Structural weaknesses identified in social care pandemic response

Building a resilient social care system in England, published in conjunction with the London School of Economics, explored how the social care sector responded to the outbreak of Covid-19 in England, identifying areas that would make the sector more resilient in future.

The report said that the sector was in a ‘precarious state’ at the point the pandemic hit and Covid-19 further exacerbated its underlying issues.

It argued that the government, NHS England and Public Health England missed opportunities to prepare the sector in the years before the pandemic. The sector was excluded from some planning exercises and problems that were identified in other exercises were not addressed. There was also a lack of understanding about the structure of the social care workforce and what their jobs involved.

Funding was also a problem. The tendency to allocate funding sporadically limited the scope for strategic investment. For example, ‘chronic under-investment’ in the sector over the preceding decade had limited spending on data, information systems and digital innovations and this had an impact on the speed and effectiveness of the response.

Entering the pandemic, there was no central information on key questions such as the sickness of workers, accurate occupancy rates of care homes or even who was in receipt of social care. Low pay and widespread use of zero-hours contracts also contributed to challenges. Many staff worked in multiple jobs across numerous settings increasing the risk of spreading the infection.

Low pay also contributed to poor recruitment and retention. ‘A failure to address this issue over the preceding two decades means that underlying challenges have been exacerbated during the pandemic, when retaining and supporting this critical workforce has been vital,’ the report said.

The research also pointed to the fragile state and complexity of adult social care infrastructure, with residential care buildings and equipment singled out in particular. Small organisations found it difficult to interpret continually updated guidance and outdated buildings struggled to isolate or group together infected residents and to accommodate wider infection control measures.

Natasha Curry (pictured), deputy director of policy at the Nuffield Trust said that what happened to social care at the start of the pandemic was ‘the consequences of letting one of our most important public services languish in constant crisis for years’. ‘Those early months exposed an array of weaknesses within social care that impacted the shape, speed and effectiveness of the response. Many of these difficult challenges could have been eased had warnings been heeded,’ she added.

And Adelina Comas-Herrera, from the Care Policy and Evaluation Centre at the London School of Economics and Political Science, said there were opportunities to learn from international experience. ‘Our research shows that social care in England needs a system-wide reform to be able to respond not just to emergencies, but to the implications of longevity and competition for workforce with other sectors.’

Miriam Deakin, director of policy and strategy at NHS Providers, called for the sector to be properly funded and supported. ‘Just like the NHS, social care needs a long-term workforce plan to ensure enough staff – with better pay, terms and conditions and valued for the work they do – to meet growing demand,’ she said. ‘The social care sector urgently needs long-term, sustainable funding and reform to address severe workforce shortages, unmet need, quality of care, innovation, and digital and data improvements.’

In an evidence session with the Commons Health and Social Care Committee this week, social care minister Helen Whately (pictured) was grilled over the level of pay within social care. She was asked if she was comfortable that social care staff are the lowest paid workers in the country. She pointed to the recent 10% increase in the national living wage and highlighted plans to create more of a career path within social are. However, she conceded that ‘I do not want people to think of social care as being a national living wage job’. ‘I think that people should be rewarded for what they do and I want there to be an opportunity for career progression in social care,’ she said. ‘When people gain more skills, that should be recognised.’

She said the government was not in a position to put social care staff on agenda for change terms and conditions. But she said the issue and funding mechanisms were not straight forward. The government provides grants to local authorities to support the provision of social care. Local government pays fee rates to providers, which, in turn, enables providers to reward staff.

‘We want the funding that is going into local authorities—the grants and extra support for discharge, for instance—to allow there to be an increase in the provision of social care over and above the baseline,’ she said. ‘For instance, I want us to be in a much better position over the coming months, particularly as we go into winter, to make sure there is social care for people who need to be discharged from hospital. That is dependent on the workforce being there to provide that social care, which has a relationship with pay.’