Challenges and solutions: commissioning social care during COVID-19

• Pandemic-related costs to local authorities and providers were predicted to far exceed the Government Emergency Funding of £3.2 billion in 2020/21. There was also extra support for social care via infection control funding, funding for rapid testing and workforce capacity. This plus transfers from CCGs was vital in shoring up the financial position for councils.
• At September 2020 ADASS reported that only 4 per cent of directors were confident that budgets would cover their statutory duties.
• COVID-19 led to a large increase in net spending on adult social care services (£933 million) and public health spending (£486 million). Gross expenditure on adult social care increased by £2.9 billion (12.8%). But there were significant variations across councils. There were lower than expected increases in costs in children’s social care in part due to reduced referrals.
• There were further pressures on some already struggling councils as income from charges and business rates reduced significantly (Health Foundation).
• Councils spent £443 million (28.2%) more on ‘commissioning, strategy and admin support’.
• Adult social care funding is still below the 2010/11 level. There are concerns that the social care white paper and promised funding do not provide enough money to move out of the crisis, meet the growing demands, address sector pressures and deliver reform.

• Early in the pandemic it was feared that extra costs and reduced occupancy of care homes would result in a significant number of providers, or a large provider, going out of business.
• With additional funding and support, the ‘market’ fared better than feared. Despite reductions in occupancy, CQC report that the number of registered care home beds remained stable to April 2021.
• ADASS however reported that one in two councils had to respond to a care home closure or bankruptcy in the six months to November 2021. They also reported increasing numbers of home care providers handing back contracts or not able to accept new work.
• Fees remain an issue. There was already a 10 per cent shortfall in care home fees paid by local authorities. Any further pressure on fees or running costs could mean care homes closing or only supplying to the higher paying self-funders. New builds tend to target self-funders and charge higher end rates.
• Quality remains an issue with nearly one in six registered services rated as requiring improvement or inadequate.
• Staff vacancies in care homes present a big risk to viability rising from 6% in April 2021 to 11.5% in December 2021. Vacancies across the sector generally have also risen and were at 9.4% in December 2021.
• New waves and variants of COVID-19 have caused additional pressures. Lack of staff plus COVID-19 related worker absence and infection rates in homes, resulted in many care homes not accepting new referrals in December 2021. This has a significant impact on hospital discharge too.

• Some people are not getting, or for long periods did not get, the support they need due to temporary closure of services, providers not accepting new people and some people refusing support out of fear or the need to shield. Prior to the pandemic, Age UK estimated one in seven older people don’t get the care and support they need.
• ADASS reported in November 2021 that over 500,000 people were waiting for an assessment of their needs or waiting for a service.
• More than 2 million hours of commissioned home care could not be provided between January and March 2022 because of a lack of staff.
• Choice has been limited. Lack of appropriate assessments, rapid discharge to care homes or quickly arranged support in the community means people may be in homes they wouldn’t have chosen, have not had help to return home or are not getting support that is right for them.
• Thirty-five per cent of local authorities report fewer people presenting needs relating to domestic abuse and safeguarding since lockdown in March 2020.
• There is also insufficient access to primary, community services and mental health services to support local people’s needs.
• An additional 4.5 million carers are providing unpaid support in the crisis. Existing carers are providing more support and facing isolation, stress and financial pressures with many more having to decide between caring for someone or giving up work.
• Modelling, however, indicates that many people are over-supported. Support approaches and the way contracts operate limit opportunities to tailor support and help people gain more independence.

• The pandemic has highlighted the skills and dedication of many workers.
• Death rates amongst care workers are double the general population – with higher risks still for black, Asian and minority ethnic workers and for men
• Poor terms and conditions for care workers added to the spread of the virus. Many don’t have contractual sick pay, 25 per cent are on zero hours contracts working multiple shifts across sites and simply cannot afford to take time off.
• Recruitment and retention are ongoing concerns. Skills for Care estimated that vacancy rates across the sector were 10.3% in May 2022 having risen from 6% in March 2021.
• Turnover which decreased early in the pandemic is back above pre-pandemic levels at over 30 per cent and higher in some areas.
• Skills for Care also point to sickness rates increasing during COVID-19 and the number of workers leaving or ill due to burn-out.
• Recruitment and retention is a major concern especially given higher pay and shortages in other competing sectors. New immigration and Brexit rules have added more pressure (visas are currently only available for professional and more senior roles). Concerns about the loss of workers due compulsory vaccinations has led to the requirement being suspended.

• During the two peak periods of COVID-19, April to September 2020 and October 2020 to March 2021, 39,350 deaths in care homes were attributed to COVID-19.
• Around 40 per cent of all care homes reported an outbreak in the first four months of the pandemic.
• Transmission was accelerated by the congregate nature of homes, residents with COVID-19 moving in, lack of testing and lack of PPE.
• Lack of specialist healthcare going in to care homes has resulted in people suffering a range of health complications – not just COVID-19.
• Providers faced rising costs of more than 30 per cent higher than usual – largely due to PPE inflated costs, sick pay, retaining higher staffing ratios and backfilling with more expensive agency staff.
• Two-thirds of providers reported delays in receiving additional funding as this took time to pass through via local authorities.
• Residents – many of whom have dementia – experienced distress, confined to their rooms with no outside visitors.
• Poor or rushed assessments made it hard for staff to understand the needs of new residents.
• Since the start of the pandemic, occupancy levels in care homes have fallen from 86% to 76% in care homes with nursing and from 87% to 81% in residential care (August 2021).
• Staff vacancies in care homes present a big risk to viability rising from 6% in April 2021 to 11.5% in December 2021. The National Care Forum reported even higher rates in the not for profit sector.
• New waves of COVID-19 have caused additional pressures. Lack of staff plus COVID-19 related worker absence and infection rates in homes, resulted in many care homes not accepting new referrals in December 2021. This has a significant impact on hospital discharge too.

Community-based services have also faced issues with staff sickness, absence, costs, PPE and loss of business. The lack of regular testing for people receiving social care, home care workers, unpaid carers and personal assistants will have accelerated transmission across a range of settings.

Supported living schemes faced similar challenges to care homes, but did not get official access to testing until much later, despite supporting people facing higher risks from COVID-19, including people with learning disabilities.

Many buildings-based services – day centres and short breaks – have had to close temporarily or change their offer. Some services have still not returned to face to face support.

Support for direct payment users was variable across the country. Some areas were slow off the mark. Many direct payment users felt abandoned:

“The only communication from my council was very general and addressed to “Dear DP user”.”

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This under-estimated the challenges individuals were facing with access to and inflated costs of PPE, workers being off, contractual issues, the difficulty and cost of back-up support and contingency planning, let alone the isolation and fear that people experienced.

Shared Lives carers experienced varied responses from local authorities. Some council-run schemes saw co-ordinators redeployed leaving households with limited support. Shared Lives schemes were missed from early government guidance so had inconsistent messages, and Shared Lives carers were not initially recognised as keyworkers. Some experienced difficulties accessing PPE (though some local authorities provided this). Households locking down together faced extra costs and added pressures when other usually essential supports were not available.

Digital barriers are a significant issue. As more services moved online, despite real efforts by many providers to keep people connected, exclusion and isolation were compounded for those without digital access. Lack of digital skills for staff was also an issue.

Summary and purpose Princess Homecare is a small domiciliary care agency in a rural part of Wiltshire Council with less than ten clients (older people). Since the start of the COVID-19 crisis, the Council has been proactive, supportive, as well as approachable and responsive to questions. They have acted as a sounding board for questions or signposted Princess Homecare to further information, which has been crucial particularly at the break of the crisis.

Wiltshire Council have supported us providers by agreeing to pay all invoices sent to us, ensuring we are financially stable to continue the service during the crisis. They have also offered to pay for additional costs such as training new staff, extra travel incurred due to emergency service provision and the purchase of tablets for the use of video calling service users’ families during the lock down. These have enabled our company to continue providing services safely and without financial concern, particularly with the cost of personal protective equipment (PPE).

We have kept a log of actions and activities taken due to COVID-19 to ensure we know what happened and when. We have also been able to keep in touch with the service users’ families with regular updates on top of their video calls. Because of this, we are able to easily reference resources we have found, reasons we have taken actions and provide accurate information to families for peace of mind. Examples of actions taken below:

• Providing video calls between clients and families.
• Recruiting volunteers to phone clients weekly.
• Working collaboratively with other providers, sharing resources and involving them in contingency plans.
• Working with Wiltshire Care Partnership (WCP) to connect with other providers.
• Sharing our insights and experiences with SCIE.
• Engaging with webinars provided by organisations such as Skills for Care and SCIE.
• Providing technology to ensure those who can work from home are able to, boosting motivation and support.
• Continually checking latest guidance and best practice to ensure we are working as safely as possibly.
• Making sure staff never run out of PPE.
• Regular checks on staff health and mental wellbeing.
• Working with staff to develop working schedules rather than just handing them their weekly rota.
• Providing regular updates to staff (weekly videos in a format they all wanted) and clients/families (website updates and email communication).
• Separating staff from care service and other services to ensure minimal cross-over and risk of transfer.
• Use of technology to enable call diverts away from land-based office to remote working.

Challenges and learning points The key challenge has been to keep up to date with the amount of information being released daily, and being able to translate it in a practical way to staff, service users and families. The fact that the information is not organised in one same place has added to the difficulty, as some days we received several emails from different sources with similar information. To help combat this, we have been recording weekly video updates for staff with the key information they needed to do their jobs. We also forwarded some information for them to read, but provided a video summary to facilitate accessibility to the key messages and give staff the opportunity to listen to them when suitable. One key lesson is how much more we can achieve and how much further can we reach working collaboratively. We have been linking to other small providers in the area and supporting each other emotionally and professionally. The level of collaboration between small companies has been incredible. Contact Charlie Marillier, Registered Manager

• Information about employment, sick-pay and contractual issues. Some insurance and payroll companies, and their legal helplines, have been providing clear advice and regular updates to individuals and groups.
• Help to recruit new personal assistants safely.

• Some DP support services quickly set up online, phone or social media groups (e.g. Facebook) for people to stay in touch, share solutions and enjoy socials.
• Webinars arranged by inControl/Be-Human have been sharing fantastic ideas and advice including on contingency planning, rights and legal issues.
• Regional groups such as the London SDS Forum are connecting people using DPs along with workers and allies to share support and advice.

• Pro-actively supporting flexible use of funds. Helping people explore ways to meet their outcomes if workers aren’t available, activities have stopped or to negotiate a different offer from a service.
• Support and advice on employing family or household members.
• Use of DPs to stay in touch e.g. purchase of dongles to get online for shopping, or to stay connected with family and friends.
• Reducing process, permissions and keeping monitoring to the minimum.
• Training for social care workers so they can support the above.

• Some areas used government funding to cover additional costs to DP users.
• Contingency funding for DP users (with quick decision-making/ authorisations) e.g. Tower Hamlets provided an upfront 10 per cent contingency to all DP users with permission for flexible spend.
• Supporting DP users to continue paying personal assistants (PAs) to sustain contracts (if furlough not possible) or funding alternative support if PAs can’t work.
• Some local authorities handled sustainability arrangements e.g. with day services so DP users did not have to pay for services they weren’t using.
• However, some DP users are worried about building up excess funds so clarity and reassurance has been helpful.

• Some areas quickly arranged regular PPE supplies to DP users. This also gives people a knock on the door and follow up calls can be made as needed.
• Training and advice for DP users and PAs in use of PPE.
• Mutual aid support with food, medicines and regular phone calls, etc.
• Issuing ID letters and access to free parking for PAs.

We contacted all our DP recipients at the start to make sure people had plans, give support and we continued contact where this was requested. Our PAs have access to PPE, Infection control training and swab testing. We also have a back-up pool of PAs. Nottinghamshire

Summary and purpose Dawn is an operations manager in Mencap in Kirklees. She works with day care services, domiciliary care and three residential homes for adults with learning disabilities (30 residents across the three residential homes). When COVID-19 lockdown began, the day care services closed, the domiciliary care services reduced enormously due to shielding, and staff numbers in residential homes were reduced due to being ill or symptomatic. The senior management team created a ‘backup workforce’ from these affected staff to work across different services – most of whom agreed to take part. Staff previously working in day services or domiciliary care started working in residential homes to fill the gaps and keep the service safe. One of the care homes had several people ill and three individuals had died, which created a staffing problem in terms of numbers. It was also hard on those who were still working or in the care home and affected by the illness/death of people close to them. Staff suggested and implemented very innovative and engaging activities for people to thrive. For example:

• Being inspired by the quote ‘you can’t go to the world so we bring the world to you’, staff dedicated one day each week to a specific country so staff and residents experienced food, films, songs, etc. from that country.
• Residents ran a walk in shop, so others could buy those little things that they missed such as sweets, magazines and toiletries.
• Residents used social media platforms to video call people important to them and to maintain relationships. They also wrote letters to the local school children to maintain community links and much more.

One of the great achievements has been the increase in knowledge, skills and sense of one big team. The relationships between staff at a personal and professional level have developed in a very positive way, which allows them to work better together. Challenges and learning points The challenge will be to build members’ confidence to return and engage in the new normal; some people and family carers are very fearful. One key lesson Dawn learnt is that it would have been better to centralise calls to reduce the amount of them, rather than relying on different service managers to deal with the calls to their individual service. Contact Dawn Wood, Operations Manager Mencap in Kirklees website Facebook

Shared Lives arrangements are high quality, flexible and adaptable by nature. There were many positive stories of supportive households and resourceful Shared Lives carers building on their networks. Shared Lives Plus and local schemes provided support, guidance and connections to enable households to cope and often thrive. There are examples of Shared Lives carers who provide short breaks and day support being paid (Portsmouth) in the absence of their usual ‘business’ to retain their skills and flexibility.

Shared Lives offers fantastic local options and is strongly placed to respond rapidly to add local capacity (Growing Shared Lives) including for hospital discharge.

Lots of evidence of how it works really well for hospital discharge and back to independence but also builds relationships and connection that is sustained even when people move back home. Lots of schemes taking referrals, fast tracking new carers assessments, using tech to make matches etc. Now that testing is more widely available it should make things easier too. We want to scale this solution up in response to the crisis.

Shared Lives Plus

Community micro-enterprises have been offering a wealth of support through tailored local provision and have flexed rapidly to deploy creative solutions. In Somerset micro-enterprises successfully support significant numbers of people with network co-ordination by Community Catalysts. Micro-enterprises collaborated to set up The Buzz – online sessions of dance, art and activities for people around the country to connect and have fun during the crisis.

Self-managed teams have performed well offering a responsive alternative to traditional home care centred around an individual and their natural networks. They are already highly responsive, solution focussed and maximise people’s skills and relationships. They also offer decent pay and conditions for workers, shared decision making and flexibility. Radical-home-care.

Summary and purpose The Inter-generational Sustainable Skills Exchange is funded by Liverpool City Council and is delivered by IIIN Community, a Community Interest Company. The sessions bring together socially isolated older adults and allow them to teach their life skills to parents and children in their community. These skills include, but is not limited to:

• sewing
• knitting
• crocheting
• embroidery
• card making
• cooking
• baking
• gardening
• wood work
• bike repairs.

The older adults would plan the session in advance amongst themselves, with IIIN Community providing a little guidance or steer as needed. These sessions empower the older adults and enhance their feelings of self-worth and value. Older adults feel valued and respected in society once again and begin to realise they have a wealth of skills and experiences that are incredibly valuable and we mustn’t lose. As sessions progress the younger generations share skills, often digital skills, supporting the older adults to become proficient in any areas they wish to be. These sessions also:

• help parents and children reduce, reuse and recycle items/clothing that many would normally throw away
• allow parents to devote a large amount of time and attention to their children which improves the relationship between parent and child
• help older adults make and maintain friendships with members of their community, which they can call upon in a time of to help reduce feelings of social isolation and loneliness.

COVID-19 impact When the COVID-19 pandemic hit Liverpool, all intergenerational sessions were halted as the majority of the older adult participants were required to shield, unable to spend time with anyone or leave their homes. Initially, significant support was given around meeting essential needs, such as food shopping. ‘Hello’ bundles were established from donations with some essential items, including a range of toiletries when items were hard to obtain. However, it became apparent that the older adults were missing the contact they had with the children and parents. The IIIN Community devised ‘VIRTUALITEA’ where older adults would eat a meal with each other via FaceTime/WhatsApp video. This alleviated some of the isolation the older adults were feeling. IIIN Community decided to attempt to bring the groups together virtually and ‘Virtual knit and natter/Crochet and Chat’ was born. The idea was for older adults to attempt to continue teaching their skills to parents and children virtually. Challenges and learning points Internet access was a huge obstacle. Many older adults who were able to use smart phones/iPads etc. would use communal WiFi areas (e.g. in sheltered accommodation) to access the internet. These areas were placed out of bounds by housing providers, which then resulted in their internet access being suspended. Many older adults who used their own internet had low data plans which would not allow them long periods on FaceTime/WhatsApp. IIIN Community spent many hours talking participants through how to increase data plans or access WiFi outside of communal areas. IT Proficiency Most of the older adult participants could not use or had no access to smart phones/iPads and only three of our 50 older adult participants had the necessary skills and knowledge to be classed as proficient. Social housing providers/community organisations loaned equipment to those without the necessary technology to get involved. IIIN Community then began to devise a teaching programme to enable all participants to take part in online sessions. Additionally, we assigned one of our local high schools to design lesson cards to teach older adults how to use a mobile phone and load FaceTime and WhatsApp. The online sessions drastically reduced the older adults’ feelings of social isolation and loneliness. They began finding activities for the parent and child to do during the week based on their skill i.e. sewing or knitting task and the sessions gave them a focus, a purpose. Older adults continued to plan these sessions between them, identifying the focus for the session, any resources required etc. to which IIIN Community would then facilitate. All resources were delivered to participants by IIIN Community. Feedback Parents reported children were thrilled to maintain contact with their older adult. Children found the activities a nice break from the online homework tasks. Children also maintained some form of routine by virtually meeting with their older adult, which gave them some stability in extremely uncertain times. Older adults have reported their relationships and friendships with parents and children have become deeper. They were able to call upon them for shopping, prescription collection, as they were unable to go out due to shielding. Many reported feeling well supported and classed them as family/friends rather than being supported by the state/local government. Many older adults returned/stopped government food parcels as they had food support from their parent/child partner. Parents have gone above and beyond to support the older adults involved in our intergenerational sessions – cooking meals, purchasing shopping, delivering books and magazines to alleviate boredom. Children have surpassed all expectations by writing letters, drawing pictures and designing cards to send to their older adult partner to show how much they value them and the role they play in their life. Contact Gemma Black, Commissioning and Contracts Manager

Summary and purpose David worked in mental health day services until they started to be decommissioned in 2016. As a consequence, he looked into what was the best way to redesign the service, providing support to the community and maintaining people’s jobs. They created the personalisation and social inclusion (PSI) team and the role of the navigator, which is core to the PSI team. David manages a team of ten people who cover the entirety of South Staffordshire. He also manages eight community managed libraries for Midlands Partnership NHS Foundation Trust (the Trust) in partnership with Staffordshire County Council (LA), with one paid for member of staff, whose salary is generated from the libraries income, and a group of 200 volunteers. The community managed libraries won the HSJ Health and Local Government Partnership Award last year. COVID-19 impact The impact of COVID-19 has been enormous, as the libraries are now temporarily closed and the PSI team have had to adapt service delivery. The LA and the Trust have built a pool of volunteers ready for COVID-19 support, so David, alongside them, is looking into how best to deploy these volunteers going forward. For example, using them for running the libraries, enhancing the resilience of community groups, and supporting people to go back to their lives and communities as the lockdown eases and circumstances change. There is a workshop to elicit ideas from various stakeholders and parties. Due to a reasonable volume of the library volunteers being over 70 and currently either shielding or under the ‘vulnerable’ category, this is being considered in the recovery plan. The aim is to spread this model across the entire county, and David is already in conversations with the North Staffordshire teams. Next steps:

• Identify ‘small initiatives’ that have emerged and link them together.
• Identify opportunities for volunteer deployment across the service delivery model.
• Interview existing volunteers to identify skills and interests ready for flexible deployment.
• Recruit more volunteers.
• Identify funding streams.
• Undertake research across the Trust and social care on what needs to go back to how it was and what does not.

Challenges and learning points The main challenge has been the fact that South Staffordshire is a very rural area, and maintaining communication and linking to different parties or delivering training has been challenging. They have, however, overcome this challenge and are using Microsoft Teams and OneConsultation software successfully. Another challenge is the lack of equipment, set up or knowledge of some individuals to enable them to communicate through technology (i.e. broadband, phone, teams, etc.). The key learning point is ‘that for years we have been doing things in one particular way of thinking that it was the only way. Under crisis, we have found different ways of working.’ Contact Dave Bradbury, Social Inclusion and Community Capacity Lead (Staffordshire)

Summary and purpose North Tees and Hartlepool NHS Foundation Trust set up a coordinated staff psychology support hub at the end of March to ensure internal coordination of support for staff, patients and carers in terms of information, toolkits, advice, risk assessment and onward support where needed. The hub was created following the basics of the major incident policy already existent in the Trust; it held and organised collated information from outside sources to reduce the burden of information gathering to the wider Trust and individuals. We also coordinated and planned in the early stages with neighbouring, acute, mental health and IAPT service providers to ensure there were no gaps or duplication in this process. We reached a ‘saturation’ point in terms of any novel and useful new information after approximately two weeks. The service offered:

• A hot line for senior managers and clinicians who needed support individually or asking for team support.
• Reflective spaces for individuals and groups.
• Physical space near to the hospital, but in a different space that is not a COVID-19 red zone.

Individuals seeking support were asked for agreement to provide some data, though no demographic or identifiable data was collected – the majority of them had no issues with this. Information has been collected and processed in relation to the use of the hub and an end of month report has been produced for April and May. A risk assessment was carried out and a series of protocols were developed to support the local helplines, such as toolkits for staff, toolkit for patients, child friendly booklets, etc. It has a real example of collaboration where all staff were caring and showing a clear understanding of roles and working together. Challenges and learning points The main challenge will now be going back to normal, as this threatens the continuation of what is still needed. The Trust has no capacity to fulfil this, even with support from partners and stakeholders received during the COVID-19 crisis. Feedback This ‘command and control’ style of setting up and continuing to run coordinated support services for our staff has worked well and has strengthened internal support services cooperation, learning and planning to continue to meet this needs for the future. Contact Dr Elaine McWilliams, Consultant Clinical Psychologist, Head of Medical Psychology Department

Commissioners need to be clear about measures of success. People’s efforts must result in positive impacts with citizens. Working well together may show great endeavour, but if people themselves have little say, choice or control, then effort needs to be refocused. Numbers are important but it is outcomes and the impact as defined by people themselves that matter. Many commissioned services are required to report key performance indicators (KPIs), but this can lead to a narrow focus limiting pragmatism and flexibility. Commissioners should agree delivery and reporting expectations with providers during the pandemic and beyond to unlock flexibility and target support where it is most needed. Providers need reassurance that they won’t be penalised for sensible changes or be intrusively monitored. Providers and local authorities have faced a huge burden of reporting with multiple data requests from different places. Good commissioning only collects information for a purpose.

• Be clear what information you are requesting and why – what difference will it make?
• How does this relate to outcomes – the impact on people and communities?
• Be clear about any contract reporting flexibilities – change them if you need to.
• Coordinate data requests and make it easy to submit the data e.g. portals to input data in one place.
• Feedback what the information has told us – what’s useful for providers, community sector, for local authorities as a whole, for health?
• How can the information be used to empower co-production and increase decision making with citizens?
• How do we know if citizens have co-produced approaches?
• Most importantly, what is the feedback from citizens and the impact on their lives?

Perfection is the enemy of the good – commissioners should do the best thing possible, quickly. This includes developing costed market response plans to minimise risks to individuals and risks of business failure. We have seen further waves of infection and there could be more or different crises in the future. Reach out and stay in touch so you know which services are struggling, why and who is facing the highest risks. Are standards OK, are you getting feedback from people using services? Provide the practical support to reduce risks to citizens and workers but plan for moving forward to empower people and extend choice based on what’s important to people.

• Increase choice and promote equalities. Be clear about the purpose of support. How will it help people live in the way they want to?
• Begin to scale things that are working well. Innovative and more personalised approaches, such as Shared Lives and community enterprises have delivered good outcomes throughout.
• Co-produce a new vision for mental health support ensuring a clear focus here too on innovation and good practice.
• Focus on local impacts and recovery that builds personal and community resilience; improving mental and physical health. Addressing digital barriers and exclusion must be part of this too.
• Support and invest in alternatives to congregate settings. Ensure there is good support for direct payments. There must be good support for unpaid carers too.
• Proactively engage with plans to sustain community networks as more people return to work. How can people’s efforts be sustained in varied and creative ways?

People have faced significant trauma. It’s important to enable human reflection and connections – ensure people’s relationships are restored, that carers are supported, that citizens are valued. The wellbeing of the workforce is vital and workers may need support to sustain their commitment and energy.

Co-produce – you can’t commission without the voice of citizens. How are things for them? What will improve things for them now and in the longer term? How can you do more of what helps? Co-produce a shared vision of what good looks like. The TLAP I Statements could be a good starting point for discussion along with the vision of Social Care Future.

The message is learn together – don’t rush to back to business as usual. Celebrate what people do for each other – tell stories of community, reciprocity and resilience. Give people a strong sense of being ‘larger than self’. Use this moment to bank and build social capital. Celebrate providers that have really focused on quality of life. Reflect on what you as a commissioner have done.