Covid-19: early thinking on the legacy for adult social care
16 April 2020
It now seems inevitable that the coronavirus pandemic will reshape many aspects of life in the UK.
The purpose of this short piece is to start to look beyond the end of extreme social distancing and begin to think about the possible legacy of the pandemic for adult social care.
The value of adult social care staff
The tragedy of the pandemic has placed before the general public a truly positive image of social care staff working above-and-beyond to care for and support their clients, sometimes at personal risk to themselves. It has thrown into starker relief the discrepancy between the challenge of the job, the dedication of the workforce, and the low pay and poor working conditions which are common.
No one is assuming that there will be an instant response from government as a result of this new public awareness, but it will in the future be much harder to dismiss calls for additional funding, particularly those which are targeted to increase the pay-packets of social care staff.
Post pandemic it may be difficult for the sector to maintain momentum behind demands for more funding given the anticipated scale of the wider economic downturn. We already know that the social care workforce tends to expand in times of high unemployment. There are indications that a substantial number of businesses in different parts of the economy will fail, driving up the numbers of people seeking work. Clearly new businesses will be established in the aftermath of the pandemic and these will secure some of this excess labour. However, early reports from some social care providers suggest that they are already experiencing a slight easing of recruitment pressure and this is likely to accelerate as the extreme social distancing comes to an end and the newly unemployed seek to return to the world of work.
It is, therefore, quite possible that one of the legacies of the pandemic will be a more stable and more highly valued social care workforce but not one that is better paid or has better conditions of employment. In our view, failure to address low pay and poor conditions in the aftermath of Covid-19 will only result in a repeat of the problems we have seen over the last ten years.
Residential and nursing care for older people
One area which faces the greatest challenge and is therefore likely to see some of the greatest change is residential and nursing care for older people. Where an outbreak of Covid-19 occurs in a care home it will be almost impossible to prevent the premature deaths of many older people. At this stage in the pandemic we cannot know for certain if older people living in care homes will experience a higher risk of infection, although early indications from both the UK and Europe are not good.
Communal settings for older people may ultimately prove to be far more dangerous to life than living in self-contained accommodation. Care homes cannot operate as closed institutions forever but the risks of opening the doors and letting family and the community back in will feel immense and we do not predict an early return to normal operation.
This combination of a closed environment and one which may have seen an exceptional level of Covid-19 fatalities will mean for some families that the option of a care home is far less appealing than it was before the pandemic. We do not expect the sector to collapse but some care businesses will fail, leading to some contraction of the sector.
It is important to recognise that people in receipt of domiciliary care may also experience a greater risk of infection from multiple care staff. However, it will be many weeks before any evidence of this is available.
Alternatives to residential and nursing care may become more attractive and with access to a more stable workforce there may be an opportunity to look more favourably on intensive home care allied with modern technology to support people in their own homes for far longer. We could also see the growth of more personalised, bespoke arrangements such as Shared Lives.
Local authorities have choices to make
The government’s decision to free local authorities of legal duties under the Care Act as a result of Covid-19 will reveal much about the true values which underpin what they do. Some will rise to the challenge, seeing this as an opportunity to use freedoms to make things better and to innovate. Other local authorities may seek to shrink the pool of people eligible for state funded social care. It will be important to remember the choices that different authorities make and the consequences for the communities they serve.
New ways of working
The drive to free-up space in hospitals in preparation for the surge in people with coronavirus offers a unique opportunity for learning. At this point we don’t know how well people who would have been in hospital but have been supported in the community instead have coped. Key will have been the availability and effectiveness of community-based nursing services. If community services have worked well for many it provides real evidence of the effectiveness of the alternatives to hospital admission and, in particular, the possibility of earlier discharge following elective surgery. This opportunity could frame a simple question: if something worked well during the pandemic, then why shouldn’t it continue to work well once the emergency has passed?
The Covid-19 pandemic may also tell us how well the integration of health and social care is actually working; through using rapid evaluation methodologies it will be possible to establish if those areas that have advanced further towards integration have been able to deal more effectively with consequences of the pandemic. Given the effort required of decision makers and front-line staff to respond to the impact of Covid-19 there may be a temptation to put such learning on the back burner, but we believe this would be a lost opportunity.
The future of adult social care
The NHS will for a time become the one service that politicians dare not cut. Indeed, we think that calls for greater levels of sustained funding may become politically irresistible.
But what will it mean for social care?
This government’s commitment to ‘solve the crisis in social care’ will take on far greater significance and be subject to closer and more knowledgeable scrutiny, given the performance of the sector overall and the likely high level of deaths of older people living in care homes. This government might have been able to get away with a simple fudge to avoid people having to sell their homes when they enter residential care, but this would now appear a wholly inadequate response.
It is incredible in 2020 that the fifth largest economy in the world is unable to collate and report on deaths from Covid-19 in real time from both hospitals and care homes when exactly this type of reporting is happening in other countries such as France and the Republic of Ireland. This inability to grapple with even the most basic of shared data collection should spur politicians into asking ever harder questions about the division between the NHS and social care, the solution to which is not technical but rather the political will to countenance fundamental change.
It is a tragic irony that the thousands of premature deaths and the massive social and economic disruption that have resulted from the pandemic could mean the public awareness and appreciation that has always eluded adult social care could finally be achieved.
The challenge will be to translate this greater social value into an integrated health and social care system, which utilises modern person-centred approaches and is funded to a level which means adult social care staff are properly rewarded for the invaluable work they do.
Tom Noon is Chair of Cordis Bright. He can be reached on firstname.lastname@example.org.