Vaccination- Good Progress But More To Be Done

At a press conference this morning the National Care Forum (NCF) – the leading association for not-for-profit social care providers – presented the results from its latest Pulse Survey. Working together with market research agency Information by Design, the Survey provides an in-depth analysis of how care providers are operating in the pandemic to give a picture of how COVID-19 is affecting providers and the people they support and employ.

The Survey was completed by NCF members operating 1,180 care and support services throughout England. Participants employed over 47,568 staff and supported over 42,000 residents and service users across a wide range of care service types, to include care homes, supported living, extra care housing and community-based support services.

A summary of the survey findings revealed:

• Vaccination: good progress but more to do to ensure all care staff are vaccinated by 15 Feb – key gaps remain in the care workforce beyond care homes for older people, especially in domiciliary care
• Finance: facing very serious financial pressures, which will only get worse – costs are up, income is down, occupancy is declining and many local authorities seem to be struggling to offer fee rate increases that will cover the increase in the NLW
• Workforce: combined pressure due to vacancy rates and increasing absence rates; vacancy rates sit at around 5% while the absence rates has increased to 8% in Jan 2021. It is clear that staffing pressures vary greatly, but the impact of COVID-19 infection and isolation can be very significant in individual care services.
• Visiting: providers trying hard to keep some visiting going within lockdown limits: 67% of respondents were still offering visiting during January
• Data matters: it is totally unacceptable that key COVID data collected from the sector is not being shared with the care sector: From the progress on vaccination, to visiting, to numbers of positive cases and outbreaks, providers cannot see the overall national picture, nor their more local and regional picture. This data is essential to help nimble and

responsive operational and contingency planning by care providers who need to adapt quickly to their local situation across the country

Vic Rayner, Executive Director at the National Care Forum says:

“The sustainability of many services is coming under significant pressure across the not-for-profit sector. There is a very real concern that providers may not be able to continue to operate existing services and or to invest in new services and innovate for new models of care.

“Access to social care is a positive choice for many people and for some the only choice providing life-enhancing services to those who need it the most. The long-term funding and sustainability of the adult social care sector should not just be a matter of priority for this government but an essential outworking of their responsibility to the many hundreds of thousands of people who rely on social care for their day to day living and wellbeing.”

A detailed analysis of the data showed:

Vaccination: good progress but still more to do

Given the good progress made on vaccinating residents in older people’s care homes, the findings from the Pulse Survey focused on staff. Respondents stated that, as at 31 Jan 2021, overall 59% of staff in care homes had been vaccinated. This includes both older people’s care homes and care homes for working age adults.

For other types of services with frontline care staff, they reported that overall 52% of staff had been vaccinated in extra care housing services and supported living services, while home care services had 45% of staff vaccinated. Community based services (including day services) had 40% of staff vaccinated.

In a quick snapshot follow up survey to check the position as at 8 February 2021, large gaps remain in the majority of services between the number of staff vaccinated and the target figure of 100% by 15 February. This data confirms that the biggest gaps appear to be in home care services, where 38% of those responding still had less than 40% of their staff vaccinated and over 30% of all services other than care home for older adults had less than 40% of staff vaccinated.

The data from the snapshot survey also showed significant numbers of staff who are awaiting a vaccination that has been pre-booked, which would suggest that numbers across all categories have a planned opportunity to improve potentially before the target date.

Comparing this data with the figures gathered from the Pulse survey would suggest that numbers have improved within the last week in all areas although there remains a significant number of staff to be vaccinated in the majority of service areas.

Finance: a bleak financial outlook

Respondents reported an increasingly serious financial picture: 87% of respondents have seen an increase in operating costs due to COVID-19, while 75% report a decrease in income. 95% expect that COVID-19 will continue to have an impact on their financial position for the rest of 2021.

Overall, occupancy levels have fallen consistently since October 2020 and is now reported at 79%, down from 84% in October and down from an industry average of 89% – 90% in 2019.

Local authorities do not seem be able to offer increases in fee rates for 2021/22 that will go anyway near to compensate the costs of providers. Of those responding to the survey 28% had not yet been offered any fee rate increase and of the 39% that had, just under half of them had had an offer of an increase of less than 2.2% – this is well below the increase in the national living wage and does not leave room for other increases in costs for the coming year.

Workforce: ongoing pressure to manage capacity issues

The overall vacancy rate reported in the Pulse survey was 5% while the overall absence rate has increased to 8% in January 2021 (from 5% in October 2020 and 6.7% in November 2020). Across care services, there is a big range of levels of staff absence rate. 45% of respondents had services in January with absence rate of between 5% – 9.99%, 23% had services with higher absence rates, over 10% and sometimes over 20%. What the data tells us is that staffing pressures vary greatly, but the impact of COVID-19 infection and isolation can be very significant in individual care services.

Visiting: limited but still happening

Even though we are in national lockdown, 61% of respondents had been able to continue some form of visiting in their care homes, using a combination of window visits, garden visits, indoor screened pod visits and end of life visits. Where respondents could not offer visiting, reasons included having a COVID outbreak, finding it hard to enable safe visiting dues to specific circumstances and advice from local health protection team to stop visiting.

Vic Rayner said:

“Many care homes have continued to offer visiting throughout the pandemic, balancing risks. However, all care homes must now be better supported to enable meaningful visiting and the NCF together with a number of other organisations are calling on the government to ensure that by 1 March 2021, essential caregivers can, once again, visit their loved ones in care homes.

“Over the coming weeks, it is vital that all parties address the barriers that are in place around making it possible for essential caregivers to once again be a part of care home life. Providers have worked incredibly hard to keep visiting as available as possible through the strictures of ever- changing guidance, and this is a moment where nearly a year into the pandemic, we pull out all the stops whether government, provider or relative to make this happen. This has to be a common mission with one purpose.”

Data needs: it is totally unacceptable that key COVID data collected from the sector is not being shared with the care sector

The data from the NCF PULSE survey provides a snapshot of the key issues over the period 1st – 31st January 2021 to give an insight into the impact and effectiveness of the government’s response. Much of this data is already captured and made available to the Department of Health and Social Care (DHSC) through the Capacity Tracker – the online data capture platform that is completed on a daily, weekly and monthly basis by care providers answering over 30 questions in

relation to staffing, outbreaks, vaccines, COVID-19 monitoring and many more. However, although access to the portal is available to colleagues at the DHSC, Public Health England, NHS and local authorities, despite numerous and repeated requests from provider organisations and provider representatives like the NCF, access to the reporting and analysis of the data has not been given.

Vic Rayner said:

“We have asked repeatedly for access to the data and insights that is made available from care providers on the Capacity Tracker. From the progress on vaccination, to visiting, to numbers of positive cases and outbreaks, providers cannot see the overall national picture, nor their more local and regional picture. Apart from the very valid moral argument that the data within the Capacity Tracker is provider data and is being provided at very significant effort and cost, there are some other very strong reasons why access to the national, regional and local data is imperative to helping providers in their response in the pandemic.”

Understanding the context of the area(s) in which care providers are operating services, in terms of overall trends of cases and levels of outbreaks could help providers prepare for even more vigilance if the trends are going in the wrong direction. This understanding could reveal how individual experiences fit in to the bigger national picture so that operational processes could be adapted at pace to respond.

Vic Rayner continues:

“Accurate insights into levels of community transmission and levels of outbreaks and cases, means that contingency planning can be more quickly ramped up to address the potential of staff shortages arising from isolation or illness, and any other pressures that may be on the horizon to give providers time to prepare. It is absolutely essential that we have easy access and transparency in order to help care providers do all they can in the fight against the virus. Our Pulse Surveys has been set up to fill this gap, but the responsibility lies fair and square with the government to make the data available and share more widely with the care sector.”

The full slide presentation from the press conference can be viewed here and a recording of the briefing can be accessed here.