1.Mark Drakeford AM, First Minister of Wales

2.Gillian Baranski Chief Inspector  Care Inspectorate Wales

3. Dr Dai Lloyd MS Chair Health, Social Care and Sport Committee Senedd Cymru

4.Mr M  Antoniw MS

7^th May  2020

Dear First Minister, Dear Chief Inspector, Dear Dr Lloyd,

Residential Care Homes Covid-19 inquiry  into  the management of infection and deaths in care homes

I am addressing my reply to both the First Minister of Wales and Chief Inspector,  Care Inspectorate Wales as I believe the issues that I raise and the questions that I ask require answers from both the Welsh Government and the Care Inspectorate Wales. I have also included Dr Lloyd, Chair of the Health, Social Care and Sport Committee Senedd Cymru, as the committee is undertaking an inquiry into the Covid-19 outbreak in Wales. I  refer you to my letter of 23rd April 2020 and  the reply of 28th April 2020.

Thank you very much Mrs Baranski for your reply and for your condolences on the death of my mother. We take comfort that my mother had a long and rewarding life. As a young woman in the xxxx she qualified as State Registered Nurse, when tuberculosis was raging and there was no effective treatment. In xxxx after her husband’s evacuation from Dunkirk she nursed him back to health and saw his  return to active duty. As a nurse she witnessed the arrival of penicillin and antibiotics and the birth of her precious NHS. After her retirement she looked after her granddaughters and worked in our little shop. Her horizons were wide, she forged friendships across France and just last year she was proud to be recognised as an Irish citizen. In February she celebrated her xxxx birthday.

Despite her age my mother’s death came as shock to the whole family.  We had thought that in the protected environment of a care home that she was in a place of  safety from Corona virus particularly as in November 2018 the local authority took the decision under the Mental Capacity Act 2005 that my mother did not have the capacity to decide where she lived and a best interest conference endorsed the view that she should remain in xxxx.

In the weeks before her death she had been in good health but within a week of falling ill she died of Community acquired PneumoniaCovid-19.  We are told that she died peacefully in her sleep but we could not be with her at the end. At her funeral there were just nine of us, her six granddaughters bore her coffin. There could be no requiem mass, this and the traditional Irish wake the  tórramh “the gathering in” will have to wait.

I agree with the view expressed in your reply that the safety of people using care services is of paramount importance. With this in mind I would like to know  what planning the Welsh Government and CIW were involved in to prepare for an epidemic relating  to an Influenza or novel type as referred to in the  Public Health England  Pandemic Influenza Response Plan2014.  Could you tell me whether  the CIW or Welsh Government  were involved or consulted in drafting the plan.  Was a similar  exercise held and plan devised for Wales and was the impact of such a pandemic on residential care modelled and  plan devised to respond to the event.

Similarly were either or both of your organisations  involved in the series of exercises and workshops in the lead up to a National Tier 1 Pandemic Influenza exercise ‘Exercise Cygnus’  which are referred to in the  minutes of the Powys Teaching Health Board meeting held on 25th January 2017.  These minutes stated that “PTHB has participated in a series of exercises and workshops in the lead up to a National Tier 1 Pandemic Influenza exercise ‘Exercise Cygnus’ which took place in October 2016. The key recommendations following participation in these events are expected to be available by Welsh Government shortly and will be used to inform the review of the PTHB Pandemic Influenza Framework document and other supporting documents that underpin the Framework.” Did  the key recommendations include ones relating specifically to residential  care  and were recommendations  shared   with CIW by the  Welsh Government?

I appreciate that you are currently focussing resources on supporting providers to enable them to access advice and information to provide good quality care to people. This is precisely why I think that an inquiry should be underway to learn and apply  lessons as the pandemic continues to cause  devastation in  care homes. Given the devastating effect of the virus in  care homes I would expect you to have already  begun to inquire into the actions of residential care providers and the Welsh Government. For example on testing, the provision of Personal Protective Equipment, the safe delivery of personal care, staff moving between residential establishments and the community domiciliary care services , and  the management  of transfers or the admission of new residents.

In your reply you refer to your safeguarding role. I am not suggesting that a care home provider has been wilfully negligent or deliberately harmed people. I have  acknowledged the exemplary care that the staff of xxxx provided to my mother in the two years that she resided at xxxx and my appreciation of the tenderness with which they  cared for her in her final days.

However as a bereaved relative I have many questions to ask that only an inquiry could answer.  More importantly an inquiry would provide the CIW and the Welsh Government with an understanding of the situation here and now, not merely retrospectively.  You would be able  to identify  lessons that are being learned and to apply them. I would have expected  your organisations to already be taking evidence    from the workforce, from residents and  from bereaved relatives to help you identify from their testimonies some of the lessons that you can apply now to reduce  the number of current and futures deaths in care home.

The apparent tardiness of the Welsh Government in this respect stands in stark contrast to The Health, Social Care and Sport Committee which I have learned from you is undertaking an inquiry into the Covid-19 outbreak in Wales. Its terms of reference to “consider the impact of the outbreak, and its management on, health and social care services in Wales; and its approach of  considering the impact on staff, patients and others receiving care or treatment in both clinical settings and the community” are those that should be underpinning your actions. Both your organisations which are so much better resourced then this committee should now move swiftly to establish  a public inquiry.

Unlike the Grenfell Tower inquiry this is not a singular event but a situation that will be with us for the foreseeable future. I ask this not only because of the experience of a family of woman who devoted her life to the NHS and died without her family present but to help ensure that our experience does not continue to be replicated  across Wales.

Consequently a contemporanious inquiry should be established. The Welsh Government and CIW need to take action now to establish an inquiry and issue a call for evidence.