0:00:04.043,0:00:05.473
Over the past number of weeks,

0:00:05.473,0:00:08.328
all of us have had to adapt[br]and change everything that we do:

0:00:08.328,0:00:09.994
limiting our contact with people,

0:00:09.994,0:00:12.308
being scrupulous about washing our hands,

0:00:12.308,0:00:14.883
standing patiently in line[br]to enter a supermarket,

0:00:14.883,0:00:16.355
and staying at home.

0:00:16.885,0:00:19.493
The word 'home' has become[br]loaded with meaning.

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For many of us, home is a place[br]of safety and sanctuary.

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But this is not the case for everyone.

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What has become very apparent[br]over the past few weeks

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is that care homes for older people[br]have not been places of safety

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either for staff or for residents.

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The care home setting has been[br]the forgotten front line in the UK.

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Numbers of cases and deaths[br]in UK care homes were not reported

0:00:42.102,0:00:43.813
in the early stages of the pandemic.

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And it is only now

0:00:45.251,0:00:48.013
that we're beginning to understand[br]the scale and the impact

0:00:48.013,0:00:50.969
that the coronavirus has had[br]in this environment.

0:00:50.969,0:00:52.254
Many, who like me,

0:00:52.254,0:00:56.180
who've conducted research in care homes[br]and are familiar with the sector

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are, sadly, not surprised[br]by what has happened.

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So why has it happened?

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And what lessons can be learned[br]from this tragedy?

0:01:04.483,0:01:05.479
Care homes,

0:01:05.479,0:01:08.901
which is a term sometimes used[br]to describe nursing or residential homes,

0:01:08.901,0:01:10.011
provide care,

0:01:10.011,0:01:14.827
usually to older people who are unable[br]to continue to live in their own homes.

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The average age of residents[br]is around 80 years.

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The population is largely women -[br]about 70 percent.

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And most will have two or three[br]medical conditions, including dementia.

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This means that they will be taking[br]a number of medications,

0:01:27.837,0:01:29.991
and in some cases, more than 10.

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Care home residents[br]tend to be more prone to infection.

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And research that we did[br]in Northern Ireland in 2011

0:01:37.222,0:01:40.130
showed that there were higher levels[br]of antibiotic prescribing

0:01:40.130,0:01:43.320
used to treat infections[br]in Northern Ireland nursing homes

0:01:43.320,0:01:46.773
compared to homes[br]in other European countries.

0:01:46.773,0:01:49.727
Another study, which we published in 2010,

0:01:49.727,0:01:52.750
found high levels[br]of a bacteria called MRSA

0:01:52.750,0:01:55.137
in both residents and staff.

0:01:55.587,0:01:57.040
Further research showed

0:01:57.040,0:02:00.135
that controlling infection in care homes[br]was difficult for staff

0:02:00.135,0:02:01.719
because of lack of time

0:02:01.719,0:02:03.338
and they didn't have the resources

0:02:03.338,0:02:06.894
to purchase the necessary equipment[br]to prevent infection.

0:02:07.324,0:02:10.123
A survey conducted by Mather LifeWays,

0:02:10.123,0:02:15.237
which provides care services[br]to older people in US nursing homes,

0:02:15.237,0:02:20.056
found that staff felt ill-prepared[br]to deal with public health emergencies.

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In the UK context,

0:02:21.874,0:02:24.822
care homes are not seen[br]as part of the National Health Service.

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Many of them are privately owned,

0:02:26.645,0:02:31.200
and this may affect access[br]to personal protective equipment, PPE.

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And, importantly, as the name suggests,[br]care homes are homes.

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They are the residents' homes,

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albeit on a communal basis,

0:02:39.552,0:02:42.637
and staff will try to enhance[br]that homely environment

0:02:42.637,0:02:44.635
rather than create a clinical environment,

0:02:44.635,0:02:46.843
which would be commonly seen[br]in the hospital.

0:02:47.753,0:02:48.947
So all of this background

0:02:48.947,0:02:52.364
highlights how a perfect storm[br]has been created in care homes

0:02:52.364,0:02:54.124
during this pandemic:

0:02:54.124,0:02:55.529
a vulnerable population,

0:02:55.529,0:02:57.056
a high-risk environment,

0:02:57.056,0:02:59.022
and lack of resources.

0:02:59.022,0:03:02.343
But, perhaps, there's also been[br]an intangible factor at play

0:03:02.343,0:03:06.241
and something this society[br]may not have been prepared to admit:

0:03:06.241,0:03:09.167
do we really care[br]about what happens in care homes?

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The residents are old[br]and are probably going to die anyway.

0:03:13.244,0:03:14.722
So why bother to test?

0:03:14.722,0:03:18.346
And why bother to count[br]the number of cases and deaths?

0:03:19.176,0:03:21.996
Prime minister Boris Johnson[br]stated in the UK Parliament

0:03:21.996,0:03:24.217
on Wednesday, May the 6th:

0:03:24.217,0:03:26.308
'There is an epidemic[br]going on in care homes,

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which is something I bitterly regret.'

0:03:29.125,0:03:30.650
There's been growing recognition

0:03:30.650,0:03:33.832
that care homes were left behind[br]and forgotten in the early stages.

0:03:33.832,0:03:37.806
and there's now a concerted effort[br]to play catch-up with testing,

0:03:37.806,0:03:39.116
the provision of PPE,

0:03:39.116,0:03:41.716
and further support from the NHS,

0:03:41.716,0:03:44.217
with hospital nurses[br]now working in care homes

0:03:44.217,0:03:47.709
and other staff providing advice[br]on infection control.

0:03:48.269,0:03:51.501
Care home staff have worked[br]under the most difficult of circumstances

0:03:51.501,0:03:53.358
to provide the best care to residents,

0:03:53.358,0:03:56.007
to the extent that many[br]are now living on-site

0:03:56.007,0:04:00.085
to maintain lockdown conditions[br]and minimise the risk of transmission.

0:04:01.105,0:04:03.077
As we move towards a possible lifting

0:04:03.077,0:04:06.267
of some of the more extreme[br]elements of lockdown,

0:04:06.267,0:04:08.744
might the experience[br]witnessed in care homes

0:04:08.744,0:04:10.990
lead to a more sustained[br]and permanent change

0:04:10.990,0:04:13.211
in how society views older people

0:04:13.211,0:04:16.159
and particularly those[br]who reside in care homes?

0:04:16.159,0:04:17.411
Might care homes be seen

0:04:17.411,0:04:20.204
as an important part[br]of health and social care,

0:04:20.204,0:04:22.399
not sitting at the periphery of the NHS

0:04:22.399,0:04:23.402
and often viewed

0:04:23.402,0:04:25.766
as the care provider of last resort?

0:04:26.396,0:04:27.863
In 2007,

0:04:27.863,0:04:29.652
the British journalist Polly Toynbee

0:04:29.652,0:04:32.396
wrote in an opinion piece[br]for The Guardian:

0:04:32.396,0:04:34.537
'Schools are hot politics;

0:04:34.537,0:04:36.608
old folks' homes aren't.'

0:04:36.608,0:04:38.529
13 years later, in 2020,

0:04:38.529,0:04:42.140
care homes have become hot politics,[br]but for all the wrong reasons,

0:04:42.140,0:04:45.248
and society has been appalled[br]at what has happened.

0:04:45.248,0:04:49.686
But perhaps this tragedy will be[br]the catalyst for change in care homes.

0:04:49.686,0:04:50.730
On a Thursday night,

0:04:50.730,0:04:54.710
we stand on our doorsteps[br]to applaud those working in the NHS

0:04:54.710,0:04:56.676
and other front-line workers.

0:04:57.126,0:04:59.784
Let us reflect, in particular,[br]about care homes -

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the staff, the residents -

0:05:01.039,0:05:03.972
and what they have faced[br]over the course of this pandemic.

0:05:04.602,0:05:07.552
It is timely that we think[br]about what we value

0:05:07.552,0:05:12.998
when it comes to the care and protection[br]of some of the most vulnerable in society.

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And we should think[br]about what we would want for ourselves

0:05:15.721,0:05:18.971
if, in the future,[br]we become care home residents.

0:05:19.791,0:05:21.822
Alan Bennett, the writer and playwright,

0:05:21.822,0:05:25.145
has been an advocate[br]for improving care for older people.

0:05:25.145,0:05:28.315
He has written movingly about[br]his own mother's time in a care home,

0:05:28.315,0:05:30.038
where she eventually died.

0:05:30.588,0:05:32.061
In his book 'Telling Tales',

0:05:32.061,0:05:36.222
he reminds us that old age will come[br]to many of us despite what we think.

0:05:36.222,0:05:37.847
He writes the following:

0:05:38.457,0:05:41.119
'And one of the ways the young[br]think they are safeguarded

0:05:41.119,0:05:44.511
against the fate and the future[br]of their grandparents is by their names.

0:05:44.511,0:05:48.495
Sharons don't suffer from dementia[br]or Damiens from incontinence.'

0:05:48.975,0:05:52.775
Alan Bennett goes on to warn us[br]that our names are not enough to save us.

0:05:52.775,0:05:53.915
I quote:

0:05:53.915,0:05:57.159
'But coming up the road are the Danes[br]and the Darrens and the Waynes,

0:05:57.159,0:05:58.875
and they too shall fail.

0:05:58.875,0:06:01.465
It won't be long before[br]even Tiffany is a grandmother

0:06:01.465,0:06:03.986
and her cot got ready in the corner.

0:06:03.986,0:06:06.655
Her children, middle-aged[br]and vaguely resentful,

0:06:06.655,0:06:09.301
come and sit with her[br]on Sunday afternoons

0:06:09.301,0:06:12.936
while she tries to remember[br]who they are and who she is.

0:06:12.936,0:06:14.388
"You're Tiffany, Mother,

0:06:14.388,0:06:16.780
and this is your little granddaughter."

0:06:16.780,0:06:18.619
And what will her name be?'