It takes two

By Ann McGauran | 20 July 2020

The Prime Minister announced £3bn in new funding for the NHS last week to boost readiness for a potential second wave of COVID-19, alongside plans for further easing of lockdown in England.

But Boris Johnson’s big strategic roadmap to guide us through the next stages of the crisis was silent on adult social care. This is despite one reasonable worst-case scenario prediction of up to 120,000 winter deaths ahead, and almost 20,000 care home residents in England and Wales dying with coronavirus between 2 March and 12 June.

In response, chair of the New Local Government Network Professor Donna Hall said on Twitter: ‘NHS additional funding is welcome, but there is no extra money so far for social care or public health. An integrated place-based funding allocation [is needed] for health and care, please.’

In a joint statement, the Chartered Institute of Public Finance and Accountancy (CIPFA) and NHS Providers called for joined up policy making across health and care.

The social care sector is still reeling from the impact of the virus. Replies from 50 NHS trusts and boards last week to a national newspaper’s Freedom of Information request revealed that two-thirds of elderly patients discharged from hospitals to care homes when the pandemic was at its peak were not tested for COVID-19.

There have been concerns within the sector for some time about a perceived lack of strategic focus on social care, including a roll-out of testing for staff and residents in care homes that was criticised for being too slow and too irregular to control infection.

Last week it emerged that Rosamond Roughton, the top civil servant overseeing care homes in England, is on a career break, according to Whitehall sources. Tweeting in a personal capacity, senior fellow at the King’s Fund Richard Humphries said: ‘This is appalling timing, and will fuel a growing crisis in the national leadership of social care.’

There has also been a furious response from the care home sector to the decision by ministers to leave care home staff out of a post-Brexit fast-track visa system for health workers. There was already a shortfall of around 120,000 workers in the care sector before the pandemic.

Mr Johnson’s comments earlier this month on the high COVID-19 death toll among care home residents – claiming ‘too many homes didn’t follow procedures’ sparked fury within the sector. Later, a spokesman for Number 10 insisted Mr Johnson was not blaming care homes, saying they ‘have done a brilliant job under very difficult circumstances’. Speaking at the time, the policy manager for health and social care at CIPFA, Dr Eleanor Roy said the PM’s remarks were, at best ‘misguided’. She added that most social care settings could not reasonably be expected to deal with the demands of the coronavirus, ‘particularly when guidance for the sector was being repeatedly withdrawn and changed’.

Writing for The MJ last month, Dr Roy emphasised that while the Government had provided £3.2bn of funding to councils to cover the costs of services being provided in response to the pandemic, ‘this covers the entirety of local government services, not just social care’.

She also said the £600m Infection Control Fund to support the private provider market was an ‘administrative burden’ to councils ‘from which they largely do not benefit’. None of the funding ‘comes anywhere close to the estimated £6.6bn of additional costs related to COVID-19 reported for adult social care alone’, she concluded.

Speaking to The MJ last week, she emphasised that COVID-19 had brought added urgency to the need to reform social care funding and has ‘been one of the thorniest issues in the political landscape for a long time’. She said there was consensus that the funding of health and that of social care needs to be made more equitable – ‘and there have been numerous proposals that have got to various stages around that. Where agreement seems to be lacking is where the quantum of funding comes from to pay for that.’

She added: ‘I think that if anything, the pandemic has brought the issue more into the public domain. If that doesn’t stimulate a move towards reform, then I don’t think anything ever will.’

Adult social care has been ‘plunged into this situation that nobody could have foreseen’, said Dr Roy, ‘and I just think with the best of intentions, there’s been a lack of understanding of the issues within the sector, for example, in relation to the discharge programme (from hospitals into care homes)’.

She said the key message at the early stage of the crisis was to ‘protect the NHS – and that was an infinitely sensible thing to seek to do. However I think there was a lack of an appreciation of the residential care sector’s ability to deal with the infection’.

Dr Roy added: ‘Your average residential home wouldn’t have had access to any sort of (COVID-19) expertise, wouldn’t have been equipped with the personal protective equipment (PPE) to deal with infectious patients, and didn’t have facilities to isolate. Numerous pieces of guidance were put out on staffing, PPE, etc, and if you’re a small family run care home provider, that’s quite a lot to deal with, to just wade through that guidance.’

‘But there was a clear gap of a month between the discharge policy, and clear, coherent guidance for what the sector should be doing, which they (the care home sector) understandably felt distraught by.’

Natasha Curry is acting deputy director of policy at the Nuffield Trust. She told The MJ that while the injection of £3bn in funding into the NHS was ‘much-needed money, and very welcome’, a big question mark remains on what is going to happen with social care.

She added: ‘If COVID has shown us anything it’s how interdependent the two systems are, and how bolstering one and leaving the other is just not a long-term solution’.

The adult social care sector was in a very bad state before COVID, and is in a worse one now, Ms Curry added. She warned that if a second wave does hit, ‘the sector is in a very weak position starting out’.

But she said in conclusion it could be premature to focus on future waves when the first stage of the pandemic is still very much ongoing. ‘It’s not over for the care sector at all at the moment, so it’s very disappointing there hasn’t been an announcement on funding.’

Working through the pandemic to support care homes in Leicester

Strategic director of social care and education at Leicester City Council Martin Samuels reported last week on Twitter that due to the ‘success of our shared efforts to protect care homes in Leicester, results from the latest round of tests show that almost nine out of every 10 homes are completely virus free’.

On 11 May all care home staff and residents in England became eligible for testing, with the launch of an online portal for care homes to arrange testing. But speaking to The MJ, Mr Samuels emphasised that the key issue is ‘not necessarily testing, but the care that’s provided’.

His frustration is apparent when he says that getting hold of testing data has been ‘enormously difficult’. On Monday, health secretary Matt Hancock has announced plans to share more data with local government in a bid to help track and trace COVID-19 cases more effectively, but it remains to be seen how quickly the problems he is highlighting are resolved.

He added: ‘It seems impossible for the national testing programme to tell us anything about what they’re doing. The only way I can find out about the results of tests is that my team have to ring care homes and say have you had tests done recently, and if you have had results, what were they? This takes a huge amount of time and effort, but it does give us the ability to see what’s going on.’

He outlined the blueprint for the council’s success at bringing down COVID-19 cases to a low level – an achievement that is particularly notable in the context of the fact that Leicester became the first area in the country to experience a local lockdown due to infection rates that accounted for 10% of all positive cases in the country.

Mr Samuels said that with the support of the NHS, by the end of April the council had set up a contract with a provider with a separate facility which acted as an isolation unit for discharged patients whose COVID status was uncertain.

He said that right from the start his teams have had very good contact with care homes, speaking to every one of the 103 homes in the city at least twice a week on the phone.

They were able to quickly identify areas of pressure as they arose, including issues around personal protective equipment (PPE), and to provide equipment drops. There have also been issues around what PPE should be worn in which contexts, ‘so with considerable support from the public health team we took the national guidance and summed it up’.

He added: ‘The principle was that the people working in care homes are unbelievably busy. They haven’t got time to read a 20 or 30 page document that sets out in great detail what they should do. We reduced it to a single page so that a care worker would be able to pick up a single piece of paper and know exactly what they were doing.’

Care homes have ‘all the time felt supported, connected and engaged’ as a result of the overall approach, he concluded.

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