COVID-19: added winter pressure for adult social care | Sarah Hutchinson

Sarah Hutchinson

As we move towards winter and the peak of the second wave, Sarah Hutchinson, of the NHS Confederation, emphasises the cruciality of social care getting the support it needs to survive the next few months, until a plan for long-term sustainability can be put in place.

While the promised plan for social care reform has not emerged this year, 2020 has still been a momentous year for the sector. COVID-19 has focused public attention on the situation in social care like never before, as the reality of cutting local government funding to the bone hit home in the face of a pandemic.

The sector was at the frontline of the first wave of the virus, which spread quickly through many care homes in particular. The impact has been devastating, with not only vulnerable elderly care recipients hit by the illness, but over 600 care and health staff have lost their lives.

It quickly became clear that the size of the task of managing infection control in a decentralised, underfunded sector - with no single method of distributing PPE, where domiciliary care staff move between people’s homes, and agency staff may move between different care homes, and where family carers play a crucial role in maintaining wellbeing – presented the government with huge challenges.

To meet these, a number of changes have been introduced to support social care through COVID-19, including:

  • an adult social care action plan, published 15 April 2020
  • a care home support package, published 15 May 2020
  • £1.1 billion made available through the Infection Control Fund to support providers to reduce transmission- £600 million paid in May/July, and an additional £500 million announced in the winter plan
  • emergency grant funding to local governments to address pressures on local services due to COVID-19.

In October, the Department of Health and Social Care published an adult social care winter plan, setting out additional support and guidelines for the sector, to help address the dual threat of a second wave of COVID-19 alongside with the normal winter pressures and flu season.

As well as the additional Infection Control Fund money, this plan announced increased distribution of free PPE for COVID-19 needs for all providers and care workers until March 2021, the appointment of a chief nurse for adult social care, the extension of the NHS flu vaccination programme to personal assistants, guidance to limit staff movement between care settings, and ringfenced capacity of 100,000 tests per day in the care sector.

While the adult social care winter plan, and additional funding is to be welcomed, there are still concerns about the resilience of the social care sector this winter. On any given day, social care needs to fill around 112,000 job vacancies. Coupled with staff absences due to COVID-19, self-isolating, or other winter illnesses, this will make it difficult to ensure that staff are not moving between care settings, and increase the likelihood of staff burnout. There has also been a sharp reduction in the number of people moving into care homes, leading to a doubling in the number of empty care home beds in a year, raising the possibility of market failure.

Critical concerns remain around hospital discharge, particularly to care homes, which the adult social care winter plan sought to address. It included:

  • an additional £588 million of funding is being made available to the NHS to support discharge - people would be tested for COVID-19, with results received, ahead of discharge to a care home 
  • the CQC is developing a designation for premises to which a person with COVID-19 or awaiting a result can be safely discharged
  • no care home should be forced to receive someone who is COVID-19 positive if they cannot safely be isolated; in this case the local authority is responsible for finding an alternative setting.

Despite these measures, we have heard from our members that discharge to care homes remains difficult, and this is creating significant pressure on hospitals in some areas, with patients languishing on wards when they should be receiving care in the community.

In addition to a lack of care packages and nursing care beds, and a lack of staff due to outbreaks, members are reporting that care homes are reluctant to take on the risk of accepting designation due to the reputational risk – and financial risk if residents pass away after admission. Where someone’s usual care home cannot or will not accept them as they leave hospital, local government is meant to make alternative provision – however, since funding for hospital discharge was allocated to the NHS, and given the practical challenges of identifying additional or alternative places, this adds yet more pressure to a system already on its knees.

While progress has been made since the first wave of COVID-19, adult social care faces critical challenges as we move into winter. It is vital that the whole system continues to work closely together to ensure that service users can move safely between hospital and other care settings. Without this, not only will the care sector struggle to cope, but the NHS’s capacity will be seriously constrained.

Critically, the government must continue to ensure that social care has the funding it needs to get through this winter - to enable swift access to domiciliary care, smooth and safe discharge to care homes, recruitment of staff to fill the huge gaps – including additional funding to prevent market failure. It must then urgently bring forward the much-promised plan for social care reform to ensure its long term sustainability.

Sarah Hutchinson is senior policy adviser at the NHS Confederation. Follow the organisation on Twitter @NHSConfed

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