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Challenges and solutions: commissioning social care during COVID-19

Published: January 2021
Last updated: May 2022

This guide addresses the challenges faced by the social care sector during the pandemic. It describes how local authorities, providers, individuals and communities have responded with a range of solutions to ensure people have the support they need. It includes examples of practical and financial support for market continuity as well as innovative solutions benefiting individuals and communities.

Commissioners, providers and the community sector will find this useful to inform immediate responses to the crisis as well as longer term market shaping plans.

Introduction and overview

The challenges of COVID-19 are many and the impacts ongoing. The sector already faced enormous challenges prior to the pandemic – longstanding financial pressures, a precarious and narrow provider market, limited choice and control for citizens in many areas, struggles to scale innovation and engage community assets, an undervalued workforce and increasing workforce shortages. The crisis has magnified these issues and local authorities are taking a huge financial hit.

Despite that, social care has continued to function. Overall, people were not left without care (though waiting lists are now growing). Community mobilisation ensured people received vital food and medicine. Some providers responded flexibly to meet needs in creative and positive ways. The provision of care, however, came at a terrible cost for people living in care homes, their families and care workers. Those using and providing other forms of support also faced considerable challenges. People missing out on reablement or healthcare may have reduced independence or suffered damage to their mental health as a result. The same is true for the millions of people awaiting surgery and the estimated 1.9% of the population experiencing long COVID. The longer term impacts of these on people’s needs and on the workforce are still to be understood.

At the beginning of the pandemic local authorities and commissioners needed to respond quickly to a rapidly developing crisis to ensure people received vital care and support. Approaches that helped include:

  • Stabilising the sector through sustainability funding and meeting extra costs
  • Practical support and advice – personal protective equipment (PPE), testing, infection control and help with recruitment
  • Positive communication and relationships to understand issues and to develop shared solutions – building on co-production and partnerships
  • Community support and mobilisation
  • Flexibility and responsiveness – particularly through more personalised arrangements such as direct payments, Shared Lives and micro-enterprises
  • Strong local decision-making – often in advance of Government guidance
  • Collaboration with local health partners to ensure the required health input
  • Personal dedication of care staff, unpaid carers and the resilience of individuals.

Some local authorities have taken proactive steps to engage with citizens, develop innovative solutions or taken market shaping measures to ensure social care providers are able to continue operating. Future planning, though, must be based on what people actually want. If it’s propping up a market that doesn’t give real choice, it’s time to think again. Plans must address the risk of future outbreaks and the multiplying impact of winter pressures, increasing needs, limited availability of some services and dire staff shortages to avoid what may be experienced by some who use social care as a ‘permanent lockdown’.

Principles for good commissioning responses to the pandemic

Use evidence-based commissioning approaches – understand what works and what doesn’t locally and why, as well as likely future pressures.
Embed values – choice, control, community connections and co-production.
Share power and maximise expertise – building collaborative approaches.
Meet immediate needs, but don’t rush to long-term solutions.
Support community responses – don’t get in the way, help when needed to add value.
Align long term planning to wider agendas – employment, poverty, loneliness, health.
Money – use it locally, use it wisely, get the best impact.
Save lives and improve lives.
Support what works – invest in what delivers good outcomes.

The pressures COVID-19 has caused the sector

The social care sector is complex and crucial. It involves millions of people and vast sums of money. Failures would be devastating for individuals, their networks and beyond. COVID-19 emphasised the scale and importance of the sector.

  • Social care is a keystone of communities employing over 1.5 million people in England and contributing £50.3 billion to the economy in 2020/21.
  • Local authorities spent £23.3 billion on social care in 2019/20 and provided long term support to 839,000 adults (King’s Fund).
  • People privately purchasing their own care are estimated to spend £11billion per year.
  • There are an estimated 6.5 million unpaid carers with millions more taking on caring responsibilities during COVID-19.
  • Around 18,500 provider organisations deliver services across 39,000 establishments, and 70,000 people employ their own staff via a direct payment.

A number of pressures which already existed in social care have been amplified by the pandemic as summarised below,

Solutions to commissioning challenges during COVID-19

There have been varied solutions to the issues faced. Commissioners will want to ensure the positive community and innovative solutions become embedded in ongoing approaches. The ADASS budget survey and Coronavirus survey from June 2020 showed how councils rapidly adapted and enhanced provision of information and advice, re-trained council staff and partnered with volunteers to enhance support. There has been a range of measures of practical and financial support for providers throughout the pandemic. Importantly, providers, communities, carers and individuals have adapted to respond positively to the challenges.

Financial support

Local authorities provided funding (including via emergency funding from the government) to local providers to support cash flow, sustainability, cover excess costs and extend services. Examples include:

  • payments in advance and immediate payments to support cash flow
  • sustainability payments for providers with reduced business or unable to operate – paying for commissioned capacity rather than occupancy in care homes, home care and day services
  • increased rates for home care and care homes, contingency funds for direct payments and financial support for unpaid carers
  • guarantees to micro-providers in receipt of direct payment income
  • emergency funds for providers to claim back excess COVID-19-related costs
  • funds to support and sustain voluntary and community sector organisations
  • funding expansion of some voluntary and community sector (VCS) activity such as adding capacity to mental health teams to broaden their support offer and reach
  • funding crisis accommodation for people with learning disabilities and mental health needs.

Practical support

Local authorities also provided practical support including:

  • procurement and delivery of PPE at no cost to providers, unpaid carers and people receiving direct payments
  • a local seven-day public health support and advice line on COVID-19 for care providers
  • expert training and advice, e.g. weekly webinar training sessions on infection prevention and control for providers
  • early arrangements for testing and, importantly, re-testing for people in all care and support facilities (e.g. by Bexley with Queen Elizabeth pathology lab)
  • supporting clinical links such as ‘virtual’ GP and pharmacy appointments for care and nursing home residents through supplying iPads to care homes
  • recruitment: local campaigns, undertaking recruitment for providers
  • leverage and leadership to change local behaviour – for example, a local DASS intervened when blanket DNR notices were being sent.

CQC has been documenting innovative and inspiring examples of how providers are responding to COVID-19. Examples include supporting people to stay in touch with family and friends, use of technology, virtual exercise classes, enhanced infection control, supporting people and their families with information and advice, plus practical ways of supporting staff such as with safe travel arrangements as well as emotional support.

Providers themselves have adapted rapidly and many have implemented changes to ensure safety whilst promoting wellbeing.

Support with hospital discharge and to reduce admissions

With urgent pressure to free up NHS beds, local authorities quickly established routes to support hospital discharge. Some pre-empted the devastating consequences of rapid discharge and quickly closed care homes to all new admissions. Examples to support and avoid hospital admissions include:

  • Re-deploying occupational therapists (OTs) from hospitals to support home-based reablement so people did not lose skills and independence
  • Moving OTs to front-line calls to understand needs and advise accordingly
  • Block booking care home beds and capacity for environments with enhanced infection control and separate infection-free areas
  • Securing extra capacity with home care providers
  • Using hotel facilities for hospital discharge and respite
  • Modelling how to maximise admission avoidance by increasing ‘safety net’ and interventions at home
  • Re-deploying council, Clinical Commissioning Groups (CCG) staff and nurses to staff new accommodation with support for people who have been infected, but no longer need hospital
  • Use of Shared Lives to provide enhanced support at home
  • Quickly mobilising a COVID-19 step down unit
  • Direct payments – promoting their flexible use and supporting people to pay family members as appropriate.

Flexible support approaches

People achieve better outcomes when they make their own decisions about support, rather than receiving services scripted by commissioners or assessors. Innovative services also help attract new people into social care, plus experienced staff wanting more creative, quality and sustainable jobs. Commissioners can help by promoting direct payments, innovation and flexible support.

Support for direct payment (DP) users

Direct payments (DPs) offer choice and control, and are designed to be used flexibly and innovatively. Commissioners should support and promote their use.

There are positive reports of pro-active support, advice and practical help by local authorities and by DP support services. Areas with strong co-production were closer to understanding what was working for people and ensuring citizens shaped the response. Some areas have seen shifts towards DPs for people wanting more flexibility than their commissioned arrangements allowed, including for hospital discharge support.

In regular meetings with the social care minister, members of the National Co-production Advisory Group and other self-advocates have fed through patterns of experience. This has been complemented with registers of people’s experience such as the Be-Human register.

Actions reported as helpful by people using direct payments include the following:

Community support

Flexibility of community support has proven key in providing meaningful connections. A number of services extended their offer to reach people in new ways. Whilst many centre-based services closed, some rapidly responded by contacting people, making regular phone calls, dropping off supplies, offering in-reach and activities.

One short break service continued its support to adults to with learning disabilities and their families and moved its community choir online. Some services distributed digital devices and helped people get online – something commissioners could support post-COVID-19.

There has been positive feedback on individual service fund (ISF) arrangements as providers used person-centred approaches to quickly re-shape support in line with people’s wishes and changing circumstances.

We offered evening and weekends online – evening and quizzes- they do virtual walks – really essential. More informal 24/7 as online so extend reach.

Day service provider

The TLAP ‘Directory of innovations in community centred support’ has documented how groups and organisations are working differently during the pandemic and offering great person-centred support. Their stories of promise also charts the multitude of creative responses that have evolved in communities across England. Themes include: keeping people connected; digital innovation; information and advice; self-directed support; and workforce.

Support for unpaid carers

Commissioners must ensure effective support for all carers during the crisis and beyond. Areas that know their communities and carers well have been able to respond quickly and flexibly to get the right support to carers. The following approaches have been shown to be effective:

  • Linking social care and mutual aid networks to connect known carers and identify ‘new’ ones.
  • Getting digital devices to people, running Zoom training sessions so carers can join coffee mornings, do online shopping, etc.
  • Coordination by carers’ organisations so people don’t have to navigate multiple systems. Linking carers to expert advice such as on housing, employment, money, legal issues and health conditions.
  • Support to shift to direct payments to employ family members to reduce transmission.
  • Practical support such as the supply of PPE and food.
  • Support for carers’ mental health.
  • Peer support that is emotionally beneficial and offers practical support as carers share advice, tips and resources.

We were very keen to support family carers and wanted to support our commissioned organisation to continue and develop their support offers, including calling regularly.


Community mobilisation – a reminder of community strength

The amazing community mobilisation response through the pandemic serves as a reminder to commissioners that strong communities are essential to providing solutions. Grassroots organisations and community anchors have a deep local understanding of what’s needed and have real strength in organising. It broadens the concept of which organisations can provide support. There are fantastic examples of local businesses such as food suppliers, handypersons, takeaways, pubs, restaurants and hotels responding to provide great practical solutions. Such an approach also benefits the local economy.

Many groups came together harnessing the energy, commitment, goodwill and knowledge of local people. They add value and connect people using social care with community offers to enhance support or provide back-up and tackle loneliness. Examples of community coordination in local areas include:

  • An alliance of 13 voluntary and community sector (VCS) organisations, coordinated by an infrastructure organisation, set up a collaborative response within two weeks with one central support line number.
  • A community hub system was established with a volunteer platform, supportive local infrastructure and teams deployed (including from council roles) to fill gaps of capacity and expertise.
  • A VCS infrastructure organisation coordinates the community/village agent network and volunteer network of ‘coronahelpers’. This avoids dilution or overlap of community offers.
  • Commissioned providers are encouraged to make use of and contribute to community led activity.

Supporting community mobilisation

Commissioners need to find the right relationship balance to ensure that non-statutory effort remains mobilised. The TLAP report, Towards resilience: making community matter in social care highlights how community focused initiatives are key to a more resilient future for all those that draw on, provide or commission adult social care support. Mutual Aid groups, neighbourhood support and peer networks can also play a key role in sharing information and reaching people. Commissioners can help facilitate links with the statutory sector and fill the gaps where council activity can make most difference. This, however, should not replace, restrict or slow down non-statutory efforts.

Blend the mutual aid, council and national offers. Using Cormac Russell’s term, be ‘Alongsiders’.


Accelerating investment in community anchors enabled working with community business and user led groups and doing together to develop the response to COVID and beyond.

Local authority commissioner

Mutual aid emerged very quickly – now 5k involved on Facebook. As DASS, I check in every day, as do members of our Area Council Teams – spotting issues, offering support and guidance, filling gaps.


Collaborative approaches – communication is key!

Relationships, communication and trust are pillars of good commissioning and have been vital in responding rapidly and effectively to the crisis. Areas that already had strong relationships in place quickly built on these. Respective knowledge and expertise was maximised for a ‘sum is greater than the parts’ effect in these examples:

  • Existing trusting relationship enabled a council to give money to a community business to manage the mutual aid response knowing they could do it better and without the restrictions of KPIs on the money.
  • Professionals being redeployed has shown how skills can be utilised in different settings and helped increase their understanding and support for skills across the system.
  • ASC department investing in community neighbourhoods to understand and gather live research on the needs of social enterprise organisations and supporting their responsive developments through co-production, openness and trust.

Early, frequent, and supportive communication with providers has been highly valued. The examples below are just a few of many demonstrating the benefits and practical steps to support this – some commissioner-led, some provider-led.

We started with communication with providers to understand their situation. We rang all providers, not just commissioned ones and then set up a website to collate all issues and information. People really appreciated being asked. It went a long way to getting a good partnership set up.

  • The integrated commissioning function was re-focused to ensure daily contact with main providers.
  • Weekly virtual provider forum meetings to build peer support, share good practice, resolve issues such as staff absence and wellbeing.
  • Forum run by a regional care association with over 100 local stakeholders and close working with CCG and the local authority.

A place to come to share grievances and work through solutions. It has been good then to have a place where the local authority and CCG want to come in and talk about things that are important to providers as normally commissioners invite providers in.

CEO of national not-for-profit provider
  • Open-book accounting gave transparency on cost-pressures and helped to build trust and really understand what’s needed.
  • Commissioning and public health out of hours on call arrangements for advice and support including on infection control.
  • Links with unions and workforce representatives to hear about and respond to issues of shared concern.

We celebrate on social media the wonderful examples we get sent of how people are coping.


Moving to digital

The Performance tracker 2021 sets out how public services responded to the pandemic. One key area is the fundamental shift in how technology is used. For example use of the Capacity Tracker app has provided central government, local authorities, NHS trusts and providers with useful data on capacity in care homes and its potential could be expanded.

Greater use of technology has also improved communication between local authorities, providers and the families and friends of people using services. But this shift has not benefitted everyone and some people have been further excluded as many services moved online.

Members of the SCIE Co-production Network talked about how digital meetings had made it easier for them to be involved without the effort of travelling and balancing other commitments. Action on Disability (a disabled people’s organisation) has provided a safe and supported venue that people can choose to come to join other virtual meetings.

It’s important that commissioners work with local people to take stock of digital shifts. Digital should not be the only channel but there must be capacity building within communities to increase digital inclusion. Don’t leave people behind.

Key takeaways for commissioners

Challenges and solutions: commissioning social care during COVID-19