'They were withering away': Why did Colin Harris and nine others die in a Skye care home?

Covid-19 did not come to Skye for a long time, so much so that the people there thought they had escaped it. But Zoe Docherty knew better. Driving to her at-home visits on the Scottish island, the 27-year-old care worker heard a drumbeat of dread, a steady rat-a-tat, all through the months of March and April and into May.

“I knew it was a matter of time,” says Zoe. “I didn’t see what makes Skye so special that it wouldn’t come here.” When the first case of Covid-19 in the Highlands was confirmed on 14 March, Zoe told a colleague: “It’s coming.” But her colleague was dismissive. “She said: ‘The Highlands is a big area,’” Zoe remembers. “I said: ‘You’re missing the point here. It’s a virus. It won’t not come here, just because we’re rural.’”

Zoe kept doing her rounds for the NHS, providing personal care to older or disabled people and helping them with their medication. On her days off, she visited her 66-year-old father, Colin Harris, at Home Farm, a 40-bed care home in Portree, the largest town in Skye. Colin, a former jockey and appliance engineer, had Parkinson’s disease and dementia. He had moved into Home Farm in January 2016, after a chest infection and stroke left him needing 24-hour support.

March passed without incident, and most of April, too. Still, Zoe heard that beat. “I had this feeling that something bad was going to happen involving Dad,” she recalls. “Like it was around the corner.” And then, on 27 April, somebody posted on Facebook that her son, a care worker at Home Farm, had tested positive for Covid-19. It had arrived.

The virus rampaged through Home Farm with an appalling severity. Ten residents died of Covid-19, in one of the worst outbreaks in a care home in Scotland. Among them was Colin Harris. Zoe had been right. Something bad was coming, and her dad was at the centre of it.

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Colin was quiet, loving and troubled. Something traumatic happened to him when he was a child, but his family don’t talk about it much, other than to say that it is partly why he had depression.

When Mandie, now 47, met Colin in 1992, he had recently got divorced and was the father of a son, Liam. Colin was 20 years older than Mandie, but they bonded over the fact that they were both from Glasgow and shared the same dark sense of humour. “We were kind of an odd couple,” says Mandie. “He was older, I was younger, he was short, I was tall. It was like Little and Large.”

Colin and Mandie moved in together on their third date, having Zoe in 1993 and a son, Ethan, in 1996. They kept themselves to themselves apart from their increasing collection of pets: birds, cats, dogs, fish, a snake, a lizard and ferrets. “A lot of people would think we had quite a boring life,” says Mandie. “Because Colin wasn’t into mixing with large groups of people, we didn’t go out that much. But I wasn’t fussed.”

Colin had an affinity with animals that had been abused. Ethan remembers going with his dad to inquire about rehoming a crofter’s dog called Bruce. “He had a long, shaggy coat and he lived outside, and he had marks from a chain around his neck,” says Ethan, who is 23 and works for the RNLI. “As soon as my dad saw him, it was like a green light went on in his head. He took Bruce away. He had a really strong bond with that dog.”

Colin had worked as an appliance engineer until the late 80s, when his depression worsened and he had to give it up. “He had anxiety being around people,” Mandie says. She worked as a housekeeper and waitress, while Colin looked after the kids. He was fastidious, often vacuuming around the children with a miniature vacuum cleaner as they were eating, to chase down any wayward crumbs. “If you went into a kitchen to make a sandwich,” says Zoe, “he’d follow you in there and say: ‘Clean your mess!’ I’d say: ‘Dad, I haven’t even made it yet.’”

Crumb tyranny aside, Colin was gentle with the kids. He would stay up late watching action films with Zoe; she liked the Terminator franchise, he preferred Rambo. Zoe felt that she could talk to him about anything, without judgment. “He’d never sugar-coat things,” Zoe says. “He was honest … he gave me ‘the talk’ [about sex] about three times.”

When Colin’s depression was bad, he would become taciturn. “Normally he’d take the dogs for a walk,” Mandie says, “but if he wasn’t doing well he’d only take the dogs out when they needed to wee. That’s how you could tell he was feeling low.” But, despite Colin’s struggles, they were happy.

Mandie likes to remember Colin at Coral Beach in Skye, a sandy stretch on the north-west tip of the island. “Everywhere he went, he took a flask of tea. He’d sit with a blanket out, drink it and then go and throw stones for the dogs, or play with the kids.”

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As Colin’s health worsened, the family responded the only way they knew. “We used humour to get through things,” Mandie says. “Because if you don’t laugh, you’ll cry.”

Colin had so many health problems. Depression (diagnosed in the late 80s). Parkinson’s (diagnosed in 2012). Dementia (also diagnosed in 2012). Lung cancer (also in 2012 – it was a bad year). A stroke (in 2015). Hepatitis C, from a contaminated blood transfusion (diagnosed in 2007). The family compared him to Rambo, the indestructible hero of his favourite action film. “It became a bit of a twisted joke in our family,” says Zoe. “Nothing would kill dad.” When Colin was hospitalised in 2017 with a chest infection, the family assembled at his bedside. “He came around and said: ‘I’m scared, I think I’m going to die,’” Zoe says. “And we said: ‘Ah, shut up. There are plenty of things that could have killed you before now. You think a chest infection is going to get you?’”

Mandie looked after Colin at home for as long as she could. “I’d always told Colin that I wouldn’t put him in a home,” she says. But in 2015, social workers insisted Colin needed permanent residential support. Intellectually, Mandie knew they were right – she was at breaking point. Sometimes, she would check on Colin dozens of times in a night, sleeping only when he slept, for an hour or two at a time. But, at the same time, she did not want Colin to go into care; she only agreed to it thinking that a bed would not become available for years. But a bed became free almost immediately. “I had my hand forced,” Mandie says. After Colin moved into Home Farm, she slept for an entire week. “I was so exhausted.”

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Colin was lucky to get a spot so close to Mandie, Ethan and Zoe, who all still live in Skye: there is a shortage of care home spaces in Scotland, with just 826 places available in March 2019 to serve a population of 5.45 million.

Home Farm is owned by Britain’s largest care home operator, the HC-One group, which is itself owned by a private equity fund. HC-One’s parent company is registered in the tax haven of the Cayman Islands. It paid dividends to its investors of £42.3m in 2017 and £6.2m in 2018.

Even before Covid-19, the Care Inspectorate, which regulates care homes in Scotland, had raised concerns about Home Farm. A 2019 report (pdf) found evidence that staff were “too busy, overwhelmed, and struggling at times”, that there were times when residents “did not receive the care and support they needed” and that the home had “difficulties ensuring the right number of staff were available”.

In January this year, another report (pdf) raised concerns about infection control policies, finding that “on some days there was only one member of housekeeping staff on in the morning for all the domestic duties in the whole home, and there was no housekeeping staff on in the afternoon and evening”. The home agreed to stop taking new residents until staffing issues could be addressed.

According to staff, working at Home Farm during this period was often challenging. A change of management in 2018 had resulted in an exodus of staff, and remaining staff worked overtime to cover the shortages. “I was working 24-hour shifts last year,” says Alice (not her real name), a Home Farm staffer whose identity we have obscured at her request. Agency workers would be brought in, but the turnover was so high that staff were continually having to train them up, only for them to leave and the process to start again.

In response, HC-One says it does “not expect nor condone 24-hour shifts” and, if this occurred, it would have been on a voluntary, short-term basis to cover unexpected staff shortages. HC-One also says that extra staff were present when agency workers needed to be “onboarded”. While acknowledging “well-documented recruitment challenges, in part due to the rurality of the home”, it says it “always ensured the home was well staffed”.

Management struggled to recruit permanent staff to fill the vacancies, particularly because Skye is a tourist hotspot, with plentiful hospitality work in the summer. Care workers at Home Farm are paid £9.75 an hour, which is above the Scottish Living Wage and the UK’s national minimum wage. However, Alice says it is a “lower wage” than elsewhere: “Hotels and restaurants, you can get tips. There are jobs out there that are easier. Caring is a difficult job.”

But life at Home Farm was often full of joy. Staff would decorate the upstairs dining room with balloons to celebrate birthdays. At Christmas, they would put tinsel in their hair and dress up in novelty jumpers. “We treated each other as a family,” says Alice. “We loved each other.”

Like her mother, Zoe had reservations about Colin going into Home Farm. She had worked there for a year, in 2014. “It was hectic,” she says. “We always seemed to be short-staffed.” When she left to work for the NHS in 2015, the contrast between a state-run social care service and the private sector felt stark.

Her experiences at Home Farm did not fill Zoe with confidence that her father would get the best possible care. She resolved to visit her father as often as she could, to monitor the situation.

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The way to describe Colin’s final months in Home Farm, Zoe says, is to imagine that a child has run into a busy road. “There’s all these people watching, but no one’s doing anything. And then after the child gets hit by the car, someone says: ‘Ah, maybe you could have run out after it.’”

When the family went to visit Colin, they would sometimes find that he had soiled himself and had not been changed, or his dentures were not glued in properly, making it impossible to chew food. “There was an issue every bloody time we went in,” says Mandie.

Staff shortages were noticeable. “There just weren’t enough staff,” claims Mandie. “You’d go in and it would be like the Mary Celeste. There was just nobody there, just the occasional resident wandering the halls.” The family came in almost daily to assist with Colin’s care. “We felt we had to,” Mandie says. Zoe would wash her father and get him ready for bed. She even took his laundry home to wash.

In August 2019, as Zoe was cleaning Colin, she noticed an open wound in his groin. “Whoever was changing Colin obviously wasn’t cleaning him properly, otherwise they would have seen it,” says Mandie. They requested steroid cream for the wound, but staff did not obtain it, so Zoe bought it and applied it herself. HC-One says: “We were unable to verify this event. From a clinical standpoint, steroid cream is an inappropriate treatment for an open wound.”

Colin’s family complained often to management about shortcomings in his care. In response, Home Farm’s manager said he was struggling to recruit. “He would say that he was trying to get new staff, but just couldn’t get them in,” Mandie says. “I said: ‘Well, maybe if you put the wages up a wee bit, you’d get more people coming in.’”

By the beginning of the year, the quality of Colin’s care was deteriorating. “Towards Covid, it got more frequent that we’d find him wet,” says Zoe, “or I’d have to take him to the bathroom and change him. I couldn’t understand why it kept going on.” After persistent complaints, Home Farm management agreed to implement a plan to improve Colin’s care and, on 12 March, Mandie and Zoe had a meeting at the home to discuss the proposals.

Appeased, they took him out for lunch, only to return to find that Home Farm had gone into lockdown. “Straight away we were concerned,” says Mandie. “We had just had this meeting and we were worried about how we could keep an eye on what was going on. If his level of care was this poor with us helping, what would happen without us being able to go in and help?”

***

“Right from the start,” announced the health and social care secretary, Matt Hancock, on 15 May, “we’ve tried to throw a protective ring around our care homes.” His words ring hollow now, with 19,394 Covid-related care home deaths since the pandemic started – about 42% of all the deaths to date.

Once Home Farm went into lockdown, Colin’s family did what they could remotely. On a video call with him on 8 April, Mandie says she was alarmed to see a staffer wandering in and out of shot freely, without wearing PPE. She emailed Home Farm to complain. “Where is the infection control?” she asked.

Lying in bed at night, Zoe considered making face masks herself and dropping them off at the home. The drum beat grew louder, the sensation of impending catastrophe more difficult to ignore.

On 22 April, Mandie got a response to her complaint. “We follow government guidelines at all times,” a staffer told her, explaining that at that time masks had not been mandatory under government guidance, which stated that care home employees needed to wear personal protective equipment (PPE) only if individuals were showing signs of Covid-19. Home Farm management had obliged staff to wear face masks from 18 April, although it was not until 26 April that PPE was required for all care home staff (pdf) in Scotland.

HC-One states that “Home Farm colleagues have always complied with the PPE requirements set by the Scottish government” and that there is “no evidence” supporting Mandie’s account of the video call on 8 April.

How to explain the delay in making PPE compulsory in care homes, given that the government knew at the time that Covid-19 could be transmitted asymptomatically and that older people were particularly vulnerable to the virus? The UK government’s own guidance, from 15 April, makes its rationale clear: PPE was to be prioritised for NHS workers because there was not enough of it to go around. “It is vital we take an evidence-based approach to the use of this precious resource to ensure that we can always provide appropriate PPE for those who work in genuinely higher-risk areas,” the guidance stated.

In July, the House of Commons’ public accounts committee found that the government “squandered the opportunity to build up supplies [of PPE] in January and February” and that there was a “stark contrast between the approach taken [by the government] towards protecting the NHS, compared with the care sector.” In other words, what limited PPE was available in the early weeks of the pandemic was allocated to the NHS, rather than private care homes.

On 26 April, Zoe went to check on her dad through the window of Home Farm. “He was really sick,” Zoe says. “The only time I’d seen him like that was when he had the chest infection. He was shaking and he didn’t recognise me at all.”

What Zoe did not know at this time – but would later emerge after the deaths at Home Farm – was that, at the start of the pandemic, staff had been redeployed from other HC-One care homes elsewhere to Skye, to make up for staffing shortfalls. “These individuals had not been tested and they were allowed to start work straight away,” says a Skye councillor, John Gordon, 46, from Portree. His father, John Angus Gordon, died in Home Farm of Covid-19, at the age of 83. Home Farm says the incomers “self-isolated in advance of their move”, but acknowledges that they were not tested before commencing work, because of a “national shortage of testing”.

Five hospital patients had also been discharged into Home Farm without being tested for Covid-19. “Testing was not available at the time of the admissions in March,” says HC-One. This reflected a wider trend across the UK, as elderly patients were discharged from hospitals into care homes without being tested. In January 2020, there were 1,028 patients aged 75 and over waiting to be moved out of Scottish hospitals; by April, there were only 393. Virtually none of these patients were tested for the virus before their discharge: until 16 April, government guidance stated: “Negative tests are not required prior to transfers/admissions into the care home.”

On 27 April, the news broke locally that a Home Farm employee had tested positive for Covid-19. Ripples of alarm spread across the island. “We thought: if a care worker has it, what exactly does it mean for the rest of the staff and the residents?” says Gordon. Over the next three weeks, 29 of Home Farm’s 34 residents contracted the virus.

He was surrounded by strangers, not allowed to see his family. He had no comfort in his dying days

Working in the home, Alice saw that Covid-19 did not manifest in the way she had expected. “No one was coughing or having respiratory problems,” she says. “They were just withering in a way that was eerie and weird.” As staff began to get sick – 26 in total contracted Covid-19 – those who remained worked nonstop. “There were moments that you would want to just curl up in a ball and cry,” says Alice, “but you knew you were doing a job and had to act professional and be there for those people. They were relying on you.”

On 29 April, the family received the news they were dreading and expecting: Colin had tested positive for Covid-19. “Part of me thought: ‘He’s fine,’” says Zoe. “‘This is the man who can’t be killed.’ But I just had this feeling.” On one of her last visits before the home went into lockdown, she had looked at her father’s hands and been startled to see how frail they looked. Had they always been like that? “I thought: ‘I don’t know if he is going to beat it this time.’”

The deaths started on 3 May. By now, the NHS had stepped in to run the home. Mandie, Zoe and Ethan spoke to Colin on a video call on 4 May. “He didn’t talk,” says Zoe. “His eyes were shut. His face was sunken in. It looked like he was dying.” He was dying.

Claudia (not her real name), another staffer at Home Farm, told Colin’s family about his last, anguished days. “She told me that, about two days before he died, she was sitting with him and he was uneasy and upset,” says Zoe. “She asked: ‘Are you all right?’ and he said: ‘No.’ She asked: ‘Are you scared?’ and he said: ‘Yes.’ He knew he was dying.” Claudia sat with Colin and said a prayer. “He wasn’t given a good death,” says Zoe. “He was surrounded by strangers, not allowed to see his family. He had no comfort in his dying days.”

On 6 May, the family received a call from Home Farm: Colin was dying. Zoe, living closest to the home, arrived first and was dressed in PPE and taken through to his bedroom. When Mandie arrived with Ethan, Zoe asked staff whether her mother, dressed in PPE, could swap places with her. This was something Mandie had queried with the home in advance and she had been told it would not be a problem, as long as only one person was in the room with Colin at a time.

But the nurse would not allow Mandie into the room. Zoe persisted and she went to check with the manager, leaving Mandie and Ethan outside Colin’s room. This is how Mandie watched her husband of 25 years die: squinting through a window on a sunny day. “We couldn’t see clearly,” says Mandie. “The sun was reflecting off the window.” By the time the nurse came back to Colin’s room, he was dead. As the nurse was certifying Colin’s body, Zoe noticed that an engagement ring had perforated her medical glove, exposing bare skin. “There is no evidence to support this occurred,” says HC-One.

Even after Colin was dead, they would not let Mandie into the room to say her goodbyes. “The way it was all handled was abysmal,” she says. HC-One later apologised “wholeheartedly” for “any distress and upset”.

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In all, 10 people died of Covid-19 in Home Farm. In May, the Care Inspectorate initiated legal action to strip HC-One of its licence, although it dropped legal proceedings in August after observing “considerable improvements in the quality of care in the home”. Earlier this month, NHS Highland announced it would be purchasing Home Farm from HC-One. The provider has stated publicly that it has not benefited financially from the NHS purchase. In the week that the purchase was announced, the Care Inspectorate released its inspection report from Home Farm for the month of May – when the NHS entered the home.

The report made for distressing reading. Inspectors found that staff did not consistently use PPE to protect themselves and others from infection, that they did not dispose of this PPE correctly, and that PPE stations were missing essential items. Three of the HC-One staff who had been redeployed from other homes initially refused to have a Covid-19 test, despite being requested to do so by public health officials. Infection control arrangements were “unsatisfactory” and staff had not followed public health advice about the use of disinfectants to control the spread of infection. When the Covid-19 pandemic started, HC-One was resistant to working with NHS Highland and refused its offer to clean and disinfect the home. “This placed people at unnecessary risk,” inspectors concluded.

There were not enough staff to meet residents’ needs (some staff were regularly working in excess of 60 hours a week) and the home was “very dirty” and in disarray. Residents were lying in dried urine and faeces without being changed, medicine was not being administered correctly, and some residents did not have toothbrushes. The kitchen was so dirty that residents were at risk of food poisoning, which can be fatal in those older than 65. One resident who was visibly upset was described as “attention-seeking” by a member of staff. “The provider’s failure to prepare for a potential outbreak, poor-quality care planning, and a lack of well-established safe and person-centred work practices contributed to the poor care people experienced … People were living in an unsafe and unclean environment that posed a risk to their life, health, and wellbeing,” inspectors concluded.

“Our priority is to deliver the best possible care to every resident we serve, and we know that at times we fell short of this at Home Farm,” HC-One says. “This is in part due to the challenges of operating a service in a rural area where recruiting for clinical and leadership roles has been challenging for some time. We have apologised to everyone connected to Home Farm for these shortcomings, and specifically to the Harris family for what took place around the time of Mr Harris’s passing. Over recent months, a huge amount of work has taken place to make significant improvements at the home, which has been recognised by the Care Inspectorate.”

Across Scotland, 47% of all Covid-19 deaths to date have taken place in care homes. A higher share of deaths took place in privately run care homes: there were 207 deaths in Scottish HC-One homes alone. A recent report into Scottish care home deaths from the Common Weal thinktank was scathing. “[It] has been an unmitigated disaster … It is the worst possible health and social care outcome that anyone could ever have conceived of for older people,” the report concluded.

Colin’s funeral was on 14 May. It was small, just Mandie and the kids. At Colin’s request, they played Pink Floyd’s Comfortably Numb. “It’s a song about a man in a lot of a pain … My dad felt like it described his life. He’d had a lot of pain and he’d got to a comfortable state.” As the song played, Mandie said: “Trust Colin to pick the longest possible song.” The family started laughing. “We found comfort in that,” says Mandie. “That we can have a laugh.”

Gordon has become an unofficial spokesman for the families who lost loved ones in Home Farm. Some are considering legal action against HC-One. “Covid has exposed a lot,” he says, “and one of the things it has exposed is how we deliver care to our elderly. This system does not work. The privatisation of healthcare – I think it’s just repulsive. There are directors out there making as much profit as they can. Is that how Covid got into the home? Because there were so many cuts and there wasn’t the leadership there that there should have been?” The Department of Health has indicated that reform of the social care sector is forthcoming.

Skye is a small place and some residents – and indeed, families of those who died – would prefer to chalk Home Farm up to the ugliest of bad luck and move on. “Some people are under the impression that we will never know how Covid got into the home, so we should just move on and grieve,” says Ethan. “But I think it’s really important to find out how Covid got into the home. If you can learn what has gone wrong, it will help people in the future.”

Mandie, for her part, will not stop, just as she would not stop fighting for Colin when she found him in soiled clothes, dentures sticky and unglued, when she visited Home Farm. “I want every one of those directors at HC-One to never forget my name,” she says. “I want them to think: ‘Oh, not her again.’ I’ll be a thorn in their side. We need to do more to ensure that these private companies can’t get away with this type of behaviour.”

For a few months, the mood on Skye was sombre. “Because Skye is so small, everyone was touched by it,” says Ethan. But concern about the pandemic has dwindled. “Before the lockdown, people were saying: ‘Close the Skye Bridge! Keep the tourists away.’ But that’s all dead news now,” says Ethan. “We’re getting back to normal. That blase attitude will cause the second wave. Tourism on Skye has gone boom. We have thousands of visitors. We’re at our highest risk.”

Away from Home Farm, life goes on. Traffic throbs across the Skye bridge: the camper vans and the people carriers and the family sedans, windscreens glinting in the sun, back seats dusted with crumbs. Day trippers with Thermos flasks unpack folding chairs from hire car boots. Tourists brandish selfie sticks at the Fairy Pools. A streaming influx of visitors into this rural idyll, bodies and hands and breath, in one accord.