Written evidence submitted by Care England (CLL0013)
As the largest representative body for independent providers of adult social care, Care England is pleased to submit written evidence to the Health & Social Care and Science & Tech Select Committee’s inquiry into Lessons Learned.
Such exercises are of fundamental importance in gaining a fuller picture of the United Kingdom’s response to coronavirus and will hopefully improve future policymaking. At its core, we owe it to our adult social care staff and service users to learn such lessons and ensure that they are safeguarded to the fullest extent over the coming months.
The role of the regulator: Regulators can obviously play a part in playing a traditional disciplinary role, but also, can play a role in supporting the sector. During the course of the pandemic, Care England believes that the response of the regulator, CQC, has been lacklustre and ineffective. We’ve consistently heard from members that they too believe that they did not receive a satisfactory level of guidance and communications from the regulator.
The ineptitude of the CQC’s response is crystalised when one considers the response of other regulators for example the Care Inspectorate in Scotland which placed their staff within care homes to help deal with the pandemic. This highlights the proactive nature of their regulator in a way that many social care providers did not feel was the case with the CQC.
The withdrawal of NHS services: In the first wave, many adult social care providers felt unsupported by the NHS. Some of this feeling emanated from the withdrawal of the NHS community services from care homes, for example, district nurses. As we approach a second lockdown and with cases on the rise, the adult social care sector cannot again be neglected. The decision to do so previously led to an increasingly burdened adult social care workforce.
Communications versus reality: It is our impression that there has been a consistent divide between policy announcements and the reality of their implementation. This has led to frustration amongst many adult social care providers and led to a distrust in some cases. For example, the announcement that “all adult social care staff would be tested” itself lacked nuance.
We sincerely hope that such issues do not remerge in the coming months. For example, Care England hopes that the announcement of free PPE for all adult social care providers is met in reality. However, we are already receiving worrying reports from our members that some items have been particularly difficult to come by. This is not only a matter of policy enactment but also, the future safety of the adult social care workforce and its residents.
At the onset of the pandemic some care homes with extra facilities approached the Government to offer their location in what now would be deemed a designated care site. We understand that these offers were not taken up in many cases and it is worrying that the planning for the sites is behind. We believe that the lack of take up amongst providers is a reflection of the Government’s failure to take account of the initial issues which the sector sited with the scheme including the lack of indemnity.
Attention: We concur with the evaluation of Professor Oliver at the last meeting of the inquiry when he stated that ““Protect the NHS” essentially meant protect the acute hospital bed base, with everything else a bit of an afterthought. That was a mistake. In the coming weeks and months, attention cannot be allowed to once again be solely placed upon the NHS. This pandemic has demonstrated that the health and care system is fundamentally intertwined in nature. This is an issue of fundamental importance amidst the recent rises in cases and evidence emerging regarding the potential for the NHS to itself be overrun.
Workforce: As stated in Care England’s submission to the Health and Social Care Committees inquiry into workforce burnout and resilience, the adult social care workforce was pressurised prior to COVID-19. However, COVID-19 has merely exacerbated many of the structural pressures which already existed within the system. Thus, learning from the past and looking forward, the Government must take the necessary steps to support the adult social care workforce. For example, it must no longer neglect the appropriate funding of the adult social care sector to account for increases in the National Living Wage. Therefore, Care England is particularly worried about the Government’s recent move to ban all staff movement between care homes. We fear that this does not take appropriate account of the law of unintended consequences and the potential for the move actually adversely to affect the adult social care sector. It is of importance that the Government and key partners listen to the sector on both this issue and an array of others over the coming weeks and months.
There has and continues to be dysfunctionality in terms of data strategy in the adult social care system. At present, the system is inhabited by a disparate array of ‘data groups’ – many of whom are operating in their own silos. Thus a coherent data structure needs to be struck in the coming months. The COVID-19 pandemic has elucidated the fundamental importance of data in informing policymaking.
Many care providers have also felt that data the data strategies implemented have not always taken sufficient account of providers needs and realities. In turn, future policy development should put providers at the heart of it and ensure that their voices are heard.
The importance of rapid and reliable tests cannot be over emphasised. Care homes must not be de-prioritised. All elements hinge on testing including visiting and indemnity.
Care England has expressed concern about the way human rights of people who use social care services are being breached. The guidance available to care providers from Government too often feels one-dimensional in scope and has regularly failed to give proper weight to the importance, if at all possible, of meaningful contact between loved ones. Providers have been torn not only between ensuring safety and empowering residents to enjoy some level of freedom, but also between encouraging family bonds, and fear of blame and legal action if they go further than Government guidance suggests. A more nuanced approach is necessary, one where risk is assessed flexibly and individually, in light of changing data, rather than on a blanket basis and as a ‘one-off’, one which promotes as much contact as can be arranged between people who love each other is essential for their health and happiness. Most importantly, actions that restrict the freedom of others must be necessary and proportionate, and the least restrictive option to meet identified risk.
Care England shared its statement of principles for care homes visiting with the Secretary of State for Health and Social Care in mid October and hope that the DHSC will take them on board in future decisions.
Learning Disability Sector:
Care England has expressed concern over the course of the Covid-19 pandemic that the nuances of the adult social care sector have been largely conflated. This was demonstrated in the lack of bespoke guidance for each care setting and service user. The implications of such a blanket approach being adopted manifested itself in the very real situation of care providers being hindered in delivering the physical and psychological care and support that they are obligated and commissioned to provide. Although emerging systems to manage the Covid-19 virus have been put in place as a result of the change Covid-19 has demanded, the underrepresentation of the learning disability and autism sector continues to be evidenced through: free PPE remains a challenge to access for Supported Living services who are ineligible for the PPE Portal; issues around best interest decisions being upheld in regard to visiting; and the new designation scheme seemingly conflating the multiplicity of need of individuals in receipt of care.
Funding: Since the start of the pandemic, Care England has made the point that funds hadn’t made their way to the frontline in a timely and efficient manner. Instead, many local authorities imposed bureaucratic conditions upon adult social care providers. Whilst these issues have been somewhat alleviated; we believe that there is now a lack of financial support to ensure the sustainability of care providers. Instead, we now have the Infection Control Fund, which, whilst appreciated, goes no way in supporting the sustainability of adult social care providers.
Ultimately, the adult social care sector was not in as good a shape as it could have been due to the long term neglect of the sector by parties of all stripes. In turn, despite the current focus upon COVID-19, it is important that this focus does not lead to the neglect of the reform agenda and ensuring the long term sustainability of the sector. Adult social care has shown itself to be of fundamental importance to England’s society and community. Thus, it can no longer be neglected.
Again, we thank you the Committees for this joint inquiry and hope that the above list will prove useful. The importance of such lessons being taken and applied is only more acute in the context of the forthcoming second lockdown.
Care England’s Chief Executive, Professor Martin Green, would be more than happy to give oral evidence at future sessions.