COVID-19: Social Care Update - What happens when the clapping stops?
21 May 2020
The coronavirus outbreak has brought challenges for all sectors of society, but particularly for those engaged in the provision of social care services. Staff and management of nursing and residential care homes have had to cope, not only with practical difficulties the pandemic has brought, such as PPE shortages, but also the emotional impact. Social care staff have suddenly found themselves as the main point of direct human contact for residents unable to have visitors and in too many cases have had to deal with the sad demise of residents.Any loss of life is first, and foremost, a personal tragedy for the family and friends of a resident. Often, however, care staff will have built up close relationships with residents in their care and will also personally feel that loss. This all at a time when the staff’s own health is at increased risk.
The public recognition of the dedication of those working in this sector has been tangible. There have, however, also been public expressions of concern as to the social care sector’s preparedness for, and response to, the outbreak.Calls have already been made for a public inquiry and inquests into individual deaths. This is perhaps unsurprising given that:
- Almost 45% of Covid-19 recorded deaths in NI to 8th May 2019 were in care homes; and
- Figures released by the NI Health Minister as of 19th May 2020 listed 71 active care home outbreaks.
The immediate focus remains on the ongoing provision of care. Locally, substantial progress has been made with the roll out of a testing programme for all staff and residents in care homes, including those with no outbreak or reported cases of coronavirus. Alongside this measure, support for care homes has been strengthened by hospital-to-community outreach teams and an additional £6.5 million financial support package has been announced.
When, however, minds do turn to investigating and addressing the concerns that have been raised, the below issues need to be borne in mind:
- Whilst many care homes are privately run, they work closely with HSC Trusts and typically rely on central and local government advice. There is a widely held view that the Government’s response to protect care homes was too slow. By way of example, Public Health England’s ‘Guidance for social or community care and residential settings’ issued on 25th February 2020, stated that “Currently there is no evidence of transmission of COVID-19 in the United Kingdom. There is no need to do anything differently in any care setting at present”. This guidance further stated that “During normal day-to-day activities facemasks do not provide protection from respiratory viruses, such as COVID-19 and do not need to be worn by staff in any of these settings. … it remains very unlikely that people receiving care in a care home or the community will become infected”. This guidance was based on the premise that there was no community transmission within the UK at that stage.This was despite the fact that, as early as 10th February, the Scientific Advisory Group for Emergencies (SAGE) was stating that it was a realistic possibility that there was already sustained transmission in the UK. By 5th March, Professor Whitty, the Chief Medical Officer for England, was advising that it was “highly likely…that there is some level of community transmission in this virus in the UK now”. The guidance that the risk of infections in care homes was low was not, however, withdrawn until 13th March 2020. It is striking that the ‘Coronavirus (COVID-19): Care Home Support Package’ guidance (last updated on 19th May) now states “care homes have been particularly susceptible to outbreaks of COVID-19”. The above is illustrative of the, sometimes, dramatic shift in the guidance that care home providers have been working to both across the UK and in Northern Ireland. It is, therefore, understandable that when Ms Pauline Shepherd of Independent Healthcare Providers gave evidence to the NI Health Committee on 19th March 2020 she emphasised the need for “timely and consistent guidance applied by and across trusts, the Public Health Agency (PHA), the Regulation and Quality Improvement Authority (RQIA) and the Department of Health.”
- The likelihood that the application of governmental guidance has been a factor in care home death rates is underscored by the fact that this is not an issue that has been confined to any particular home, care group provider or, indeed, geographical area of the UK (with even remote locations like Skye being impacted).
- The fact that there have been long-standing pressures on the sector, such as staff shortages. Mr Robin Swann, the Health Minister has recognised this, stating that “The social care sector has been struggling for years and as whole is not fit for purpose. The structural reasons for this are well documented and are no fault of staff”. The Health Minister further stated an intention to proceed with reform and investment plans in the sector.This is to be welcomed. (Going forward, it will be important that such investment is undertaken in a focused manner with input from those with expertise in the field as to where monies may best be targeted).
- Precisely what guidance and information was available to providers at each individual point in time;
- Global constraints such as limited availability of PPE; and
- The long-standing pressures under which those delivering care in the social care sector routinely work.
It is essential that any future examination of the response of the social care sector to the pandemic, either of individual providers or the sector as whole, takes take full and careful account of:
It would be unfair for private and non-profit bodies providing social care to be pilloried for having following governmental guidance, or as a result of long standing pressures, systemic or staffing issues that have been outside of their control.
*Please note that this information is for guidance purposes only and does not constitute, nor should be regarded as, a substitute for taking legal advice that is tailored to your particular circumstances.