WHAT'S GOING ON IN RESIDENTIAL AND DOMICILIARY CARE

We've heard a lot today from ministers about what's going on (or should be going on) on in social care

As good as the intentions might be there's sometimes a v big gap between the podiums and the frontline. Here's why.

First, testing in care homes. You may have seen me tweeting about this- but a recap.

govt has promised that care home workers and symptomatic patients should be part of testing programme. Hancock repeated it today

But it seems PHE can't deliver all of it at least in some places

Weeks ago, I visited a care home in Hove. The manager there, Sandra, a wonderful woman, is doing her best to keep #covid19 out and protect the residents she so clearly loves.

Unfortunately, last night, she had the first death in her home. 90 year old Peter.

He was tested. However, Sandra now has five other patients displaying Covid symptoms.

She wrote to PHE asking for tests

They replied today saying they are not available because "the processes to enable this are not yet established...I do not have a time scale for this"

The way it's written has a hint of exasperation- it implies they're aware of a government announcement on care home testing but don't know how they are supposed to deliver it

Sandra has worried relatives on the phone begging for answers and tests and she can say so little

Sandra told me: "I can offer no reassurance to loved ones, relatives or staff, whether we’ve got cases or where we go from here. I think it’s awful they stand there every night on TV saying they’re going to help homes, I’ve had the experience today - they’re not helping us."

Tonight, after our investigation, Public Health England have apologised to the care home and said: "PHE would like to apologise if our letter has caused confusion to the care home. All residents and staff will be tested and we will arrange this straight away."

This is great news. But I worry if there's a pattern here. Several sources have told me that if a home kicks up a fuss against PHE then they'll get tested. This cannot be any way to run a system.

Brighton alone has capacity for 1000 tests a day. Only 350 were done on Tuesday.

So the uniformity of what's available seems to be all over the place.

The more I think about this, the more I think it's about how England is governed. No surprise that Scotland and Wales, the problem is a bit less acute- because they have much smaller units to manage.

In Durham since last week testing of residents been offered by local trust and County Council community teams. Local official tells me it's been put in place because centrally there's no direction: "You can’t run response to pandemic from a desk in Whitehall."

No surprise that places which have managed their outbreaks best, often have strong regional political structures. The demands, just from care alone, on Dept Health and PHE are so great. They're drowning.

More broadly, in residential care, the same problem I was reporting on a month ago is still there: An over-reliance on agency staff who are still largely untested going to multiple homes in a day and spreading the disease. This is why people are dying in homes.

It's become fashionable to say care homes are the forgotten front. But if so domiciliary care is even more removed from our minds.

I've spoken to several domiciliary carers today. What they've told me is absolutely shocking.

One carer from a private company told me that she's been told in by her manager that she shouldn't expect PPE as it "interferes" with her duties and "scares" residents she's visiting

She's been given one disposable mask which is supposed to last 2 weeks. It lasts for 30 mins.

Another carer told me: "we’re going to people’s homes, we’ve only got gloves and aprons. No masks. We have v close contact with the people we’re going to , we have to wash them, dress them...they're breathing on me, breathing on us and we’ve got no protection at all."

They point out that district nurses are coming into the same homes for far less time and have full protection.

The only times domiciliary carers get proper protection is if they know the client has covid, which they usually don't and in any case, lots are asymptomatic

It's common for a dom carer to visit 20 homes in a day

20 homes. 20 chances to get infected or infect someone else. Without proper PPE.

You see the problem?

The dom carers I've spoken to think they're not getting it partly because their companies don't want to pay for PPE partly because they can't get it anyway

Their bosses have told them they're following Public Health England guidelines. That is absolutely not the case.

These are people (usually women) on min wage taking enormous personal risks.

They've been told that if they take time off or self isolate, they'll only get statutory sick pay, if that. They can't afford it.

Many are paying for PPE out of their own pockets. Min wage pockets.

One dom carer told me that despite the fact that at various times both she and her colleagues have had symptoms their boss had told them to go to work, "the companies are saying get on with it, it’s like keep quiet and carry on"

It hardly needs saying how reckless that policy is

Worryingly, some v vulnerable people who need care at home have started to refuse care because their parents don't have PPE: "My clients are getting all upset, they’re telling people to leave, some clients have refused care altogether because they’re scared for their own lives."

What struck me most about what these domiciliary carers was how completely abandoned and defeated they sounded. One told me they felt: "Upset. Degraded. Not worthy. We don’t mean anything to anyone. No one’s bothered, as long as we’re doing the job, no one’s interested

. @unisontheunion tell me they are receiving literally *thousands* of pleas for help from care workers, especially domiciliary care workers, feeling terrified about their lack of PPE. It is an enormous issue and there seems little respite in sight.

Tonight millions of people gathered outside to clap for carers. But as much as they might appreciate that, what they want most are the tools to do their jobs. Sometimes they’re called angels. But they’re not-angels don’t need protection. People, our carers, most certainly do.

Lots more on this on @BBCNewsnight at 10.45pm. Do tune in.

Am sure everyone would agree these are hugely important issues, affecting some of the most important yet poorest members of our society. We asked if a minister would come on @BBCNewsnight last night to discuss them. No one was made available. https://twitter.com/esmewren/status/1253629001429639169?s=21 https://twitter.com/esmewren/status/1253629001429639169