New analysis by the Health Foundation reveals the devastating impact the pandemic has had on social care in England. The independent charity says the findings provide further evidence that the government acted too slowly and did not do enough to support social care users and staff, and that protecting social care has been given far lower priority than the NHS.
The Health Foundation finds that policy action on social care has focused primarily on care homes and that this has risked leaving out other vulnerable groups of users and services, including those receiving care in their own homes (domiciliary care). It also notes that the shortcomings of the government’s response have been made worse by longstanding political neglect and chronic underfunding of the social care system.
Since March there have been more than 30,500 excess deaths* among care home residents in England and 4,500 excess deaths among people receiving domiciliary care. While high numbers of excess deaths of people living in care homes have been well reported, the analysis shows there has been a greater proportional increase in deaths among domiciliary care users than in care homes (225% compared to 208%). And while deaths in care homes have now returned to average levels for this time of year, the latest data (up until 19 June) shows that there have continued to be excess deaths reported among domiciliary care users.
The Health Foundation says that decades of inaction by successive governments have meant that the social care system entered the pandemic underfunded, understaffed, and at risk of collapse. Any response to COVID-19 would have needed to contend with this legacy of political neglect. As the UK prepares for potential future waves of the virus, the Health Foundation warns that social care must be given equal priority to the NHS, including a greater focus on domiciliary care, and that more fundamental reform of the social care system is needed to address the longstanding policy failures exposed by COVID-19.
Dr Jennifer Dixon, Chief Executive at the Health Foundation, said:
‘The pandemic has had a profound impact on the lives of people receiving and providing social care. The social care system has lacked adequate investment for decades and successive governments have not faced up to the issues facing the sector. COVID-19 has highlighted the extent of this neglect, with tragic consequences. Against this backdrop, the government’s response has been too little, and come too late. The consequences are now clear and in plain sight.
‘Government must learn now from the first phase of the pandemic to invest in and support social care. In the next year we must see long-overdue reform which should 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. The Dilnot proposals, to cover catastrophic social care costs, are already on the statute book in the 2014 Care Act and are ‘oven ready’ – the government could make a start to reform there. The Prime Minister’s commitment a year ago to fix social care once and for all, needs to be honoured now.’
The Health Foundation’s analysis also highlights potential unmet health need among social care users over the course of the pandemic and presents new evidence around the factors that might have contributed to the spread of the virus in care homes.
During March and April, there was a substantial reduction in hospital care use among care home residents, with elective admissions reduced to 58% of previous years and emergency admissions to 85% of previous years. The Health Foundation says that by reducing hospital admissions, care home and NHS teams may have reduced the risk of COVID-19 transmission. However, this reduced risk of ill health from COVID-19 needs to be weighed against the significant increase in unmet health needs among residents, particularly for elective care.
The analysis also found that discharges from hospitals to residential care homes decreased in England during March and April. However, over the same period, discharges from hospitals to nursing homes increased to 120% of the historic average, though we don’t know whether these led to subsequent outbreaks of COVID-19. Decisions to discharge patients from hospitals were made in part to reduce the risks 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. These difficult decisions 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, including major issues with access to testing and PPE.
