(Image: PA)
Scotland moved faster than the rest of the UK to isolate people sent from hospital into care homes during the first wave of Covid-19, but the sector still entered the pandemic unprepared and was treated as an "afterthought", the UK Covid-19 Inquiry has found.
Baroness Hallett's sixth report, published on Tuesday, examines the care sector across all four nations.
There were 4,272 deaths involving Covid-19 among care home residents in Scotland, out of 43,088 across the UK.
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It rejects as unfounded the claim, made by the then UK health secretary Matt Hancock in May 2020, that a "protective ring" had been thrown around care homes "right from the start".
Matt Hancock claimed a 'protective ring' had been put around the care sector
Baroness Hallett said: "Quite the opposite was true. During the crucial weeks of March and early April 2020, the overriding focus of the UK government and devolved administrations was on protecting hospitals."
The report finds that Scotland was the first nation to advise isolation for everyone admitted to a care home from hospital, including those who had not been tested.
That followed a meeting on March 18, 2020 between the then health secretary Jeane Freeman and Dr Donald Macaskill, chief executive of Scottish Care, and was set out in Scottish Government guidance on March 26.
England did not advise isolation until April 15, Wales until April 22 and Northern Ireland until April 26.
Baroness Hallett concluded that the early move in Scotland "is likely to have reduced the risks of people admitted to care homes who were potentially Covid-19-positive infecting others."
But the report also exposes the scale of untested discharges and the pressure on homes to keep taking patients.
Some 3,595 people were discharged from Scottish hospitals to care homes between March 1 and April 21, 2020. Of those, 82% went without a Covid-19 test.
3,595 people were discharged from Scottish hospitals to care homes between March 1 and April 21, 2020 (Image: PA)
The Inquiry agreed that patients had to be discharged quickly to free up space in the wards, because Scotland was projected to need 37,000 more beds than it had by March 12, 2020.
It also says studies concluded that discharges were one of several routes by which the virus entered care homes and were unlikely to have been the dominant driver of infection in the first wave.
However, the precise extent could not be determined because of the lack of testing capacity.
In her evidence, Ms Freeman, who died earlier this year, told the Inquiry that, had there been enough testing capacity, she would have introduced testing on admission to care homes earlier.
The report shows she went further than her chief medical officer's advice on testing.
On April 20, 2020, the then Interim Chief Medical Officer Dr Gregor Smith told Ms Freeman and then First Minister Nicola Sturgeon that "blanket testing of all admissions to care homes prior to their admission is not advised at this stage".
He warned that PCR tests could give false reassurance.
Ms Freeman told the Inquiry she wanted to go further and at a quicker pace because of how vulnerable care home residents were.
The following day, she announced that patients should have two negative tests before discharge to a care home.
Jeane Freeman, Nicola Sturgeon and Dr Gregor Smith Scotland's chief medical officer applaud the NHS outside St Andrew's House (Image: Jeff J Mitchell/Getty)
Baroness Hallett's report singles out the Clinical Guidance for Nursing Home and Residential Care Residents and Covid-19 published on March 26.
The document said it was "imperative" for care homes to continue taking admissions where clinically safe to do so.
The Inquiry says wording of this kind was "plainly intended to actively encourage care homes to accept admissions to ease pressure on hospital settings."
Dr Macaskill told the Inquiry that homes felt undeniable pressure to help NHS Scotland create capacity.
He pointed to the National Care Home Contract, which covered 70% of care home residents in Scotland and said a registered home should not ordinarily refuse admission unless there were very clear clinical reasons.
There was also criticism from the Inquiry over the lack of planning.
In Scotland, guidance on influenza pandemic preparedness for health and social care was still in draft form in 2019.
There was no national overview of care home bed capacity, and despite it being a condition of registration with the Care Inspectorate, not all care homes had business continuity plans.
Exercise Silver Swan, a Scottish pandemic flu exercise in 2016, had raised concerns about the robustness of plans for backup social care capacity.
It recommended that regional resilience partnerships produce plans that included health and social care partnerships.
Ms Freeman told the Inquiry that at the start of the pandemic she did not have oversight of how many partnerships had actually been integrated into local plans.
First Minister Nicola Sturgeon speaking at a coronavirus briefing (Image: Scottish Government/PA)
The workforce was also stretched before the pandemic began. The report says adult social care entered Covid in a fragile state.
In Scotland, 48% of care homes for adults reported staff vacancies in 2020, rising to 63% in 2021.
In care at home, 59% of services reported vacancies in 2020 and 71% in 2021.
Ms Freeman described longstanding difficulties in recruiting and keeping care staff.
Protective equipment was also an issue. Pandemic stocks were made available to social care from the week beginning March 17, 2020. Even so, a GMB Scotland survey found that 76% of its private care members had not been given appropriate PPE.
Every care home was promised a top-up supply on April 17. Across the UK, the report says shortages left some workers in unsuitable PPE or none at all.
There was also criticism of the Care Inspectorate's decision to scale back routine inspections in early March 2020.
On-site inspections resumed on May 4 after serious concerns about one home, including the lack of PPE use, hygiene, contaminated food and leadership.
Enforcement action followed, and the home was later sold and its registration transferred to NHS Scotland.
The report does not name the home, but it is likely Home Farm in Portree on Skye.
Ten residents died there in a Covid-19 outbreak, and the Care Inspectorate went to court in May 2020 to cancel the registration of its operator, HC-One. It dropped the action in August after finding considerable improvement, and NHS Highland agreed in September to buy the home.
On visiting, the report says the restrictions "caused incalculable harm to residents and their loved ones".
Care Home Relatives Scotland described a "complete postcode lottery" of rules, with some providers based in England applying English guidance in their Scottish homes.
The report praises Anne's Law, which was brought in under the Care Reform (Scotland) Act 2025.
Care homes must now identify an essential care supporter for each resident, with a legal presumption that suspending those visits is likely to cause serious harm.
Visits can be suspended only where essential to prevent a risk to life, health or wellbeing.
Dr Macaskill described the Inquiry's report as a "sobering and at times deeply painful read".
"The report is particularly significant in acknowledging that social care was too often treated as an afterthought rather than as an equal partner within our system of public protection."
Dr Macaskill added: "Accountability matters, but this report cannot be only about past failure. It must become a mandate for lasting change."
GMB Scotland survey found that 76% of its private care members had not been given appropriate PPE (Image: PA)
Scottish Labour's health spokesperson Jackie Baillie said: "This report is utterly damning of pre-pandemic preparedness and the lack of protection for those working and resident in care homes.
"For social care to be treated as an afterthought by decision makers is heartbreaking for those who lost loved ones.
"The act of discharging untested patients to care homes is one of the biggest scandals of the pandemic. Then First Minister Nicola Sturgeon admitted it was a mistake in 2021, after it was revealed that 1,300 patients were discharged before a robust testing system was in place.
"Nicola Sturgeon was health minister during the C. diff outbreak, where it was clear that discharging untested people into care homes had a devastating effect, yet no lessons seem to have been learned from that. People deserve to know why.
"John Swinney was by her side during that period. The Scottish Government must deliver a serious and comprehensive response to this report, and an apology for families grieving the loss of loved ones because of a deadly decision to send untested patients into care homes."
A Scottish Government spokesman said: "The Scottish Government welcomes the publication of this report and will take the necessary time to fully and carefully consider its findings and recommendations."
He added: "Throughout the pandemic, the Scottish Government's overriding objective was to protect people and minimise loss of life."
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At Westminster, Prime Minister Andy Burnham said: "The Government is committed to learning the lessons from the inquiry and ensuring the social care sector is prepared for a future pandemic. We will consider carefully the findings and recommendations of the report and respond in due course."
STUC General Secretary Roz Foyer said: "It's abundantly clear that workers and care home residents were put in harm's way by the disastrous discharge of untested patients from hospitals into care homes. This damning report confirms that care worker deaths were not centrally recorded, which limited the understanding of the serious risks workers were exposed to."
She added: "This report cannot be ignored nor sidelined by either the Scottish or UK Government. The government must accept and act on all the recommendations, along with a full and unequivocal apology to all those workers and care users who unnecessarily suffered because of government decisions."
Covid-19 Bereaved Families for Justice UK called Mr Hancock's claim a "cruel lie", although its solicitor, Nicola Brook, described the report as a "superficial damp squib". Unison said the report underlined the urgent need for proper funding, root-and-branch reform, and decent pay and conditions for social care staff.