Keeping care going in a pandemic

By Dr Carol Tozer | 27 March 2020

The Isle of Wight (IoW) comprises one of the oldest populations in England: nearly 1 in 5 people is aged over 80 and 65% of elders live alone. The adult social care (ASC) sector, with an estimated 5600 jobs, is the island’s largest single employment sector – and the majority of us who work in ASC, live on the island. We belong to the communities we serve.

As the Association of Directors of Adult Social Services (ADASS) trustee for co-ordination with our nine voluntary regions across England, I know that my own department’s response to the coronavirus is typical of actions taking place nationwide – characterised by multiple daily reviews. It includes:          

  • helping people home rapidly from hospital when they do not need to be there;
  • identifying those people already in receipt of ASC who are most at risk - and agreeing the contingencies we will deploy, if and when, care capacity is significantly reduced (e.g., because of care staff self-isolating or becoming ill);
  • identifying elders and disabled adults not ‘on our books’ (e.g., self-funders and people whose needs to date have rendered them ineligible for ASC) – and developing systems, especially with our voluntary and community sectors (VCS), to ensure that they are supported; 
  • re-engineering our social care management processes – because whilst there is likely to be some changes to some Care Act duties, many statutory responsibilities (e.g., safeguarding, Mental Health Act Assessments etc), remain in place;
  • developing daily information systems detailing provider capacity and other issues being experienced – especially those that compromise staffing (including Personal Assistants and tech support); 
  • providing support and guidance to our care providers – with their concerns focusing especially on securing personal protection equipment, practice guidance to enable new people to enter into services as safely as possible and the additional funding needed (many providers are using agency staff because their own staff are following government guidance about staying at home); and    
  • providing guidance to our own staff about working from home and ensuring that they have the right tools to do so, with the right support and supervision so that payments to providers (including PAs) are made, safeguarding meetings happen and urgent requests for support and review are responded to - as well as how to support staff needing to protect their own health and adhere to government guidance when they are in the high risk group or show symptoms.

In addition, of course, ASC has been responding to the avalanche of guidance and emergency legislation. ADASS has been working with Government, user organisations, the Local Government Association, Care Quality Commission, national care provider representative organisations and NHSEI in the development of that guidance.  The ADASS central team has provided superb input – while the ADASS President, Vice President, Trustees and Regional ADASS Chairs (all jobbing directors) have been undertaking national work in addition to keeping care going in their own local authorities.       

ASC is playing its fullest role in getting out everyone out of hospital who is medically fit for discharge.  It has never been more important to eliminate delayed transfers of care (DTOCs) and many ASC departments are reporting low levels of DTOC. My own department had not one person who delayed last week – and I am not alone.  

ASC departments have good intelligence about capacity in care homes: this is a lot more difficult to calculate across domiciliary care agencies because of the way in which they employ their staff and adapt daily in response to demand. Locally and nationally, we are agreeing with care providers, including Personal Assistants, how all their capacity is made available and what we need to do to support them. In doing so, it is vital that ASC maintains its ‘home first’  focus. Part of my own council’s response has been to identify those colleagues who can be redeployed into frontline care in order to augment capacity in the community. Our learning and development department has developed a suite of training to ensure that these colleagues have the necessary training in infection control, moving and handling, medicines management and safeguarding. 

The VCS and ASC have come together across the country to offer helplines and response services to people who need it. Locally, we have built on our Living Well Service and our helpline and response service became fully operational on 19 March. The VCS is also, in many local authorities including my own, co-ordinating the multiple offers from local businesses to provide practical support to people who cannot get out (such as the delivery of meals and prescriptions).  In short, ASC is doing everything possible to keep care going – under extraordinary circumstances.

Finally, some reflection. The notion of heroic leadership has been redundant for some time. The most effective leaders do not ‘swoop in and save the day’: rather, they operate as part of systems  – where each knows their role. However, the notion of heroes keeping the NHS and ASC going is very much the public narrative about coronavirus. I welcome this. Not for romantic reasons - but because it is underpinned by the realisation that social care professionals are as much at the frontline efforts to protect lives as our NHS colleagues. Social care is finally being recognised. It is a vital set of services and supports that has been under severe pressure  for many years before coronavirus has highlighted its complexity and necessity.   

The sector is already resounding with accounts of ASC being hugely creative and industrious in keeping care going. At the end of this nightmare, we must use ASC’s response to coronavirus as categorical evidence as to how our future should be modelled…and funded. We are responding magnificently.  

Dr Carol Tozer is director of adult social care and housing needs at Isle of Wight Council and a trustee of the Association of Directors of Adult Social Services  

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