‘Incremental tragedy’: tier 4 means no hugs or hand-holding in English care homes

Hopes for hugs and hand-holding in care homes this Christmas have been dashed in swathes of south-east and eastern England by new tier 4 rules banning close-contact indoor visits.

Guidance issued last night by the Department of Health and Social Care said visits to care homes in tier 4 areas can from today only take place behind substantial screens, in visiting pods or through windows. The emergence of a new, more transmissible strain of Covid-19 has also raised fears about the safety of close-contact visits outside tier 4, enabled by rapid testing, which does not detect all positive cases.

The cancellation of contact was described as “incremental tragedy” by Judy Downey, chair of the Relatives & Residents Association. She acknowledged the potential higher risk of infection in care homes from the new strain of the coronavirus, but said: “hopes have been got up so cruelly”.

“Some families are no longer being recognised,” she said. “Spouses are going in and the person turns their face away and says: ‘Who is that?’”

The move was described as “deeply distressing for residents and their loved ones” by Vic Rayner, executive director of the National Care Forum, which represents independent care providers. It was also, he said, a “huge blow to all care providers who have spent the last week preparing to enable meaningful visits and spending time on training on the use of lateral flow devices”.

The new lockdown restrictions, which replaced the planned five-day Christmas window for family get-togethers, have also triggered a rush to ensure adequate home care.

Many people with significant care needs had cancelled home care visits because they were going to be with their family, Rayner said. This could have “a monumental impact”, because rotas are made weeks ahead and it is a difficult time to get staff, raising fears some vulnerable people may go without care.

Ministers had, earlier this month, promised to make hand-holding and hugs a possibility in care homes in time for Christmas by rolling out rapid lateral flow testing to visitors.

The care minister, Helen Whately, said the virus had “torn families apart and denied so many the simple human pleasure of contact with a loved one”. Matt Hancock, the health secretary, said they would have “meaningful contact with their loved ones by Christmas”.

But the prime minister, Boris Johnson, said on Saturday the new strain of the coronavirus appears to be up to 70% more transmissible than the old variant, and could increase the R number by 0.4.

Covid-19 ravaged care homes in the spring, with official figures recording more than 21,000 excess deaths related to Covid-19 in care homes. Physical contact visits, which started earlier this month, have now been halted.

Care homes outside the tier 4 areas are still being asked to enable physical contact using lateral flow tests and PPE to prevent infection spreading. The government guidance remains that two visitors should be enabled twice a week for residents using testing, but the new variant of Covid is raising fears that these may not be enough to stop the virus getting in.

“The evidence around lateral flow tests remains challenging … if you get a negative result it can be a false negative,” said Nadra Ahmed, chair of the National Care Association, which represents independent care homes. “There are some very worried providers, especially as insurance remains an unresolved critical issue.”

Before the new lockdown, some local authorities told care homes not to rely on the tests, including in Greater Manchester and Sheffield.

“Directors of public health are mounting a concerted effort to stop lateral flow tests being used as a magic bullet,” said one senior director of public health.

Downey said the emergence of the new strain also increased the need for more care home workers to agree to receive the vaccine, which is currently believed to be equally effective against the mutation. Earlier this month, the National Care Association warned that up to a fifth of care workers were saying they did not want the jab. Many have been citing concerns that the speed of its development may compromise its safety.

The NHS says it “met strict standards of safety, quality and effectiveness set out by the independent Medicines and Healthcare Products Regulatory Agency” and “reports of serious side-effects, such as allergic reactions, have been very rare”.