October 21 2026 - 11:45am
Yesterday, the Covid Inquiry released its latest report on the government’s response to the pandemic. This time it was focused on the care sector. However, as usual, the report offers glimpses of insight into the failures of the British state during the pandemic without really getting to the heart of the problems.
As in most countries, care homes saw a high number of deaths attributed to Covid, especially in the early months of the pandemic. Much of the public anger at the time focused on the role of discharging hospital patients back into care homes in those deaths, despite them not being tested for Covid. However, the evidence for this is, in fact, thin. Peer-reviewed research into care homes in England and Wales concluded that hospital transfers could explain only a very small proportion of care home infection outbreaks or deaths. Similarly, evaluations of asymptomatic testing within care homes provide little evidence of effectiveness in preventing outbreaks.
Instead, it is no surprise that vulnerable elderly people were particularly susceptible to a respiratory infection such as Covid is. What seems to be more important in explaining differences in mortality rates are underlying factors such as quality of care and staffing levels. On these aspects, the broader effects of UK policy on both Covid and non-Covid deaths in care homes need to be considered.
ONS data on Covid deaths by cause show that non-Covid deaths in care homes also peaked in April and May of 2020. It is true that some of these deaths may have been misattributed and, in fact, caused by Covid. But, importantly, the data is based on death certificates rather than Covid tests, which were limited at the time. This suggests a significant proportion of those excess deaths may have actually been caused by policies aimed at preventing Covid spread rather than by Covid itself. In particular, this included isolation of elderly residents for long periods, even when there was no evidence they had Covid. Furthermore, strict rules limiting or even prohibiting visits by relatives are strongly associated with care home mortality.
For example, one study found that care homes which maintained at least some visiting rights had 21% lower mortality than homes which remained completely closed. Another study from the US found that although isolation and visitor restrictions reduced Covid cases, they also caused long-lasting mental health impacts which persisted long after the pandemic. But even more seriously, restrictions actually increased overall mortality figures, with the effects particularly strong for residents with dementia.
But the government’s report does not take this seriously. In her recommendations, the author of the report, Baroness Hallett, simply calls for advancing “guidance on how limiting visiting will be decided upon in a future pandemic”. This is a shocking missed opportunity.
This is not the only case from the pandemic where policymakers ignored ethics on the basis that “the end justifies the means” but did not even manage to achieve positive “ends”. A year after the initial spike in care home deaths, the Government announced mandatory vaccination for care home workers, arguing that the increase in vaccination take-up would reduce care home mortality. My research with Professor Sourafel Girma concluded that the mandate had no observable impact on care home mortality. However, it did cause many care home workers to leave the sector. There was a net reduction of roughly 14,000 to 18,000 staff, which was about 3 to 4% of the workforce at a time when the sector was already facing a staffing crisis.
It is no surprise that policy mistakes were made during the pandemic given the fast-changing and uncertain situation. What is less forgivable is the way that critical debate about Covid policy was shut down. On lockdowns, masks, visitor restrictions, school closures and vaccine mandates, critics of mainstream policies were labeled as “granny killers” and conspiracy theorists. The best lesson that we could learn from the pandemic is that policymaking benefits from robust critique and alternative viewpoints, even at times of crisis.
David Paton is a Professor of Industrial Economics at Nottingham University Business School.
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