UK Covid Inquiry: Pandemic planning for adult social care an 'afterthought'
The 6th report from the UK Covid-19 Inquiry has been released.
The UK Covid-19 Inquiry has found the pandemic had a ‘devastating’ impact on millions across the country who receive adult social care and also negatively impacted millions more who provided that care, whether paid or unpaid.
The sixth report from the inquiry said protecting adult social care appeared to be an ‘afterthought’ as the initial focus of the 4 UK Governments was to protect hospitals which came at the expense of the care sector. Despite at the start of the pandemic claims of a ‘protective ring’ around care homes, the report says no such protection existed until mid April 2020.
There were over 43,000 recorded deaths involving Covid 19 between March 2020 and July 2022 and Covid was the second leading cause of death in care homes across the UK in 2020.
The report's key findings:
The adult social care system is made up of many different parts, meaning ministers could not easily see what was going on or control what was happening. The report said action by all four governments to protect care workers came too late.
In March 2020, the four governments made the decision to speed up the discharge of patients from hospitals to free up much needed beds. Baroness Hallett did not criticise this initial decision but said a lack of testing meant many patients went into care homes without knowing if they had Covid-19.
To prevent the spread of the virus at that time, patients who came from hospital had to be separated and isolated from others in case they had been infected. However, the report found this was not listed as official guidance by March 2020 in England, Wales or Northern Ireland. The report called this a ‘significant oversight’.
Early guidance for care workers said they should keep 2 metres away from the patient being cared for. However, this was unrealistic due to most social care requiring close contact, including daily activities such as washing, dressing and eating.
Poor Quality PPE
Official advice in March 2020 was for care staff to wear personal protective equipment (PPE). However, a severe shortage of supplies at the beginning of the pandemic meant many care workers had to work in either unsuitable or poor-quality PPE, or not PPE at all. Some examples of improvised PPE included waterproof ponchos from festivals, bin bags and bed linen. Baroness Hallett described this as ‘unacceptable’.
Visits to care homes were very limited during the pandemic to try and reduce the risk of infection. However, the strictness and limits on visits caused ‘enormous’ harm to both residents and their loved ones. This often resulted in a significant decline in the health and wellbeing of care home residents.
Offering support to care workers staying away from their jobs if they were infected with Covid-19 was also crucial to stop the spread of the virus. The report said financial support to protect care workers must be in place from the start of any pandemic.
Questions about quality of care during the pandemic were also forced to go unanswered due to the stopping of routine, in-person inspections in care homes.
There were approximately 5.8 million unpaid carers across the UK during the pandemic. Despite some support being offered to these carers, Baroness Hallett concluded it came too late and it was often hard to identify who needed support.
In Wales, Scotland and Northern Ireland, registers of care workers meant recently retired care workers could be invited back to work. These registers also made it easier to communicate with the workers and highlight guidance. However, there is currently no workforce register in England.
Lack of data
Real time data on the number of deaths in care homes were hard to publish until mid April 2020 due to differences in how death data was collected across the industry.
There was also a lack of data about the number of people who received social care in their own homes who then died of Covid-19. However, the data that is available suggests the number of deaths of people in these circumstances did rise. Pressure was often put onto the family and friends of those requiring at home care as healthcare professionals were not always available to provide support. This left untrained people to provide end of life care without proper medication or guidence.
The speed of the pandemic meant that sensitive discussions around future medical care should someone become seriously ill was often rushed or did not happen at all. Also, before the pandemic, health and social care professionals were not required to have end of life training. Baroness Hallett outlined that this much change, and this sensitive training must be provided.
The report's recommendations
In total, the covid inquiry highlighted 8 recommendations and said they must be implemented as soon as possible. These are:
- Improving arrangements for pandemic planning to ensure clearer structures, roles and responsibilities.
- Better planning for isolating care home residents with potential infections.
- Implementing financial support schemes ready to be rolled out to support adult social care staff who must self-isolate.
- Publish guidance on how limiting visiting of patients in care homes will be decided upon in a future pandemic.
- Maintaining inspection by developing protocols to allow the inspections of care homes to continue.
- Improving collection of data about deaths of workers in the adult social care sector
- Establish mandatory end of life training for relevant social care staff
- Recognise and support the social care workforce in England through the introduction of a voluntary register.
This was the sixth report from the Covid-19 inquiry. The next report looking into the Test and Trace system is set to be released in November.