Health Policy May 4, 2020
A disconnect in the direction of travel

By Professor Martin Green - Accountable Care Journal

The coronavirus pandemic requires all agencies to work together but, with the benefit of hindsight, it could have been so much quicker had there been less of a disconnect between social care and the wider health service. It seems absurd that social care, which is right at the centre of Covid-19, has had to fight its corner at both national and local levels.

I think this crisis has really underscored some of the fault lines in the system. Social care providers of all sizes, as well as those that are for-profit and not-for-profit, right across the country are united in their concerns. To date, these have focused primarily on personal protective equipment (PPE), testing and staffing.

On PPE we have seen major challenges in distribution, but problems have also arisen due to a lack of clear and consistent advice on how it is to be used in each situation. Mixed messaging has left both care providers and people dependent on their services, unclear on PPE. The scale of PPE required is immense. Millions rather than thousands of masks and aprons are needed urgently.

Testing is another area in which UK policy has not adapted to the needs of the care sector. What we have seen so far is a testing approach based on a more centralised NHS bases strategy.

The needs of each care home within a given community can vary and there is a requirement for flexible testing offerings. People in care homes are often frail. Sitting in a car for multiple hours and queuing at a testing site might not be an option for them. Using the care home minibus is not permitted, and, of course, some care workers, who also need testing, are unable to drive. The situation needs thinking through in order to bring the Government’s plans for widescale testing to fruition.


Supporting the health sector’s “backbone”

If we are to have a truly integrated care system, we have to make sure people don't forget the crucial role that social care plays at the end of the process. We have had big announcements about extra money for the NHS, with politicians saying they will pay “whatever it takes” to help the sector through the crisis. It was recently announced that £1.3 billion would be put into social care. I do not underestimate how big this figure is, but less than 24 hours later an announcement was made stating that £14 billion was going to be wiped off NHS deficits.

This demonstrated the disconnect in Government priorities, which leaves the social care sector playing catch up time and again. The Department for Health and Social Care (DHSC) is more aware of the problems, but given the complexity that has arisen after many years of refusing to meet the issues head-on, it is not a quick turnaround, rather a realisation that health and social care need to be on the same page for training and access to resources.

The adult social care sector is incredibly supportive of the NHS and, in many respects, is its backbone. The Government was wrong, however, to assume that the care home sector would be able to free up 15,000 beds at the blink of an eye. Care homes are desperate to play their part and help, but it would be ridiculous to accept many thousands of hospital patients without either sufficient PPE or testing in place. The risk assessments of each care home must be considered. We need only to look at Spain to see the devastating impact the vicious disease has had amongst care homes, which in turn has had a knock-on effect on staff and their families.

The adult social care sector is incredibly supportive of the NHS and, in many respects, is its backbone. ”

Without additional support from adult social care, the NHS will be simply inundated when it is already at breaking point. Looking to the future and how this crisis is indicative of the fundamental worth of social care workers, we hope that government will ease its immigration policies and also put real energy into a dedicated recruitment campaign for what is clearly a vital and very skilled profession.


A remarkable sector

What I am truly proud of is the way in which social care staff have responded to this pandemic. Staff have completely gone the extra mile and done things that were not necessarily what they were contracted to do.

It is absurd to think that we have had to fight for social care workers to be recognised as key workers. Indeed, members have reported that their staff have had their status questioned by supermarkets, schools and police forces. On the flip side, we have reports of a great many people who are out of a job signing up, via platforms such as www.nationalcareforce.co.uk, to work in social care. The Government needs to amend its employee furlough rules in order to open jobs in this remarkable sector that spans so many different areas, all of which involve care for vulnerable people.

Out of this difficult situation we have seen some things achieved that were never thought possible. We must ensure this ethos of ambition is applied to social as well as the NHS. This pandemic has underscored the crucial importance of the social care sector. While people are beginning to understand this, we cannot slip back into a position where social care is the underdog of the discussion to the wider sector.


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