The Scientific Advisory Group for Emergencies (Sage) social care working group has published a consensus statement saying that discharging hospital patients into care homes without testing for Covid-19 was not the main driver of outbreaks in care homes during the first wave of the pandemic.

After reviewing studies from the UK and abroad of outbreaks of Covid-19 in care homes, Sage found that, although hospital discharges were highly likely to have caused or intensified some care home outbreaks, they were highly unlikely to have been the main driver.

With almost 30,000 more deaths among care home residents during the first wave of the pandemic than would have been expected, the government’s policy of discharging untested residents from hospitals to care homes to free up NHS beds during the first wave has been blamed for increasing the death count.

However, evidence from several studies repeatedly pointed to the size of a care home as being most strongly associated with the increased risk of an outbreak, with larger homes significantly more likely to have an outbreak, the statement said, pointing to the greater “footfall” in larger care homes with more staff moving between them and other professional visitors, such as GPs and district nurses.

“Based on the very much larger associations between care home size (a proxy for all modes of disease ingress) and outbreaks, hospital discharge does not appear to have been the dominant way in which Covid-19 entered care homes,” it continued.

Sage recommended greater thought be given to minimising potential exposure in care homes in any future epidemic to which older people are especially vulnerable. It also called for better social care data, commenting that a lack of “good quality routine data” when compared to the NHS limited their analyses.