Five key insights on COVID-19 and adult social care

This week, the Health Foundation published two new briefings on COVID-19 and social care. Adult social care and COVID-19: Assessing the impact on social care users and staff in England so far analyses the available data on social care and gives an overview of the impact of the pandemic. In it, we carry out new data analysis to describe the scale of the mortality in the social care sector, examine factors that contributed to the severity of the impact and quantify the disruption to health and social care access during the pandemic.

In the second briefing, Adult social care and COVID-19: Assessing the policy response in England so far, we review government policies on social care in England during the first phase of the pandemic. We provide a detailed description and timeline of the government’s social care response, consider the role that social care has played in the overall policy narrative and identify the underlying factors within the social care system, such as its structure and funding, that have shaped its ability to respond.

Here we highlight five key insights from these publications.

1. The impact of COVID-19 on social care has been devastating

The pandemic has had a profound impact on people receiving social care. As of June, there had been 30,500 more deaths among care home residents in England than we would normally expect. 

While the absolute number of deaths reported among those receiving care at home is smaller than in care homes, the proportional increase is greater and those receiving care at home are continuing to die at a higher rate than in previous years.

Additionally, social care workers are among the occupational groups at highest risk of COVID-19 mortality. Social care staff – mostly women and more ethnically diverse than the general population – have been around twice as likely to die from COVID-19 as other adults. 

2. There are multiple possible reasons for outbreaks in care homes

COVID-19 outbreaks in care homes may be driven by multiple factors, including community transmission increasing prevalence among staff and visitors, staff unwittingly transmitting the virus and infections picked up during hospital stays. 

Discharges from hospitals to residential care homes decreased in England to 75% of the historical average in March and April, driven by a reduction in the number of people admitted to hospital. However, discharges from hospitals to nursing homes (care homes for people requiring medical support) increased to 120% of the historic average, though we don’t know whether these led to subsequent outbreaks. Decisions to discharge patients were made in good faith by clinical teams, in part to reduce the risk of exposure to COVID-19 for those medically fit and stable, and in part to free up space in hospitals for an expected surge of new patients with COVID-19. 

However, at the time, testing for COVID-19 was not recommended prior to discharge from hospital and without testing it is unlikely that asymptomatic patients would have been identified. There is also evidence that care homes struggled to implement isolation measures and that accessing supplies of personal protective equipment (PPE) was challenging. 

These difficult decisions to discharge patients were made in an urgent and uncertain context but may have played a role in transferring risk to a poorly supported social care system lacking the right protection. 

3. Access to hospital and social care were reduced

During March and April, there was a substantial reduction in the number of hospital admissions for care home residents. Elective admissions reduced to 58% during this period and emergency admissions to 85%. By reducing admissions, care home and NHS teams may have reduced the risk of COVID-19 transmission. Some care needs may have been met by additional NHS support in the care homes, such as weekly check-ins from primary and community care teams. However, there may have also been a significant increase in unmet health needs, particularly for elective care. 

Temporary powers to relax the Care Act and widespread pressures on services are also likely to create unmet need for social care, though the data on this are limited. Even before the pandemic, unmet need for social care among both younger and older adults was high. Some local authorities have reported an increase of 1–5% in unmet need during the outbreak so far.

4. Central government support for social care was too slow and too narrow

Central government support for social care came too late, and policies to support social care have faced major and widespread problems. Some initial policies targeted the social care sector in March, but the government’s COVID-19: adult social care action plan was not published until 15 April – almost a month after national social distancing measures had been introduced. Another month passed before government introduced a dedicated fund to support infection control in care homes.

Protecting and strengthening social care services appears to have been given far lower priority by national policymakers than protecting the NHS. Policy action on social care has focused primarily on care homes and risks leaving out other services.

Government must learn from the first phase of the COVID-19 response to prepare for a potential second wave of the virus. Both short-term actions and more fundamental reform of social care are needed. Short-term actions should include greater involvement of social care in planning and decision making, improved access to regular testing and PPE, and a commitment to cover the costs of local government’s COVID-19 response. 

5. The pandemic played out against a backdrop of political neglect

The social care system that entered the pandemic was underfunded, understaffed, undervalued and at risk of collapse. COVID-19 exposed longstanding structural problems, which have influenced the social care policy response in England. These include a complex and fragmented organisational structure, long-term underfunding of the sector, a deep staffing crisis with high vacancy rates, and a lack of data.

Fundamental reform of the social care system is needed to address longstanding policy failures. This reform must be comprehensive and include action to improve pay and conditions for staff, stabilise the care provider market, increase access to publicly funded services, and provide greater protection for people against social care costs. 

If reform is avoided, government will be choosing to prolong one of the biggest public policy failures of our generation, and people in need of care and their families will continue to suffer unnecessarily.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.