Direct answers on patient transfers not fully provided by Health Trusts

On November 4, 2020, the Regulation and Quality Improvement Authority (RQIA) issued a notice proposing to cancel the registration of home’s care provider, with serious concerns cited around care quality and the environment for patients.

Action commenced to transfer the 53 residents to other facilities; however, it would emerge 20 died in the immediate aftermath, including an elderly man receiving end-of-life care.

Given his frail condition, nursing staff had pleaded to let him remain in familiar surroundings and to pass away with dignity and with as little disruption as possible.

This was refused, however, and staff were instructed to prepare the gravely ill patient for transfer to a facility almost 30 miles away, where he died the following day.

The Western and Southern Health and Social Care Trusts were each asked how many patients they were each responsible for, why the designated GP for the home was not consulted around transfer decisions, and how many patients were moved to facilities with confirmed Covid outbreaks?

They were also asked if there is acceptance that the transfer procedure detrimentally impacted on the health and well-being of those patients who died in the immediate aftermath?

In addition, the Southern Trust were asked why a patient who had contracted Covid-19 while undergoing treatment for unrelated issues in Craigavon Area Hospital, was discharged to the Valley Nursing Home, which until then had remained free of the virus.

Also, despite previous assurances of adherence to infection and prevention guidance, why was the home not notified the patient was Covid-19-positive, until the day after discharge?

A Southern Trust spokesperson advised 30 patients were under its care, and “staff were in daily contact and frequently present in the home, supporting residents and families in their personal choice to move to alternative and suitable accommodation”.

They continued: “In December, 2020, RQIA took enforcement action to deregister Healthcare Ireland as the provider.

“Regrettably, this ensured the small number of remaining residents were required to seek alternative accommodation.”

In relation to the discharge of a Covid-19-positive patient to the home, the spokesperson fell back on the now standard response of being unable to comment on individual residents; however, they added: “All infection, prevention and control guidance was followed when relocating residents.”

As this didn’t appropriately address very specific questions, the Southern Trust were asked to reconsider their responses.

Meanwhile, the Western Trust confirmed responsibility for 21 residents, and while providing slightly more information, a similar stance was adopted to its Southern Trust counterpart, with generalised comments for answers.

On the failure to engage with the designated GP, a Western Trust spokesperson contended: “The GP would be involved in the initial placement under the Care Management Process.

“If required, a review would have been completed to ensure clarity of assessed need and appropriate facility.”

This failed to explain why the GP wasn’t notified of patients being transferred out.

Neither was there explanation why patients were moved to facilities with confirmed Covid-19 outbreaks.

Instead, the Western Trust referenced adherence to infection prevention and control.

Pressed on whether there is acceptance the transfers detrimentally impacted on many patients, the spokesperson side-stepped a direct reply, stating: “The health and wellbeing of our clients and patients is always our priority.”

Asked who instructed the transfer of the elderly patient despite staff concerns, and if it is accepted this potentially hastened his death less than 24 hours later, the spokesperson said: “Due to confidentiality reasons, we cannot comment on individuals.”

Given the wholly inadequate responses, the enquiries were sent back to the Western Trust.

At the time of publishing, neither Health Trust has provided answers or further comment.