Unaddressed weaknesses in social care affected the COVID-19 response 

Structural weaknesses left social care struggling to provide the service and protection that people needed during the initial waves of Covid-19, according to a new report from the Nuffield Trust and London School of Economics.

A lack of visibility of the sector, unclear accountability, insecure funding and poor workforce pay and conditions impacted the sector’s ability to implement protective measures in a timely way, the report said.

The report looks at issues which emerged with the Covid-19 response in the social care sector in England. Focusing on the initial four months of the pandemic response (February-May 2020), it found that the fragmented nature of the system and a shortage of civil servants working on social care contributed to confusion over who was responsible for decisions and implementation in the Covid response, undermining the effective distribution of PPE and testing for care staff.

Based on interviews with sector experts, workshops with social care stakeholders including care users, policy documents and literature, the research pinpoints areas that could put social care on a more resilient footing in the future.

Among the key findings is that the government, NHS England and Public Health England missed opportunities to prepare the sector for a pandemic in the years immediately before Covid-19. They excluded social care from pandemic-planning exercises such as Exercise Alice. After exercises that did include the sector, such as Operation Cygnus, action was not taken to address the problems that were identified.

Once infections took hold in England, the government did not sufficiently apply pre-existing knowledge of infection spread in care settings.

Moreover, there had been no dedicated director general for social care in the Department of Health and Social Care (DHSC) since 2016. No adult social care representatives sat on the Scientific Advisory Group for Emergencies (SAGE) in the opening weeks of the pandemic. This meant social care leaders felt largely invisible, despite the critical role of the sector.

The wider Covid-19 response, which was perceived to be hospital-focused at the outset, caused many issues for social care staff because the structure of the workforce and what their jobs involved were not well understood. A lack of access to Covid testing and sick pay had far-reaching consequences for staff when self-isolation policies were in place, especially for those on zero hours contracts.

The tendency of governments to allocate funding to social care in the form of sporadic injections of cash – both before and during the pandemic – limited the scope for strategic investment and planning. Extensions to emergency funding were often announced with only weeks, days or in one case hours before the end of the scheme and did not allow those on the front line to spend it to meet the needs they could see.

The report noted recent progress, with the DHSC bolstering its social care capacity and expertise and the signalling of it as a priority area with the appointment not only of a specific director general but also a chief social care nurse. After the first four months of the Covid-19 response, progress was made to plan for ongoing outbreaks in the short to medium term, and the prioritisation of carers in the vaccination rollout was widely regarded as a positive step forward.

Natasha Curry, Deputy Director of Policy at the Nuffield Trust, said: ‘What happened to social care at the start of the pandemic represents the consequences of letting one of our most important public services languish in constant crisis for years. Those early months exposed an array of weaknesses within social care that impacted the shape, speed and effectiveness of the response. Many of these difficult challenges could have been eased had warnings been heeded.

‘Governments of all hues have failed to make social care and those who need it a priority. Despite the pain endured during the pandemic, we now have the ominous sight of reforms being yet again delayed. As the Covid-19 Public Inquiry begins to reflect on the tragedies we saw, I hope one positive legacy might be that we will realise how much we need strong, healthy social care services, and act accordingly.’

Image: Edward Howell