One of Scotland’s largest health boards says further research is required to establish if any of the patients discharged from hospitals during the first wave could have introduced covid-19 to the care home they were placed in.

Fewer than five of the 787 patients discharged earlier this year from hospital to a care home within NHS Lothian involved a patient with covid-19 who could potentially have introduced the virus to a care home, a report published yesterday has concluded.

It follows a national report at the end of October that concluded at least 78 older people were discharged from NHS hospitals to Scottish care homes after testing positive for covid-19 in the early months of the pandemic.

The findings for NHS Lothian are outlined in the internal review, carried out to understand if the virus could have been transferred from a hospital setting to a care home, as well as to  examine whether national guidance regarding testing and isolation requirements were followed.

From the 1^st March to the 31^st May 2020, 787 people were discharged from hospital to care homes in the region.

Of these fewer than five discharges were found to have taken place in which a patient with covid-19 could potentially have introduced the virus to a care home.

However, the report does not establish whether they did.

As there are numerous strains of the covid-19 virus, the reports states, further virology work is needed to determine if any of the discharged patients passed the virus on.

The health board says that in the case of each discharge each care home was asked to take  to take all the same enhanced infection control measures they would take if they were dealing with a person who had covid-19, including isolating the incoming resident for 14 days.

The discharges took place before testing was introduced by the Scottish government in late April. 

A report published by Public Health Scotland in October found at least 78 older people were discharged from NHS hospitals to Scottish care homes after testing positive for covid-19 in the early months of the pandemic.

The Scottish government insisted the report found no statistical relationship between hospital discharges and outbreaks in care homes.

Meanwhile representative body Scottish Care said testing for all discharges from hospital should have started much earlier than it did. The organisation’s head Dr Donald Macaskill described the report as “only part of the story” as it missed out the experience of frontline care workers who believe hospital discharges led to the virus being introduced in their care home.

And last week leading care home operator Robert Kilgour accused the Scottish government of trying to “blame” the sector for Ministers’ failings during the pandemic.

Professor Alex McMahon, Executive Lead for Infection Control at NHS Lothian, apologised for the distress suffered by staff, residents and their families:

“We recognise how concerning this has been for residents of care homes and their families and how important it is to understand the impact of the discharge of patients from hospitals to care homes in the early months of the pandemic, before testing was introduced.  We are very sorry for the distress this has caused.

“In line with our values of openness and responsibility we are publishing this report at the earliest opportunity, as we said we would.

"It is a mark of the importance NHS Lothian places on this issue that our review has been so thorough and detailed. This has been a significant piece of work requiring meticulous examination of the medical records of well over a thousand patients discharged from NHS Lothian during the period from the 1^st March to the 31^st May 2020. 

“We now know that there was a small number of discharges - fewer than five – involving patients who were later found to have had the virus and who could potentially have introduced it to their care homes. However, it is still not yet known if these cases were the source of onward transmission and further virology tests are required to establish that.”

The review also found that testing practice in Lothian hospitals followed national practice, with capacity increasing ‘over time and in line with Scottish Government guidance’.

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