A lot has changed since my last piece. The political focus has now shifted to easing the lockdown and minimising the economic impact of COVID-19. The general perception is of a crisis reaching an end; this isn’t the reality for adult social care. Social care is still amid the pandemic and looks set to remain the centre of the current and subsequent outbreaks of the virus for months to come.
Adult social care has been on the frontline in the battle against COVID-19 from day one, but our politicians have failed to recognise, plan and prioritise for this. People working in social care and people in need of care have sadly been losing their lives to the virus at a higher rate than in any other sector. We might have expected 16,000 deaths of people in care homes in an ordinary year at the time of writing; in fact, we have seen 40,000 – each of them a personal family tragedy.
The £3.2bn made available by the government to contribute to increased costs associated with the pandemic, support additional services, local providers, care homes, as well as guidance to test, track and control the spread of the infection, were all welcome. The Department of Health and Social Care (DHSC) and the minister for social care, have been working inclusively and sharing leadership. Councils acted to put in place measures to try and protect people and services. Directors, councils, public health services, social care providers, care staff, carers and families have all worked tirelessly to ensure people needing care and support get it as safely as possible. Local authorities have taken several steps to shield and offer financial support to local providers – including advance payments, block purchases, temporary fees uplifts to protect local providers’ cashflow and sustainability. Councils have worked closely in partnership with local clinical commissioning groups (CCG)s, to ensure a local and effective response plan is in place. Social workers and GPs, working together, have demonstrated that they can shift to a radically different model of care.
However, this support comes on the back of years of relative neglect by successive governments. High levels of staffing vacancies and turnover, insufficient training and development, too few personal assistants for people on personal budgets, carers with insufficient support for their own health, a care market urgently in need of reform, limited access to PPE, insufficient access to primary and community health services – all these factors meant that action to limit the impact was, in practice, tragically late in comparison to national action taken to protect NHS services.
COVID-19’s impact on practice and workforce capacity poses major risks to continuity of services and support. We need to be able to ensure safety for our older people and draw-up plans for what the future of lockdown means. We need to support working age disabled people who have been heavily impacted by COVID-19 and might be disproportionately affected by the incoming economic crisis; support those who are homeless and not receiving support to overcome addiction, and not forget that we are facing one of the most profound mental health crisis the country has witnessed in decades.
Inequality has been laid bare by COVID- 19. Social care must champion change to combat this discrimination, to use the evidence to challenge policy and make recommendations about change that will protect and improve lives.
We need to establish a social care system stronger than COVID-19, one that embraces the many changes this pandemic has forced. We need to expand our understanding of how outbreaks have developed across all care settings, not only in care homes, from before the first symptomatic person appeared. We need this knowledge to be based on scientific data and shared experiences, so that our response is efficient and reduces avoidable deaths to zero. We need an ethics framework that doesn’t leave people isolated and which can cope with people who lack the capacity to make decisions, and which protects liberty. In return for an increase in intrusion of testing and tracing, we need to offer preventative protection that enhances lives.
We need social care, health care, housing support, and other community services to operate in unison, supporting each other as equals, with frequent assessment to prioritise support for the partner that needs it most. In the context of a health emergency that disproportionately affects disabled and older people, this means that social care needs to be prioritised at all costs and placed on an equal footing with equal resources. It means properly funding social care so it can support all of us. It means delivering a comprehensive long-term plan for social care.
We will not rid ourselves of COVID-19 and life will not return to normal if social care isn’t a permanent priority. Successive outbreaks of the virus will engulf social care and the price will be borne by those with care and support needs, their families, their communities, and those working to provide them with the necessary care and support. The time has come to prioritise and protect social care for all our sakes.
James Bullion is the president of the Association of Directors of Adult Social Services