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COVID-19 bulletin 14: NHS will publish guidance – and enough morphine?

Peter Foster in Brighton reports that Home Secretary Priti Patel is facing urgent calls to relax rules on the use of controlled drugs to treat seriously ill coronavirus patients, after repeated warnings that some are facing “significant and unnecessary distress and pain” because of the UK’s laws on palliative drug control.

Ms Patel has received a letter from the head of the Royal College of General Practitioners, Martin Marshall, advising that regulations should be changed for the duration of the Covid-19 crisis to facilitate the “more efficient and ethical supply” of drugs such as morphine, that help sufferers to die more peacefully.

Medics are seeing cases where patients — many of whom hyperventilate and face great discomfort in the final stages of dying from coronavirus — are suffering unnecessarily, causing great distress to them and their families.

Professor Marshall speaks

In his letter, Professor Marshall said a combination of localised supply shortages and strict regulations made it more difficult for carers to obtain drugs to provide pain relief as patients enter the final hours of their lives. The regulations, which require all prescriptions to be made out to a named patient, were introduced after Dr Harold Shipman was convicted of using controlled drugs to kill 15 patients,

Dr Adrian Tookman, clinical director of the Marie Curie Hampstead Hospice, called on the government to “cut the red tape” and make the requested changes “happen urgently”.

Tracey Bleakley, chief executive of Hospice UK, which runs the UK’s hospice network providing end-of-life care for 225,000 families a year, said: “It is critical to have a workable and pragmatic prescribing system. “This has been an issue for a number of weeks now and we are urgently calling the government to relax the law during this challenging time.”

A National Health Service spokesperson told the FT that the NHS is working closely with partner organisations including the Home Office and the Department of Health and Social Care, to publish new guidance which will ensure people in care homes get the medicines they need when they need them.





Outsourcing 9: Care homes crisis

Before 1990, healthcare in the United Kingdom was provided by health authorities which were given a budget to run hospitals and community health services in their area. The National Health Service and Community Care Act 1990 introduced an internal market into the supply of healthcare in the United Kingdom, making the state an ‘enabler’ rather than a supplier of health and social care provision.

Care homes were then outsourced by local authorities to the private sector which employed large numbers of low-paid workers with weak representation by unions and professional organisations. Spending on social care is now below 2010 levels.

Gill Plimmer describes the way in which global private equity, sovereign wealth and hedge funds have piled into the sector in the past three decades, lured by the promise of a steady government income and the long-term demographics of Britain’s ageing population.

Three of the biggest chains — HC-One, Four Seasons and Care UK — are in the hands of buyout groups.

At the Four Seasons Whitchurch Care Home in Bristol (above), emergency buzzers went unanswered, some medicines were not dispensed and many of its frail and elderly residents had not been given a bath, shower or a wash for a month, an official inspector’s report found. A broken elevator meant residents on the second floor could not be taken to hospital appointments.

Problems are in part a result of:

  • a long-term decline in fees paid to providers for social care,
  • a state mandated rise in the minimum wage,
  • a decline in state funding for local governments, which pay for 60% of their residents,
  • short term investment and speculation,
  • larger private equity-owned care homeowners have a short-term investment focus and complex structures, involving scores of subsidiary companies, many of which are listed offshore and
  • the money to fund the trading coming from taxpayers or from middle class people running down their savings.

When Terra Firma (building better businesses) bought the Four Seasons chain in a £825m deal in 2012, there was still £780m of outstanding borrowings hanging over the business. Now around £1.2bn of interest-bearing debt and loans from unspecified “related” parties.

Nick Hood, analyst at Opus Restructuring & Insolvency, which has advised several care home chains, said “owners are playing with the debt and expecting returns of 12 or 14 per cent and that is simply unsuitable for businesses with heavy social responsibilities”

He adds that the watchdog — the Care Quality Commission — should require the entire corporate structure to be held within the UK

Jon Moulton, the private equity veteran who ran Four Seasons in the early 2000s recommends that care home chains should hold a certain amount of capital, just as banks are requited to do by the Financial Conduct Authority.

Toothless regulator/watchdog places all responsibility on Britain’s cash-strapped local authorities

Kate Terroni, chief inspector of adult social care at the CQC, says that for now it has no authority to introduce minimum capital requirements or to intervene to prevent business failure. “Our powers are to provide a notification to assist local authorities who are responsible for ensuring continuity of peoples care

Meanwhile, as Four Seasons “hurtles towards insolvency”, directors are paid lavishly and their care homes continue to close.