Every adult social care strategy from the past 20 years is centred on ‘helping people to stay at home’ – events that I attend with people involved in adult social care all lead to the same conclusion. But registered residential and nursing care home beds in England have increased year on year throughout that period.
Before austerity, a huge return on investment was possible from care homes – one of the highest yields of any investment sector. Directors of adult social services have long been calling for reform of the social care sector and especially the powers of the Care Quality Commission (CQC) to regulate the ownership and financial stability and behaviour of the companies who own the country’s care homes. And we need a comparable ‘decent homes standard’ for care home buildings.
Despite all of our best efforts in local government and the care sector, COVID-19 has had a tragic impact in care homes. Around 10% of residents have died in England and there will be lessons to learn on personal protective equipment (PPE), testing and policies with our NHS.
I don’t believe we could have asked for more from care home staff and registered managers who worked in unimaginably difficult situations, particularly in homes where an outbreak occurred. We must take the time to listen to their stories to inform our resilience plans of the future. And we need to be mindful that ‘quality of life’ will inevitably have fallen during the period when we’ve demanded ‘preservation of life’. We need to be supportive of care homes managers to get back to the quality they aspire to for their residents.
But people and families are voting with their feet. They are genuinely worried about the risk of future outbreaks in care homes, of separation because of visiting restrictions and that the NHS will not prioritise them.
The combination of higher death numbers and lower placement numbers, particularly of those who fund their own care, combined with the risks of managing the staffing and infection control is a perfect storm for care homes. In my own council of Bradford, occupancy in care homes has fallen by 12.4% so far and 26 care homes now have an occupancy level of below 70% – unsustainable.
While £3.2bn has been provided to local government, only just under half has been spent on adult social care. A further £600m for an Infection Control Fund had multiple grant conditions which made this difficult for care homes to spend. The cost of PPE alone this year is likely to dwarf both sums and more money is needed immediately to prevent an unmanageable situation of care home closures into winter. It is a testament to commissioners that more homes have not already closed.
But every strategy is still centred on helping people to stay in their own home. As part of renewal and recovery planning, councils must take this opportunity to strategically invest in services to achieve this. This could include a better pay differential for homecare workers, investment in our voluntary sector, acceleration of new models of care like Shared Lives or Burtzoorg – and capital investment in more extra care housing. We need to allow some residential care homes to close safely and in a managed way in favour of better housing models with wraparound care and the local community activities people want. There is learning from pioneering councils who have embraced the latest assistive technology to respond to any decline in health or social interaction.
And there is a new deal to negotiate jointly with our NHS partners to play a bigger role in modern nursing homes. Some councils are borrowing and building new facilities to respond to the highest levels of need in their area. These need to become places where people who are able rehabilitate and regain their independence alongside NHS therapists, where we nurse the sickest people and manage their health conditions or where people are provided with a peaceful and dignified place at the end of the life, rather than being in hospital. But funded nursing care is not sufficient and reform of continuing healthcare is required.
There is a small window for us now to make that step-change we’ve planned for 20 years, build on the better working relationships with the NHS and persuade government that now is the time to invest in modern adult social care services that meet people’s expectations in a post-COVID world.
Iain MacBeath is strategic director, health and wellbeing at Bradford City Council