PROFESSOR MARTIN GREEN, CARE ENGLAND – WRITTEN EVIDENCE (PSR0004)

 

 

Care England, a registered charity, is the leading representative body for independent care services in England.  Membership includes organisations of varying types and sizes, amongst them single care homes, small local groups, national providers and not-for-profit voluntary organisations and associations. Between them they provide a variety of services for older people and those with long term conditions, learning disabilities or mental health problems.

 

Whilst adult social care is not a public body, we deem it to be a public service and a public good in itself. This crisis has accentuated the role of the adult social care workforce and adult social care providers in the care for some of society’s most vulnerable. We hope that the recognition stimulated by the COVID-19 pandemic for the sector propels forward those reforms necessary in ensuring its long-term sustainability. For too long, adult social care has been kicked into the long grass by governments of all stripes. At its core this includes the creation of a system which means that adult social care providers no longer have to merely focus upon keeping their heads above water.

 

Professor Martin Green OBE, Chief Executive of Care England, would be willing to give oral evidence at future Committee meetings.

 

  1. What have been the main areas of public service success and failure during the Covid-19 outbreak?

 

Successes:

-          At its core, adult social care services have continued to function at a time of unprecedented crisis, in a sector that was already structurally burdened as a result of the policy inertia pursed by governments of all stripes over the last two decades. 

-          NHS Mail

-          GPs working with care homes for example using innovative ways to ensure that virtual appointments can proceed and installing critical medical equipment on site

-          HMT zero rating VAT on PPE for three months; however, this is only a partial success as the sector needs VAT relief in order to ease the financial burden on the sector.

-          Care England carried out its own costing analysis (as part of an ongoing costing exercise that will be built upon over the coming weeks and months) which found that COVID-19 costs had added additional £72,571,189 to older persons care services, along with, £7,340,444 to LD and supported living services.

-          Enhanced Health in Care Homes.  Again, although welcome, this is only a partial success as it was not a new initiative but simply brought forward. However, at the same time we hope that this forms part of a longer-term trend towards integration and joint working between the NHS and social care.

-          Life assurance.  Initially this was only open to those staff in the NHS, but the Government listened to the adult social care sector and agreed to open it out to all health and social employees

-          DHSC and CQC worked at speed to input changes to DBS checks

-          Care sector’s collaboration with private business, for example the National Care Force (NCF, https://www.nationalcareforce.co.uk/), Uber Health (https://www.uberhealth.com/gb/en-gb/), Asda (been ahead of the curve in terms of helping care workers and care homes), Sixt car rental who offered cars to the sector as did hotel groups who offered rooms to staff who may not want to go back home to their families for fear of contamination.

-          Supermarkets have recognised the parity of esteem between adult social care and the NHS by opening their doors for adult social care staff during priority hours. Again, we hope this forms part of a longer term trend to a situation where corporate discounts are extended to both NHS and adult social care staff alike.

-          Care Badge adopted by the DHSC; symbolic of the recognition of the care sector. It is important that this adoption is not merely a communications campaign, but also, manifests itself in the creation of those policies which support the long term delivery of the adult social care sector.

 

Failures:

-          At the beginning of the pandemic the adult social care sector felt abandoned by the NHS. For example, patients were discharged from hospital into care homes without the necessary COVID-19 tests.

-          PPE was requisitioned for the NHS at a time when the adult social care sector needed PPE to the greatest extent. We believe that these practices were part of a broader failure in government strategy which encompassed an overarching focus upon the needs and vulnerabilities of the NHS rather than social care. 

-          Care home residents were encouraged to sign DNARs

-          Primary health care professionals did not offer their support services

-          CQC’s silence was deafening and didn’t support the providers nor was it able to deliver the testing programme

-          Care home residents were not treated as individuals; for example, many did not receive shielding letters and those with learning disabilities were ignored.

-          Providers were asked by local authorities to capture data and duplicate it time and time again rather than adhere to the NHS Capacity Tracker. This was particularly burdensome given the workforce pressures which adult social care providers have and will continue to experience as a result of COVID-19.

-          COVID-19 emergency funds from the Government were routed via local authorities which in the main have not delivered to the front line in a timely and effective manner. We continue to hear from many Care England members who have not received offers. Whilst an offer in itself may not be indicative of sufficient support despite giving a semblance of support. For example, many offers consist of solely a “cost recovery option” and are not accompanied by any fee uplift of one-off payment. Whilst the cost recovery option is not a guarantee that any funding will be received. ADASS’ own rapid providers survey suggests that just 25% of LAs have offered a fee uplift of 10% to adult social care providers.  

-          Care workers had to fight for key worker status to be recognised.

-          Lack of clear and timely guidance from PHE and other statutory bodies.

-          Lack of appreciation for diverse nature of adult social care for example care services such as supported living are still being overlooked and unaccounted for

-          Failure to get money and resources to where they were needed efficiently. The desire to create from new rather than review what was already in place has been striking, as has the inability to employ predictive models from existing data sources.

-          There has been a systemic inability to model and take into account the cumulative impact of decisions taken in one part of society on other parts of society, and the focusing on one area at a time not realising the full impact on other areas has had dire results. A classic example of this is not realising what the focus on one part of the health and social care continuum would have on other parts.

-          The delivery mechanisms for money and other resources have been flawed mainly because of the inability to use digital systems to connect people and ensure people are adequately connected.

 

  1. How have public attitudes to public services changed as a result of the Covid-19 outbreak?

 

There has been a general public attitudinal change to the adult social care workforce and the contribution that they make with greater appreciation of what the sector does, but this sea change in public attitude needs to be reflected in national policy or these important steps will be lost.

 

People have realised that ‘public service’ comes in many formats and needs to be better defined. There has been an increased awareness of the need to have the ability in public service to scale up when occasion calls for it. The potential for mobilisation of people via digital channels top perform public service should be enhanced.

The public has realised the contribution of all care workers. This includes how the COVID-19 pandemic has highlighted the diversity of both the adult social care and NHS workforces and, in turn, the contribution of migrants to some of society’s most vulnerable. Care England therefore urges the Government to recalculate who it values in its future immigration system.  Rhetoric and lip service to appreciation of the adult social care workforce is worthless unless it is followed by the realities of policy changes.

 

Similarly, the COVID-19 pandemic has served to recalibrate some of calculations which society makes in terms of what should be valued. Professors Andrew J Scott and Lynda Gratton recently said that “saving human lives has been revealed to be more important than avoiding dramatic falls in GDP.” We hope that this change in the societal narrative is reflected in those policies being brought forward which serve to support adult social care in its own support for saving human lives.

 

We believe that the COVID-19 pandemic has shone a light upon the ageism which still resides within our societies. Callous arguments have been made by some that those who died from COVID-19 were going to die anyway. However, some studies have shown how, in fact, men who die of Covid-19 are losing, on average, 13 years of their lives, scientists said, while women have 11 years cut off their life expectancy.

 

Whilst care staff have been portrayed in a positive light Care England is very concerned about the negative image of care homes as settings in themselves during the pandemic.  Care homes are an essential part of the continuum of care and need to be recognised as such.  This pandemic must not be an excuse for local authorities to exercise financial expediency to close care homes, this in turn shifts the challenges of an ageing society whereby not everyone can, or will want to, live in their home. Steps need to be taken to ensure that the archaic perceptions were once held in relation to residential care are not resurrected as a result of the COVID-19 pandemic. Therefore, we would echo the comments made by the Kings Fund that “a nuanced and carefully targeted public information campaign may be required to assure the public that the NHS and social care are safe and ready to provide the care people need.”

 

Many adult social care providers have chosen to source PPE from private providers owing to impatience with public provision.  The latest tranche of money from DHSC for infection control, £600m, has so many clauses attached to it that it is nigh impossible for providers to utilise it to relive their very substantial COVID-19 cost including costs for PPE.

 

The bottom line is that providers do not feel supported by the Government as pledged funds have not reached the front line.

 

Resource, efficiency and workforce

 

  1. Did resource problems or capacity issues limit the ability of public services to respond to the crisis? Are there lessons to be learnt from the pandemic on how resources can be better allocated and public service resilience improved?

 

At the onset of the pandemic the NHS aimed to free up 30,000 beds in order to have capacity.  All resources were diverted into the NHS with social care ignored despite the fact that care homes were at risk given the demographics and co-morbidities of their residents albeit care homes for older people or people with learning disabilities and/or autism.

 

There were enormous challenges in terms of securing sufficient PPE not helped by 40 different versions of PHE guidance on what was deemed to be suitable PPE for providers.  Ministerial intervention was sought for securing PPE supply chains which alleviated the problems to some degree.

 

Projects Cygnus and Iris have demonstrated the need for significant amounts of PPE and the pivotal role of care homes, but this was not shared with the ASC nor acted upon.

 

Hospitals were loathe to accept care home residents even when they were very unwell and needing treatment.  Community support was no longer available for care homes.

There are many ways of addressing this, however from a digital transformation point of view the injection of urgency into risk management and assessment should be a priority. In too many cases risk management has become a tick box exercise and the government needs to show leadership in real risk management and scenario planning.

 

  1. Did workforce pressures preceding the crisis, such as difficulties in the recruitment or retention of workers, limit the ability of public services to meet people’s needs during the lockdown? How effectively, if at all, have these issues been addressed during the Covid-19 outbreak? Do public services require a new approach to staff wellbeing?

 

Prior to COVID-19 there were significant challenges in recruiting and retaining the adult social care workforce.  These challenges remain and have been made more acute by the lack of routine testing meaning that staff have to self-isolate. Therefore, we sincerely hope that adult social care is given priority access to routine testing processes when they are up and running.

 

The DHSC volunteer recruitment programme was solely focused on recruiting volunteers in the NHS rather than adult social care, which was equally, if not more, in need.  The most recent announcement this weekend, rolling the scheme out to support social care staff, is very welcome, but perhaps another example of disconnect between intentions of national government and translation into policy.

 

The nurse returners programme took months to get up and running and there was a disparity between how much the NHS and adult social care workforces benefited from it despite all the workforce shortages the adult social care workforce saw before and during the crisis.  We believe that adult social care should have been promoted as a positive option for nurses to return to and fast tracked. Care England, throughout this crisis, suggested that there was a need engage in effective workforce planning to ensure that this was not the case, however, our calls were not heeded in many cases.

 

Agency workers were necessitated by the workforce shortages within the adult social care sector. Prior to the COVID-19 outbreak the pleas of the sector for workforce shortages were not taken seriously, thus, more agency staff were needed which in turn may have contributed to cross contamination and spreading.  When agency staff were in situ they were not fully supported, for example, they were not given access to testing as matter of course.

 

As and when a vaccine is developed for COVID-19 it is essential that those working in adult social care are first in line. 

 

  1. Why have some public services been able to achieve goals within a much shorter timeframe than typically would have been expected before the Covid-19 outbreak – for example, the increase in NHS capacity? What lessons can be learnt?

 

As stated above, funding has not reached the front line quickly enough mainly owing to vast swathes of bureaucracy. In contrast £13 billion NHS’ debt was written off overnight. Many external consultancies including the military have been called into action to assist, begging the question as to what the statutory purpose of many bodies is

 

Some parts of the system, especially in the NHS, were able to deliver because they had so much attention lent to them at the start of the crisis. This over commitment to one part led to an unbalanced response mirroring the disjointed nature and lack of understanding between health and social care. The NHS, because it’s a public body, was heard to a greater extent than adult social care. Perhaps politicians feel a greater sense of responsibility and accountability for the NHS, because it is more visible than adult social care.

 

COVID-19 compounded longer term trends where the NHS was perceived as the long-term project whilst neglecting adult social care, in the same way that its been neglected over the last 20 years by Governments of all colours.  Issues which have occurred in care homes are symptoms of long-standing trends intertwined with the COVID-19 pandemic.

The most important factor has been the ability to exercise central control. For example, change in the NHS has been achieved due to a clear command chain. Even where new roles have had to be created, they have fitted into an existing structure with a wide reach. In care there has been too much diffraction of leadership between NHS, DHSC, CQC, MHCL (local government via LGA and ADASS), and so clear leadership has been lacking.

 

Technology, data and innovation

  1. Has the delivery of public services changed as a result of coronavirus? For example, have any services adopted new methods of meeting people’s needs in response to the outbreak? What lessons can be learnt from innovation during coronavirus?

In social care there has been a definite move towards using digital technology and its use has become normalised. People have started using remote monitoring and video technology in a way in which many of us wanted to see them being used before, so the Covid-19 situation has presented an opportunity to mobilise innovative forces. The involvement of people and families in a person’s care is now being fully realised and the add-ons to existing electronic care planning systems have meant that a person and their family are now directly plugged into the planning process for a person’s health and wellbeing

 

In the past, there has been too much of an institutional approach and not enough of a person-centred approach. Technology gives us the opportunity to gain people’s views and let people react quickly. So, while there is the need for clear positioning from the centre, there is another force at play which is people’s ability to choose and influence the way they are supported and cared for.

 

For example, change in the NHS has been achieved due to a clear command chain. Even where new roles have had to be created, they have fitted into an existing structure with a wide reach. They have not been able, however, in many cases to bring this to the personal level – a case in point being the blanket issuing of DNAR’s without consultation and without consideration of a person’s situation. However there has been some good practice in how GPs have reorganised themselves into effective unit, on an urgent footing by triaging more stringently. In social care there has been too much diffraction of leadership between NHS, DHSC, MHCLG (local government via LGA and ADASS), and so a clear leadership structure has been lacking.

 

The last three months have seen an acceleration in digital adoption, and, in spite of the very tough situation in care, there is real hope that out of adversity is coming a new, valuable way of working. The challenge now is to maintain the momentum and ensure traction for these new solutions to change the care and health landscape.

Community support was taken away at the beginning of the pandemic thus meaning that care services have had to fulfil roles that community services used to fill. Some of the increased workforce costs have been associated within Learning Disability services and for people with dementia, both of whom need extra support. The commitment of the adult social care workforce has allowed the sector to be flexible to the needs of those individuals whom its supports. For example, dealing with additional behaviours that are deemed as challenging, some of which have stemmed from the additional pressures of lockdown for adult social care service users. 

 

One of the most radical means by which some care services have changed as a result of COVID-19 has been for adult social care staff to actually live amongst service users. The choice made by many adult social care staff to not see their loved ones for many weeks on end in order to safeguard the health of services users is a true reflection of the adult social care workforce’s commitment to supporting some of society’s most vulnerable. Whilst many other care services had contingency plans in place in the event that there was an outbreak in their care services, including, staff being willing to go into a state of lockdown at these settings.   

 

Supporting staff:

 

In addition, adult social care services have had to implement additional time for staff in response to the additional pressures emanating as a result of the COVID-19 pandemic. For example, allocating additional time for the debriefing of staff in response to the additional being put upon staff as a result of COVID-19 in both their personal and workplace environments. Similarly, staff have had to take up additional training in order to ensure that they had sufficient understanding of COVID-19 specifically.

 

In an Institute of Public Policy Research (IPPR) report, YouGov polling found that 50% of 996 healthcare workers questioned across the UK said their mental health had deteriorated since the virus began taking its toll. Significantly, only 30% of staff felt that there was an adequate level of governmental support to protect their mental health; 42% said too little was being done, including 43% of those working in hospitals.

 

At the same time, adult social care providers have implemented a plethora of programmes aimed at ensuring the wellbeing of their staff. Below we list some of the ways one provider has sought to do so in their own words.

 

Provider 1:

 

https://www.headspace.com/register

https://maudsleylearning.com/insights/mental-health-covid-19/

 

I also personally believe that supporting our teams’ mental health is broader than support tools; it’s about ensuring that they feel they have the information, support, confidence and competence to continue to fulfil their roles well at this time. So I’d include:

 

Overall, these are but a few of the ways which adult social care services have had to adapt in reaction to the unprecedented pressures stemming from the COVID-19 pandemic.

 

  1. How effectively have different public services shared data during the outbreak?

A lack of data and poor data systems have cost lives. The lack of interconnectedness between care homes and health facilities has been laid bare. A case in point is where existing digital systems and networks were not mobilised, and new solutions were sought instead.

 

So, what is happening? The NHS has realised the scale of the problem, and NHSX is now fully focused on ensuring care homes and social care have recourse to the digital infrastructure, hardware and training to ensure that care and health have the opportunity to be connected. This is still in the early stages and needs to be adequately resourced.

 

  1. Did public services have the digital skills and technology necessary to respond to the crisis? Can you provide examples of services that were able to innovate with digital technology during lockdown? How can these changes be integrated in the future?

There has been a flowering of remote monitoring tools in the market, and those being used in healthcare and homecare are now being mobilised in residential care. There are many examples of companies enabling remote diagnosis, consultation and assessment. NHSX’s realisation that the lack of infrastructure and access to hardware has hampered efforts has resulted in a rejuvenation of efforts to include care, and a renewed capability to listen to people in care has been impressive.

 

This begs the question: Why this did not happen before? It can only be assumed that there was not the political will, nor the belief that the new system created sufficient value in the system. These doubts have been swept aside.

 

Integration of disparate systems is now picking up pace. It is becoming commonplace to hear a call for the integration of systems such as remote patient care, alerting and alarms, video supervision and communication, online visits, fall detection, acoustic monitoring, medicine dispensing, nurse call/alarm and electronic care planning modules. There has also been a mindset shift to remote installation of new hardware and software which has been a revelation.

 

It is calculated that acoustic monitoring systems can give care staff back 40% of their valuable time, whilst also significantly reducing the number of falls and hospital admissions.

 

Echoing the comments in section 7, the NHS has started to actively put resource into promoting digital engagement in care. It has sourced Wi-Fi deals and hardware and validated some tech solutions. There is a realisation that its duty is to provide the infrastructure, and the ecosystem, into which tech solutions can fit. The Professional Record Standards Body (PRSB) has also stepped up to the plate, and the work of setting standards is starting to happen.

 

Inequalities

  1. Have public services been effective in identifying and meeting the needs of vulnerable groups during the Covid-19 outbreak? For example, were services able to identify vulnerable children during lockdown to ensure that they were attending school or receiving support from statutory services? How have adults with complex needs been supported?

 

Broadly, over the course of the Covid-19 pandemic, the concerns articulated by those who support individuals with a learning disability and/ or autism have been largely overlooked or deprioritised by statutory bodies.

 

First, there remains the issue of statutory guidance. The applicability of Public Health England’s (PHE) care home guidance (“COVID-19: How to work safely in care homes”) and domiciliary care guidance (“COVID-19: Personal protective equipment (PPE) – resource for care workers delivering homecare (domiciliary care) during sustained COVID-19 transmission in England”) to learning disability settings created great concern, particularly around the use of Personal Protective Equipment (PPE).

 

A significant proportion of learning disability and/or autism care settings are registered with the Care Quality Commission (CQC), either to provide residential care or personal care in people’s homes. As such the guidance issued to date appears to be directly applicable to them, despite the acknowledgement within the care home guidance that it may not be appropriate for Supported Living care settings. Accordingly, it still remains unclear as to where Supported Living fits into the current plethora of guidance.

 

The lack of bespoke guidance for each care setting and service user has meant that although the guidance produced to date might be suitable for older person centred care settings, where the majority of residents are aged 65 and above, this is not the case for specialist care settings, such as those supporting adults with a learning disability or dementia. The approach adopted by PHE throughout the course of the Covid-19 pandemic seems to directly undermine the governmental ambition to ensure that people with a learning disability and/or autism are treated as individuals and that blanket policies are not applied to them. Catch all policies are unacceptable for specialist care services where each individual’s care and support plan is informed by a formal risk assessment taking into account all risks to the person being supported and anyone involved in their care.

 

Second, the availability of deaths as a result of Covid-19 in learning disability and/or autism care settings remained a significant issue until early June. From late April, the Office of National Statistics (ONS) began to publish their weekly report on deaths alongside data provided by the CQC. The information provided by CQC by care homes via death notifications as part of the ONS’s weekly reporting on deaths was intended to ensure a more real time picture of Covid-19 induced deaths is captured. However, the data collected did not reveal the number of deaths of those with a learning disability and/or autism, and in which care setting these deaths have occurred. Greater national data transparency at an earlier stage would have not only allowed providers to allay families concerns who have loved ones in specialist care, but it would have also allowed providers to make better informed decisions around contingency planning.

 

Third, the availability of testing for learning disability care staff and service users. In the first phase of the Government’s new plan launched on 11 May, whole-home testing was only available for those providing or receiving care in care settings for those aged 65 and above and/ or with dementia. There are a number of individuals in learning disability care services with very complex health needs that makes them very vulnerable to Covid-19. It therefore seemed that once again the concerns of learning disability and/ or autism care providers were overlooked. 

 

  1.                    Were groups with protected characteristics (for example BAME groups and the Gypsy, Roma and Traveller community), or people living in areas of deprivation, less able to access the services that they needed during lockdown? Have inequalities worsened as a result of the lockdown? If so, what new pressures will this place on public services?

N/A

 

  1.                    Are there lessons to be learnt for reducing inequalities from the new approaches adopted by services during the Covid-19 outbreak?

 

Most inequalities are unjust because they reflect the unfair distribution of underlying social determinants. In this vein, inequalities are modifiable through the alteration of the social structures and environment. 

 

Social institutions and policies shape life experiences over time, influencing social roles, positions and statuses as well as providing meaning to such experiences. How public services have thus handled the Covid-19 crisis will therefore greatly influence future individual development and ageing.

 

What the Covid-19 crisis has meant from a life-course perspective remains to be seen. A life-course perspective provides an analytic lens used to examine the cumulative macro and micro levels of advantage or disadvantage over time and the combination of simultaneous multiple factors (such as gender, poverty, sexual orientation) which shape people’s experiences in later life. In this vein, there will need to be further research into the possible implications of Covid-19 in relation to wellbeing, for example: the health implications for those who contracted Covid-19; the health implications of lockdown; the health implications upon care staff and resident; why certain areas of the country were more affected by the pandemic than others.  

 

Although evidence suggests that we have passed the peak of the pandemic, this does not imply it is too late to do anything about the inequalities experienced as a result of Covid-19. Especially relevant to adult social care, public bodies must now focus more on preventing the progression of inequality. From a macro level, the inequality felt by the adult social care sector was a result of the lack of parity between the NHS and adult social care. At the start of the pandemic, a greater degree of statutory attention should have been lent to the adult social care sector, as early evidence suggested that the older population were more likely to be affected. Instead, what we saw, was a focus on the NHS and that meant that care homes often had their medical support from the NHS withdrawn. Accordingly, a key lesson to reduce inequality would be to place adult social care on the same footing as the NHS, both in terms of political and public salience. From a micro level, immediate interventions from public bodies can help reduce and modify further health implications from Covid-19, such as disability or comorbidity. The first significant step in this is testing. Testing must be rolled out on a regular basis for all adult social care staff and residents operating across the spectrum of adult social care settings. Finally, and more broadly, current conditions may continue to influence risks of poverty, social exclusion, or disease and disability. Accordingly, intervening to create a greater degree of equity is paramount, perhaps most significantly in terms of access to health and social care.

 

Integration of services

  1.                    A criticism often levelled at service delivery is that public services operate in silos –is said to be disincentivised by narrow targets from central Government departments, distinct funding and commissioning systems, and service-specific regulatory intervention. Would you agree, and if so, did such a framework limit the ability of public services to respond to people’s needs during the Covid-19 outbreak?

 

With a fully an integrated regulator we would have expected the CQC to be much more vocal about some of the challenges around primary care with regards to its withdrawal from care homes as well as some of the challenges around discharges from hospital at the start of this pandemic.

 

Until fairly recently there has been a problem with the lack of real-time data from ONS and indeed CQC.  This in turn contributed to a lack of understanding about the impact on care homes of COVID-19; particularly no understanding about the death rates.

 

It is also questionable as to why external bodies, such as Deloitte, were required to organise the testing regime when well staffed bodies such as CQC, were not doing their usual regulatory activity and should in theory have had the capacity to run such schemes.

 

The pandemic has highlighted some serious issues in some of the public sector bodies and quangos surrounding social care. These fall into three categories: issues of capacity; issues of competence and issues of culture. The cultural issues are about the inability to make instant decisions and to do things quickly.

 

 

  1.                    Were some local areas, where services were well integrated before the crisis, better able to respond to the outbreak than areas where integration was less developed? Can you provide examples?

 

  1.                    Are there any examples of services collaborating in new and effective ways as a result of Covid-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services?

 

  1.                    What does the experience of public services during the outbreak tell us about services’ ability to collaborate to provide “person-centred care”?

 

There are sometimes fraught relationships between hospitals and care homes around discharge. PHE coproduced some of the guidance, for example on PPE , which resulting in endless revisions, because the guidance wasn’t fit for purpose.

Local authorities have turned the dissemination of money into a bureaucratic exercise, rather than recognising the need and dispensing the required resources to assist individuals as well as providers.

The requisitioning of PPE for the NHS was the antithesis of collaboration, it certainly did not focus on the needs of the individual rather, it was more about an organisational perception rather than a true need.  It has become clear that care homes were on the front line of this pandemic, but instead of focusing PPE at areas where people are at most risk, there were blanket decisions made about the NHS taking priority

The DNARs that care home residents were ‘encouraged’ to put in place were the opposite of person centred care.

 

The relationship between central Government and local government, and national and local services

 

  1.                    How well did central and local government, and national and local services, work together to coordinate public services during the outbreak? For example, how effectively have national and local agencies shared data?

 

 

  1.                    How effectively were public services coordinated across the borders of the devolved administrations? Did people living close to the border experience difficulties in accessing services?

 

The approaches have been different for example in Wales each member of the adult social care workforce has been offered £500.  Such a scheme, if under consideration in England has not been made public.  It is really important to reward the workforce which in turn

helps to create more positive images and perceptions of the sector.  Wales has also been ahead of England in rolling out routine weekly testing for care homes.

 

In Scotland the Care Inspectorate was praised, in the main, for helping providers as opposed to the lack of support from CQC in England.  It would be useful to discover just why it took CQC so long to introduce Emergency Support Frameworks after routine inspections had stopped.

 

  1.                    Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

 

  1.                    Would local communities benefit from public services focusing on prevention, as opposed to prioritising harm mitigation? Were some local areas able to reduce harm during coronavirus by having prevention-focused public health strategies in place, for example on obesity, substance abuse or mental health?

 

 

Role of the private sector, charities, volunteers and community groups

  1.                    What lessons might be learnt about the role of charities, volunteers and the community sector from the crisis? Can you provide examples of public services collaborating in new ways with the voluntary sector during lockdown? How could the sectors be better integrated into local systems going forward?

 

It is clear that the voluntary and community sector can be more nimble than some of the statutory sector organisations.  It needs to be recognised that some private sector organisations were quick off the mark to deliver solutions for example Florence with its National Care Force app whereby example a private sector company delivered something of tangible benefit to the local community https://www.nationalcareforce.co.uk/

 

  1.                    How effectively has the Government worked with the private sector to ensure services have continued to operate during the Covid-19 outbreak?

 

The Government has had good intentions, but unfortunately because of the way in which it has used the flawed mechanism of local authorities to dispense the vitally needed money, much of the £3.2 billion allocated for adult social care has not reached the front line. This amount of money could have transformed social care, and sustained it through COVID-19 and beyond, but because of the way in which it’s been given to local authorities, with no accountability trail, this money has been in part wasted.

 

Professor Martin Green OBE

Chief Executive

Care England

info@careengland.org.uk

www.careengland.org.uk

8 June 2020