Report on link between hospital discharges and outbreaks in care homes

June 2, 2021

The National Care Forum (NCF) has responded to a report by Public Health England this week. The report draws analysis between hospital discharge rates and the number of outbreaks in care homes.

At the request of the Department of Health and Social Care (DHSC) and SAGE subgroup, Public Health England (PHE) was asked to investigate care homes that received coronavirus (COVID-19) positive patients discharged from hospital, and subsequently experienced an outbreak. The data was collected between 30th January and 12th October 2020.

According to the report, Public Health England’s analysis included a total of 514,428 laboratory confirmed COVID-19 positive tests reported to SGSS from 30th January to 12th October 2020. The address matching process identified 43,398 (8.4%) care home resident cases through pillar 1 and 2 testing (28,027 (65%) and 15,371 (35%), respectively) for this time period, of which 35,760 (82.4%) cases were linked to a care home outbreak.

Vic Rayner, CEO of the National Care Forum, said, ‘The PHE Report delivers an unhelpful analysis of data that provides at best a partial picture and at worst an unrecognisable representation of the impact that hospital discharge in the absence of testing had on the most vulnerable members of our society.’

The NCF CEO said that the data attempts to almost completely absolve the discharge programme from ‘seeding’ outbreaks within homes by presenting a set of data as complete, when in fact it was fundamentally flawed because of the very limitations of the testing regime in both hospitals and care homes.

Vic Rayner added, ‘The Report draws its analysis from testing carried out in hospital, which at the time was both extremely limited and only concentrated on symptomatic patients. It also looks at the outcome of testing carried out in care homes as part of the local PHE teams testing for outbreaks. Again, this approach to testing was very limited, with local teams only required to test up to (and in practice often less than) five symptomatic resident in any care home, with the outcome of that needing only two positive tests to declare an outbreak. At that point no further testing of residents was carried out for 28 days.’

According to Vic Rayner, this meant that residents discharged to care homes were not in any way guaranteed to be part of the testing regime in care homes, and anyone who had acquired COVID within hospital and was asymptomatic would not have been picked up within this testing regime. 'These are points of fact,' Rayner stated.

Regarding on how best to move forwards with this collated data, Vic Rayner concluded, ‘To take this partial data and use it to assert that the lack of testing of those leaving hospital and entering care homes was a relatively small factor in the ‘seeding’ of outbreaks within homes runs the risk of rewriting an element of history to suit a current narrative. In reality the low level of testing for symptomatic patients or residents, and the complete absence of testing for asymptomatic people can only mean that we do not, and probably will never know, the extent of the damage that the practice of discharge without testing delivered. It is one more example that shows social care was not front and centre of all government thinking, yet the people that it serves should have been. It was clear from the start that they were most at risk from the devastating impact of this virus.’

Visit the Government website to read the report in full.


The Care Quality Commission (CQC) launched an ambitious new strategy this week based on consultation with the public, providers of health and social care services, charities and partner organisations.

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