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A stretched and underfunded sector

The National Care Forum (NCF) is delighted to share the results of its second Pulse survey of the adult social care sector. Working together with market research agency Information by Design, the NCF conducted a comprehensive Pulse Survey to provide in-depth analysis of how adult social care providers are operating during the second wave of COVID-19. A Press Briefing was held on 16th December detailing the findings. The full slide presentation can be viewed here and a recording of this briefing can be accessed here.

The survey was completed by NCF members operating 1,456 care and support services throughout England. Participants employed over 47,000 staff and supported almost 51,000 residents and service users across a wide range of care services to include care homes, community based services, supported living and extra care housing. The data provides a snapshot of some of the key issues over the period 1st – 30th November 2020.


COVID-19 testing

99% of those responding reported compliance with whole home testing of staff weekly and residents monthly (98%). There is an indication that there has been an improvement in the speed of COVID-19 test results with almost 57% of tests returned in 48 hours compared to 24% in the last survey looking at the period of 1-31 October 2020.

Care providers reported the significant opportunity cost of administering the tests, with many stating the need for a dedicated staff member to take on this role. When asked if they felt the increase of testing to twice weekly for staff and weekly for residents was achievable, many expressed concerns due to the ongoing pressures on care providers.

“Throughout the pandemic, our organisation has remained committed to follow or exceed government guidance in order to optimise the safety of our staff and residents. This has not been easy, and has required significant time, investment and resources to do so. The increase to twice weekly testing for staff and weekly testing for residents will place additional strain on our staffing and resources due to the considerable increase in administrative work and logistics.”

“We struggle already to find the time and staffing to manage this. Care staff are taken off the floor at the moment. We will have to employ someone to do it all for us, and even then, logistically it is difficult.”

The concept of visitor testing twice weekly was seen as positive on the wellbeing of residents connecting with their relatives. However, in a busy care home environment, concerns were raised about the impact this will have on direct staff time with residents and provision of care. Previous analysis by NCF has suggested all the additional testing commitments introduced in the winter plan could add over 5 million care hours a month to an already stretched sector.

The ongoing dispute over the accuracy and use of lateral flow device testing needs to be urgently resolved. The NCF has long held the view that COVID-19 testing is an important tool in the infection prevention and control armoury against COVID-19. LFDs have their place and their value, and are simply one of the measures available, alongside other important precautions such as PPE and social distancing that should be used to comply with best practice infection prevention and control measures.

The data also indicates an increase in COVID-19 testing in other care settings, such as supported living and extra care housing. This is promising as care and support is provided to many people outside of traditional care homes, and it is imperative that they too have access to a robust COVID-19 testing regime.

Rationing of Personal Protective Equipment (PPE)

The supply and access to PPE remains an ongoing issue in what appears to be a rationing of PPE supplies. The large majority of services are using the PPE Provider Portal to source their PPE. However, 73% of services reported that the allocation of PPE was not sufficient to meet their COVID-19 responsibilities. And fewer than 1% of services are able to source PPE from the Local Resilience forum or local authority.

Care Workforce

The pressures of COVID-19 have been immense on the care workforce. NCF care providers have implemented a wide range of initiatives to support their staffs’ mental health and wellbeing, from setting up counselling and employee assistance programmes, to making available mental health resources and enhanced 1:1 support. Social care staff face challenges caused by the pandemic in the workplace, in addition to their own personal worries for their families and loved ones, which may be heightened for those who are themselves, or have dependants at home who are, considered to be clinically extremely vulnerable. While not all care workers have high-risk dependents, there are many who have school aged or pre-school children, or other care responsibilities and are balancing an increasing workload with looking after children. The responses in our survey highlight the range of different approaches care providers are using to support their staff.

Furthermore, many registered managers are also struggling to maintain resilience during a time of increased pressure and complex decision-making. The significant workload driven by the ongoing need for PPE, COVID-19 testing, a myriad of reporting / data requirements and now the administration of the vaccine places significant pressure on the care workforce which cannot be under estimated. Registered managers have an absolutely vital role in providing great care and we want to highlight the very significant COVID-related work burden that they are now carrying, alongside the ‘day job’ of keeping services running. The demands on managers’ continue to increase as the government seeks to implement its Winter Plan for social care. Such demands must come with additional resource and support.


Financial confidence about the end of year position is low with 90% reporting that COVID-19 will impact on their financial positon at the end of the year. 75% say their revenue is down, and 83% say their costs are up creating greater fragility to an already stretched and underfunded sector.

Community Based Services

Of the respondents who offered community based services, for example support services for older people with dementia  and people of working age with learning disabilities and autism, only 38% of community services were able to run fully as normal, with 62% either unable to operate or operating a much smaller proportion of their usual services.  This means that fewer vulnerable people and their families are getting the support they need. 82% of services were supporting fewer people face-to-face and 91% were supporting fewer people overall. This is having a profoundly negative effect on people and their families, such as increases in social isolation and loneliness, and missing out on relationships, friendship and activities.

Community services providers are working hard to adaptinnovation is strong as 73% were offering a  digital alternative and 90% have made other changes in order to provide support in a COVID world. A significant challenge faced by providers offering community services is the funding risk. Local authority funding is down for 48% of services and income from people who pay for their own community services is down by 48%

Vic Rayner, Executive Director at the National Care Forum says of the survey results

“This snapshot gives a vital insight into the pressure pot of social care during COVID-19. Whilst we rightly celebrate the arrival of a vaccine, it is vital that the day-to-day impact of managing during this pandemic is recognised. Values, innovation and resilience have driven the social care response to COVID-19, however, the toll on our amazing workforce, those who receive care, families and loved ones and the sustainability of organisations is immense. Government ignores this at their peril. Warm words and headline grabbing commitments mean nothing without the resource and infrastructure to support meaningful implementation – be that testing, vaccination, PPE or accolades for the workforce. “



Note to Editors:

  • The National Care Forum brings together over 130 of the UK’s leading social care organisations, representing large numbers of care providers, offering thousands of services across the country, which are not for profit and always at the heart of community provision. Collectively, these organisations deliver more than £2 billion of social care support to more than 167,000 people in 9,200 settings. The NCF membership body collectively employs more than 95,500 colleagues.
  • The survey referred to is the Pulse Survey of NCF members conducted in November 2020. It was commissioned by The National Care Forum (NCF) and conducted by Information by Design (IbyD).
  • The survey asked NCF members to provide information for the period 1st to 30th November 2020. Data was collected from a census of members of all organisations on the NCF members’ database with members invited to take part by completing an online questionnaire. The questionnaire was hosted online using the SNAP software.
  • The sample of responding providers included small, medium and large providers reflecting NCF membership.
  • More information is available on the National Care Forum at @NCFCareForum @vicrayner @NCF_Liz
  • For enquiries, please contact Edna Petzen (

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