Negative impacts of COVID-19 on social care

In this section we identify from the essays, roundtable and our wider engagement with the social care sector the key themes about the negative impacts of COVID-19 on the sector.

A sector poorly prepared for the pandemic

The COVID-19 pandemic has taken a grim toll on social care in England. Those we spoke to as part of the essays and podcasts, and who took part in the roundtable, were clear that not only was the sector ill-prepared for the crisis – with poor advance planning – but the response when it did arrive was insufficient and too late. In workshops with care managers, commissioners and managers as part of our COVID-19 work, we were told on many occasions that social care felt like it was not a priority, guidance was initially inaccurate and late, and support for funding insufficient and slow to arrive.

In terms of preparation, we heard that the years of underfunding had left the sector without the equipment and estates necessary to manage the crisis. For instance, we heard that many care homes had insufficient space to safely isolate people who had caught COVID-19 and contain the spread. Local supplies of personal protective equipment (PPE) were low, or non-existent in some places as late as the end of March, which left many care workers exposed to the virus.

If we had declared a national emergency two weeks before lockdown, local resilience forums would have been able to put in place communications that reached out and listened to their valuable residents – even the best systems with integrated place-based hubs struggled with communications in the first few weeks.

Professor Donna Hall, Chair, New Local Government Network

Frankly, the guidance we received at the start of the crisis about people being discharged into care homes without tests was wrong.

James Bullion, Executive Director of Adult Social Services, Norfolk and President of ADASS – The Association of Directors of Adult Social Services

In terms of the response, most of those we spoke to said that guidance, PPE and financial aid arrived too late to stem the initial wave of infections. The guidance, when it did arrive, was also criticised for being inaccurate and inaccessible. We heard many calls from people working in care to be more actively involved in shaping guidance.

There is no ‘one-size-fits-all’ but a set of guiding principles is needed. We need guidance written by and for care workers.

Care home manager at a SCIE’s COVID-19 care home manager meetup

The result has been well covered by the media – an unacceptable number of excess deaths in care homes, and far too many care workers dying. Several spoke of this being a ‘national tragedy’ and that lessons needed to be learned.

It was a very difficult period. A combination of strict criteria put in place before you could be placed on the extremely vulnerable list, a lack of support and difficulty getting hold of PPE equipment.

Clenton Farquharson, Chair, Think Local Act Personal and person with lived experience

A key challenge during this pandemic has been ensuring people using social care services, and those that provide them, receive regular testing. We’ve all seen news reports of people being discharged from hospital into care homes. The lack of a systematic testing programme has undoubtedly led to many thousands of otherwise preventable early deaths.

Deborah Alsina, Chief Executive, Independent Age

Only limited amount of Infection Control Fund has reached outside care homes. Fifty per cent of the workforce are in homecare but little or no additional money has been made available to support them if self-isolating. Ditto to support PPE costs.

Jane Townson, Chief Executive, UK Homecare Association

Inequalities exposed

The crisis also had the impact of exposing the deep levels of inequalities which exist in society, with evidence telling us that Black, Asian and minority ethnic (BAME) communities, adults with learning disabilities, and those on the lowest incomes, have been disproportionately affected.

From data released by CQC, NHSE and the learning disability mortality review, we have seen over 130 per cent increase in the number of recorded deaths of people with a learning disability when compared with the same period last year.

Edel Harris, Mencap

Several contributors argued that tackling inequalities needed to be a priority for any future reforms. In a recent statement, ADASS wrote:

As we reset and rebuild social care, it is vital that we proactively tackle historic inequalities and injustices, whilst ensuring that the new models of care that are nurtured and developed as a result of the reforms are equally relevant, accessible and vital to all groups.

But for this to be genuine, we need to co-produce these plans for reform with diverse communities, ensuring that their fears, aspirations and strengths are reflected, and become part of the reform narrative.

A fragmented and disconnected sector

The social care system is complex and fragmented, with care being provided by around 18,500 organisations working in 39,000 locations across England. Whilst seen as a strength, the diversity of the sector provided, in some cases, a hindrance in terms of coordinating a response. Good practice being developed in one part of the care sector is difficult to share easily with another part. Data on care home residents, workers and supplies was often incomplete or difficult to pull together.

In our interviews and surveys with commissioners, social workers, care home managers and care workers to inform our COVID-19 work, we heard a common theme that the sector was very fragmented and that data wasn’t joined up. Many of those we engaged told us that the scale and complexity of the sector posed significant practical and logistical challenges in organising effective responses. For example, in ensuring that providers have access to sufficient PPE, coordinating safe hospital discharges, and testing staff and residents in a timely manner.

You couldn’t access any real-time data on what was happening in all the different care homes – who was working where, who was entering care homes.

Commissioner interviewed to inform the COVID-19 guidance

Delayed local response

During the first few weeks of the pandemic, people who use services and carers told us that they often felt very isolated and frightened. Whilst some local authorities were good at getting in touch with people quickly, in other areas people didn’t hear from their key workers for many days. Information on websites about, for instance direct payments, was often slow to be updated.

I sometimes think about those dystopian films, where people are searching for survivors in an empty and damaged city. I felt like one of those survivors.

Ossie Stuart, SCIE Trustee and person with lived experience

Although many local authorities were praised for the support they gave to providers, others were criticised for being slow and inflexible, for instance, not passing on funding quickly to struggling providers.

Low morale amongst workers

We heard from contributors that we face a growing emergency about the morale of staff working in social care. Despite many in the workforce showing immense resilience overall, morale is low in adult social care, and care staff have felt undervalued compared with their healthcare counterparts. This has also played out in practical terms, for example, in care workers not having priority access when shopping for their clients. We were told about registered managers of adult social care services suffering from burn out and extreme anxiety. Access to high-quality and trauma-informed support to managers and frontline staff to help them recover was seen as essential in the future.

In our engagement with our social workers, commissioners and care workers for Department of Health and Social Care-funded work on COVID-19, we were consistently told that many felt isolated and experienced very low morale during the first period of the pandemic. In response, SCIE, along with other sector bodies like Skills for Care, established national forums and ‘meetup’ meetings which proved hugely popular, and we call on national bodies to continue putting on such groups.

Thank you for this space to share our experiences with people outside our organisations.

Good and useful meeting that has provided us an opportunity to link up. Thank you.

Social workers involved in SCIE’s COVID-19 meetup

New thinking on the future of adult social care
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