England has emerged from the first phase of the covid-19 pandemic with one of the highest excess death tolls in Europe, and scrutiny is now falling on the government’s response to the pandemic. As in many other countries, the impact on those living and working in care homes in England has been devastating. The UK prime minister, Boris Johnson has said that he “bitterly regrets” the care home crisis. Though he has also said that “too many care homes didn’t really follow the procedures in the way that they could have”—comments that provoked anger among sector leaders and drew much criticism.
But social care is more than care homes. What assessment can be made of the impact of covid-19 on social care services and the policy response to support the sector in the first phase of the pandemic?
There have been over 30,500 excess deaths of care home residents. Much less is known about the impact of covid-19 among social care users in the community. We do know that 4,500 additional deaths of domiciliary care users have been reported so far, a greater proportional increase in deaths than in care homes (225% compared to 208%). Worryingly, up until 19 June, which is the most recent data available, the excess deaths reported among domiciliary care users had not returned to average levels.
Only a small proportion of these deaths were attributed to covid-19, even at the height of the first wave of the pandemic. Some of the increase in excess deaths may be due to changes in reporting. But some may be due to unmet need for health and social care services. Unlike residents of care homes, we don’t even have simple information on the age or causes of death of those affected, and data collection methods omit deaths from those receiving care from self-employed or unpaid carers. Without better data collection outside of care homes, the true impact on those in the community will remain invisible.
Any covid-19 response would have been more challenging in the social care sector than in the NHS. Following decades of political neglect, social care services entered the crisis amid a deep staffing crisis, weakened by many years of underfunding. The system is fragmented. There is a complex web of national and local arrangements, and a lack of quality data on what is happening in the sector.
Nevertheless, our overall assessment is that the government response was too little, too late. Some initial policies targeted social care in March, but the adult social care action plan was not published until mid-April—the same week that the number of excess deaths in care homes peaked. By the end of April more than a third of care homes in England had reported an outbreak. It was mid-May before a dedicated fund was introduced to tackle infection control in care homes. There have been delays between a policy being announced and subsequently implemented in some key areas—regular testing for care homes is a recent example—and major and widespread issues with others.
Matt Hancock’s claim that government “tried to throw a protective ring” around care homes from the start of the pandemic does not appear to be grounded in reality. His statement also highlights the often narrow focus of national policies on social care during the pandemic so far, which have focused primarily on care homes rather than the wider sector. Expansions in testing eligibility are one example. Care homes for those aged 65 and older and those with dementia were prioritised for whole care home testing and regular testing. Personal care assistants and unpaid carers were not added to the list of essential workers until the beginning of May. The CEO of the UK Homecare Association recently stated that “Lack of capacity has meant homecare has never been on the government priority list, not even in lockdown areas”. There is a risk that government protection and support has not reached all parts of the system or all users.
There will be time to make a fuller assessment of government policy and the impact in care homes and the community in a future inquiry. For now, government needs to commit to learning from this first phase to help prepare for potential future waves of the virus. Immediate lessons include greater involvement of social care professionals and users in planning and decision making, and ensuring future plans and policies take into account the diversity of social care services. The availability of regular testing and personal protective equipment for those working in social care must continue to improve. And rapid strides need to be taken in data collection from across the sector to ensure the risks and impact on social care users and staff can be better monitored, understood and acted upon.
But the pandemic has also laid bare the failure of successive governments to reform social care. Alongside more immediate actions, fundamental and comprehensive reform of the social care system is needed now more than ever.
Sarah Deeny, assistant director, data analytics, The Health Foundation.
Phoebe Dunn, research fellow, The Health Foundation.
Competing interests: SD and PD are authors of two recent reports for the Health Foundation on social care.