for The King's Fund.

National Audit Office. 2020.

Social care: the legacy

22 October 2020
Volume 29 · Issue 19

For years under successive governments and before COVID-19, the social care sector had been a fragile, forgotten sector that should have been valued and acknowledged as it addresses the needs of vulnerable people who require care. Why was the sector ignored for years, and why was it seemingly just left to get on with things? This unsteady foundation meant that any response to the pandemic would be shaky, to say the least.

Data reveal that spending by councils on social care has risen since the low of 2014/2015; however, in real terms it continues below the 2010/2011 level. Bottery and Babalola (2020) note that most of that money was spent attempting to support a very fragile provider market, accompanied by a consistent, above-inflation increase in the fees that have been paid for residential, nursing and home care. In England, the overall council expenditure on social care is currently over £940 million more in real terms than in 2015/2016, with spending on commissioned services from external providers increasing by £1.4 billion. The spend has failed to recognise the increases in population and demand. The number of working age adults and those over 65 years has increased, with more than 70 000 new requests for support in 2018/2019, reflecting an increase of 3.8% with a total of more than 1.9 million requests.

The pandemic has exposed a social care system that is fragmented, abused, defunct and deficient of investment. Governments have been content with providing a sticking plaster for the gaping wound of a service that requires intensive care. Only now it seems that what went on behind closed doors in care and residential homes is of interest. There has been little, if any, understanding of our social care system. In the early days of the pandemic, social care was abandoned and overwhelmed. It must be acknowledged that the onset of a national emergency does not mean that long-standing problems will suddenly vanish.

A Level 4 National Incident in relation to COVID-19 was declared in late January 2020, and on 17 March 2020 measures were set out by the NHS to prepare for a surge in infections. As it took action to increase capacity, patients were being discharged. In a report requested by Parliament to scrutinise the Government's response to COVID-19, the National Audit Office (NAO) (2020) confirmed that around 25000 patients were discharged from hospitals into care homes in the first month of lockdown, sometimes without being tested for COVID-19. This policy was later changed to test all those being sent into care homes. It is not known how many patients had COVID-19 when discharged to care homes.

There is a pressing need to do better. We are being failed, all of us, our mothers and fathers, our grandparents. Substantial changes are needed. We need to care for people in a proper way. This is an urgent need, something that the coronavirus crisis has made even more obvious to those who did not know or chose not to know. The thousands of deaths that have occurred in our care homes is a blight on our nation.

The NAO (2020) report noted that the response to COVID-19 in health and social care settings was shaped by age-old differences between the health and social care sectors, as well as ongoing financial pressures. Tackling the issues faced by the social care sector before COVID-19 will be at least as important a challenge after the coronavirus pandemic. All of the issues must be taken into account by the Government.

It is clear that NHS services had to be reorganised at great speed. The adult social care sector also had to respond at great speed in order to cope with residents arriving from NHS hospitals and to manage the pandemic within care homes. Under any circumstance these actions would have been a challenge. They have, however, been made much more difficult as a result of historic and unaddressed differences and divisions between the two sectors.

The elderly are neither expendable nor are they collateral damage in the quest against COVID-19. Accepting responsibility and making an apology is the right thing to do. But so is investing in the system and those who offer care and support to residents.