Revealed: How 'protect the NHS' abandoned the seriously ill and elderly 

After another shift tending to the dying, Marie Curie nurse Kasia Patynowska scrubs down and stands in line outside her local supermarket just like everyone else. "I wouldn't even use my Marie Curie ID in the shops," she says, "because everything is really about NHS, NHS, thank you NHS."

The 36-year-old volunteered to return to palliative care from her desk job and is now supporting dementia sufferers infected with Covid-19 in nursing homes in Belfast. She adds: "There are so many others that are dealing with this, not just Marie Curie, other charities, bus drivers, delivery drivers, dentists, all these people, but we only see the NHS."

For the social care sector, and charities now buckling under £4 billion deficits across the UK, there remains a sense the Government's "protect the NHS" obsession needs to start spreading the love.

"We have been talking a lot this week about the greatest generation - it being VE Day on Friday - there is a real risk, I think, that the greatest generation becomes the forgotten generation," says Marie Curie's chief executive Matthew Reed.

"It's absolutely right that the Government and nation has been focused on getting the healthcare right, but what has become very obvious is that the same degree of attention is needed to get social care right. For people who need care now, the need is obviously very urgent."

The frontier in the war on an invisible enemy has shifted. As hospital deaths peaked in the middle of last month, there was still four times more space than normal in hospitals, with around 40 per cent of acute beds unoccupied.

Yet as nine (still largely unused) NHS Nightingales were being built, policies designed to prevent hospitals from being overwhelmed pushed a greater burden on those that look after the estimated 400,000 mostly elderly or infirm who live in care homes across Britain.

The care sector cites problems wherever you look. Marie Curie would tell MPs of “confusion in both central and local Government about who should be supplying PPE to non-NHS frontline services”. The charity - which usually supports around one in ten of those who die in Britain - has since been forced to deprive some patients of visits.

Nursing homes have also suffered desperate difficulties testing staff as well as patients. Edgemont View in Bristol is one of hundreds to have only been able to test a handful of patients while becoming completely overwhelmed.

Care England, meanwhile, told the Sunday Telegraph that many of its members were on the brink of financial collapse. Martin Green, the representative body's chief executive, disputes claims that two thirds of £3.2billion in local Government support would be heading their way.

And it is not just the vulnerable elderly who are slipping through the gaps. More than 2,000 cancer cases are going undiagnosed every week, according to Cancer Research UK, and hundreds have had transplant operations postponed.

"A great job has been done to support the NHS, but what we really want to do is support people rather than institutions," Mr Reed adds. "Support the NHS was code for 'support people who need care in the NHS'. Equally true is that when people need to leave hospital they need to go somewhere else - their home or a care home."

Prof Stephen Powis, medical director for NHS England, also recognised on Friday that "it is really important that we do get on top of outbreaks in care homes". However, he added: "It's also important to note that it is a relatively small number of discharges from hospitals that go directly into care homes, somewhere in the region of around one in 20 are going into care homes for the first time. We have also done some preliminary work on whether there is any correlation between areas of outbreaks and discharges, and we can't see a correlation. It is right, though, that we put as much support as we possibly can do into care homes."

Mr Reed refutes the suggestion that "we've over-protected the NHS" at the expense of other services. It's just that we needed the same attention and same focus in central care because it's the same human beings that are travelling from hospitals to care homes or their own private homes," he said. "And it's the gap between those two things where we are seeing the ravine I'm identifying where people are dying at the moment. Covid-19 is shining a brutal searchlight on this problem.

"When the NHS and the country moved tremendously to create the capacity when required, it demonstrated that it can move with the same intensity. It shows that we can do it when there is the political intent. We now need that same attention given to care homes."

For those on the front line, some of the Britons are facing unthinkable trauma while in isolation.

Mother-of-two Lin Dalton, 63, from the West Midlands, gave up on chemotherapy in January after her rectal cancer spread. She may not live until the end of lockdown and district nurses have spoken to her only via video call, but she has no time for complaining.

"I'm not going to pretend I don't have dark moments but I try not to dwell," she says. "You can't just say pull yourself together, but I do try to focus on today. I try to focus on what you can do, rather than what can't do. I've ordered some fabric so I can make some masks for my family. I've got a little garden that I potter around in. I try to focus not on what I can't do but what I can do. And try to remember that I am lucky, very lucky. I'm hoping there will be a time I can go out again, but I'm not hanging my hat on it."

Doctors are concerned it may take longer than expected for healthcare and non-related surgeries to return to normal as lockdown eases. Two clinicians, speaking on condition of anonymity, told how there remain shortages in anaesthetics at several hospital following the crisis.

Ellie Emmott, 47, from Tadcaster, North Yorkshire, had already faced heartbreak after her six-year-old daughter Sarah had her kidney transplant postponed. 

"Sarah’s had a really difficult life since birth, so having to go through all that and having this amazing plan in place just to have it snatched from under our feet all of a sudden is absolutely devastating," she told the Telegraph. 

"She had her kidneys removed at the end of February, and a transplant was planned for four weeks after that. We’re just heartbroken and in shock. Although we were aware of what was going on with corona in China and Italy at that point, it had not directly affected anyone here, and especially around where we are and our hospital - Leeds Children’s Hospital. That makes it harder to swallow and accept. I was really cross. Not with anybody or anything - just annoyed with it generally."

Fiona Loud, policy director at Kidney Care UK, believes there is light at the end of the tunnel, however. “We’re glad to hear that guidance has been sent out to transplant centres about restarting the kidney transplant service." she says. "This includes living kidney donation and is likely to happen slowly at first and only where it is safe to do so."

But while hospitals on the front line hope they can return to something resembling normal as Covid-related admissions fall, Ms Patynowska, who moved to Belfast from Poland 20 years ago, sees no immediate end in sight for the vulnerable elderly in the community.

"When I’m with the patients, I don’t feel the risk, I don’t feel the stress to myself - it’s at the end of the shift, when you’re actually coming home," adds the mother of two.

She has visited countless dementia patients who cannot understand why their family cannot visit. One dying man particularly struck her. "I started talking to him, explaining why I was there, what I was going to do. He was semi-conscious, not able to respond... but after a few moments of me talking to him, I noticed some tears gathering at the side of his eyes. That really really touched me."

In a paper published this week, the Commons Digital, Culture, Media and Sport Committee said £750 million of support announced last month for the charity sector was insufficient to close a £4 billion funding gap.

As far as the elderly are concerned, perhaps the Government should feel duty-bound to repay a debt too. "The Second World War generation are those that need this care now," Mr Reed, the Marie Curie chief, says. "Whilst the generation were clapping on Friday, holding the minute's silence, actually the greatest commitment we could do is getting the end of life care that they need."