Scottish care home inspection was blocked, inquiry hears

Update: A previous version of this story named a home that was blocked from inspection, which the Care Inspectorate later told BBC Scotland News was incorrect. This story has been updated further with written evidence to the public inquiry, clarifying the situation in two care homes. The Care Inspectorate has declined to confirm which care home was blocked from inspection.

Public health officials blocked a safety watchdog from inspecting a care home in Scotland which was badly hit during the pandemic, the UK Covid inquiry has heard.

Kevin Mitchell of the Care Inspectorate told the inquiry he wanted to visit the home in the west of Scotland where a number of residents had died in April 2020 but he was prevented from doing so.

Thousands of deaths that took place in Scotland's care homes are being investigated by a special Crown Office unit, set up in 2020.

It is the largest investigation of deaths in Scottish history, with many complex cases.

The UK Covid inquiry heard that the Care Inspectorate stopped onsite inspections of care homes between 13 March and 4 May 2020.

Mr Mitchell, who is the inspectorate's executive director of scrutiny and assurance, said after the pandemic began he was required to get agreement from directors of public health before going onsite.

He told the inquiry he had tried to do that for a particular home in the west of Scotland which was in a "critical position" but the director of public health blocked an onsite visit and said the "inspection was not necessary".

Remote inspections during lockdown

Mr Mitchell did not name this home in his oral evidence and the Care Inspectorate declined to do so when asked by the BBC.

In his written evidence to the inquiry, Mr Mitchell has a section about plans to inspect the "terrible and distressing circumstances" of Burlington Court Care Home in Glasgow where a number of residents had died in April, 2020.

Between 27 March and 4 April 2020 he said there were 15 deaths at the home, 11 of these with suspected Covid.

Mr Mitchell raised the possibility of an onsite inspection on 4 April after a call with the home revealed 17 residents had suspected Covid, nine of these people were receiving end of life care.

It was agreed with NHS Greater Glasgow and Clyde's Director of Public Health that one of their officials would visit, but that ended up as a phone call instead.

Burlington Court Care home was inspected on 21 July 2020 and rated as 'weak' for its infection control and care during the pandemic.

Thirteen residents in Glasgow's Burlington Court Care Home died in one week in 2020 following a suspected outbreak of coronavirus

Mr Mitchell also said "permission proved very difficult to obtain" from public health officials in NHS Highland to support an onsite visit to Home Farm in Portree.

He described the situation as "escalating" in April 2020 but he said NHS Highland's public health team assessed the home as "green" after the home gave satisfactory answers on managing Covid over a phone call.

Mr Mitchell detailed how restarting onsite inspections was "triggered by the serious concerns" about Home Farm between 1 and 3 May.

He said the inspection found there was "a serious risk to life, health or wellbeing" on 4 May.

Later that year the privately-run home was taken over by NHS Highland.

Home Farm Nursing Home on Skye was moved into public ownership after its most serious Covid outbreak

The Care Inspectorate has powers to enter care homes with or without prior notice.

However, Mr Mitchell told the inquiry that - following a meeting chaired by then First Minister Nicola Sturgeon - "it was very clear to us that we were not allowed to act unilaterally".

He said it would have been a very difficult decision to go against strong advice from Public Health Scotland and directors of public health to not go into care homes.

Mr Mitchell said the closest he got to going against that advice was for the inspection at the start of May, but inspectors were given the official go-ahead.

PPE and Covid tests were prioritised for frontline health workers with very little supplies allocated to inspectors.

Mr Mitchell said he believed the "root cause" of not being able to inspect safely was because of the lack of preparation for a pandemic by not manufacturing PPE or having a test and trace system that could have been scaled up.

Video calls were used to help inspect during the pandemic.

Mr Mitchell said people would need directed to show inspectors everything, but video calls worked well to talk to relatives who could not be there.

The number of care home inspections dropped substantially during the first year of the pandemic from 603, compared to 1,129 the year before.

There were particular issues with "limited resources", according to Mr Mitchell, which meant they had to prioritise care homes to inspect.

In May 2020, he said there were only 17 inspectors available. In 2025, there were 117 inspectors.

The number of inspections returned to pre-pandemic levels in the past couple of years.