Simon Bottery, Senior Fellow, Social Care, The King’s Fund
Care homes needs short term support to get through Covid-19 and a long-term plan afterwards.
Asked in 1972 about the impact of the French Revolution, the Chinese leader Zhou Enlai is famously supposed to have said: ‘It is too early to tell’.
While that may be taking historical perspective to the extreme, we should surely be cautious about forecasting the impact of Covid-19 on social care and the care home sector in particular. It is too early to tell, particularly as the country has just returned to lockdown.
Even before Covid-19, the warning signs for the sector were all too apparent. The sector struggled to find enough workers. In residential care, the vacancy rate stood at 5.7% – around 1 in 17 staff. This was better than social care as a whole and far better than domiciliary care but still a concern. For the key role of registered nurse, the numbers were much worse at 12.3% – roughly 1 in 8 posts vacant at any one time.
Finance was also, inevitably, a worry. One of the sector’s largest players, Four Seasons, went into the Covid-19 pandemic in administration and there were countless other smaller providers struggling to get by. This was despite above-inflation increases in fees paid by local authorities, particularly for older people, since 2015/16. And while quality, as measured by CQC ratings, had nudged upwards there were still 1 in 6 care homes below an acceptable standard.
And then came Covid-19. The pandemic shone a harsh light on the sector. Some of what it revealed – a dedicated, resilient workforce, for example – will have helped the sector’s reputation. But the scale of the crisis in care homes in the first part of the epidemic – demonstrated tragically by around 30,000 excess deaths – can’t be understated. It led to reduced occupancy levels which in turn worsened the sector’s funding problems. Additional costs for PPE added to existing pressures on wages as a result of the national living wage.
As the pandemic appeared to slow, there had been some glimmers of light. On workforce, there were signs that one impact of Covid-19 had been a fall in the vacancy rate, helping offset a reduction in staff due to illness, shielding and self-isolation. Much of this was likely to have been temporary as a result of furloughing and unemployment in other sectors but there must also have been people who were inspired to join the care sector for good (in both senses of the word). After the initial fall in new residents, occupancy levels had also recovered somewhat. And there was some progress, albeit painfully slow, in allowing visits with real contact between residents and their families.
The latest lockdown throws much of this into the air again and creates fresh fears for residents, staff and families, though the availability of a vaccine for offers genuine hope. It is encouraging to see that policymakers who, at the start of the pandemic, did not have social care at the front of their thoughts have now prioritised the sector’s service users and workforce for vaccination. It cannot happen too quickly.
However, an insidious effect of the pandemic has been to give cover to the government’s inaction on the wider problems that were already facing the sector. From apparently having ready-made plans for social care – as the Prime Minister indicated on the steps of No.10 Downing Street – we now have no more than the promise of proposals at some stage this year.
If the sector is to fully recover it will need not just short-term support but also a long-term vision for social care and a plan to tackle the longstanding issues around workforce, quality, and market fragility.
Will it happen? History demonstrates the difficulties in achieving social care reform but we should be encouraged by the sheer weight of support, from all sides, for action. When a letter to the Telegraph, calling for better support for care homes, is co-signed by the Labour former shadow care minister Barbara Keeley and Sir Graham Brady, the chair of the 1922 Committee of Conservative backbench MPs, perhaps anything is possible.