Coronavirus Covid-19, disabled people, and home nursing

The UK government is now being criticised by some respected public health experts for a lack of transparency and urgency, especially around home nursing.

One such critic is Professor John Ashton from the north west of England, who my late wife Lorraine Gradwell knew and respected from her time working at Health Manchester 2000.

In short, the criticism is of a lack of transparency about the NHS and it limitations to cope with an epidemic. Because of austerity there have been massive cuts in the number of hospital wards and beds, and this includes intensive care units, ICUs. Hospital beds and ICUs are already at full capacity because of so-called winter pressures. We knew that staff shortages were already an issue from the debates in the General Election last year. The controversies about the alleged 40 new hospitals and 50,000 new nurses, or not.

We now know that between 70% and 90% of people will get a covid-19 infection. After this, there is so-called herd immunity. There will be no vaccine ready during this period.

For most people, their infection will be mild. Some younger, healthy people may not even know they have had the infection and have been contagious.

But for elderly people and for many chronically sick and disabled people with compromised health the infection will be severe and many will die. Somewhere between 1% and 3.4% of the population will die as a result.

Even at the lower end of the estimate, there are nowhere near enough ICU beds in hospitals. And brutally speaking, the chances are that hospital ICU beds will be reserved for “special cases” such as younger people only, and even then might be stretched to the limit.

So, if the UK government was being transparent, they would say now that for the vast bulk of people who will be severely infected, it will be what is called “home nursing”.

In the absence of proper, transparent advice, we have to try and plan for what that might mean for disabled people who already use personal assistants (PAs) for what some health professionals might consider as a form of basic nursing.

So let us make a guess: home nursing in the community will, like the hospitals, being very over-streched. So if they find someone with PA support they will expect PAs (along with any family members living in the same home) to provide the bulk of nursing.

Frankly, I think and fear that this will be mostly oxygen (tanks delivered to the house, by the bed with a nose cannula) and pain relief. Experienced nurses will probably be given authority to prescribe and carry morphine, at least for a year.

I wish I could be more optimistic here, but in the absence of transparency I don’t see what more can be done by the NHS.

When you go around a museum and see the field hospitals used in World Wars One and Two, with volunteer nurses, army orderlies (who could change dressings), and stretchers laid out in lines – I suspect we will be working at that level again, but hidden away in hundreds of thousands of homes rather than in tents in the park.

And the advice will move on – call 111 when someone has died.

But for now, no transparency.

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