A leaked letter has revealed the health service's top civil servant told trust bosses at the height of the coronavirus outbreak in care homes that 'positive' cases from hospitals should still be admitted - as long as they could be isolated.
The correspondence, issued by Richard Pengelly, also stresses that a new testing regime designed to prevent the spread of the disease by swabbing patients 48 hours before they leave hospital and go into homes "must not hold up a timely discharge".
Health trust chief executives received the letter on April 25, when health minister Robin Swann announced an "enhanced" programme of support to the sector following an outcry over inadequate swabbing of residents and staff.
The letter was also sent to the RQIA watchdog and was copied to the Chief Medical Officer Dr Michael McBride and the Chief Nursing Officer Professor Charlotte McArdle.
Latest figures show that care home residents account for more than half of all coronavirus-related deaths in Northern Ireland.
Mr Pengelly, who is Permanent Secretary at the Department of Health and one of the most powerful figures in the system, wrote: "In advance of discharge from hospital to a care home each patient must be tested for Covid-19. Ideally this test will be undertaken 48 hours prior to the patient's discharge to their identified care home.
"This testing requirement must not hold up a timely discharge (this sentence is written in bold). The information from the test result, together with any supporting care information, must be communicated and transferred to the relevant care home.
"Some care providers will be able to accommodate individuals with a confirmed Covid-19 positive through effective isolation strategies or cohorting policies. If appropriate isolation or cohorted care is not available with a local care provider, I would request that relevant trust provides alternative appropriate accommodation and care for the remainder of the required isolation period."
Mr Pengelly added that in "exceptional cases" where tests results for suspected coronavirus are not available "at the point of discharge from hospital", these patients must still leave and be cared for in the trust's "alternative accommodation".
There has been widespread criticism of the department's response to the pandemic in care home settings, with the Older Person's Commissioner Eddie Lynch and other representatives claiming the same level of planning was not there compared to hospital settings.
Mr Lynch was also scathing of the department's failure to introduce universal testing across all homes - whether they had Covid or not - at an earlier stage in the pandemic. The measure was introduced last month.
Mr Swann has rejected this criticism, insisting that detailed planning was going on "behind the scenes" in the months beforehand.
However, the chair of the Stormont health committee last night said he was "dismayed" by the content of Mr Pengelly's letter and claimed the practice of admitting hospital patients with coronavirus to care homes may have led to "further spread" of the disease for those "most at risk".
Sinn Féin's Colm Gildernew also said he wrote to Mr Swann a few days prior to Mr Pengelly's correspondence, seeking assurances on the matter.
"I am deeply concerned that mixed messages were going out to trusts in relation to discharge policies in what were very vulnerable settings," Mr Gildernew told The Irish News.
"I wrote to Robin Swann on April 23 asking specifically that the additional capacity in hospital would be used to prevent the discharge of anyone either with a Covid-19 test or awaiting the result back from a test - that those patients would be held until such times they were clear of Covid.
"So I’m dismayed that a couple of days later that this letter was issued. Also, I think that the requirement of 'isolating' positive cases in care homes following their admission from hospital was an incorrect strategy.
"Even at that time, we had the benefit of knowing what had happened in Italy and we should have learned from that and implemented stricter controls to prevent spread.
"I think discharging Covid positive patients out of hospitals into care homes was a risk we didn’t need to take."
The Irish News asked the Department of Health if the same "requirements" contained in Mr Pengelly's April 25 correspondence were still in place, in relation to care homes receiving Covid-19 patients from hospital.
The department was also asked to respond to the concerns raised by Mr Gildernew in relation to the strategy and the risks it posed for the vulnerable.
A spokesman said the health minister has commissioned "expert analysis" of "all aspects of the epidemic as experienced by care homes in Northern Ireland".
He described hospital discharge is one of the "many complex and challenging areas to have been faced over recent months".
The department spokesman added the priority "at all times" had been placing patients "in the most appropriate setting, be that in hospital or otherwise, to care for their particular needs".
"Keeping older people in hospital when they are medically fit to be discharged is detrimental to their physical and mental health. That is the case in normal times. It is particularly true in the current pandemic, given the potential for clusters of Covid-19 associated with hospitals and also the potential for patients to acquire other healthcare associated infections while in hospital," he said.
"Trusts have been working closely with care homes to provide them with support and manage the challenges faced by all parts of the Health and Social Care sector during the course of this pandemic."