Social Care In A Post-Covid World
By Tony Stein, Chief Executive, Healthcare Management Solutions (www.hcsolutions.co.uk)
The impact of the pandemic on social care settings is well documented. In the 12 months since the UK entered its first lockdown, the number of elderly people living in social care settings has dropped by around 10% overall, and whilst it varies from service to service, the average occupancy numbers being reported by operators support this figure. When this will recover to pre-covid levels is yet to be seen, however the high death rate among the elderly population has, in the short term, reduced the numbers of people looking for care and the volume of enquiries has fallen.
It should be remembered that it is the local authorities that have a duty under the Care Act to manage the availability of provision in their areas and, to ensure that sufficient numbers of the right type of beds are maintained. LA’s are not financially able to improve fees to providers
to a level that will allow them to survive at occupancy levels where they are now. Without central government support the care sector would have been in dire financial trouble that would only have been possible to survive with the forbearance of lenders, landlords and investors. Once central government financial support is withdrawn, and this must happen eventually, there will be casualties, thus reducing the available provision of beds at a time when the elderly population is growing. If homes that currently provide for the public pay part of the market close, the margins at current LA fee levels do not support the building of new services given the capital cost. In other words, once it’s gone, it’s gone for good.
It has been said that the pandemic has demonstrated the need for care homes to have en-suite accommodation to better provide for the isolation and barrier nursing of those infected. There is, as yet no actual analysis or evidence to demonstrate that death rates were higher in homes that lacked en-suite accommodation. There is a detailed study in Scotland, carried out by the universities of Glasgow and Edinburgh, that clearly shows that larger homes had proportionately higher mortality rates, however this could be because larger homes are generally located in areas of higher population density. If home size was the issue, then logically it would suggest smaller homes would be the way to go post- covid to minimise future risk. If, however it was asymptomatic transmission by staff moving between the homes and a much higher densely populated community, then this would suggest that homes would be better in sub-urban or rural environments. Either way, there is a cost to replacing or moving existing provision that cannot be met at current fee levels.
One thing is for sure, and that is that funding needs to allow providers to offer sick pay to ensure that employees are not forced, through eco-nomic need, to attend work when feeling ill.
What the pandemic has shown clearly is that at times like this, the NHS and social care need to work closely to provide a functional solution. It was also clear that central government had to step in to provide the emergency support that was required to enable providers to buy PPE, pay staff (additional staff, sick pay, furlough pay), cover voids in beds, and purchase equipment. During this pandemic, the LA’s were used as pass-through agencies as a way of distributing funding. Because of this, each local authority took a slightly different approach, leading to a ‘postcode lottery’ in funding with some actively encouraging take-up by providers whilst others made access much more difficult. A national care service, funded centrally, could have managed this far better.
Pre-Covid there were huge disparities between different LA’s and their ability to meet their obligations to fund care. This isn’t going to be any easier post-Covid as LA’s face the problem of recovering from the additional spending that they’ve incurred during the pandemic. In addition, as high streets have seen shop closures and people have become more settled into different patterns of working, LA revenue streams will dry up (business rates, parking revenues, higher urban unemployment); the worry is that the disparities will only get worse.
Some difficult issues, and only a detailed analysis of how and where deaths occurred will allow us to know what needs to change for the inevitable next pandemic. It is too early to be making informed deci- sions, but one thing is for sure: if LA fees remain where they are, we need to rely on the existing care home stock to provide the beds for the foreseeable future. This means protecting the services that are out there and I am certain that LA’s that couldn’t fund care needs pre-Covid are in a far worse position to fund them now.