Government urged to seize chance of reform, amid closure fears and claims NHS left some homes to fend for themselves
Senior care leaders are calling for urgent reform of the way Britain’s elderly population is looked after with the creation of a new national service.
As care homes emerge from the worst of the first wave of the pandemic, bodies representing owners, staff, residents and their relatives have all urged Boris Johnson to deliver on the pledge to fix social care that he made on the steps of Downing Street after becoming prime minister 11 months ago.
Covid-19 has left the social care system in a critical state. Of the 43,000 deaths directly linked to the coronavirus, around a third have been in care homes. With the total number of people living in care estimated at 330,000 in the last census, that means about one in 20 residents has died after contracting the virus.
Male care workers have been 2.5 times as likely to die as other working-age men, according to official figures. Many of those who survived are now facing job losses as care homes shut down, hit by the rising cost of protective equipment and extra cleaning, set against lower income. Meanwhile, vulnerable residents are being forced to find new accommodation at short notice.
During the first weeks of the pandemic ministers were slow to react because, in contrast with the NHS, they had little information about social care and few powers to intervene. The government has given local authorities £3.2bn to help care homes, but only £500m has so far been paid out, with some councils close to technical bankruptcy. Ministers have set up a taskforce in an attempt to persuade councils to part with the cash.
“The NHS doesn’t work perfectly, but when the government said ‘here’s new rules and regulations on how you deal with infection control’ by March there were structures in place to make it happen,” said Christina McAnea, assistant general secretary of the union Unison and a member of the taskforce. “In the care sector, that just doesn’t happen.”
She added: “We have to learn the lessons of what went wrong. That means quick change, not a new commission. We know the problems. We just need some proper decisions to be taken. We’re calling for a national care service, but we’re not precious about it – whether it’s part of the NHS or standalone or some other body. We’re saying that somebody has to take control of this.”
Many care home managers agree. Mike Padgham, who runs St Cecilia’s care home in Scarborough and is chair of the Independent Care Group, said the sector should be merged with the NHS. “Matt Hancock and Boris Johnson can make a name for themselves,” he said. “They could say ‘I’m going to make my name like [Nye] Bevan. I’m going to make a service we’re proud of’.”
He said he was aware of at least three homes in his area that were closing, or on the brink of closure. “Every political party has said how important social care is, and every one of them has kicked the can down the road,” he said. “There are no more excuses.”
Even those who don’t want to see care swallowed by the NHS agree there is an urgent need for a national body to take control of information flowing into and out of care homes and home care. Vic Rayner, executive director of the National Care Forum, said: “It is the right time and it has to be now. There is an absolute hunger in the sector for serious reform.”
She said the NHS’s new capacity tracker, which gives live information about the availability of beds in care homes, plus new data collection by the Care Quality Commission and the Office for National Statistics were “components of what we need to make up a centralised system of information” for ministers to understand what was happening in care.
“The fact that nobody anywhere could tell you how many people were in receipt of care tells you everything you need to know about the value placed centrally on care. The covid lens has given us an opportunity to pull ourselves together.”
The experience of people in care has varied widely from region to region. In some areas, such as Somerset, partnerships have developed, with different bodies trying to integrate hospitals, care homes and home care staff. In others, the divide between health and social care has been stark. Councils in north-east England threatened to withhold funding unless care homes accepted confirmed Covid-19 patients. In the east of England the owners of a small independent group of homes told the Observer they had been gradually abandoned by the NHS.
First, their local district nursing team said they planned to stop visiting the homes and asked staff to administer insulin and change dressings themselves. GPs from different surgeries would only treat patients remotely. “The only conversations they wanted to have were about end-of-life care,” one of the owners said. “It was assumed that if you were old, getting infected was a death sentence.”
Eventually the home bought its own Covid-19 tests, oxygen and other medical equipment to treat about 20 residents who had symptoms. But they could not persuade the residents’ GPs to prescribe antibiotics to prevent a secondary bacterial pneumonia or use subcutaneous fluids. The group spent an additional £1m – about 10% of its annual turnover.
Dr Jane Townson, chief executive of the UK Homecare Association, said some homecare providers – who delivered assistance in people’s own homes – had had a similar experience.
“I was talking to a group of providers in Oxfordshire recently. They provide homecare into an extra care housing scheme. And first of all the social workers vanished. Then the housing managers vanished, and the cleaning company vanished, and the Care Quality Commission vanished, and the district nurses vanished. And the only people left were the homecare workers – the lowest-paid people of all. But they are the ones that were in every day to look after people.”
She said homecare workers still couldn’t get routine coronavirus testing, despite going house to house to look after elderly people.
“People don’t plan for ill health,” she said. “None of us really knows if we’ll need care. Even if you eat well and exercise, you might be hit by a car and lose a leg. Some people might need £1m, others need nothing. We all pay taxes as a form of health insurance. Imagine if you had to pay £10,000 to have a baby.
“Dementia is a disease. Some forms of dementia have the same disease process as heart disease. One affects the vascular tissue of the heart, and another affects the vascular tissue of the brain. But care for people with dementia is not covered by the NHS.”