COVID-19 and the Long-Term Care system in England (UK)

Structural characteristics of the LTC system, impacts of the pandemic, measures adopted and new reforms

This country profile contains a section of the LTCcovid International Living Report on COVID-19 Long-Term Care that brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in England, as well as description of the system and of new reforms. The LTCcovid Living report is updated and expanded over time, as experts on long-term care add new contributions. This profile also provides links to research projects on COVID-19 and long-term care, to key reports, and lists key experts on the impacts of COVID-19 on the long-term care sector in England.

Recent updates for England:

Impact of the pandemic on workforce shortages in the Long-Term Care sector

Impacts of the pandemic on access to care for people who use Long-Term Care

Impacts of the pandemic on unpaid carers

Impacts of the pandemic and measures adopted on the health and wellbeing of people who use Long-Term Care

Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

Workforce conditions: pay, employment conditions, qualification levels, shortages

Vaccination policies for people using and providing Long-Term Care

Living report: COVID-19 and the Long-Term Care system in England (UK):

PART 1 – Long-Term Care System characteristics and preparedness
  • 1.00. Brief overview of the Long-Term Care system
    The majority of long-term care in England is provided by unpaid carers. Formal long-term care in England is provided by a complex system involving organisations in charge of health, social care, housing and other services. There is an important distinction between means-tested social care (non-medical services aimed at supporting people with LTC needs with their daily living activities) and health care services, which are free at the point of use and funded from general taxation. Formal care services include home-based care services, personal assistants, residential/institutional care, day care and professional services such as social work, occupational therapy and aids and adaptations. Most publicly funded services are commissioned at local level, but, as a large share of the population who use long-term care is not covered by the public system, a large share of care is purchased directly from private providers. There is strong consensus on the urgent need to reform the social care system in England. Further reading: CEQUA report on England (2017), LTCcovid report on England (2020), Report on the problems with the social care system in England (2018)
  • 1.01. Population size and ageing context

    By mid-2020 the population in England was estimated to be 56,550,000, representing 84% of the total population of the United Kingdom. The median population age in England was 40.2 years. The share of the population aged 65 years and over was 18.5% and the share aged 85 and over was 2.5% (Source: ONS).

  • 1.02. Long-Term Care system governance

    The Department of Health and Social Care (DHSC) has overall policy responsibility for setting adult long-term care policy in England and the legal framework, and is accountable to Parliament and public for the performance of the system. The Ministry of Housing, Communities & Local Government oversees the distribution of funding to Local Authorities (LAs) and the financial framework within which local authorities operate.

    The Care Act 2014 sets out the responsibilities of 152 LAs in the assessment of social care needs, commissioning and organisation of care, LAs also deliver some services directly, but this is increasingly rare.

    The National Health Service (NHS) in England was established by the National Health Service Act of 1946. NHS England is an arm’s-length body of the DHSC and is responsible for arranging the provision of health services in England. The DHSC sets objectives for the NHS through an annual mandate. Since 2013, Clinical Commissioning Groups have been responsible for commissioning hospital and community care for their local populations. In relation to Long-Term Care, nursing and rehabilitation services are mostly provided through the NHS, or funded by the NHS and provided by social care providers for individuals who require nursing in a social care setting or that are considered to have primarily a health need..

    The Care Quality Commission regulates care providers for quality, monitoring and inspecting services to ensure they meet quality and safety standards, and also provide oversight of the financial resilience of the largest and potentially most difficult-to-replace care providers. They publish their findings, including performance ratings.

    Although there are initiatives at local and regional levels which aim to integrate health and long-term care services (with varying degrees of success), they remain two separate systems. The NHS White Paper published in February 2021 sets out legislative proposals to establish Integrated Care Systems (see question 4.04 for more details).

  • 1.03. Long-term care financing arrangements and coverage

    A large share of the resources that fund long-term care are provided in kind, through the time and effort of unpaid carers. Formal long-term care services in England are funded differently for health care, which is free at the point of use through the National Health Service (NHS) and social care, which is means-tested. Individuals who need care and their families also contribute to the costs of care through purchasing services privately or out-of-pocket payments for services. There is strong consensus on the need to reform social care funding and reforms are under way (see question 4.02).

    As an illustration of who bears the costs of long-term care in England, it is useful to look at this study of the costs of dementia, which found that, in 2015, 42% of the £24.2 billion costs of care of people with dementia were attributable to unpaid care, formal social care services represented another 42% and health care 16%. Out of the £10.2 billion social care costs, £6.2 billion were met by people who use care and their families, and £4.0 by the government. This means that the public sector only funds one third (32.6%) of the costs of dementia, leaving users and families to shoulder the rest of the costs through unpaid care or care fees. The cost of dementia estimates include health care costs that are not strictly “long-term care”, for example diagnostic services and hospitalisations, meaning that the share of public funding for long-term care for people with dementia is even lower than this estimate (Wittenberg et al., 2019).

    In England Local Authorities (LAs) organise and fund social care for people who are eligible. The LAs are funded largely through a combination of a grant from central government and local revenue-raising mechanisms, including a tax on housing (council tax). Social care funding is not ring-fenced, which means that local authorities can decide how much of their budget they allocate to care. Unlike the NHS, where healthcare is free to those using it, access to social care is determined by both need and means. A restrictive means test, which had not been adjusted since 2010, means that people with property (including housing), savings or income in excess of £23,250 must meet the entirety of their care costs alone. Those with means below the threshold of £23,250 may be eligible for part or full state funding for their care but they must also be deemed to have sufficiently severe care needs.

    The King’s Fund Social Care 360 annual report provides a useful overview on public funding for social care in England. In 2019/20, gross social care spending through LAs was £23.3 billion. Of this, £7.5 billion was spent on long-term support for working-age adults (£2.5 billion on nursing or residential care, £451 million on supported accommodation and £4.6 billion on community support, including home care). They also spent £159 million on short-term support for working-age adults. Spending for long-term support for older people was £7.9 billion (£5 billion on nursing or residential care, £121 million on supported accommodation and £2.7 billion on community support, including home care). Theyalso spent £450 million on short-term support for older people (Bottery and Ward, 2021).

    During the last decade, funding to councils has been cut by almost 50% (source: National Audit Office), which has put pressure on councils to spend less on care either through reducing the rates they pay providers or by reducing the number of people they fund. Because local authorities have a responsibility to raise revenue locally to subsidise the grant they receive from national government, those local authorities in more affluent areas are able to raise more (source: Institute for Fiscal Studies). The result is wide variation in the eligibility for care between local areas, despite the intention of the Care Act (2014) being to standardise eligibility.

    The distinction between ‘health’ and ‘care’ creates further inequity. A person deemed to have health needs may be able to access social care via the NHS’s continuing healthcare programme (although subject to restrictive eligibility criteria and long waiting times), but someone with personal care needs (e.g. arising from dementia) and no medical requirements is subject to the means test (source: Nuffield Trust).

    In 2018, LTC expenditure in the United Kingdom was estimated by the OECD to represent 1.8% of Gross Domestic Product.

    References:

    Bottery S and Ward D (2021) Social Care 360. The King’s Fund. https://www.kingsfund.org.uk/publications/social-care-360

    Wittenberg, RKnapp, MHu, B, et al. The costs of dementia in EnglandInt J Geriatr Psychiatry2019341095– 1103https://doi.org/10.1002/gps.5113

  • 1.04. Approach to care provision, including sector of ownership

    Care is provided by approximately 9,000 home care providers and over 15,000 care home providers. Around 78% of all adult care services are privately owned and run (source: ICF report). The Care Act 2014 places a duty on local authorities to ensure that there is diversity and quality in the market of care providers. However, due to the downward pressure on fees stemming from cuts to local authority budgets, many providers find that the fees paid by local authorities fall short of covering the full costs of providing care. People who fund their own care are being charged on average 41% more than local authority funded residents because of this shortfall (source: CMA report). It is increasingly common for care providers to go out of business, struggle to stay in business, or hand back contracts to local authorities. A survey in 2019 found that some 75% of councils reported that organisations had either closed or handed back contracts in the last six months of 2020, creating enormous disruption and discontinuity for those receiving care. Because of market fragility, the government has introduced market oversight and a failure regime covering financial as well as quality failure (source: CQC).

  • 1.05. Quality and regulation in Long-term care

    The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care and serves as the independent regulator for both health and long-term care.

  • 1.06. Care coordination and personalization

    There is a clear policy drive towards integrated care in England. Health care has traditionally been coordinated through local National Health Service (NHS) planning and provider organisations, which are accountable to the national government. In contrast, social care contrast is under the responsibility of local authorities, which have their own governance structures and are accountable to elected local governments. Local authorities can make their own decisions about implementation and funding allocation. Since the late 1990s to 2010 the government focused on the structural elements of partnership through multiple policy reforms. A review of progress in that period concluded that there was insufficient attention to supporting joint working through building relationships and trust (Glasby et al, 2011).

    Since 2010, England introduced initiatives to encourage better integration between health and social care, building on previous efforts to improve partnerships between the two sectors. A study reviewing progress on integrated health and social care in England from 2010 to 2020 has concluded that a focus on locally relevant and specific tasks or issues has resulted in the greatest progress. Broader ill-defined goals and constant policy changes are not helpful (Miller et al, 2020).

    A review of the findings from three key integration pilot programmes (Integrated Care Pilots, Integrated Care and Support Pioneers, and New Care Model ‘Vanguards’ highlights the challenges of identifying the objectives of integrated care). All three programmes shared the aim of improving coordination between hospital and community-based health services and between health and social care. However, over time, the NHS narrowed the lens used to evaluate their success to impact on reducing unplanned hospital admissions, which led to a diminished role for local authorities and voluntary sector partners. The evaluations of the pilots show that integration is a long-term project and that reductions in unplanned hospital admissions are not necessarily the best way to measure success (Lewis et al, 2021).

    The NHS Long Term Plan published in 2019 announced Integrated Care Systems (ICS) everywhere by April 2021, bringing together local organisations to deliver a ‘triple integration’ of primary and specialist care, physical and mental health services, and heath and social care. These ICSs are rooted in the NHS, with the expectation that local authorities, the voluntary sector and others will partner with them.

    The plan also includes the expansion of the Enhanced Health in Care Homes model to the whole country by 2023/4 to strengthen links between primary care networks and care homes.

    The Plan announces support for local approaches to blending health and social care budgets and that a forthcoming green paper on adult social care will set out further proposals for social care and health integration.

    References:

    Glasby J, Dickinson H, Miller R. Partnership working in England – where we are now and where we’ve come from. International Journal of Integrated Care. 7 March 2011; 11: 1–8. DOI: https://doi.org/10.5334/ijic.545.

    Lewis, R. Q., Checkland, K., Durand, M. A., Ling, T., Mays, N., Roland, M., & Smith, J. A. (2021). Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes?. International Journal of Integrated Care, 21(S2), 5. DOI: http://doi.org/10.5334/ijic.5631

    Miller, R., Glasby, J., & Dickinson, H. (2021). Integrated Health and Social Care in England: Ten Years On. International Journal of Integrated Care, 21(S2), 6. DOI: http://doi.org/10.5334/ijic.5666

  • 1.07. Information and monitoring systems 

    There is no national minimum dataset for care homes, or social care in England. During the pandemic, the limited existing data was supplemented by data collections from several bodies (the NHS, providers themselves, the death registration system, Public Health England, and the Care Quality Commission (CQC)). Those working in the sector report that this has led to repeated collection of similar data, by multiple stakeholders. This reflects the lack of data and technology infrastructure in the social care sector, which by comparison with the health care sector in England and Wales, has received little investment.

    The COVID-19 crisis has stimulated some technological innovation in care homes, for example, the NHS has expanded the use of encrypted NHS emails to care home staff, developed a web portal for Personal Protection Equipment (PPE) emergency procurement, and has piloted ‘remote’ social care interventions. Some care homes and General Practices (GP) have also used tablets and video calling to allow GP visits and to communicate with families. The digital lifeline initiative during the COVID-19 crisis enabled over 5,000 adults with intellectual disabilities in England to receive internet-enabled devices, with data and local support to help people learn how to use their device, with promising impact in the short term. However, this is in the context of fundamental issues with capacity of the care home sector to engage in these initiatives due to a lack of infrastructure (e.g. broadband), or low usage of digital technology among home care staff.

    At a provider and individual level, data and information sharing are limited. There have been several successful partnerships between the health and local authority sector across England to link social care data collected by councils with health care data. However, this only covers people whose social care provision is provided by local authorities, not those who pay themselves. There are no national datasets on social care utilisation or individual expenditure and the complex and fragmented nature of the provider market makes data collection difficult. The development of the Capacity Tracker (source: About Capacity Tracker – NECS (necsu.nhs.uk) for care homes, mandated during Covid-19, is a welcome addition with potential to provide market intelligence, although there are concerns about the accuracy of data entered, with implications for planning and prioritisation in central government (source:  Covid story_v5.docx (laingbuisson.com). It remains impossible to obtain an accurate estimate of the number of self-funders or total social care spend across all care settings (source: Adult social care statistics: the potential for change | The Nuffield Trust).

    Source:

    https://ltccovid.org/2020/05/14/the-invisibility-of-the-uk-care-home-population-uk-care-homes-and-a-minimum-dataset/

  • 1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

    Currently, there is no national workforce strategy for the adult social care workforce – the last strategy was published by government over a decade ago in 2009. Proposals on workforce reforms are expected to be outlined in two forthcoming white papers, on adult social care reform and health and social care integration, respectively.

    On average in 2020/21, 6.8% of posts were vacant in the English social care sector, equivalent to 105,000 at any one time. Care providers continue to report difficulty recruiting and retaining workers, particularly to the roles of care worker, registered manager and nurse.

    Data indicate that the sector suffers from high staff turnover, poor working terms and conditions, and 24% of the workforce are on zero-hours contracts. Pay levels are low compared to other competing sectors such as retail and hospitality. The national minimum wage has increased in recent years and is set to rise to £9.50 per hour as of April 2022. While this is positive for entry-level staff, there has been no parallel action to boost the pay of more experienced staff with 5 or more years of experience. As a result, the pay differential between junior and more senior care workers has narrowed to an average of 6 pence per hour by March 2021. There are few opportunities for training and progression, with data on qualification levels indicating only 45% of direct care-providing staff in 2020/21 held a relevant adult social care qualification.

    The adult social care workforce is reliant on migrant labour. It was reported that in total, an estimated 98,710 migrant workers joined the formal care workforce between 2009 and 2019, with 9% from EU and 11% from non-EU countries. In London, more than two in five care workers are from abroad. However, under the new points-based immigration system introduced on 1st January 2021, care workers have not been recognised as eligible for the ‘skilled worker’ route. As a result, the number of new entrants to the social care sector from abroad fell from 5% in 2019 to fewer than 2% in the spring of 2021.

PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
  • 2.02. Deaths attributed to COVID-19 among people using long-term care

    The Office for National Statistics provide weekly updates of deaths registered in England, which include any death where COVID-19 was mentioned (by a doctor) on death certificates. Between December 28, 2019, and November 6, 2020, the ONS estimated that 15,659 people died linked to COVID-19 in care homes

    As of March 12, 2021, the ONS have reported 127,911 COVID-19 related deaths, with 39,196 of these occurring in care homes (23%). In terms of deaths of care home residents in England, that is, those care home residents who died from COVID-19 but did not necessarily die in a care home, the Office for National Statistics publish data on weekly deaths of care home residents that are registered in England and Wales. As of March 12, 2021, there have been 41,107 COVID-19 related deaths of care home residents in England and Wales. Subtracting the total number of care home resident deaths in Wales (1,911 deaths) gives a total of 39,196 care home resident deaths in England up until March 12, 20201. Therefore, care home residents accounted for 31% of all COVID-19 related deaths in England. There are 425,408 care home residents in England. Therefore, the number of COVID-19 related deaths of care home residents represents 9.21% of this population.

    There is relatively little data on the impact of COVID-19 on people who use long-term care and reside in private households. Using data from the Care Quality Commission, the Health Foundation estimated that, between March 23 and June 19, 2020, there were an additional 4,500 deaths among people using domiciliary care from providers registered with the Care Quality Commission, compared to the previous three years during the same period (an increase of 225%). The deaths of 819 service users had been notified and published as involving COVID-19 during this period.

    The ONS reported that the largest number of excess deaths (compared to the last five years during the same period) between March 20 and October 30, 2020, happened in private homes (25,634, of which only 2,571, 10%, were registered as COVID-19), followed by deaths in care homes (22,948, of which 15,415, 60%, were registered as COVID-19). In contrast, there were 2,724 fewer deaths than expected in hospices during that period. These figures do not include all deaths of care home residents, as some will have died in hospital.

    In July 2021, the Care Quality Commission published care home level data on deaths notifications involving COVID-19 for the period from April 10, 2020, to March 31, 2021. In total, the Care Quality Commission had been notified of 39,017 deaths in that period that took place in 6,765 care homes.

    Deaths linked to COVID-19 among people living with intellectual disabilities

    Multiple studies using data sources have reported higher COVID-19 mortality rates among adults with intellectual disabilities in England. An analysis of notifications of deaths of people with intellectual disabilities to the LeDeR programme up to 5 June 2020 reported an estimated COVID-19 mortality rate of 3.6 for adults with intellectual disabilities compared to the general population. The ONS linked primary care record data to death certificate data from 24 January to 20 November 2020, reporting age-standardised mortality hazard ratios for COVID-19 of 3.5 for men with intellectual disabilities and 4.0 for women with intellectual disabilities aged 30+. Controlling for residence type (private household, care home and other communal establishments) reduced these COVID-19 mortality hazard ratios to 2.1 for men and 2.2 for women. A further analysis linking primary care record data (using a less expansive set of codes for intellectual disability than the ONS analysis) to death certifications reported a COVID-19 mortality hazard ratio of 8.2 for adults with intellectual disabilities aged 16+ between 1 March and 31 August 2020; and 7.4 between 1 September 2020 and 8 February 2021.

    Deaths linked to COVID-19 among people living with dementia

    Half (49.5%) of all COVID-19 related deaths in care homes in England and Wales between March and June 2020, were in people living with dementia (Source: ONS).

  • 2.04. Impacts of the pandemic on access to care for people who use Long-Term Care

    Omicron wave

    The rapid spread of the Omicron variant has had a drastic impact on the ability of services to continue to operate due to very high rates of staff sickness. A survey of members of the National Care Forum (the largest body representing not-for-profit care providers) released on the 13th January 2022 found that 66% of homecare providers responding are having to refuse new requests for home care, 43% of providers of care homes are closing to new admissions and 21% of home care providers are handing back existing care packages as they are unable to fulfil them. The providers reported an 18% vacancy rate and 14% absences as a result of Omicron.

    Also on the 13th January 2022, the Association of Directors of Adult Services reported that 49 out of 94 councils that answered a questionnaire reported taking measures to prioritise care to support the most basic tasks only (eating, drinking and going to the toilet, but not help with tasks such as getting out of bed) and having to leave people with learning disabilities, dementia or mental illness alone for longer than usual.

    Previous waves of the pandemic

    In the initial part of the pandemic carers reported delays in health treatment for the person they care for (57%) and for themselves (38%). More than half of carers (65%) in a Carers UK survey carried out in September 2020 reported to have postponed attending health care services for their own health needs. Reduced access to health care and social services for the person they support was also reported by carers of people with dementia (90% of 795 respondents)(Source: Alzheimers.org).

    Many community–based care services, such as day care, were interrupted as a result of the COVID-19 pandemic. Guidance on safe delivery of day care has been published by the Social Care Excellence Institute on the July 10, 2020.

    It is likely that there have been reductions in the use of domiciliary care services, such as home care, as a result of people fearing contagion through contact with staff, and as a result of staff shortages due to their own need to self-isolate or shield. Lack of access to PPE and testing for home care providers may have exacerbated this problem. There is no data yet on the extent to which services have been reduced or the degree to which this has affected the people who rely on those services and their family and other unpaid carers, although a national survey by the Association of Directors of Adult Services reported substantial increases in social care need arising from the unavailability of services, hospital discharge, carer breakdown, and concerns about abuse and safeguarding.

    Impact on access to health and social care services for adults with intellectual disabilities

    UK-wide interviews with approximately 500 adults with intellectual disabilities and surveys with approximately 300 family carers and support workers of adults with intellectual disabilities who could not take part in an interview, at three time points during the pandemic, have reported that access to a wide range of health services (including primary care, more specialist therapists, and annual health checks) significantly reduced from before the pandemic to the lockdown in the winter of 2020. Access has improved since then up to the summer of 2021, but not to pre-pandemic levels, with more consultations being conducted by phone rather than face to face.

    The picture is similar concerning access to a wide range of social care services, including day services, community activities and short breaks, with the exception of support at home which has continued at consistent levels through the COVID-19 pandemic. Reduced access to many health and social care services was evident for a greater proportion of adults with intellectual disabilities with greater needs, particularly adults with profound and multiple intellectual disabilities.

    In England, national statistics on local-authority funded social care reported that 1,500 fewer adults with learning disabilities were receiving long-term social care at the end of March 2021 compared to the end of March 2020, reversing a long-term trend of increasing numbers of adults with learning disabilities receiving long-term social care.

  • 2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

    People living in care homes

    Guidance issued by the government on April 2, 2020, said that care homes should advise family and friends not to visit except in exceptional circumstances. There is concern and, increasingly, reported international evidence that some of the measures taken to reduce the risk of COVID-19 infections in care homes, such as closing care homes to visitors (including family members), reduction in social interactions and activities, and needing to isolate have had negative impacts on the wellbeing and mental health of people living in care homes (Comas-Herrera et al, 2020). There are multiple reports warning about the alarming rate of deterioration that people with dementia are experiencing under these isolating conditions and being detached from their families. For instance, a survey conducted by the charity Alzheimer’s Society found that 79% of care homes surveyed reported that the lack of social contact is causing a deterioration in the health and wellbeing of their residents with dementia. A survey of care homes from across England found that by late May and early June, 2020, 85% of managers had detected low mood among residents (Rajan et al, 2020).

    People living in the community who use long-term care

    There is emerging evidence that reduced use of social support services has had detrimental effects on the quality of life of people affected by dementia and older adults (Giebel et al, 2021).

    In a study of community-dwelling adults with dementia and their carers (Rand et al, 2021), it was found that the later stages of COVID-19 restrictions in England (specifically, from reintroduction of the tier systems in 2nd December 2020 until the end of the study in April 2021) were associated with poorer care-related quality of life outcomes when rated by proxy based on the proxy-person perspective (i.e. the proxy respondent’s rating based on their estimate of the person with dementia’s view).

    Impacts on adults with intellectual disabilities

    UK-wide interviews with approximately 500 adults with intellectual disabilities across the UK reported that in the four weeks before being interviewed in the summer of 2021: 13% of people said they often/always felt angry or frustrated, 15% often/always felt sad or down, 21% felt often/always worried or anxious, 12% often/always felt lonely with no-one to talk to, and 19% of people said they had a new or worsening health condition. Across all these indicators well-being had improved from previous interviews in winter 2020/21 and spring 2021. In the summer of 2021, 50% of adults with intellectual disabilities interviewed felt at least a little worried to leave the house – this was at a similar level to the winter of 2020/21, reversing an improvement in spring 2021.

    The same project included surveys with approximately 300 family carers and support workers of adults with intellectual disabilities who could not take part in an interview. In the summer of 2021, family carers and support workers reported that 14% of people were often/always angry or frustrated in the four weeks before the survey, 12% of people were often/always sad or down, 25% of people were often/always worried or anxious, and 28% were reported to have had a new or worsening health condition in the four weeks before the survey.

    Impact on people living with dementia

    During the early part of the pandemic it was reported that there was evidence of substantial increases in the prescription of anti-psychotics to people with dementia (Howard, 2020). Some of this may have been due to increased need linked to delirium management or palliative care, but it is also likely to be attributable to worsened agitation and distress linked to COVID-19 restrictions (such as people in care homes being confined to their bedrooms, or not being able to receive family visits).

    A qualitative study involving people living with dementia, their carers and therapists were interviewed at two time points around May 2020 and July 2020, generating evidence on the causes and effects of deconditioning. The study observed a set-reinforcing vicious cycle among participants: lockdown made the person apathetic, demotivate, socially disengaged, frailer and less confident, which reduced their activity levels, which in turn reinforced the effects of deconditioning. External supporters had an important role in motivating people to keep active and, with appropriate support and infrastructure, some participants could use tele-rehabilitation (Di Lorito, 2021).

    References:

    Comas-Herrera A, Salcher-Konrad M, Baumbusch J, Farina N, Goodman C, Lorenz-Dant K, Low L-F (2020) Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.

    Di Lorito, C., Masud, T., Gladman, J. et al. Deconditioning in people living with dementia during the COVID-19 pandemic: qualitative study from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation. BMC Geriatr21, 529 (2021). https://doi.org/10.1186/s12877-021-02451-z

    Giebel, C., Cannon, J., Hanna, K., Butchard, S., Eley, R., Gaughan, A., Komuravelli, A., Shenton, J., Callaghan, S., Tetlow, H., Limbert, S., Whittington, R., Rogers, C., Rajagopal, M., Ward, K., Shaw, L., Corcoran, R., Bennett, K., & Gabbay, M. (2020). Impact of COVID-19 related social support service closures on people with dementia and unpaid carers: a qualitative study, 25(7), 1281–1288. DOI:https://doi.org/10.1080/13607863.2020.1822292

    Giebel, C., Lord, K., Cooper, C., Shenton, J., Cannon, J., Pulford, D., Shaw, L., Gaughan, A., Tetlow, H., Butchard, S., Limbert, S., Callaghan, S., Whittington, R., Rogers, C., Komuravelli, A., Rajagopal, M., Eley, R., Watkins, C., Downs, M., … Gabbay, M. (2021). A UK survey of COVID-19 related social support closures and their effects on older people, people with dementia, and carers. International Journal of Geriatric Psychiatry, 36(3), 393–402. DOI:https://doi.org/10.1002/GPS.5434

    Howard, R., Burns, A., & Schneider, L. (2020). Antipsychotic prescribing to people with dementia during COVID-19. The Lancet Neurology, 19(11), 892. DOI:https://doi.org/10.1016/S1474-4422(20)30370-7

    Rajan, S., Comas-Herrera, A. and Mckee, M., 2020. Did the UK Government Really Throw a Protective Ring Around Care Homes in the COVID-19 Pandemic?. Journal of Long-Term Care, (2020), pp.185–195. DOI: http://doi.org/10.31389/jltc.53

    Rand S.E., Silarova B, Towers A.-M. and Jones K. (2021) Social care-related quality of life of people with dementia and their carers in England. Health and Social Care in the Community. https://doi.org/10.1111/hsc.13681

    Willner, P., Rose, J., Stenfert Kroese, B., Murphy, G. H., Langdon, P. E., Clifford, C., Hutchings, H., Watkins, A., Hiles, S., & Cooper, V. (2020). Effect of the COVID-19 pandemic on the mental health of carers of people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 33(6), 1523–1533. DOI:https://doi.org/10.1111/JAR.12811

  • 2.06. Other impacts of the pandemic on people who use Long-Term Care

    People with intellectual disabilities and autistic people

    Apart from impacts of the COVID-19 pandemic on access to health and social care services and the health and wellbeing of people with intellectual disabilities, UK-wide interviews with approximately 500 adults with intellectual disabilities and surveys with approximately 300 family carers and support workers have reported a range of other impacts on people’s lives. In July-August 2021, largely after COVID-19 restrictions were lifted in England, 19% of people with intellectual disabilities with greater support needs across the UK (including people with profound and multiple intellectual disabilities) were reported to be still shielding. Over a quarter of adults with intellectual disabilities reported that someone they knew well had died (of any cause) during the COVID-19 pandemic. In terms of paid employment, most but not all people with intellectual disabilities in paid employment before the pandemic were in paid employment in the July/August 2021, often via furlough or people’s jobs being held open.

    No systematic information is available concerning the impact of the COVID-19 pandemic on autistic people without intellectual disabilities in England.

     

  • 2.07. Impacts of the pandemic on unpaid carers
    Impacts on health, wellbeing, and quality of life

    Many carers have expressed the experience of stress and a negative impact on their physical and mental health. Carers UK reported that the negative impact on the mental health of carers was greater among carers experiencing financial difficulties. Research found that variations in hours of support were associated with higher levels of anxiety and lower levels of well-being (Giebel et al, 2021).

    In a survey of approximately 300 largely family carers of adults with intellectual disabilities across the UK in July/August 2021, carers most commonly reported their caring role had affected them in terms of feeling tired (66%), a general feeling of stress (60%), or disturbed sleep (53%), with little change compared to previous surveys in December 2020-February 2021 and April-May 2021 (Willner et al., 2020).

    In a study of community-dwelling adults with dementia and their carers (Rand et al, 2021), there was no significant association between the phases of the COVID-19 restrictions in England and carers’ care-related quality of life. Significant positive associations were found between care-related QoL and carer self-rated good health and satisfaction with social care support; negative associations were found with high-intensity caregiving (>50 hours per week), co-residence with the person with dementia, severe cognitive impairment and financial difficulties due to caring. The sample (n=313) reported high levels of unmet social care-related QoL need, with over 50% of the sample having unmet needs in five of the seven QoL domains (except self-care (32%) and personal safety (3%)).

    Increase in numbers of people providing unpaid care

    Evidence suggests that, since the beginning of the COVID-19 pandemic, a substantial number of people have taken on new care responsibilities. Several reports on unpaid carers have shown that there has been an increase in unpaid carers, many of those who have cared prior to the pandemic have increased their care commitment, largely due to reduced availability of services.

    Carers Week and Office for National Statistics reports show that the number of people providing unpaid care has increased substantially since the COVID-19 related lockdown measures were put in place in March 2020. The Office for National Statistics report states that 48% of people in the UK cared for someone outside their own household in April 2020. The Carers Week report estimates that 4.5 million people in the UK have become unpaid carers during the COVID-19 outbreak in the UK. The reports show that people who have taken on new care responsibilities continue to be more likely to be female, although there was a high proportion of men taking on new care responsibilities. Carers who have taken on care responsibilities since the onset of the COVID-19 pandemic were slightly younger (45-54 years) compared to the groups that are usually more like to provide care (aged 55-64). The most frequently reported reasons for an increase in care responsibility were increased care needs and the reduction or suspension of local services. The Carers Week report found that new carers were more likely to be working and to have children (under 18 years).

    Increase in care provided by family carers

    Carers UK have reported that care responsibilities have increased for most carers, with the average time spent caring increasing by 10 hours to 65 hours of unpaid care per week. However, a small proportion of carers have provided less care. An increase in care responsibility and time spent caring was reported among most unpaid carers of people with dementia (73%). Many carers attributed the increase in time spent caring to the reduced availability of services. This proportion was particularly high among Black, Asian and Minority Ethnic (BAME) carers.

    Concerns expressed by carers

    A survey by Carers UK showed that a large proportion of unpaid carers are concerned about what would happen to the care recipient if the unpaid carer became unable to provide care (87%). A second concern expressed was the risk of infection due to domiciliary carers entering people’s homes. Carers of people with dementia also reported that people with dementia had difficulty following the distancing rules and understanding why their routines had been disrupted.

    Impact on carers’ finances

    Carer’s UK published evidence in April and October 2020 of a negative impact on carers finances, with some incurring increased costs (food, bills, equipment) and a reduced ability to work or loss of employment. While some carers highlighted that working remotely provided them with greater flexibility to manage care and work, others experienced greater challenges. Research on unpaid carers caring for someone outside their household found that carers with paid jobs worked fewer hours than other people in employment, and that female carers worked fewer hours than male carers. Financial pressure on carers was also illustrated through foodbank use, with 106,450 carers (1.76% of carers) reporting that their household had to rely on foodbanks in the past month. Foodbank use was higher among female and among young carers (aged 17-30). The research also showed that in the households of 228,625 unpaid carers, someone had gone hungry in the week prior to the survey. Again, this was higher among females and young carers (aged 17-30).

    Impacts on use of respite care for carers of individuals with dementia

    The pandemic has heightened some of the demands of caring for people living with dementia as there have been fewer opportunities for social contact and breaks. A qualitative study conducted between March and December 2020 investigated the impact of COVID-19 on the views and expectations of 35 carers of people living with dementia about residential respite (i.e., staying in a care home for a short period of time).

    Thematic analysis of interview data revealed that although residential respite is positive and provides some carers with an opportunity to take a break from caring (which is especially important during the pandemic as caregiver stressors may have been heightened), confidence in using respite was found to be compromised. This was for a variety of factors: firstly, carers described regularly negotiating the risks and stresses of the pandemic, weighing up changing family arrangements to facilitate caring and preventing infection. Secondly, the challenge of prioritising the needs of their relatives whilst bearing the impact of cumulative caregiving responsibilities was discussed. Participants in the study also revealed uncertainty about future residential respite due to anxieties around ongoing restrictions (such as quarantining before seeing visitors), availability (due to some care homes closing permanently during the pandemic), and disheartening sources of information about the pandemic (Samsi et al., 2022).

    References

    Giebel, C., Lord, K., Cooper, C., Shenton, J., Cannon, J., Pulford, D., Shaw, L., Gaughan, A., Tetlow, H., Butchard, S., Limbert, S., Callaghan, S., Whittington, R., Rogers, C., Komuravelli, A., Rajagopal, M., Eley, R., Watkins, C., Downs, M., … Gabbay, M. (2021). A UK survey of COVID-19 related social support closures and their effects on older people, people with dementia, and carers. International Journal of Geriatric Psychiatry, 36(3), 393–402. DOI:https://doi.org/10.1002/GPS.5434

    Samsi, K., Cole, L., Orellana, K., & Manthorpe, J. (2022). Is it worth it? Carers’ views and expectations of residential respite for people living with dementia during and beyond the COVID-19 pandemic. International Journal of Geriatric Psychiatry. https://doi.org/10.1002/GPS.5680

    Rand S.E., Silarova B, Towers A.-M. and Jones K. (2021) Social care-related quality of life of people with dementia and their carers in England. Health and Social Care in the Community. https://doi.org/10.1111/hsc.13681

    Willner, P., Rose, J., Stenfert Kroese, B., Murphy, G. H., Langdon, P. E., Clifford, C., Hutchings, H., Watkins, A., Hiles, S., & Cooper, V. (2020). Effect of the COVID-19 pandemic on the mental health of carers of people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 33(6), 1523–1533. DOI:https://doi.org/10.1111/JAR.12811

  • 2.08. Impacts of the pandemic on people working in the Long-Term Care sector
    Sickness levels during the Omicron wave

    A survey of members of the National Care Forum (the largest body representing not-for-profit care providers) released on the 13th January 2022 found that providers reported an 18% vacancy rate and 14% absences as a result of Omicron.

    Impact in terms of mortality

    Data from the Office for National Statistics show that, between 9 March and 28 December 2020, there were 469 deaths of social care workers. People working social care had higher rates of death involving COVID-19 compared to people of similar age and sex. For men working in social care, there were 79.0 deaths per 100,000 (compared to 31.4 for the general population and 44.9 for health care workers in the same age groups) and 35.9 deaths for 100,000 for females, compared to 16.8 for the general population and 17.3 for women working in healthcare.

    Mental and physical health impacts

    A survey of 296 frontline care workers that took place during July and August 2020, found that nearly half of the respondents (47%) indicated that their general-health had worsened since the onset of COVID-19 and 60% indicated that the amount of time their jobs made them feel depressed, gloomy, or miserable had increased since the start of the pandemic. Additionally, 81% reported an increase in the amount of time that their jobs made them feel tense, uneasy, or worried. A significant minority of 23% indicated their job satisfaction had increased, whereas 42% said that they had become a little or a lot less satisfied with their job since COVID-19. In another survey of 43 care home managers in England, 75% of managers reported that they were concerned for the morale, mental health, and wellbeing of their staff (Rajan et al, 2020). In addition, data reported by Skills for Care indicates that the percentage of days lost to staff sickness have increased by 180% (from 2.7% before the pandemic, to 7.5% between March and August 2020).

    Impact on wellbeing and quality of life

    A recent study compared cross-sectional data from at three timepoints during the pandemic to examine how the workforce (health and social care) has been affected by the pressures of COVID-19, and how employers can help rebuild their services. Wellbeing and work-related quality of life was significantly compromised between May/July 2020 and May/July 2021, with respondents increasingly using negative avoidant coping strategies (such as substance abuse and self-blame) during this period. Between December 2020/November 2021 and May/July 2021, burnout was found to significantly increase. Consistent with other literature, the study that highlights that despite its resilience, much of the health and social care workforce has been overwhelmed by the COVID-19 pandemic (Gillen et al., 2022).

    References:

    Rajan, S., Comas-Herrera, A. and Mckee, M., 2020. Did the UK Government Really Throw a Protective Ring Around Care Homes in the COVID-19 Pandemic?. Journal of Long-Term Care, (2020), pp.185–195. DOI: http://doi.org/10.31389/jltc.53

    Gillen, P., Neill, R. D., Manthorpe, J., Mallett, J., Schroder, H., Nicholl, P., Currie, D., Moriarty, J., Ravalier, J., McGrory, S., & McFadden, P. (2022). Decreasing Wellbeing and Increasing Use of Negative Coping Strategies: The Effect of the COVID-19 Pandemic on the UK Health and Social Care Workforce. Epidemiologia 2022, Vol. 3, Pages 26-39, 3(1), 26–39. https://doi.org/10.3390/EPIDEMIOLOGIA3010003

  • 2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

    One of the key messages from the recent State of Care report (by the CQC) is that although staffing pressures have been felt across both the health and care service delivery sectors, the impact of the pandemic has been seen most acutely in all areas of adult social care (including care home and home-care services).

    The care workforce has been under increasing pressure due to people leaving the social care sector, which happened at a steadily increasing rate throughout 2021. Various factors explain the decline in care staff over this period, for example the appeal of more attractive salaries in the retail and hospitality industries, staff from adult social care (especially nurses) taking vacant posts in hospitals, and the requirement for all care home workers to be fully vaccinated against COVID-19 (as of 11 November 2021) (CQC).

    Omicron wave

    The rapid spread of the Omicron variant has had a drastic impact on the ability of social care providers to continue to offer services due to very high rates of staff sickness (ADASS).  In January 2022, more than 90 care operators declared a ‘red’  alert i.e. they don’t have the staff to meet patient demands. A survey of members of the National Care Forum (the largest body representing not-for-profit care providers) released on the 13th January 2022 found that 66% of homecare providers responding are having to refuse new requests for home care, 43% of providers of care homes are closing to new admissions and 21% of home care providers are handing back existing care packages as they are unable to fulfil them. The providers reported an 18% vacancy rate and 14% absences as a result of Omicron.

    Also on the 13th January 2022, the Association of Directors of Adult Services reported that, as a result of staff shortages, 49 out of 94 councils that answered a questionnaire reported taking measures to prioritise care to support the most basic tasks only (eating, drinking and going to the toilet, but not help with tasks such as getting out of bed) and having to leave people with learning disabilities, dementia or mental illness alone for longer than usual.

  • 2.10. Financial and other impacts of the pandemic on Long-Term Care providers

    Care home providers

    Financial impact

    There are concerns about the viability of some care home providers, due to lower occupancy rates (as a result of a high number of deaths and people putting off entering care homes), and higher costs linked to additional staffing and PPE expenditure. Analysis by the Care Quality Commission (CQC) published in July 2020 shows that there has been a substantial reduction in admissions to care homes during the pandemic, although the rates vary significantly. Admissions funded by local authorities for the week ending June 7, 2020, were on average of 72% (range 43 to 113%) of the number received in the same period in 2019. In contrast, self-funded admissions, were on average at 35% of the 2019 levels (25% to 51%). One source reported that the occupancy of care home beds dropped approximately 13% over the course of the pandemic.

    Community-based care providers

    Data from a survey by the CQC showed that, as of May 2 to 8, 2020, around a fifth of agencies were caring for at least one person with suspected or confirmed COVID-19. Providers also reported that access to PPE was a big concern, with many instances of wrong or poor quality items being delivered. While homecare services were experiencing lower levels of activity (homecare hours were at 94% of pre-pandemic levels), local authorities continued to pay for planned hours, which helped to protect the providers they commission from, from the decrease in activity.

PART 3 – Measures adopted to minimise the impact of the COVID-19 pandemic on people who use and provide Long-Term Care
  • 3.02. Governance of the Long-Term Care sector's pandemic response

    Guidance on infection prevention and control for care homes was updated numerous times during the pandemic. Some of the relevant guidance was issued in policy documents from the Department of Health and Social Care, and some from Public Health England. Initial guidance on February 25, 2020, advised that it was unlikely that people receiving care would be infected (at the time there had been no known transmission within the UK). It was not until April that the guidance documents in England took into account the possibility of pre-symptomatic or asymptomatic transmission both with regards to testing and isolation policies.

  • 3.02.01. National or equivalent Covid-19 Long-Term Care taskforce 

    On June 8, 2020, the Government announced the creation of a social care sector COVID-19 taskforce in order to ensure concerted action to implement key measures taken to date. In particular, the taskforce was intended to support the delivery of the government’s social care action plan, published on April 15, 2020, and its home care support package. The taskforce, which included representatives from across government and the care sector, was intended to “support the national campaign to end transmission in the community, and will also consider the impact of COVID-19 on the sector over the next year and advise on a plan to support it through this period”. The Taskforce published its report in late September 2020, identifying a total of 52 recommendations across a range of domains including PPE, testing, workforce, and controlling infection in different settings. The learning disabilities and autistic people advisory group to this taskforce published 5 key recommendations, which the co-chairs of the advisory group have stated were not reflected in the taskforce report as a whole. These were accessible guidance and communications, restoring and maintaining vital support services, expanding PPE and testing, tackling isolation and loneliness, and seeking and supporting people who may be in crisis.

    Additional Sources:

    https://www.gov.uk/government/news/national-action-plan-to-further-support-adult-social-care-sector

    https://www.gov.uk/government/publications/coronavirus-covid-19-support-for-care-homes/coronavirus-covid-19-care-home-support-package

  • 3.02.03. Measures to support, facilitate and compensate for disruptions to access to care

    During March and April 2020, there was a substantial reduction in hospital admissions among care home residents. Elective admissions reduced to 58% of the 5-year historical average and emergency admissions to 85% of the 5-year historical average. By reducing admissions, care home and NHS teams may have reduced the risk of transmission, but there may have also been an increase in unmet health needs.

    To facilitate access to crucial medicines, on April 23, 2020, the Department of Health and Social Care published new standard operating procedures for the use of medicine in care homes and hospice settings in England. The scheme allowed care homes and hospices to re-use medicine that was issued for one resident for another under specific circumstances and only in crisis situations. The guidance document contains information on the specific circumstances in which medicines labelled for one person (who no longer needs them) can be used for another person. The usually strict regulations around re-using or recycling medication were relaxed as there were ‘increasing concerns about the pressure that could be placed on the medicines supply chain during the peak of the COVID-19 pandemic’.

    From May 15, 2020, the NHS was expected to ensure that care homes were able to receive clinical support from primary care and community health services.

    Additional Source:

    https://www.health.org.uk/publications/reports/adult-social-care-and-covid-19-assessing-the-impact-on-social-care-users-and-staff-in-england-so-far

  • 3.04. Financial measures to support users and providers of Long-Term Care

    The action plan for social care, published on April 15 2020, confirmed the announcement in March of £2.9 billion of funding ‘to strengthen care for the vulnerable’. Of the £2.9 billion, £1.3 billion was earmarked for collaborative efforts between the NHS and local authorities, particularly to fund additional support following hospital discharge, and £1.6 billion of the funding was allocated to support local government with the provision of services, including adult social care. The action plan outlines that local authorities are expected to use the additional funding to protect providers cash flow, monitor ongoing cost of care delivery, and adjust fees to meet new costs. It is anticipated that this funding covers the cost for additional personal protective equipment (PPE) required. The government suggests that the additional money provided could also be used for backfilling shifts as well as to maintain income for workers unable to work due to physical distancing measures as far as possible. This is intended to financially support workers who may have to stop working temporarily because they are unwell or self-isolating. Furthermore, the plan made a plea for donations to support social care workers who may experience financial difficulties, similar to the donations that NHS charities have received. A survey examining funding access found that only 30% of care home managers reported receiving a financial uplift at the time, with 73% stating that they needed more funding.

    On May 15, a £600 million Infection Control Fund was introduced as part of a wider package of support for care homes to help providers reduce the rate of transmission in and between care homes and support wider workforce resilience. The funding is being paid in 2 tranches. The first was paid to local authorities on May 22. The second tranche was paid in early July. This money has been allocated to local authorities and is in addition to the funding already provided to support the adult social care sector during the COVID-19 pandemic. Local authorities are expected to pass 75% of the initial funding directly to care homes in their area for use on infection control measures, including to care homes with whom the local authority does not have existing contracts. The second payment will be contingent on the first being used for infection control. The remaining 25% must also be used for infection control measures, but local authorities are able to allocate this based on need.

    Local authority directors responsible for administering this new fund have expressed “deep concern” that it apparently cannot be used by homes to purchase PPE, requires detailed and prescriptive accounting and reporting, does not cover domiciliary care and supported living schemes, resulting in “a confused and overly bureaucratic system, which makes it difficult for providers to claim and impossible for local authorities to deliver within the required timescales”. An independent analysis commissioned by local authorities estimated that providers could face over £6 billion in additional costs during April to September 2020, because of higher staffing costs (mainly due to cover staff who are ill or self-isolating), PPE, and extra cleaning and overhead costs.

    On October 1, the Department of Health and Social Care (DHSC) announced a second round of funding worth £546 million for the Adult Social Care Infection Control Fund. This is to be extended until March 2021, following on from May 2020, when the fund was initially worth £600 million. The purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movements between sites. Half will be paid on October 1, and the other in December. Local authorities should pass on 80% of this to care homes on a per bed basis and CQC-regulated community care providers on a per user basis, both of which must be within the local geographical area. The other 20% should be used to support care providers, allocated at the discretion of the local authority. This allocation cannot be used to pay for the cost of purchasing extra PPE.

    As recently as November 3, 2020, 75 care organisations called on the government to align the Carers Allowance with Universal Credit, as it is currently in Scotland, to recognise the disproportionate impact of the pandemic on carers.

    On December 23, DHSC announced £149 million to support the rollout of Lateral Flow Device (LFD) testing in care homes. This funding will be paid in January 2021. All funding must be used to support increased LFD testing in care settings. Local authorities should pass on 80% of this to care homes on a per bed basis, which must be within the local geographical area. The other 20% should be used to support care providers to implement increased LFD testing, allocated at the discretion of the local authority.

    On January 13, 2021, NHS England (NHSE) announced that the amount that local vaccination services could claim for delivering COVID-19 vaccinations in care home settings was increasing from the original £12.58 Item of Service fee and an enhanced payment of £10. This has been increased so that first doses delivered in a care home setting from December 14, 2020, to close January 17, 2021, will carry an enhanced additional payment of £30, and doses delivered in the week beginning January 18 a payment of £20. The £10 will continue to apply for all COVID vaccinations in a care home setting between January 25 and 31, as well as for the second dose for all patients and staff who received their first dose on or before January 31. Primary Care Networks (PCNs) bringing in additional workforce between now and the end of January will be eligible to claim up to £950 per week (a maximum of £2500 per PCN grouping).

    On January 17, 2021, DHSC announced the Workforce Capacity Fund, worth £120 million, which was to support local authorities in boosting staffing levels and deliver measures to supplement and strengthen adult social care staff capacity to ensure that safe and continuous care is achieved. This funding is available until March 31. The first £84 million (70%) will be paid in early February and the second £36 million (30%) will be paid in March.

    On March 12, Nuffield Trust released analysis explaining that there was no mention of social care in the budget announced by the Chancellor. Short-term emergency support (the Rapid Testing Fund, the Infection Control Fund, and the Workforce Capacity Fund) was crucial in enabling the social care sector to function throughout the pandemic, and is due to expire at the end of March.

    On March 18, LaingBuisson reported that an extra £341 million was to be provided to support adult social care with the costs of infection prevention control and testing so that visits can be carried out safely. This commitment was for a three-month period. There was no mention of an extension to the Workforce Capacity Fund. On the same day, the National Care Forum reported that there were announcements around additional funding for hospital discharge.

    Updated on October 1, the 2021 to 2022 Better Care Fund is one of the national vehicles for driving health and social care integration. It requires clinical commissioning groups (CCGs) and local government to agree a joint plan, owned by the Health and Wellbeing Board (HWB). This will total approximately £6.9 billion, with a minimum NHS (CCG) contribution of nearly £4.3 billion, an improved Better Care Fund (iBCF) of just over £2 billion, and a Disabled Facilities Grant (DFG) of just over £570 million.

    Additional Sources:

    https://www.gov.uk/government/publications/coronavirus-covid-19-personal-protective-equipment-ppe-plan/covid-19-personal-protective-equipment-ppe-plan

    https://www.gov.uk/government/publications/adult-social-care-infection-control-fund/about-the-adult-social-care-infection-control-fund

    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/885214/14_May_2020_-_MSC_letter_-_support_for_care_homes_1.pdf

    https://www.disabilityrightsuk.org/news/2020/november/75-organisations-again-call-government-make-carer%E2%80%99s-allowance-fairer-carers

    https://www.nuffieldtrust.org.uk/news-item/what-are-carers-entitled-to

    https://www.gov.uk/government/publications/workforce-capacity-fund-for-adult-social-care

  • 3.05. Long-Term Care oversight and regulation functions during the pandemic

    The Coronavirus Act (March 25 and renewed on September 30, 2020) included provision to relax the responsibilities of local authorities under the Care Act 2014 to streamline their services in case of workforce shortages or increased demand. The Act also enabled rapid discharge of patients from hospital by allowing assessments to be delayed. There was concern that the Care Act Easements included in the Coronavirus Act would be widely used to reduce care packages but only a small number of councils utilised them. As of November 2020, the Care Quality Commission (CQC) reported that no local authorities were currently using Care Act Easements.

    The CQC interrupted routine inspections on March 16, 2020. In May 2020, the CQC began to implement an Emergency Support Framework setting out its approach to regulation during COVID-19. This involved suspending routine inspections of services and instead using and sharing information to target support where it’s needed and taking action to keep people safe and protect their human rights. The CQC are now starting to resume some inspections in 300 random homes in relation to management of the pandemic, examining four key areas; safe care and treatment; staffing arrangements; protection from abuse; assurance processes monitoring and risk management. Much will be conducted remotely and in person inspections will take place under exceptional circumstances only.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. During this period, the CQC will continue to apply a risk-based approach to inspection, using information from a range of sources, including from people using services and their families, to shape their inspection activity. Additionally, they will ensure that all inspections of care providers consider how well services are managing infection prevention and control, taking swift regulatory action where provider-level performance requires rapid improvement. This will include monitoring compliance with vaccinations as a condition of deployment within its inspection activity.

    Additional Sources:

    https://www.legislation.gov.uk/ukpga/2020/7/contents/enacted

    https://www.health.org.uk/publications/reports/adult-social-care-and-covid-19-assessing-the-policy-response-in-england

    https://www.communitycare.co.uk/2020/04/30/eight-councils-triggered-care-act-duty-moratorium-month-since-emergency-law-came-force/

    https://www.cqc.org.uk/news/stories/routine-inspections-suspended-response-coronavirus-outbreak

    https://www.cqc.org.uk/news/stories/joint-statement-our-regulatory-approach-during-coronavirus-pandemic

  • 3.06. Support for care sector staff and measures to ensure workforce availability 

    The social care action plan recognised the urgent need to increase the social care workforce during the pandemic “to cover for those who are not in work, and to relieve the pressure on those that are”. The action plan included an ‘ambition’ to attract 20,000 people into social care over 3 months.

    On March 19, 2020, social care staff were designated as ‘key workers’ to enable them to continue to access childcare once schools were closed. On May 6, the government launched a dedicated CARE app to support the social care workforce during COVID-19, offering access to guidance, learning resources, discounts, and other support all in one place.

    On May 11, the Department of Health and Social Care (DHSC) published guidance on maintaining the health and wellbeing of the adult social care workforce. This placed the responsibility on employers to check in on team members regularly, especially those who are working remotely. It stated that employers should encourage teams to create a wellness action plan so that employees can identify how to address what keeps individuals mentally well at work. This additionally suggested that employers should encourage those who are identified as being extremely clinically vulnerable to stay at home. Where this is not possible, they should be supported to work in roles or settings that have been assessed as lower risk.

    On 15 May, the Government announced a new wellbeing package for social care staff delivered through the CARE app, including two new helplines, led by the Samaritans and Hospice UK. This is intended to help support care staff with their mental health and wellbeing, and support those who have experienced a traumatic death as part of their work.

    On October 1, DHSC announced a second round of funding worth £546 million for the Adult Social Care Infection Control Fund. This is to be extended until March 2021, following on from May 2020, when the fund was initially worth £600 million. The purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, in particular by helping to reduce the need for staff movements between sites. This includes ensuring that staff who are isolating in line with government guidance receive their normal wages, limiting all staff movement between settings unless necessary, limiting the number of different people from a home care agency visiting a particular individual, limiting or cohorting staff, supporting active recruitment of additional staff, and providing accommodation for staff who proactively choose to stay separate from their families.

    On January 17, 2021, DHSC announced a £120 million Workforce Capacity Fund to help local authorities to boost staffing levels. The aim of this is to strengthen social care staff capacity so that safe and continuous care is achieved by all providers of adult social care. This additionally stated that providers should not be deploying people in care homes if these people are being deployed to provide care in other settings, unless in exceptional circumstances. This places the responsibility on local authorities for contacting private providers with excess capacity to redeploy these staff into other settings to best meet workforce demand. This fund can be used to pay overtime rates to encourage staff to work additional shifts, cover childcare costs to allow staff to take on hours they would usually be unable to work, and enable care providers to overstaff at pinch points to lessen the impact of any staff absences should they arise. Additionally, local authorities are responsible for considering whether there are trained individuals who have been made redundant from care providers which have exited the market and so would be able to transition quickly into a new care setting. There may be individuals without care experience who have recently been made redundant and may require support applying to the care sector and training.

    On February 9, DHSC announced that the government was asking people to register their interest in taking up short-term paid work in the adult social care sector to meet urgent demand during winter.

    On March 3, DHSC published guidance on restricting workforce movement between care settings. This stated that staffing requirements should be planned so that routine movement is not required to maintain safe staffing levels, with mitigations such as exclusivity contracts and block booking used to minimise staff movement where temporary staff are needed. Additionally, should a provider need to deploy an individual between two settings, they should ensure a 10-day interval between the individual attending the two settings. The individual must have a PCR negative test in the 7 days before starting the placement. Additionally, this states that providers should cohort staff to individual groups of residents and ensure staff movement is limited between these groups. Providers should take steps to limit the use of public transport by staff and discourage lift sharing arrangements.

    In October 2021 the DHSC launched a national recruitment campaign highlighting the positive aspects of working in the social care sector. There are other measures in place to facilitate rapid recruitment to the sector, such as recruitment guidance and resources by Skill for Care (RecruitmentReady), and free rapid online induction and refresher training.

    The Capacity Tracker, a web-based digital insight tool and the Adult Social Care Workforce Dataset are being used to monitor the situation. As of November 2021 the vacancy rate in social care was 9.2%

    Published on November 3, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This will provide £162.5 million through the workforce recruitment and retention fund to support local authorities and providers to recruit and retain sufficient staff over winter, and support growth in workforce capacity of the existing workforce, until 31 March 2022.

    The DHSC has made available guidance and resources to support the wellbeing of people working in health and social care, including a collaboration with charities that provide mental health support, and a risk reduction framework for providers to reduce the risk of infection for staff working in social care.

    To release the recruitment pressures (old and new pressures stemming from the new wave of Omicron), in December 2021, the government  announced that care workers, care assistants and home care workers will be added to the Shortage Occupation List as part of the health and care visa to make it quicker, cheaper and easier for social care employers to recruit eligible workers to fill employment gaps. The changes are planned to come into effect early 2022, initially for a period of 12 months. The inclusion on the Shortage Occupation List will stipulate an annual salary minimum of £20,480 for carers to qualify for the Health and Care visa and it will allow applicants and their dependents to benefit from fast-track processing, dedicated resources in processing applications and reduced visa fees.

  • 3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, training and implementation support

    Guidance for home care providers was provided relatively late in the pandemic. On April 27, 2020, Public Health England issued guidance on PPE use for care workers providing domiciliary care. The government published wider guidance for domiciliary care providers on May 22, 2020, much later than equivalent guidance for other long-term care settings was issued. This covered PPE, shielding of clinically vulnerable people, hospital discharge, and government and local authority support. The guidance has continued to be updated, including for providers to divide the people they care for into ‘care groups’ and allocate teams of staff to provide care specifically to those care groups.

    The government issued guidance for unpaid carers, which recommends that carers develop an emergency plan with the person they care for in case the carer becomes unable to continue to provide support, to follow hygiene rules, and to maintain their own health. Additionally it sets out how to react in case the person with care needs or the carer themselves develop symptoms of COVID-19.

    Guidance for unpaid carers of adults with intellectual disabilities and autistic adults is very similar to the general advice for unpaid care (published on April 24, 2020), and was last updated on 24 August 2021 to cover the lifting of restrictions and new guidance on self-isolation. There are, however, specific points raised around communication and coping with bereavement.

    As of December 2021, government guidance for care staff supporting adults with intellectual disabilities and autistic adults was last updated on August 24, 2021, which links to a range of other relevant guidance and resources. This includes more detailed guidance from the Social Care Institute for Excellence on supporting autistic people and people with intellectual disabilities, including guidance for social workers and occupational therapists, guidance for care staff, and guidance for carers and family.

    Government guidance has not always been accompanied by accessible versions for people with intellectual disabilities, autistic people, and family members, and several NGOs (including some financially supported by the government for this purpose) have been producing easy-read and other accessible information, resources and guidance guidance. Interviews with people with intellectual disabilities across the UK suggest that people are most likely to gain useful information about COVID-19 and associated restrictions from television news, with people rarely accessing government websites for guidance.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This will provide £388.3 million in further funding to support IPC, testing, and vaccination uptake in adult social care settings.

    Updated on November 24, 2021, the UK IPC COVID-19 guidance for the winter period 2021 to 2022 supersedes the previous guidance for maintaining services within health and care settings. Recommendations for universal use of face masks for staff and face masks/coverings for all patients/visitors are to remain as an IPC measure within health and care settings over the winter period. This is likely to be until at least March/April 2022.

    Source:

    https://www.gov.uk/government/publications/coronavirus-covid-19-providing-home-care/coronavirus-covid-19-provision-of-home-care#shielding-and-care-groups

  • 3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

    One of the most controversial policy decisions taken at an early stage in the management of the coronavirus crisis was the rapid discharge of older patients from hospitals to care homes around the country without testing for COVID-19. The British Medical Journal has referred to this as a ‘reckless policy’, a sentiment echoed by the Public Accounts Committee. On March 17, 2020, the Chief Executive of the NHS instructed managers to urgently discharge all hospital patients who were medically fit to leave in order to free up a substantial number of hospital beds. Discharges, including to care homes, may already have been taking place at this point in readiness for the expected surge in COVID-19 admissions.

    Guidance issued on March 19, in support of hospital discharge arrangements, announced that the existing North of England Commissioning Support (NECS) care home tracker, designed to facilitate rapid searches for available capacity in care homes, would be expanded to cover all care homes across England. All care home providers were to sign up and use the tracker to identify vacancies from March 23. Even if the available care home was not their first choice, patients were to be moved to a care home as soon as possible and could be moved to their preferred care home afterwards. The guidance also outlined funding to provide care for people discharged from hospital into institutional care settings irrespective of whether a care assessment had been completed or where their ordinary residence was.

    Care homes were to receive funding out of the NHS COVID-19 budget to expand their capacity to provide care. Funding to support people leaving hospital was renewed in August, with £588 million being allocated to the NHS to pay for additional support and rehabilitation for up to 6 weeks. At this time, testing capacity was limited and available primarily for patients in critical care and those requiring hospital admission with symptoms of pneumonia, acute respiratory stress syndrome, or flu like illness. The guidance published on April 2 was explicit that ‘Negative tests are not required prior to transfers / admissions into the care home’.

    The National Audit Office estimated that around 25,000 people were discharged from hospitals to care homes between March 17 and April 15, 2020. Using an approach which also accounted for discharges for new as well as existing residents of care homes, the Health Foundation estimated that, for the period of March 17 to April 30, 46,700 people had been discharged to care homes, 7,700 fewer than in previous years. However, the pattern of discharges differed between residential care and nursing homes. While residential care homes saw a decrease in discharges (with 12,400 discharges) compared to previous years, nursing homes saw an increase with 17,000 discharges.

    National bodies representing care homes complained about homes being pressured to accept residents that had not been tested. The guidance published on April 2, stated that “patients can be safely cared for in a care home if this guidance is followed”. However, clinicians reported that it was a “major error” to assume “that care homes could cope with isolating patients and infection control measures in the same way a hospital could”. It has been reported that the Care Quality Commission had been informed by care home managers that several hospitals discharged people to their care home despite suspecting, or even knowing, they were infected. NHS Providers, the membership organisation for NHS hospitals, has strongly rejected the suggestion that hospitals ‘knowingly’ transferred infected patients to care homes, but does acknowledge that some asymptomatic patients may have been transferred early, though “not in large numbers”. Evidence is lacking for any accurate assessment of the extent to which hospital discharges in this period led to transmission of infection into care homes and genomic analyses suggest multiple routes of ingress into care homes.

    In the COVID-19 adult social care action plan published on April 15, 2020, the government declared that it was “mindful that some care providers are concerned about being able to effectively isolate COVID-19 positive residents”, and in this context set out a commitment to test all residents prior to their admission to care homes, including on discharge from hospital. In cases where the results of the test cannot be obtained in time for discharge, patients should be cared for in isolation as if they had tested positive for COVID-19. Asymptomatic patients who have tested negative should also be cared for in isolation for 14 days. The same was recommended for patients with COVID-19 symptoms and a positive test result where the patient needed to be discharged from acute NHS care within the 14-day period since the beginning of the symptoms. The action plan recognised that not all providers will be able to accommodate these individuals through appropriate isolation or cohorted care (a reality supported by a survey of 43 English care home managers), and in these circumstances the individual’s local authority will be asked to secure alternative appropriate accommodation and care for the remainder of the required isolation period. For admissions from the community, it is assumed they will be tested prior to admission, and in consultation with the family the care home can decide whether isolation is appropriate.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. A further £478 million to continue enhanced hospital discharge support until March 2022 will be provided.

    Additional Sources:

    Scally, G., Jacobson, B., & Abbasi, K. (2020). The UK’s public health response to covid-19. BMJ, 369. DOI:https://doi.org/10.1136/BMJ.M1932

    https://publications.parliament.uk/pa/cm5801/cmselect/cmpubacc/405/40503.htm#_idTextAnchor000

    https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf

    https://www.gov.uk/government/news/more-than-half-a-billion-pounds-to-help-people-return-home-from-hospital

    https://www.carehome.co.uk/news/article.cfm/id/1623968/Anger-amongst-care-home-owners-told-to-accept-people-with-coronavirus

  • 3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

    Guidance

    There have been two major difficulties in identifying and isolating infected individuals effectively in care homes in England. First, guidance issued to care homes focused only on people who were displaying symptoms (initial guidance only mentioned a persistent cough and fever as symptoms). It took a long time for official guidance to consistently recognize the potential for pre-symptomatic or asymptomatic transmission. Guidance on identifying residents and staff who may have been in contact with persons who had the virus and subsequent preventive isolation became available on April 2, 2020.

    Ahead of the second wave, the government set up a scheme to prepare ‘designated settings’ that could provide safe isolation for people who were discharged from hospital while positive for COVID-19 and who needed to move to a care home. The settings had a to meet a set of standards to deliver safe care for COVID-19 positive residents.

    Evidence on implementation difficulties

    The ability of care homes to implement existing IPC guidance was hampered by a lack of access to testing (tests for asymptomatic residents and staff only started to be available after April 28, 2020) and PPE, staff shortages, and facilities that were not suitable for effective isolation or cohorting (Rajan et al., 2020). Where care homes are not able to implement adequate isolation or cohort policies, it is the responsibility of the local authority to secure alternative accommodation for the isolation period, drawing on the £1.3 billion discharge funding.

    Reference:

    Rajan, S., Comas-Herrera, A., and Mckee, M. (2020). Did the UK Government Really Throw a Protective Ring Around Care Homes in the COVID-19 Pandemic?. Journal of Long-term Care, (2020), 185–195. DOI: http://doi.org/10.31389/jltc.53

    https://ltccovid.org/2020/06/12/asymptomatic-and-pre-symptomatic-transmission-in-uk-care-homes-and-infection-prevention-and-control-ipc-guidance-an-update/

    https://www.gov.uk/government/news/2-9-billion-funding-to-strengthen-care-for-the-vulnerable

  • 3.07.03. Visiting and unpaid carer policies in care homes

    The initial guidance in England published on March 13, 2020, advised against visits by people who had suspected COVID-19 or were feeling unwell. The main care home chains stopped non-essential visits around that time. Although no formal ban on visits to care homes was issued, the advice was not to visit except in exceptional (usually end of life) situations. The Prime Minister also announced on March 16 that the physical distancing measures should also apply to care homes. Guidance on family visits was issued on the July 22, linking the visiting policy to local levels of risk of transmission and advising that visits were limited to a ‘single constant visitor’.

    On October 1, the Department of Health and Social Care (DHSC) announced a second round of funding worth £546 million for the Adult Social Care Infection Control Fund. This is to be extended until March 2021, following on from May 2020, when the fund was initially worth £600 million. The purpose of this fund is to support adult social care providers to reduce the rate of COVID-19 transmission within and between care settings, which includes enabling safe visiting of care homes.

    On October 13, the Care Minister announced the government’s intention to pilot a care home visitor scheme, in which designated visitors would be recategorized as ‘key workers’ and given priority access to weekly rapid antigen tests and PPE.

    Following the announcement of the second national lockdown, more than 60 care organisations collectively called on November 3, 2020, for safe visits to care homes to continue. A similar call was made by ADASS. In response to the ongoing restrictions, a high court judge ruled on November 3, that visits to care homes were legal. Following this, government guidance on visiting arrangements were updated on November 5, advising directors of public health and providers to facilitate visiting where possible in a ‘risk-managed way’. There is ongoing concern as to whether the arrangements are sufficiently flexible and sensitive to the needs of people in care homes and their families.

    On December 1, DHSC released guidance on arrangements for visiting out of the care home, which was then updated on March 8, 2021. This stated that visits out of care homes should only be considered for care home residents of working age, and although regulations could technically allow residents to form a support bubble with another household, this is not recommended. This suggested that the assumption should be that visiting is allowed unless there is evidence to take a more restrictive approach, where the needs of the individual are balanced against a consideration of the risks to others in the home. For visits to take place, the residents and all members of the household must have had a negative result from a lateral flow device immediately preceding the visit. It is suggested that those involved in the visit should limit the number of people they meet for 2 weeks prior to the visit out. Upon returning to the care home, the resident should self-isolate for 14 days. In the event of an outbreak in a care home, all outward visiting should be immediately stopped.

    On January 21, 2021, DHSC released guidance for care homes during the winter. This stated that visits to care homes could take place with arrangements such as substantial screens, visiting pods, or behind windows. This stipulated that end-of-life visits should always be supported.

    On March 12, Nuffield Trust released analysis explaining that there was no mention of social care in the budget announced by the Chancellor. Short-term emergency support in the form of the Rapid Testing Fund was crucial in enabling safe visits to occur in care homes, because it provided funding to allow every visitor to be tested. This support is due to expire at the end of March.

    On March 18, LaingBuisson announced that an extra £341 million was to be provided to support adult social care with the costs of infection prevention control and testing so that visits can be carried out safely. This commitment was for a three-month period. There was no mention of an extension to the Workforce Capacity Fund.

    Since May 17, every care home resident can nominate up to 5 named visitors who will be able to enter the care home for regular visits (and will be able to visit together or separately as preferred). Residents with higher care needs can choose to nominate an essential care giver who may visit the home to attend to essential care needs. The 5 named visitors may include an essential caregiver (where they have one) but excludes babies and preschool-aged children (as long as this does not breach national restrictions on indoor gatherings). To reduce the risk of infection, residents can have no more than 2 visitors at a time or over the course of one day (essential caregivers are exempt from this daily limit. In August, the guidance removed the advice on the number of ‘named visitors’ and did not limit the number of visitors a resident can have in a single day. The essential caregiver should be able to visit even if there is an outbreak in the home (except where carer or resident are COVID-19 positive), or if the caregiver is not fully vaccinated.

    Updated guidance published on November 25, puts more emphasis on visits taking place wherever is most comfortable for the resident and that physical contact should be supported to help health and wellbeing. Visiting restrictions due to an outbreak should only be in place for 7 to 8 days following negative testing. Advice around flu and other transmissible viruses has also been added, along with guidance on how care homes can support residents on visits outside of the care home.

    Additional Sources:

    https://www.bbc.co.uk/news/52674073

    https://www.bbc.co.uk/news/uk-politics-54528021

    https://www.gov.uk/government/publications/coronavirus-covid-19-support-for-care-homes

    https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf

  • 3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

    Limitations on testing capacity meant that the initial workforce testing strategy focused on NHS workers with symptoms. This was extended to social care workers (with symptoms) from April 15, 2020, and on April 28, a policy of one-off whole home testing was announced for all staff and residents of care homes with residents over 65 or with dementia. An online portal was launched on May 11 to help care homes arrange deliveries of test kits.

    Although testing capacity was increasing, this was not without problems. The BBC reported that on April 22, 159 out of 210 care providers contacted about testing reported that none of their staff had received a test. On May 12, the Guardian reported that care home operators accused the government of “a complete system failure” regarding the promised testing in care homes. According to this article, only tens of thousands had been tested so far, leaving many vulnerable people at risk. Different government agencies were accused of passing responsibilities to each other. A survey of 43 English care home managers, which was conducted at the end of May and early June 2020, found that only 40% had accessed testing of asymptomatic residents and 50% of asymptomatic staff. At that time, only 36% of residents had been tested, with many describing a chaotic and poorly co-ordinated service, and only 10% of care homes surveyed had successfully tested all residents in their care home.

    On June 8, 2020, the Government announced that all remaining adult care homes would be able to access whole care home testing for all residents and asymptomatic staff through the digital portal, including adult care homes catering for adults with intellectual disabilities or mental health issues, physical disabilities, acquired brain injuries, and other categories for younger adults under 65 years old. It should be noted that these ‘whole care home’ testing arrangements do not apply to supported living settings, extra-care settings, and domiciliary care. In these situations, individual tests can be applied for through self-referral. From 3 July, care home staff were promised weekly testing, but domiciliary care staff were still only eligible for free testing if symptomatic, as the general population.

    In light of advice from the Government’s Scientific Advisory Group for Emergencies (SAGE) and results from the Vivaldi 1 study, regular retesting of staff and residents in care homes for over 65s and those with dementia was announced to be implemented from early July. It was reported that this had been delayed until September, with promises of new rapid point of care tests, although these had yet to be formally approved and questions remained about the most suitable and safe tests for such a vulnerable setting.

    On December 23, the Department of Health and Social Care (DHSC) announced £149 million to support the rollout of Lateral Flow Device (LFD) testing in care homes. Local authorities should pass on 80% of this to care homes on a per bed basis, which must be within the local geographical area. The other 20% should be used to support care providers to implement increased LFD testing, allocated at the discretion of the local authority. Care homes currently have access to 3 tests per week for their staff, with daily testing for 7 days in the event of a positive case. Care homes will have additional LFDs to test individuals working in more than one setting before the start of every shift.

    On February 16, 2021, DHSC published guidance announcing that weekly COVID-19 testing is to be made available to personal assistants working in adult social care in England. After testing positive, a person does not need to test again for 90 days unless they become symptomatic. This guidance gives personal assistants responsibility for informing their employers if they receive a positive result.

    On January 17, 2021, DHSC announced a £120 million Workforce Capacity Fund to help local authorities to boost staffing levels, so that safe and continuous care is achieved by all providers of adult social care. If the specific way in which staff capacity is strengthened means that they do not have access to routine asymptomatic testing or LFD testing, then it is suggested that the local authority could use their allocation of LFD tests for routine testing.

    On March 5, DHSC published guidance on LFD testing in adult social care settings. This stipulated that it is necessary to obtain consent before residents and staff are tested and their results shared. If a person receives a positive result from a LFD, then they will need to take a confirmatory PCR test and immediately self-isolate. With a negative test, the person can stop self-isolating but must continue to follow national and local rules and guidelines.

    On March 12, Nuffield Trust released analysis explaining that there was no mention of social care in the budget announced by the Chancellor. Short-term emergency support in the form of the Rapid Testing Fund was crucial in enabling safe visits to occur in care homes, which is due to expire at the end of March.

    On March 18, LaingBuisson announced that an extra £341 million was to be provided to support adult social care with the costs of infection prevention control and testing so that visits can be carried out safely. This commitment was for a three-month period. There was no mention of an extension to the Workforce Capacity Fund.

    Published on November 3, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. A further £388.3 million in further funding to support IPC, testing and vaccination uptake in adult social care settings will be provided. Regular asymptomatic COVID-19 testing will be maintained throughout winter for all staff and unpaid carers in adult social care, as well as more intense testing regimes in settings deemed higher risk, in line with clinical advice. Additionally, £126.3 million will be provided to continue to support the sector to deliver COVID-19 testing from October 2021 to the end of March 2022.

    Additional Sources:

    Rajan, S., Comas-Herrera, A. and Mckee, M., 2020. Did the UK Government Really Throw a Protective Ring Around Care Homes in the COVID-19 Pandemic?. Journal of Long-Term Care, (2020), pp.185–195. DOI: http://doi.org/10.31389/jltc.53

    https://www.gov.uk/government/news/government-to-offer-testing-for-everyone-who-needs-one-in-social-care-settings

    http://www.nationalhealthexecutive.com/Health-Care-News/government-portal-care-home-testing

    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/933134/Routes_for_Coronavirus_testing_in_adult_social_care_in_England_accessible1.pdf

    https://www.gov.uk/government/news/roll-out-of-2-new-rapid-coronavirus-tests-ahead-of-winter#:~:text=Millions%20of%20new%20rapid%20coronavirus,and%20labs%20from%20next%20week.&text=Millions%20of%20ground%2Dbreaking%20rapid,testing%20capacity%20ahead%20of%20winter

    https://www.gov.uk/government/publications/coronavirus-covid-19-lateral-flow-testing-in-adult-social-care-settings

  • 3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

    The government has faced criticism and legal challenges for failures in the availability and distribution of PPE, particularly in the early phase of the pandemic. There was a significant shortage of PPE (face masks, aprons, gloves and visors). Furthermore, the central stockpile was designed for a flu pandemic. In the view of the British Medical Journal, the government “failed to protect staff in the NHS and social care by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice”. Directors in the social care sector specifically claimed that “a critical lack of PPE and testing of social care staff and service users is putting them at unnecessary risk of exposure”. Resentment about prioritisation of the NHS for distribution of PPE has been expressed.

    Initial steps announced on March 18, 2020, included the distribution of PPE to every care home and care home provider to ensure that they had at least 300 fluid repellent face masks for immediate needs, followed by a further tranche of items of PPE in early April. However, the government did acknowledge PPE supply shortages and published a PPE plan on April 15 with the goal that “everyone should get the personal protective equipment (PPE) they need”.

    In the social care sector, providers have traditionally organised the PPE they required through the market. The adult social care action plan announced that the government was now stepping in with arrangements to support the supply and distribution of PPE. A parallel supply chain has been established for emergency PPE provision, involving new logistics networks and support from the army and including a national supply disruption response (NSDR) system to respond to emergency PPE requests, and a 24/7 helpline for providers who have an urgent requirement.

    Announcements by the government about the number of items of PPE being delivered have been questioned. According to the BBC, over half of the 1.2 billion items of PPE the Department of Health announced on May 10 for health and social care providers in England were surgical gloves, with gloves individually counted rather than in pairs and faulty equipment subsequently being recalled. It is not clear how the protective equipment delivered was divided between health and social care and there have been suggestions that delivery systems have been failing to provide to care homes, requiring them to secure their own supplies individually. One example reported was that of a care provider who was provided with 400 face masks while requiring over 35,000 masks a week. In a survey of English care homes at the end of May and early June, 70% of care home managers reported insufficient PPE supplies, with 34% of providers purchasing supplies directly from abroad.

    On September 30, the government announced that they were extending existing infection control funding with an additional £388.3 million. The funding is intended to help providers with PPE costs, amongst other needs.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This set out that free PPE for COVID-19 needed to the adult social care sector would continue to be provided until the end of March 2022, with sufficient stock to cope throughout winter. Following a consultation on extending free PPE to the health and care sector after the current end date of 31 March 2022, on 13th January 2022 the government announced that free PPE will continue to be provided to health and care providers until 31st March 2023 or until infection control measures are withdrawn.

    Additional Sources:

    https://www.nao.org.uk/wp-content/uploads/2020/06/Readying-the-NHS-and-adult-social-care-in-England-for-COVID-19.pdf

    https://goodlawproject.org/news/the-ppe-fiasco/

    https://www.adass.org.uk/statement-by-adass-and-unions-on-ppe-in-the-care-sector

    https://www.ft.com/content/6afb06d6-abd6-4281-ac16-74f500f096d0

    https://www.carehomeprofessional.com/recall-notice-issued-for-faulty-ppe-masks-sent-to-care-homes/

    https://www.theguardian.com/world/2020/may/09/uk-care-homes-scramble-to-buy-their-own-ppe-as-national-deliveries-fail

  • 3.10. Use of technology to compensate for difficulties accessing in-person care and support

    A considerable proportion of unpaid carers in the UK reported to have used technology for social contacts, a smaller proportion for health and long-term care services. The use of technology for remote support received mixed feedback. A report by Age UK has found that there was no significant change in the use of digital engagement during the first few months of the pandemic. The main barrier reported for peopled aged 75 and older was ‘lack of digital skills’.

    A press release by the Department of Health and Social Care (DHSC) on April 24, 2020, announced that they, together with the Ministry for Housing Communities and Local Government, had awarded up to £25,000 to 18 innovative digital solutions as part of the TechForce19 challenge. Among these, one app that received funding aims to ‘help carers identify health risks and deterioration within elderly communities’.

    Research accompanying the virtual cuppa project, which offered unpaid carers the possibility to connect virtually for half an hour on weekdays with others in similar situations, facilitated by a professional carer coach, found that over time, carers developed friendships with other members participating in the project, shared resources and experience, and that the virtual cuppa group became “a resource in its own right to develop individual resilience” (p.22).

    The digital lifeline initiative during the COVID-19 crisis, funded by the Department for Digital, Culture, Media and Sport (DCMS), enabled over 5,000 adults with intellectual disabilities in England to receive internet-enabled devices, with data and local support to help people learn how to use their device, with promising impact in the short term.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This sets out continued support for care providers to make best use of technology to support remote monitoring, enable secure online communications, and enable people within care homes to remain connected with friends and families. NHSX, a joint unit of DHSC and NHS England, will provide a package of support over the winter to help care providers make the best use of digital tools, safely and securely. A new ring-fenced care provider Digitising Social Care fund of up to £8 million will be available. Additionally, there will be implementation funding support to all 7 NHSEI regions to significantly increase levels of technology-enabled remote monitoring within care homes. Plans have been agreed for over 100,000 people living in a care home to receive digitally enabled support by March 2022.

    Additional Sources:

    https://www.carersuk.org/images/News_and_campaigns/Behind_Closed_Doors_2020/Caring_behind_closed_doors_Oct20.pdf

    Giebel, C., Cannon, J., Hanna, K., Butchard, S., Eley, R., Gaughan, A., Komuravelli, A., Shenton, J., Callaghan, S., Tetlow, H., Limbert, S., Whittington, R., Rogers, C., Rajagopal, M., Ward, K., Shaw, L., Corcoran, R., Bennett, K., & Gabbay, M. (2020). Impact of COVID-19 related social support service closures on people with dementia and unpaid carers: a qualitative study. 25(7), 1281–1288. DOI:https://doi.org/10.1080/13607863.2020.1822292

    Giebel, C., Hanna, K., Cannon, J., Eley, R., Tetlow, H., Gaughan, A., Komuravelli, A., Shenton, J., Rogers, C., Butchard, S., Callaghan, S., Limbert, S., Rajagopal, M., Ward, K., Shaw, L., Whittington, R., Hughes, M., & Gabbay, M. (2020). Decision-making for receiving paid home care for dementia in the time of COVID-19: A qualitative study. BMC Geriatrics, 20(1), 1–8. DOI:https://doi.org/10.1186/S12877-020-01719-0/TABLES/2

  • 3.11. Vaccination policies for people using and providing Long-Term Care

    Latest data on COVID vaccinations among people using and providing social care in England:

    Detailed data on COVID vaccinations is published weekly by NHS England.

    By December 16 2021, it was reported that 95% of all eligible residents and 94.2% of staff in all care homes had been given a second COVID-19 vaccine dose. 77.9% of residents and 33.6% of care home staff had had a booster.

    Among social care staff working for registered providers in other settings, including domiciliary care, 81.2% had two vaccine doses and 23.1% had had a booster.

    For the 8.5 million people aged 16 to 64 who are identified as “at risk” or as carers, 83.6% had had two thoses and 50.1% had had a booster. This group includes people with intellectual disabilities.

    Vaccination rollout and social care:

    On November 27, 2020, Public Health England (PHE) published their COVID-19 vaccine guidance for health and social care workers. On December 7, NHS England (NHSE) published a standard operating procedure on vaccine deployment for care home staff. This gave care home providers the responsibility to inform their staff, organise logistics, and encourage vaccine uptake.

    On December 20, NHSE published information stating that a roving model to deliver the vaccine in care home settings was to be deployed as soon as possible. On December 30, NHSE announced that vaccines should still be offered to older adults in care homes which have cases, although for those who are acutely unwell or within four weeks of the onset of COVID-19 symptoms, this should be temporarily deferred.

    On December 30, the Department of Health and Social Care (DHSC) published information on vaccination priority groups. Previous publications by the Joint Committee on Vaccination and Immunisation (JCVI) had stated that the first priority group for receiving COVID-19 vaccinations were residents in care homes for older adults and their carers. Frontline social care workers, including those who work in hospice care, are to be included in the second priority group. Carers of those with an underlying health condition should be offered vaccines alongside these groups, which is group six unless the person they are caring for is in a higher group.

    On January 7, 2021, NHSE published additional operational guidance, further to the guidance from December 30, 2020. This stated that by mid-January, NHS Trusts would be established as hospital hubs, which were the default provider of COVID-19 vaccinations for all healthcare and social care workers. On January 11, DHSC published an update to their vaccine delivery plan. This aimed to have offered a first vaccine to everyone in the top 4 priority groups by 15 February. This stated that local vaccination services had a responsibility to coordinate and deliver vaccination to people who were unable to attend a vaccination site, such as the homes of housebound individuals, and residential settings for people with intellectual disabilities or autism.

    On January 13, NHSE published information regarding the next stage of the vaccine rollout in older adult care homes. The addition of the Oxford/AstraZeneca vaccine to the schedule from the w/c January 4 meant that smaller care homes could be vaccinated. First doses were expected to be administered to care home residents and staff by January 17, and by January 24 at the latest. This was to occur 8am to 8pm, 7 days a week. It was suggested that primary care networks (PCNs) had a responsibility to provide mutual aid to other PCNs to ensure that all care homes had been vaccinated by the end of the w/c January 18. On January 14, NHSE published an update outlining the next steps for eligible social care worker vaccination.

    On January 26, the National Care Forum (NCF) published the results of a snapshot survey across 750 care homes for older people in England between January 25 and 26. Of these 750, 715 had achieved whole home vaccination, representing 95% vaccine take up. Whilst most organisations who responded noted that 50% or more of staff had been vaccinated, only 27% reported vaccination over 70% for their staff. The NHSE target to vaccinate all residents and staff by January 24 has been missed, and the next goal is the government objective of getting all those in JCVI groups 1-4 vaccinated by February 15. On February 15, the BBC reported the announcement from the Health Secretary that a third of social care staff in England had not had the COVID-19 vaccine. Everyone in the top four groups had been offered the COVID-19 vaccine.

    On February 24, PHE reported that the JCVI had advised that all people on the GP Learning Disability Register were to be invited for vaccination as part of the JVCI group 6 (people with Down’s syndrome are included in group 4). On March 8, NHSE published an operating procedure relating to COVID-19 vaccine deployment for unpaid carers who will now be part of the JCVI cohort 6. Where the person they care for is part of the JCVI vaccine cohort 6, then they are able to receive their vaccination at the same time.

    On March 10, Nuffield Trust released some analysis. This showed that by the end of February, fewer than 3 in 4 staff working in care homes for older adults had received their first dose. This showed regional variation, with rates highest in the North East and Yorkshire and lowest in London. Rates for other social care staff are even lower with fewer than 3 in 5 having had their first dose.

    By August 29, it was reported that 95% of all eligible residents and 82% of staff in older adult (65+) care homes had been given a second COVID-19 vaccine dose. In England, 78.7% of all care homes had at least 80% staff and 90% residents vaccinated with at least one dose. Among younger adults living in care homes, 88.9% had been given a second dose.

    From September 16, 2021, the government began rolling out booster vaccinations to those in JCVI cohorts 1 to 9 who received their second dose more than 6 months ago, and boosters are now being delivered and administered to older adult care home residents and staff within their homes.

    Policy on mandatory vaccination:

    On March 22, The Telegraph reported that leaked details of a paper, ‘Vaccination as a condition of deployment in adult social care and health settings’, submitted to the COVID-19 Operations Cabinet sub-committee showed that the Prime Minister and the Health Secretary had requested that vaccinations become a legal requirement for care home workers. The legal change would be likely to affect England only, with health policy the remit of the devolved administrations in Wales, Northern Ireland, and Scotland. Only around a quarter of care homes in London, and half in other parts of England, have reached the level of vaccination among staff and residents deemed safe by government scientists, which SAGE set at 80% vaccination among staff and 90% among residents of a care home.

    On August 4, it was announced that full COVID-19 vaccination would be mandatory for staff working in care homes by November 11, despite it being reported by the Guardian that there were concerns from providers that this may worsen existing staff shortages. Analysis of data reported by the Department of Health and Social care indicated that as of 26th October 2021, 39% of agency staff and 10% of directly employed staff deployed in care home settings had not yet received two doses of a covid-19 vaccine.

    Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This will provide £388.3 million in further funding to support IPC, testing, and vaccination uptake in adult social care settings. Following consultation, the government announced on November 9, 2021, that all frontline NHS and care staff, including volunteers, will also be required to be fully vaccinated against COVID-19 from April 1, 2022. From November 11, 2021, being fully vaccinated against COVID-19 will be a condition of deployment for people working or volunteering in care homes, unless they are exempt. These requirements will apply to all CQC-registered care homes in England that provide accommodation for persons who require nursing or personal care.

  • 3.12. Measures to support unpaid carers

    Very few measures were initially announced to support unpaid carers. These increased over time and included specific guidance for unpaid carers, enabling those experiencing symptoms to be tested and providing guidance related to the unpaid carer role. Additionally, the government provided funding for the Carers UK helpline.

    A major source of support for many working unpaid carers was the furlough scheme, which enabled them to maintain up to 80% of their income. During the vaccine rollout, unpaid carers were included in priority group 6.

    Sources:

    https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020

    https://ltccovid.org/wp-content/uploads/2020/06/International-measures-to-support-unpaid-carers-in-manage-the-COVID19-situation-17-June.pdf

PART 4 – Reforms to address structural weaknesses of Long-Term Care systems and to improve preparedness for future pandemics and other emergencies
  • 4.02. Reforms to the Long-term care financing system

    On September 7th, 2021, the Prime Minister announced a social care reform plan to cap the costs of social care, with the aim of protecting people against catastrophic costs of care. This is to be funded through a new UK-wide 1.25 per cent Health and Social Care Levy that will be ring-fenced for health and social care, based on National Insurance contributions. This levy will be applied to all working adults, including those over state pension age. Of the £36bn that will be raised through this mechanism, £5.4bn will be for social care (spread over 3 years).

    The new cap on social care has been set at £86,000 in care costs over the course of a person’s lifetime (estimates vary but it would take someone in residential care around 4 years to reach the cap and around 6 years for someone receiving home care). So far it seems that the cap will start from October 2023 and that costs up to that point will not be taken into account. The cap will only cover ‘personal care’ costs, such as dressing, washing, and eating, amongst others. Accommodation, food, and other ‘hotel costs’ that are included in care home fees and costs of other forms of social care support (such as activities to enable social participation) will not count towards the cap.

    An important measure included in this reform will be an increase to the means-test, changing the ‘floor’ above which individuals are able to access any public funding for social care, which will change from £23,350 to £100,000. People with assets below £20,000 will not be asked to contribute to the costs of their care from their assets.

    In summary, people with assets over £100,000 will be ‘self-funders’ until the amount they have spent on ‘eligible care costs’ reaches the cap of £86,000. People with assets between £100,000 and £20,000 will contribute to the costs of their care from their assets and income until they have either reached the cap or have less than £20,000 left in assets and savings. People with assets below £20,000 will only be asked to make contributions from their income. The financing of long-term social care for working-age adults has not been considered.

    This article by Natasha Curry in the BMJ provides an initial analysis of the changes.

    An amendment to the Health and Care Bill has excluded means-tested council support payments from the new £86,000 lifetime limit on costs.

    The government published its long-awaited white paper for social care reform on 1st December 2021. In it, it restated its plans to raise additional funding for social care via a health and social care levy (as previously announced on 7th September 2021) and that, beyond the three year spending cycle, there is an intention for a greater share of the revenue to be allocated to social care (at present, only £5.4bn of the total £36bn raised is set to flow to social care in England). The majority of that extra funding will go towards the new cap on costs and the more generous means test. In addition, it is intended to fund fairer fees for providers of social care, better staff training and investment in innovative care models, housing and digital and technological initiatives. On launch, the document was met with scepticism that the funding envelope would be adequate to achieve the vision that it set out (see for example: Adass; LGA;   LGA responds to adult social care reform white paper | Local Government Association; Social care white paper an important step but must be financially backed to pull care sector back from the brink | The Nuffield Trust).

  • 4.03. Reforms to develop or improve Long-Term Care data and information systems

    The primary national-level strategy for forward looking long term care data policy in England is outlined in the UK Government’s Data Saves Lives: reshaping health and social care with data (DSL). DSL aims to bring a coherent data strategy to a large and diverse range of stakeholders across both health and care sectors, traditionally sectors with different data needs, different data practices and different levels of digital maturity. DSL was launched in June 2021 and aims to feed into primary legislation through the Health and Social Care Bill, and also influence secondary legislation. The strategy is being run by NHS England & Improvement following the merger of NHSE&I with NHS X and NHS Digital in November 2021.

    Much of the strategy is given over to building on what it perceives as  momentum gained during the pandemic in health data. Specifically the linkage, integration, interoperability of data within health systems and between health and social care systems for the purposes of informing decisions with population health data and creating efficiencies in the aggregation and use of health data by researchers.

    One chapter of seven is given over to long term care, Chapter 4 Improving data for adult social care. General commitments are made to addressing the following issues: access to basic information for providers of adult social care; addressing gaps in data collected by local authorities (for instance, all those they don’t fund);  integration of health and social care data; expanding the use of care technologies. The problems are discussed at a high level and financial costings, committed budgets and delivery dates are not included and have been absent from subsequent policy announcements on social care planning and spending.

    A survey and consultation on the strategy ran throughout the summer of 2021 and attracted submissions from a broad set of stakeholder organisations such as health and care think tanks and data specialists such as the Information Commissioners Office, The National Data Guardian and the UK Pandemic Ethics Accelerator.

    A webinar hosted by LTCcovid on 18th October 2021 brought together a panel of leading practitioners and academics from different parts of social care and across the UK. They identified seven data issues for policy makers working on digital transformation in the sector:

    • Lessons about social data use during the pandemic are not agreed by everyone. For instance, data infrastructure such as the adult social care capacity tracker has had unforeseen consequences such as increased burdens on staff. These are often unacknowledged in plans for future data policy.
    • The continued lack of data on people who pay for their own care or do not receive services from local authorities remains a priority issue across social care.
    • Tensions between conflicting desires for private data, more data, minimal data and no data must be addressed in future policy plans if trust in public social care data is to be built.
    • New tensions have arisen due to decisions that are being made with the data today that were not agreed with the providers from the start.
    • At the same time, robust data infrastructures are a prior condition of wider reform across UK social care, critical for anticipatory appraisal, ongoing monitoring and evaluation of innovation in services and practices.
    • Opportunities for optimism include building social care data that is designed around the wellbeing of people in communities – such data would go beyond the existing principles and values of population data in health to report on the relationships and values that matter for care.
    • For this, new measures with which to assess data quality and new ways of assessing and improving data operations within councils will be needed.
  • 4.04. Reforms to improve care coordination

    The Health and Care Bill contains provisions to enable integrated health care systems to play a greater role. There are two forms of integration underpinned by the legislation: integration within the NHS and greater collaboration between the NHS and local government. Measures will also be brought forward for statutory integrated care systems (ICSs). These will be comprised of an ICS Health and Care Partnership, bringing together the NHS, local government and partners, and an ICS NHS Body. The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the health, public health, and social care needs of the system.

    In parallel with the Health and Social Care Bill, the government is also developing an integration white paper, which is seeking to establish greater integration between health and social care services. The contents of the white paper are unclear at present but media reports in the trade press suggest that the proposals will seek to facilitate integration through the pooling of budgets and establishing a single line of accountability. The plans have raised concerns amongst experts. The exact date of publication is unknown, but it is expected in late 2021/early 2022.

    The government plan for social care, Build Back Better, contains provisions for improving the integration of health and social care. This will be shaped by three principles:

    1. Outcomes focussed – The government will work with systems to identify a single set of system-based health and care outcomes that local systems (including ICSs and Local Authorities) will be asked to deliver.
    2. Empowering local leaders – Local leaders will be given the freedom to align incentives and structures in order to deliver these outcomes in the way that is best for their communities.
    3. Wider system reforms – There will be Care Quality Commission (CQC) oversight of commissioning of adult social care by Local Authorities, which will be introduced through the Health and Care Bill, and a role for the CQC in assessing the overall quality of ICSs.

    Sources:

    https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version

    https://www.hsj.co.uk/integrated-care/exclusive-government-considering-single-leader-for-local-nhs-and-care-services/7031397.article

    https://www.gov.uk/government/publications/build-back-better-our-plan-for-health-and-social-care/build-back-better-our-plan-for-health-and-social-care

  • 4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

    A Health and Social Care Levy was announced by the government on September 9, 2021. As part of this £36 billion investment to reform the NHS and social care, at least £500 million will be allocated for funding the care workforce across three years. It is reported that it represents a five-fold increase in public spending on the skills and training of care workers and registered managers. The government have committed to providing additional support for the continuous professional development of the workforce, including training places and certifications for care workers. The funding will also be directed to mental health wellbeing resources and to provide access to occupational health funding.

    The government announced that this would be accompanied on November 3, 2021, with a new recruitment campaign to encourage people to apply for roles in the adult social care sector. ‘Made with Care’ will launch across broadcast and social media for five months and will highlight vacancies in the sector as well as showcasing the work care workers do. However, many organisations and sector leaders have raised concerns that the existing funding and measures in place are not sufficient to mitigate a deepening workforce crisis ahead of a difficult winter.

    The government published its White Paper on social care reform on 1st December 2021. In it were a suite of initiatives for strengthening the skills and training of the social care workforce. These include the establishment of a Knowledge and Skills Framework, portable care certificates, and support for mental health and wellbeing. However, it stopped short of enhancing pay and no new money beyond the previously announced (£500m over three years from the health and social care levy) and the £162.5m for the winter of 2021/22 was allocated to workforce initiatives (Guidance overview: Workforce Recruitment and Retention Fund for adult social care – GOV.UK (www.gov.uk)).

    See the government’s white paper here: People at the Heart of Care: adult social care reform white paper – GOV.UK (www.gov.uk)

  • 4.07. Reforms to Long-term care regulatory and quality assurance systems

    The government plans to establish an enhanced assurance framework for adult social care, working alongside the Care Quality Commission (CQC) and local authorities to improve adult social care oversight, access, and outcomes across England.

    The Health and Care Bill introduces a new duty for the CQC to review and make an assessment of the delivery of adult social care duties by local authorities. Where they find a significant failure, the Secretary of State will act to secure improvement. The CQC will publish the findings of their reviews with the intentions of allowing people to see how their local authority is performing in the delivery of its adult social care duties.

    On May 27, 2021, the CQC launched its new strategy outlining how it plans to change and transform to deliver more effective regulation. There are four key themes set out.

    1. People & communities – The CQC wants regulation to be driven by people’s needs and experiences, placing a focus on what’s important to people and communities as they access, use, and move between services. A key outcome for this is the development of a clear definition of quality and safety that is in line with people’s changing needs and expectations.
    2. Smarter regulation – The CQC wants to use smarter, more dynamic, and flexible regulation that provides up-to-date and high-quality information and ratings. In achieving this the CQC aims to move away from inspection-reliant regulation by placing more focus on data and feedback from people on their experiences of care.
    3. Safety through learning – The CQC wants to regulate for stronger safety cultures across the sector, prioritising learning and improvement, and collaboration.
    4. Accelerating improvement – The CQC aims to have accelerated improvements in the quality of care and encouraged and enabled safe innovation that benefits people or results in more effective and efficient services.

    Sources:

    https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-adult-social-care-assurance-and-support

    https://www.ridout-law.com/cqcs-new-strategy-what-does-it-say-and-how-will-it-be-implemented/

  • 4.10. Reforms to improve Infection Prevention and Control standards and infection surveillance in the Long-Term Care sector

    A leading nursing charity, the Queen’s Nursing Institute, has received government funding to develop a network of infection prevention and control (IPC) champions for the adult social care sector in England. This £35,000 grant will be used to cover both care home and domiciliary care services. The Department of Health and Social Care aim is to help maintain and continuously improve IPC standards across the care sector through this programme. The network, consisting of social care nurses and other professionals responsible for IPC, will share best practice through virtual meetings, a newsletter, and discussion forum.

    Source:

    https://www.nursingtimes.net/news/social-care/government-backs-launch-of-new-ipc-champion-scheme-for-social-care-11-11-2021/?micro=MjUxMzQ

Printable version of the report:

https://ltccovid.org/country/england-uk/

Experts on COVID-19 and long-term care in England that have contributed to this report so far:

William Byrd, Adelina Comas-Herrera, Natasha Curry, Cian O’Donovan, Chris Hatton, Nina Hemmings, Klara Lorenz-Dant, Joanna Marczak, Camille Oung, Disha Patel, Daisy Pharoah, Stacey Rand

To cite this report (please add the date in which the document was accessed):

Byrd, W., Comas-Herrera, A., Curry, N., Donovan, C., Hatton, C., Hemmings, N., Lorenz-Dant, K., Marczak, J., Oung, C., Patel D., Pharoah D., Rand S. COVID-19 and the Long-Term Care system in England. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., Pharoah D. (editors) LTCcovid International Living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6


Ongoing research projects on COVID-19 and Long-Term Care in the United Kingdom:

https://ltccovid.org/completed-or-ongoing-research-projects-on-covid-19-and-long-term-care/?_country=united-kingdom

LTCcovid report on England (UK), November 2020:

https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-England-19-November-3.pdf

Acknowledgement and disclaimer:

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.

Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE