Strict controls to stop spread of coronavirus in hospitals were quietly relaxed at height of the crisis

The Government quietly relaxed strict controls to stop the spread of coronavirus in hospitals at the height of the crisis, the Daily Telegraph can reveal.

Whitehall officials watered down key aspects of the infection control guidance for healthcare providers as the pandemic worsened.

The newspaper can also reveal that healthcare providers were not told to implement social distancing until 18 days after the country went into lockdown.

The findings follow warnings by the Government’s scientific advisers that coronavirus appears to be spreading between hospital staff – potentially putting the whole country at risk of a second wave of infection.

Scrutiny of amendments made by Public Health England shows that healthcare providers were instructed to avoid using temporary staff when assessing possible coronavirus patients because of the risk of spreading the virus back in January, but this guidance was later updated in mid-March to state that temporary staff were permitted after all.

The guidance published on 10th January stated: “The use of bank or agency staff should be avoided.”

In mid-March this sentence was removed and the only reference to temporary staff in the guidance stated that “bank, agency and locum staff should follow the same deployment advice as permanent staff”.

Last night experts warned that the safety of patients and staff has been jeopardised as a result of the guidance change.

Dr Rinesh Parmar, chairman of Doctors’ Association UK, said: “The guidelines have been watered down because of resource shortages and I worry that staff and patients have been put at risk as a result.”

Dr Parmar said that the changes to the guidance around temporary staff, and lifting the restriction on the parts of the hospital where staff can work are all down to ongoing staff shortages which pre-date the pandemic.

“Whilst the science might suggest that [avoiding the use of temporary staff] is the right thing to do to prevent infections spreading from one area to another, the reality is that the NHS relies upon temporary staff all the time – even in pre Covid….It goes back to the NHS being 50,000 nurses short and 10,000 doctors short coming into the pandemic.”

Health chiefs have written to every hospital and GP practice instructing NHS hospitals to take “further action to tackle infections acquired in the NHS itself”.

The move was prompted by concern that Britain remains stuck in lockdown because it has been unable to get a grip on outbreaks in hospitals and care homes – which continue to leak out into local communities and increase the risk of a second wave of infection.

Professor Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine and a member of Independent SAGE, said it was concerning that the government had relaxed the rules on temporary staff “given the evidence we now have that agency and part-time staff played a major role in spreading infection between care homes.”

In January, the guidance made no mention of social distancing. This was only added for the first time on 10th April – 18 days after the general public went into lockdown – when NHS staff were told that “social distancing of 2 metres should be facilitated wherever this is possible”.

The government also watered down an early recommendation that clinicians use a “buddy system”, whereby another person watches for “inadvertent contamination”.

The original guidance said that the system was “recommended, especially during high risk procedures and PPE removal.” 

But later versions of the guidance made no mention of using the buddy system during high risk medical procedures, and only said it should be used to monitor PPE removal “where possible”, for example where there is a “dedicated isolation room with anteroom” to allow the buddy to remain at a distance of two metres. The same guidance acknowledges this is often not the case.

Dr Parmar said the buddy system is a crucial measure for ensuring that health care workers do not accidentally infect themselves whilst removing their PPE and track Covid-19 back to their families and into the community.

“This is about the safety of staff and their family members because if you’re contaminated when you leave, you potentially then take that home, or you might finish your shift and go to Sainsbury’s to pick up your weekly shopping and spread it,” he said.

Hospitals were also initially told by government that “as a general principle” doctors and nurses who were caring for suspected or confirmed covid patients should not care for other patients “although exceptions may be necessary”.

But this directive was changed on 3rd April to state: “As a general principle, healthcare staff who provide care in areas for suspected or confirmed patients should not care for other patients. However, this has to be a local decision based on local epidemiology and the configuration of the organisation”.

Professor McKee said: “It is difficult to avoid the conclusion that many of these decisions are driven by expediency, although this has been true throughout the pandemic, as it became clear that a health system that is running at close to maximum capacity at the best of times really struggles in an emergency, despite the best efforts of staff.

“Being generous, I suppose that some of the measures might be argued for on the basis of greater access to PPE and improved understanding of how the virus is transmitted, but it would be helpful if this was explained clearly. Otherwise, many of them seem to increase the risk.”

A Department of Health and Social Care spokesperson said: “The infection prevention control (IPC) guidance is kept under constant review and has evolved in response to the changing epidemiology of Covid-19 and the emergence of new evidence and science.

“Our guidance seeks to ensure a consistent and resilient UK wide approach, but is clear decisions should be made locally based on local epidemiology and each individual place of work.”

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