicated to the treatment of patients with proven or suspected Covid-19 have popped up all over the country. There is no reason that similar dedicated provision could not be provided for care homes. This would provide considerable support, reassurance and comfort to residents, their families, and their carers alike.

4. Regular symptom checking - The Government suggested last month that all residents should be assessed twice a day for Covid-19 symptoms including cough, shortness of breath and a high temperature. This is all well and good, but there was no simultaneous pledge for provision of adequate PPE and access to rapid testing, something that would be indelible to such checks taking place safely. However, it is feasible that dedicated care home health teams could provide this service if they were established across the UK.

5. Improved, more regular communication between CCGs, GPs and hospitals - this would enable GPs to understand what capacity hospitals have when making important decisions regarding hospital admissions. The discharge procedure should also be reverted back to normal, meaning the GP is updated and can continue to provide care themselves or through the Hot Hubs and Hot Car visiting services.

6. Accurate Data - It is easy to ignore what we cannot see. The Government pledged on April 28th to publish accurate data on Covid-19 deaths in care homes alongside those occurring in hospitals. This data will include figures from the ONS and the CQC. Since 10th April, care homes have also been required to notify the CQC within three days of any resident deaths due to confirmed or suspected Covid-19 cases.  This is a very recent development and we are now many months into the crisis.

7. Integrated Health and Social Care provision - This crisis has taken the UK government and NHS infrastructure completely unawares, and we need to take steps now to minimise the chance of any future recurrence. Care homes feel detached and isolated because they really are very separate from other UK health and care provision. This has left them inadequately supported in terms of training and a consistent and reliable supply of PPE. This deficit in structuring was highlighted in an editorial published in the BMJ last month which suggested that, “The current emergency has exposed once again the need for a universal integrated health and social care service.”

We have seen that streets are becoming busier, and so it is important that these additional safety measures are put in place as soon as possible to help people observe social distancing.
We are therefore planning to widen the pavement using pedestrian barriers and install signage to encourage people to keep their distance. The images below are an example of the measures that will be provided. 

Where there are bus stops, gaps in the barriers will be provided to allow passengers access. For longer sections we will also provide gaps for access for servicing such as collecting refuse.

Along with these measures, businesses must to do everything they can to support social distancing, including limiting the number of customers on their premises and managing queues outside.

Longer-term measures to promote walking and cycling 

In the long term, we want to make it easier and safer for people to walk and cycle locally, shop on their local high street, reach local amenities such as green spaces, schools and doctors, all while maintaining physical distancing. 

We are looking at ways of doing this in Brent and will be setting out our further plans for encouraging green, active travel shortly.

In Brent, according to the 2011 Census, the BAME population is as high as 63.73%, with 18.64% Indians and 34.06% Asians.

Cllr Ketan Sheth, Brent Council’s Chair of Community and Wellbeing Scrutiny Committee highlighted that effective management mechanisms between national and local government are critical, “The role of education in daily life as well as society is very important and leaves a great impact on our progress as a community,” he said.

“Now, we have started discussions to ease our coronavirus lockdown, by re-opening schools in a bid to restart our economy. However concerns this might become a breeding ground for a second wave of Covid-19 cases may convince parents to keep their children at home.

“The role of local government is the key to unlocking, as it knows its people, communities and children. Daily local government delivers services to their local residents. Therefore, it only stands to reason that local government are a vital ingredient to a community solution.

“As Covid-19 shows, pandemics are complex social and behavioural challenges and not just technocratic issues. Parents, teachers, children are grappling with the threat of contracting the infection or dealing with personal loss. Effective management mechanisms between national and local government are critical.

“Anxiety will linger over infection rates, but if we work together, at a local level, in the communities where we live, we can be agile, and creative, in our services: together we can do it locally.”

 “We know parents are anxious about sending their children back to school or nursery.

“Plans to re-open schools and early years settings must focus on reassuring parents that it will be safe for children to return to school. Publication of the scientific advice is vital to help provide that reassurance.The safety of staff, parents and families is absolutely paramount.

“Councils need to be able to close provision where testing indicates clusters of new Covid-19 cases and it is vital that schools have the resources to provide staff with necessary protective equipment, as well as soap and hand sanitiser for cleaning.”

Cllr Butt (right) at Pakistan Independence Day celebrations

For councils up and down the country this past week will have been dominated by the decision to begin opening schools up to more pupils.

And it’s not just local authorities – the schools themselves, teachers and the teaching unions, and of course parents will have all been wrestling with what is an incredibly complex set of circumstances. In my experience, in much of our work designing and delivering public services, there are choices where it’s obvious what is the right thing to do. Then there are choices where compromises are needed but it is still possible to determine which way to go. And there are those choices where all you can do is identify the least-worst option.

Of course, the vast majority of schools in Brent have remained open throughout the Covid-19 pandemic, supporting children of key workers and vulnerable children but the question is now whether schools are ready to safely take back more children in a phased basis starting with Reception, Year 1 and Year 6.

The overriding priority must be to keep everyone involved safe from harm, not least our children and young people but also, of course, school staff. But right now, because this situation is so complicated, that’s just not possible. Until a vaccine is available, sending more children back to school risks exposing them to infection. Yet, if we continue to wait until a vaccine is ready, we risk potentially lasting damage to their personal development and academic attainment – damage that disproportionately affects those from less well-off households, of which there are many in Brent. Both risks are very real. Either on its own would ordinarily be considered totally unacceptable. But we are now nearing a point where we have to pick one.

It is central government’s clear wish that schools begin to reopen from June 1. We are told that government is acting on scientific advice and that the known benefits of a return to formal education outweigh the estimated risks of coronavirus infection and transmission. Now, I do understand the imperative, especially because of how important a proper education is to a child’s life chances. Nonetheless, councils like ours, schools, teaching unions, and parent groups across the UK are pressing government to publish that advice as it is local authorities which have a clear role in supporting and advising schools locally.

In the meantime, we have to work on the assumption that the situation is as government says, and as such we have asked our schools to begin making the necessary preparations for a June 1 reopening. However, I want to stress that, until government can provide greater assurance, although we have instructed our schools to make these preparations, we do not plan on forcing them to actually reopen. We will instead support them whether or not they choose to do so at this time. Teachers can also rely on our unconditional support whether or not they are yet ready to return to the classroom. Parents too will have our full support whether or not they feel it’s safe enough to send their children back to school.

In summary, we believe the responsible course of action to be preparing the ground for a return to school in the near future. But we are not yet certain that the many benefits of returning outweigh the risks of doing so. We will keep our position under daily review, are committed to consulting widely, and will make clear any changes as and when they are made.

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