Cornwall’s Care Home Scandal

by Natalie White

When Covid hit in 2020, many of the metropolitan middle class were able to work from home, but some quickly realised they could work just as effectively from other parts of the country, and those that could fled to their bucolic second homes in Cornwall. There was immediately a big backlash from the Cornish population, clearly apparent on local BBC coverage, as these new ‘Covid refugees’ were met with fear and resentment. This was, however, not a mindless, kneejerk parochialism. To put it in context, Cornwall has only one NHS hospital trust, offering three hospitals for a population of well over half a million people – a population swelled by the new arrivals.

For many decades now, Cornwall has been the retirement village of the U.K., and because health experts warned us that Covid would affect the most clinically vulnerable, including older people, it was no surprise that the new arrivals caused fear. Adding to these worries, it was reported that many of those seeking refuge in Cornwall were fleeing areas of high infection.

While most people perceive Cornwall as a haven for surfers and artists, the reality is that many towns and villages in Cornwall are some of the poorest in Europe. Because of the explosion in second home ownership over the past 20 years, some villages are now 70% holiday homes. Some second home owners claim their properties as ‘small businesses’ and leave a council tax deficit of around £24 million per year. Michael Gove, in January 2022, attempted to close the ‘small business’ loophole by insisting that any second home owners claiming that exempt status has to rent out their properties for a minimum of 10 weeks a year. The new rule kicks in in April 2023.

According to the Guardian, the average annual wage in Cornwall is £19,763, 79% of the U.K. average, and the county has the highest water rates in the country. On an annual basis, the country has a lower rate of unemployment than the U.K. average, but it goes up outside the tourist season. The NHS is one of the largest employers in Cornwall, with more than 14% of jobs in health and social care.

The care industry is vast and multifaceted. From care homes for children, mental health patients, vulnerable adults with learning difficulties, to the elderly and those with more complex medical needs like dementia, Parkinson’s, strokes or end-of-life care. The roles within the care industry are not limited to carers. They also include cleaners, cooks, hairdressers, administrative staff, gardeners, maintenance staff and entertainers. Each cog in this complex machine is invaluable and necessary. These staff work long, unsociable hours, on less money than they would earn at the local supermarket. They’re regularly attacked, verbally abused, spat at and sexually assaulted by residents with mental health disorders or dementia.

The Royal Cornwall Hospital, which prior to Covid spent almost every winter on ‘black alert’ due to bed and staff shortages, looked set to crumble under the encroaching Covid storm. So, when Covid struck, it was no surprise that the residents of Cornwall went into a complete panic and demanded the immediate closing of the Tamar Bridge, which links Cornwall to the rest of England, me included.

As people fled to the Cornish shores and their second homes during the first lockdown, we braced ourselves for the Covid tsunami that could decimate the population. Like the rest of the U.K., most of our cases were in the elderly and those with underlying health conditions. The trouble with Cornwall is that we had such a large number of elderly people and a hospital system that struggled to cope in a normal flu season.

As the Royal Cornwall Hospital panicked and offloaded the elderly into care homes to make way for an anticipated surge in Covid patients, friends who worked in the NHS or the care industry reported that Cornwall health facilities were becoming overwhelmed. Already understaffed, and with little or no PPE, care homes were reported to be spiralling in to chaos, both in the local media and privately to me.

That’s when I became involved.

You’d be hard pushed in my town to not know someone who worked in the care industry. Day after day, friends were calling or messaging me in tears. As ‘key workers’, despite the daily diet of fear on the news, and despite most of them having children, these people continued to work 12-hour shifts on minimum wage, risking their lives to look after their charges that were increasing in numbers all the time.

I recall friends on local Facebook pages discussing coming home after a 12-hour shift, undressing to their underwear outside the front door, placing their work clothes in a bin bag, sanitising themselves with Dettol spray, and having a shower before daring to mix with their families. Many wore masks when at home in the belief that no germs from the care homes would be passed to their families. It seems ridiculous two years on, but at the time we had no idea what we were dealing with.

The care homes faced increasing pressure to take more and more people to free up beds from the hospitals. Unable to cope, some care homes started giving the sedative Midazolam to residents.

“They’re dishing them out like smarties,” one friend told me as she sniffed back tears. “We just can’t cope. It’s the only way to get on top of everything.”

Patients with dementia, who can often become frustrated, angry and confused, and prone to wandering off, were often dosed with Midazolam, but it wasn’t long before some care staff were being bullied to give them to all residents. According to the Daily Mail, “out-of-hospital prescribing of the drug midazolam increased by more than 100%” in April 2020. It is thought by some that this was a deliberate attempt to euthanise the elderly, but that’s disputed by those I’ve spoken to in the sector.

“It was never the intention to harm or kill anybody,” I was told. “I don’t know of any cases where Midazolam caused death. But we were encouraged and sometimes bullied into giving them to residents when we were overwhelmed with residents needs, and understaffed, because it gave us more time to get to everyone.”

On June 22nd 2021, ITV News reported that Kenwyn care home, where 94% staff and 100% residents were vaccinated, experienced a significant outbreak of Covid infections.

Nevertheless, by October 2021, the Care Quality Commission declared that all care staff, from cleaner to care, had to be vaccinated by November 11th (Remembrance Day, no less) or they would be sacked. That they had risked their lives, and the lives of their families, for those most in need, and that most of them had almost certainly been exposed to Covid during this time and now had antibodies, seemed not to matter.

The combined years of experience, training and devotion of the people effected by this were irreplaceable. The people I know who chose not to get vaccinated and left the care sector weren’t ‘anti-vaxxers’; they were people who had had every other vaccine offered to them or their children. They weren’t ‘conspiracy theorists’ who spent hours down David Ike rabbit holes on social media – they worked too hard to find the time for that. They were just hard-working, caring people who were reluctant to take a vaccine they knew little about. Many I spoke to felt that forced vaccinations were against their basic principles of informed consent and bodily autonomy.

Still, the Government and the CQC continued with their plan to fire any staff who didn’t get vaccinated by November 11th. The already understaffed and overrun care industry looked set to lose around 60,000 care staff across England.

This is when things started to look like the plot of a disaster movie.

As soon as the CQC published the vaccine mandate, residential care homes plunged into disarray and have continued to decline since. As well as the unvaccinated staff that left, many of those left behind, faced with higher workloads, soon burnt out and walked away themselves. As a result, some care homes have employed large numbers of young, inexperienced staff. It has been reported to me that many new staff are not DBS checked; that new staff, who are supposed to shadow train for at least three days with a more experienced or senior staff member, are not receiving training. They have no idea how to administer medication, check blood sugar levels, use bath and shower winches and pullies, change bed sheets, bed pans, catheters, take blood, feed someone, help them sit up, move them to a chair from a bed and vice versa, how to help them wash, how to speak to them; they have no understanding of dementia, strokes, confusion, or anger. Being young, and only paid £9.50 an hour, it’s not long before some new recruits become fed up with cleaning excrement while being shouted at by care home residents and managers and walk out.

Some care homes tried to get around his difficulty by reclassifying themselves as ‘low care’ facilities or homes in which residents are classed as ‘self-caring’, both of which require less supervision. In these places residents are invariably self-sufficient; they can dress and wash themselves and cook for themselves. The carer is really only there in case of emergencies.

A woman called Daisy contacted me this week to say that she was sent to a ‘self-care’ residential home over Easter. Expecting to only have to provide basic prompting and supervision, she was met with 20, totally immobile, very poorly, extremely vulnerable residents being cared for by only two care staff. According to her, residents were left hungry and thirsty for six to eight hours or more a day, they were left in their own urine and excrement for days at a time, catheters were not changed leading to kidney and bladder infections, they remained unwashed and in the same clothes for days at a time.

“One very old, sweet, elderly man was found in excrement covered clothes and bedsheets that were dry and caked – suggesting he had been like that for at least two to three days,” she told me. “Diabetic blood tests are either forgotten, or performed by untrained staff, meaning residents commonly slip in to diabetic comas.”

Other carers have reported to me that unhygienic conditions have led to bedsores so painful and infected they’ve caused sepsis, heart problems and strokes. Falls regularly go undetected for hours. Untrained staff using winches to help residents sit up, get out of bed, or in and out of baths and showers, are regularly misusing them, leading to serious injury. The endless stream of new staff also discombobulates the residents. If they are washed at all, elderly ladies and gentlemen are having intimate bed washes, bed pan changes, or catheters inserted or removed by staff they don’t know. They’re often embarrassed, humiliated and scared. More and more are hiding soiled bed clothes and sheets out of sheer embarrassment. These soiled articles often don’t get found for days. Another of Daisy’s residents, an elderly lady, had soiled herself and needed a bath. Daisy, who was supposed to be shadowing with a colleague for three days, was simply told the bathroom was at the end of the hall. She had no idea how to use the hoists, as, while she has over 20 years’ experience in care, she had never worked in a high-care dependency unit, and was told this was ‘low care’. The elderly lady and her managed to work it out between them, but the lady was very upset and embarrassed. Daisy only stayed at the home for four days as it upset her too much. I have helped her write a formal complaint to the CQC.

The horrors within the care homes, however, can only be matched by the horrors of caring for people in their homes. In rural areas like Cornwall, some care staff have all of this to deal with as well as the added pressure of having to travel to people’s homes, miles apart, to administer care. Care staff are having to wake elderly patients from their beds at 5am, wash them, change their adult nappies, clean up any mess, quickly give them a bit of breakfast and move on to the next one before returning at some point in the day to put them to bed. Some are put to bed early to “get them over and done with” and some will not get to bed until 10-11pm. Some of these people will not see another soul, or have anything to eat or drink, all day, other than these two visits. If they fall in that time, have a heart attack, stroke or any other serious health issue, it could be hours before they’re found.

As you can imagine, any deaths in care homes, or of elderly, vulnerable patients in the community, are written up as ‘deaths from Covid’.

Cornish towns are tight-knit communities, dotted over a large area. It’s very easy to expect someone to ‘blow the whistle’ or make a formal complaint, but professional carers worry that that will mean never working in the industry again, possibly never working within the NHS again. That’s a real concern in Cornwall, given the NHS is one of the largest employers. Based on my experience, many care staff in the Southwest are mums, including single mums. Risking a career is not an easy choice.

These difficulties don’t just apply to Cornwall. Over the last year I have received hundreds of emails, phone calls, and private messages from care staff all over the country telling me the same stories. To think that many of these elderly care home residents have worked their whole lives only to be treated so despicably at the end is shocking. And the fact that so many care staff were kicked to the kerb on Remembrance Day should embarrass us all.

The High Court ruled last week that the Government broke the law by discharging untested hospital patients in to care homes – and Matt Hancock has been quick to blame Public Health England for these failings. Yet while ministers and health bodies take it in turns to wriggle out of responsibility for the Covid care home fiasco, the awfulness, death, neglect, accidents and abuse that our most vulnerable are suffering shows no sign of stopping.

Many of those that lost their jobs in November have been contacted by old employers to return now that the vaccine mandate requirements have been lifted. However, those I know have told me they simply don’t want to.

Natalie White is a single mother living in Cornwall.