CNA Staff, May 23, 2020 / 01:00 am
Catholics are calling for a public investigation into why so many elderly people have died in U.K. nursing homes during the coronavirus crisis.
More than 20,000 people have died in U.K. care facilities as a result of the pandemic, according to an analysis of official figures by Reuters. The U.K., which has a population of 67 million, has the second highest recorded coronavirus death toll in the world after the United States.
Fr. Patrick Pullicino, a neurologist who was ordained in 2019, and Lord Alton of Liverpool, a member of the upper house of the U.K. Parliament, have appealed separately for an inquiry into care home deaths.
Pullicino told CNA that an inquiry must be independent of the government, whose handling of the pandemic has been widely faulted.
He said: "If we really want to move ahead, it has to be independent and people have to ask: why were the elderly treated in this way? And we have to have a change. We have to have a complete new way of looking at the elderly and their potential in society."
Pullicino underlined the elderly's contribution to society, citing the example of Captain Tom Moore who raised more than $40 million for the NHS by walking laps of his garden ahead of his 100th birthday.
"There has to be an inquiry," Pullicino said. "A fifth of the population has been basically denied reasonable healthcare and in an arbitrary fashion. Look at Captain Tom, what wonders he did. These are the people who are the backbone of the country. You can't just say that they're too expensive, they're 'bed-blockers.' You have to set up new systems to deal with the elderly."
Pullicino, a former chairman of the Department of Neurology and Neurosciences at the New Jersey Medical School now serving as a chaplain at a London hospital, criticized a set of guidelines for the National Health Service (NHS).
The document, headed "COVID-19 rapid guideline: critical care in adults", presented a flowchart, updated March 27, helping doctors to decide whether adults admitted to hospitals with coronavirus symptoms qualified for critical care, which usually takes place in intensive care units.
Pullicino highlighted a path on the flowchart that concluded with "end-of-life care" if a patient's condition worsened after they were determined to be "more frail" but not suitable for critical care.
He argued that this encouraged doctors to treat sick elderly people who fell into this category as if they were dying, rather than as if attempts should be made to treat them.
Pullicino said: "A major problem with those guidelines was that they said that those people who were not appropriate for ventilators, if they were over 65 and if they deteriorated, there was a line going to 'end-of-life care,' which was really wrong."
He continued: "When this whole COVID crisis started, people realized that there weren't enough ventilators compared with other countries. We didn't have a lot of NHS beds either because the number has been run down over the last number of years. So I think there was panic."
"They decided to clear the hospitals to make a lot of space ready. The hospitals were cleared of the elderly and many of them were sent to nursing homes."
Pullicino suggested that some of those moved to care homes could have had the coronavirus, which has an incubation period of up to 14 days during which carriers have no symptoms of the disease.
"Basically then in the nursing homes there was no testing available, no PPE [Personal Protective Equipment]. So the situation then became that if somebody got sick in the nursing home, there was nowhere for them to go. And I think this is what's happened," he said.
In a policy paper updated April 16, the government acknowledged care providers' concerns about the difficulty of isolating COVID-positive residents.
"We can now confirm we will move to institute a policy of testing all residents prior to admission to care homes," it said.
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Pullicino himself contracted COVID-19 earlier this year. After recovering, he volunteered as a consultant at NHS Nightingale, London's coronavirus field hospital.
But he noted that the Nightingale and other hospitals did not reach capacity even at the height of the pandemic, arguing that the free beds should have been opened to the elderly.
"It's a terrible situation and there's a total lack of humanity for the elderly -- and the disabled are included too in many cases in this thing," he said.
Meanwhile, Lord Alton, a crossbench peer who has no party affiliation, said during a virtual House of Lords debate April 23 that an inquiry into nursing homes was "inevitable."
He called for the creation of a "national care service" to work alongside the NHS.
He said: "What the deaths in our care homes have made abundantly clear is that, alongside our National Health Service, we need a national care service. If a national care service emerged from the wreckage of COVID-19, it would represent a gain, among so much loss, comparable to the gain of the National Health Service post 1945."
In 2012, Pullicino raised the alarm about the Liverpool Care Pathway, an end-of-life protocol that was abolished after a government-commissioned review. He told CNA that the treatment of the elderly had deteriorated within the healthcare system.
He said: "We're building on a mindset within the NHS that has gone on for more than 10 years. It's been built on the Liverpool Care Pathway and more recently you've had these end-of-life pathways which are still going on, still unchanged basically from the Liverpool Care Pathway. So the elderly, I'm afraid, have been devalued in the NHS."
He said this was partly due to a lack of beds and partly to a lack of staff.
"I don't think individuals are to blame," he said. "The individuals work very hard. But the 65s and over represent almost a fifth of the population. You can't shortchange them. These are the people that need medical care. They need it most. You can't just say to the elderly, no more healthcare and that's it."
Dr Adrian Treloar, a consultant and former senior lecturer in geriatric psychiatry, told CNA that he shared some of Fr. Pullicino's concerns.
Referring to official guidance on care of those dying at home, updated April 8, he said: "The guidance on 'caring for someone who is dying at home from COVID-19 infection' is in fact very carefully written and very compassionate. And only to be used when absolutely certain that the person is dying and does not want to go to hospital. It is basic palliative care. But if it is used inappropriately for someone who has COVID-19 (and respiratory depression) it may be rapidly lethal."
He continued: "Care homes saw considerable efforts to prepare for the pandemic by promoting end-of-life care planning, alongside a NICE guideline which denies critical care for people with mild to moderate dementia and which promotes end-of-life care as the alternative."
"The promotion of end-of-life care and the high death toll in care homes sits worryingly alongside a system that simultaneously omitted to do even the minimum it should have done to protect the vulnerable from the virus."
Pullicino added: "These end-of-life care practices that are going on in the NHS have to be looked into. We have to look into what's happening, how the elderly are being treated and there has to be a change."
"Because I do think it's partly a question of how people view the elderly sick as a burden rather than as a challenge, and that we have to support them and look after them in the correct way if we're a humane society."