We stand at a crossroads in the development of the COVID-19 pandemic. The Government and society more generally face a series of crucial questions and choices over the coming days and weeks. Nowhere is this more obvious than in the health and social care system.
On the NHS side, thoughts have already turned to ‘recovery’, ‘refocus’ or ‘reset’, with colleagues thinking about normalising services, restarting or accelerating elective activity and re-establishing old certainties. By contrast those of us working within social care are the new frontline of the battle against COVID-19. Over the last week, political and media attention has noticeably shifted to social care and specifically to what is happening in care homes.
The recent inclusion of social care infection rates and data relating to the number of deaths in care homes in the daily data reports has shone a light on the terrible situation facing social care. Each of these cases is troubling and each of the deaths is a tragedy, and it is so important that every single life is equally valued and respected. However, the reality is we have not yet reached ‘our peak’, with concerns growing that current infection rates in care homes could rise dramatically from 25 % to 90% unless significant action is taken now.
The Government was clear that the priority in the first phase of the pandemic was to protect the NHS. We have now very clearly moved into a different phase, in which the Government and the NHS must now work to prioritise and protect social care.
By social care we mean the full range of services and support which enable people to live the lives they want to lead. The tendency in the media at present is to focus on older people and those living in residential care homes for older people. However, the reality is we need to concentrate on both older and working age disabled people, those with learning disabilities and/or autism, those experiencing mental health conditions, those who are homeless, those with drug or alcohol issues, and those experiencing domestic violence and exploitation.
There are seven things the Government and the NHS can immediately do to prioritise and protect social care.
First, ensure that people leaving hospital are tested for COVID-19 before they return home, and preferably ‘isolated’ before they enter any care home. This will help reduce the risk to those they live with and the colleagues who provide care and support.
Second, support the coordination of integrated local approaches to testing, led by councils in partnership with the NHS. Local colleagues are so much better placed than those working at a national level to respond to local challenges.
Third, switch back on health provision and treatment in care settings by ensuring that primary care, community services and enhanced end of life care are in place to support people to live good lives and die good deaths at home and in care homes. We cannot let wider health outcomes suffer as we focus on dealing with COVID-19.
Fourth, the Government must ensure local authorities and providers have the right resources to ensure safe, high quality care, not merely now, but over the next 12 months as we inevitably deal with repeated waves of the virus.
Fifth, the Government must develop and resource a national workforce strategy for social care which enables us to rapidly increases numbers of skilled workers and to respond to the challenges we face over the coming months.
Sixth, avoid raising expectations by delaying announcements nationally until the resources or systems are in place locally to deliver those promises. The reality is that there is an inevitable time lag between good ideas at a national level and implementation locally. We need to be honest with the public about what will happen and when.
Finally, the Government must use what it has learnt over recent weeks to re-imagine social care for the future. The challenge in the immediate is to protect social care at all costs to prevent an escalation of the crisis, and in the longer term to enable it to flourish.
James Bullion is the incoming president of the Association of Directors of Adult Social Services