COVID-19 and care homes in the UK

Governing Body Fellow and Professor of Sociology and Social Policy Mary Daly spoke at a ‘Conversations on Care’ series / Health and Care Initiative virtual event on COVID-19 and care homes – What went wrong and why? on 21 May 2020.

Lecture report

Green Templeton alumna Dr Gemma Hughes (DPhil Evidence Based Health Care, 2019) Health Services Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford reports from the evening:

Dr Nicholas Hicks, Associate Fellow at Green Templeton College and lead for the Management in Medicine Programme introduced the Health & Care Initiative’s virtual event on 21 May 2020.

Mary Daly, Governing Body Fellow, Green Templeton College and Professor of Sociology and Social Policy at the Department of Social Policy and Intervention, University of Oxford focused on a deeply troubling aspect of the COVID-19 pandemic – the impact on care homes in the UK. Professor Daly gave a forensic examination of the policy response to the pandemic in care homes and built a multi-faceted explanation of the inadequacy of a response that in future years might well be regarded with a sense of national shame.

The pandemic meets care homes

Professor Daly opened her talk by shining a spotlight on the particular vulnerability of care homes to the pandemic. By 19 May 2020, nearly 15,000 deaths of care home residents had been attributed to COVID-19 in England and Wales, with estimates suggesting these deaths made up around 40% of all COVID-19 deaths. The mortality rate in care homes is up by 50% (or 23,000 people) in the first 4 months of 2020 as compared with 2019. Care workers have been twice as likely to die from COVID-19 as the general population, and more likely to die from the virus than health sector workers. These figures, which must signify the existence of enormous grief and trauma, raise serious concerns about the adequacy of the response and undermine the government’s claim to have tried to put ‘a protective ring around our care homes’.

Professor Daly’s analysis centred on the policy response to care homes for older people, a particularly vulnerable population to COVID-19 within the broader population of people who live in care homes or who are supported by adult social care services. Four key questions were asked in relation to targeting, monitoring, staffing and funding. A further dimension, the timing of the response, was crucial due to the speed with which the pandemic struck globally.

Inadequate and slow policy response

On examining the timeline of policy responses, it was clear that neither the broader area of adult social care nor the specific sector of care homes were initially targeted. Policy did relatively little to prevent the spread of infection in care homes, with the Prime Minister only advising people not to visit their mothers on Mother’s Day (22 March). Prevention was largely up to care homes themselves. Moreover, it took up to 10 weeks to direct some policy measures specifically to care homes. Whilst testing and Personal Protective Equipment (PPE) have been in short supply nationally, care homes have been at the back of the queue. Testing for care workers was announced after that of health workers. There was no monitoring of COVID-19 symptoms in care homes initially, and mortality in care homes was not included in national reports until 20 April. Care home staffing issues received attention later than the NHS. Additional funding for adult social care was announced by the government in early March, but there was no targeted funding for either care homes or older people until an announcement of a new infection control fund and care home support package on 13 and 15 May.

With little policy effort to prevent and control the spread of infection in care homes, the overall response was inadequate, slow, reactive and too late.

Responses from other countries provide examples of what could have happened differently to better target and protect people living in care homes. National or regional taskforces could have focused on targeted advice for care homes, with a sub-group of the Scientific Advisory Group for Emergencies (SAGE) providing oversight from the beginning. Better information-sharing between care homes could have been facilitated. Rapid response teams could have been mobilised, and support to reduce care home occupancy could have helped with social distancing and isolation. Other possibilities include care workers being supported with increased pay or bonuses, and staff being redeployed to address shortages – as demonstrated readily in the setting up of the Nightingale hospitals to assist the NHS.

Why such an inadequate policy response?

Professor Daly built a three-tiered explanation for the troubling response to the pandemic in care homes: logistical and sectoral complexity, the legacy of austerity and cultural/political factors.

Care homes sit broadly as part of adult social care which is historically, financially and legislatively divided from the NHS. Care home provision is means-tested, and largely privatised with many small providers. The result, in the UK, is a complex, marketised sector. There is no central system of command and control and a core objective of policy is to ensure the care market functions rather than, say, to create or put into effect a policy on long-term care. Moreover, the sector has been subject to the fall-out of austerity policies which have reduced local authority funding. Care homes have suffered from reduced income, and the workforce has been affected accordingly with problems of recruitment and retention. The pandemic, therefore, met a complex, poorly organised sector, divided from the NHS and weakened by under-resourcing.

In contrast, the NHS is a towering presence with the status of a national treasure. Protecting the NHS was the central plank of the government’s pandemic response. The NHS has a clear ‘brand’, recognisable and familiar, the organisations that make up the NHS are staffed by a well-organised and unionised workforce. Social care, including care homes, is relatively under-valued, hidden and misunderstood compared to the NHS.

Future responses

The challenges of responding to the pandemic in care homes had systemic, resource-based and cultural causes. Whether these causes are to be addressed will be tested in the short term – by an inquiry, immediate support, and the status of care workers in the Immigration Bill – and the longer term by changes in the bigger picture of how we fund and organise care and housing for older people.

Professor Daly’s analysis was supplemented by virtual contributions which reflected concerns about the trauma and grief experienced by people working in care homes, those living there and their families, and acknowledged the compassion and commitment shown by care home staff and owners during the crisis. It was pointed out that policy announcement do not, necessarily, reflect the reality of policy on the ground which has caused significant difficulties for those working and living in care homes. Those stories are yet to be fully told and Oxfordshire Healthwatch intends to play a role in giving people a voice.

Professor Denise Lievesley, Principal of Green Templeton College, expressed hope in her closing remarks that we can be galvanised to address the big issues revealed by the policy response to COVID-19 in care homes.

Created: 26 May 2020