JEANE Freeman has suggested that it would be a “reasonable conclusion” that care home operators failing to put effective infection controls in place has contributed to the spread of Covid-19 in the institutions. 

The Health Secretary warned, however, that the picture is complex, and a review being carried out by watchdog, the Care Inspectorate, is taking other factors including sufficient PPE and staff training into account. 

Data from National Records of Scotland (NRS), published on Wednesday, showed there have been 1,818 deaths in care homes when Covid-19 was mentioned on the death certificate, higher than the 1,815 fatalities in hospitals. 

Speaking at Holyrood’s health committee, Ms Freeman also suggested that care homes with a limit of 30 residents "appear to do better in terms of handling the virus" but added that is only based on "early emerging evidence". 

The Health Secretary was asked by SNP MSP Sandra White whether it “would it be fair to say that prevention failings with quality in infection, prevention, control in some care homes have led to cases of Covid”. 

Ms Freeman said: “I would hesitate to be absolutist about that. 

“I think it is a reasonable conclusion to come to. 

“I think we would need to look care home by care home at how a case was first identified as quickly as possible, what were the steps that were then taken, was the guidance being followed, what were the levels of PPE, how confident were staff in their training to use that PPE – before it would be reasonable to give a reasonable yes or no answer. 

“Those are the areas that need to be looked at and those are the areas that are currently subject to the Care Inspectorate's telephone, digital and on-site inspections.” 

Ms Freeman told MSPs that 38 per cent of adult care homes have not reported a "Covid-19 incident" during the outbreak and 58 per cent of homes have not done so in the last two weeks. 

New figures show that almost 70 per cent of privetley-run care homes have had suspected cases of Covid-19, compared to only 38 per cent in the voluntary and not-for-profit sector - amid growing calls for the care sector to be reformed, along the lines of the NHS.

READ MORE: Coronavirus: Elderly hospital patients having do not resuscitate forms 'slipped into discharge notes'

The Health Secretary was also pressed about an investigation into failures and lessons learned in care homes – while she confirmed that the Care Inspectorate has carried out “27 on-site inspections in the last two to three weeks of 19 establishments” while inspectors may “go back to see whether improvements have been made”. 

She added: “The Care Inspectorate does have a number of important powers – I think we probably are seeing them exercised with respect to Home Farm care home in Skye, where they have taken a very serious step indeed of applying to the court to have the owner of that care home de-registered. 

“That does not rule out the Care Inspectorate having more powers than they current have  - I’m more than happy to look at that in the round as we look at and take the Care Inspectorate’s view as well, of course, when we look at lessons we are learning.” 

READ MORE: Nicola Sturgeon: Time right for Scotland to lift lockdown despite static infection rate

Ms Freeman said that a “clear lesson” to be learned was “requiring a degree of effort to navigate your way through all the guidance” for care home operators and that “streamlining this and making it as easy as possible for people to follow what is the most up to date guidance”. 

The Scottish Government has published updated care home guidance on March 13, March 26 and May 15 during the pandemic.

The Health Secretary also suggested that one health and social care partnership, and possibly others, had issued their own conflicting care home guidance to that published by the Scottish Government.  

She said: “I am aware that there have been at least one incident, there maybe more, where it appears that additional guidance issued by the local health and social care partnership did not help to clarify matters for individuals and created a degree of confusion. 

READ MORE: Jeane Freeman: Hospital patients may not have gone to care homes if we had known more about virus

“I remain unclear why a health and social care partnership should feel the need to issue anything but should not be working, as I would expect them to, from the guidance issued from our senior medical and clinical advisors in government and also from HPS (Health Protection Scotland).” 

Ms Freeman defended the Scottish Government’s decision to discharge elderly patients from hospitals, who were not required to be there, with many being transferred to care homes in March and April. 

READ MORE: Jackson Carlaw: Scottish Government should appoint dedicated care homes minister

It emerged 900 people were discharged from hospital into a care home in March before mandatory testing for Covid-19 was introduced. 

She told MSPs that it was “entirely appropriate” to decrease delayed discharge and bed blocking numbers, a move opposition parties have been calling for, for some time, in anticipation for an influx in hospital admissions for coronavirus

Ms Freeman added: “It was correct in the circumstances where we reasonably anticipated, based on the evidence that we had and the judgment that we made about that, that continuing to stay in a hospital setting that was gearing up to receive large numbers of Covid cases was not the safest place for someone clinically fit to leave hospital to remain." 

The Health Secretary said that judgment was "right", given the knowledge of the virus they had at the time. 

She added: "At the time, we took all the steps that we could reasonably been expected to take."