Care Sector “Something of an Afterthought” with no So-Called ‘Protective Ring’, Inquiry Finds

The Chair of the UK Covid-19 Inquiry, Baroness (Heather) Hallett, has today published her sixth report. She concludes that, in the early stages of the pandemic, not enough was done to protect people in care settings and that the adult social care sector appeared to be “something of an afterthought”.

There were more than 43,000 recorded deaths involving Covid-19 in care homes between March 2020 and July 2022. A lack of proper planning, plus failures to implement lessons from earlier pandemic planning exercises, meant the UK government and devolved administrations took critical decisions in the early weeks without the information they needed. Action to protect carers and care users came too late, with devastating consequences.

Module 6, the sixth of the Inquiry’s 10 investigations, examined the impact of the pandemic on the publicly and privately funded adult social care sector in England, Scotland, Wales and Northern Ireland, including infection prevention, visiting restrictions, the experiences of the care workforce and decisions on discharge from hospitals.

The ‘Care Sector’ (Module 6) report concludes that while the UK government and devolved administrations knew, prior to the pandemic, of the extreme vulnerability of care home residents to respiratory viruses, care homes received insufficient protection at the time they most needed it.

Not Right

The claim that “a protective ring” had been put in place around care homes “right from the start” of the Covid-19 outbreak was unfounded.

Not enough was done to protect people in care settings between March and mid-April 2020. The decision to speed up the discharge of patients from hospitals into care homes was necessary to free up hospital beds. But the decision to do so was taken in March 2020 when there was not enough testing capacity to know patients’ Covid-19 status.

At the time, isolating discharged patients inside care settings was one of the few effective protections available. Yet, in March 2020, England, Wales and Northern Ireland did not initially advise this, a failure the Inquiry calls “a significant omission”.

Today’s report shows how, as the deadly virus spread rapidly, care home residents were left feeling isolated, abandoned and alone as visiting restrictions cut them off from loved ones, in some cases for months. Some people were not allowed to be with dying friends or relatives in their final moments, leaving bereaved people grief-stricken. They could not help their loved ones with daily tasks such as eating, drinking and washing, support which can be vital for some residents. As a result, Baroness Hallett concludes: “Many remain wracked by a guilt that they do not deserve to carry.”

Visiting restrictions did not begin to ease until the summer of 2020. The report concludes that the severity and duration of these restrictions caused “profound and enduring effects” inside care homes, particularly for residents with complex cognitive conditions such as dementia.

Many millions of people across the UK receive adult social care. This includes older people, people with dementia and people living with physical and learning disabilities. For them and the people who dedicate themselves to providing their care, the pandemic totally disrupted their daily lives and had a devastating impact.

Afterthought

“At the critical early stages of the pandemic, not enough was done to protect those living and working in care homes. The mantra at the time of ‘protecting the NHS’ sometimes came at the expense of the users and providers of care. The adult social care sector as a whole appeared to be something of an afterthought.

“The profound isolation and sense of abandonment felt by residents as a result of the visiting restrictions resulted in immense emotional harm. Most distressingly, some people were not permitted to be with their dying loved ones. Many remain wracked by a guilt that they do not deserve to carry.

“During the pandemic, the action taken by the UK government and devolved administrations to try and protect workers and users of adult social care came too late. The failures were the direct result of an absence of proper pandemic planning for the adult social care sector. It underlines why my recommendations in this report must be acted upon now before the next pandemic strikes.

Baroness (Heather) Hallett, Chair of the UK Covid-19 Inquiry: The Covid-19 pandemic exposed and exacerbated the underlying fragility of the adult social care workforce. A workforce of at least 1.5 million people – including care in the home (domiciliary care) – provided care during the pandemic. Many put their own lives at risk.

Severe Shortages 

Severe shortages of personal protective equipment (PPE) meant that some care workers were left having to wear waterproof ponchos from festivals, painters’ overalls, or home-made PPE made from fabric, bin bags and bed linen. The report describes this as “wholly unacceptable”, finding that care workers were left “without the protection they needed”. It concludes that while PPE shortages were a global problem, better planning could have ensured a much better supply from the outset.

Many care workers suffered burnout. Some left the profession entirely. Changes to sick pay were introduced in England, Scotland and Northern Ireland between March and May 2020, but not in Wales until November 2020.

The UK’s 5.8 million unpaid carers were also heavily relied upon, providing complex care for longer hours with little or no respite. The Inquiry concludes that support for unpaid carers came too late and that for too long the adult social care sector as a whole has been undervalued and under-recognised.

The Inquiry’s latest report also examines concerns about the use of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, echoing concerns raised in its Module 3 report that some decisions were made inappropriately or without proper consultation, based on a person’s age, health condition or learning disability. While finding no evidence of national policy encouraging blanket use of DNACPRs, the report recommends mandatory end-of-life care training for health and social care workers, who often lacked the skills to have these conversations thoughtfully and compassionately.

Absence of Planning 

Ultimately, the report finds that these failures and others stemmed from an absence of proper pre-pandemic planning for the adult social care sector. Exercise Cygnus, a pandemic preparedness exercise conducted in October 2016, recommended developing ways to assess social care and surge capacity, but this work had not been completed by the time the Covid-19 pandemic struck. As a result, ministers were left making decisions without the information they needed about the sector.

The Chair makes eight key recommendations to ensure the adult social care sector is better protected and better equipped to respond to the next pandemic, including:

• Improving arrangements for pandemic planning to ensure clearer structures, roles and responsibilities.
• Better planning for the safe isolation of care home residents.
• Implementing financial support schemes ready to be rolled out to support adult social care staff to self-isolate or to limit staff movement.
• Publishing guidance on visiting restrictions.
• Maintaining inspection and oversight by developing protocols to enable inspections to continue, including, where possible, on-site inspections.
• Improving the collection of data about deaths in the adult social care sector.
• Establishing mandatory end-of-life care training for relevant health and social care workers.
• Introducing a voluntary register for the social care workforce in England, recognising and supporting a workforce that already benefits from such registers in Scotland, Wales and Northern Ireland.