We are all imagining what might become of the social care sector once the rest of the country’s lives have returned to something that feels like normal.
It is hard to lift your sights towards the end of this pandemic, but the only way forward is to assume that at some point in the not too distant future, this too will pass. When it does, we will need to understand what it was we learned about social care – our sector, our place in the world, our resilience and our people.
We have always known that there are real challenges around how social care is delivered in England. Across the country, there are tens of thousands of different organisations and individual personal assistants, offering predominantly bespoke and personalised services to their geographic community.
Their service ‘patch’ is often no more than three to five miles from base, and their workforce drawn from within that reach. Their links are with their local clinical commissioning group (CCG) or local authority, or if they only work with those who pay for their own care, they may be largely independent of even these.
Whilst this can be challenging at the best of times, it has proved to be a real barrier in the face of the management of a national pandemic. The demand for accurate and appropriate national guidance is being regularly undermined by conflicting regional guidance. The postcode lottery approach to the sourcing and dispatching of Personal Protective Equipment (PPE) that effectively enables compliance with the ever-changing guidance; the massive shortfall in staffing as waves of the workforce enter self- or household-isolation; the piecemeal approach of community health services reducing supply of nurses and GPs into care settings; and the dogged determination of local authorities and CCGs to engage in single-point negotiations around commissioning – all belie the real need for a national response to a national crisis.
All the focus from commentators that this is the proverbial marathon, rather than sprint, is cold comfort for a sector that has, for the last ten years, been starved of the necessary supplements and headspace for training that would enable it to be prepared for either. This has caught our sector seriously under-prepared for operating in the harshest of environments that anyone could have imagined. With – I suspect – still harder times to come.
Our place in the world
Social care – forever destined to sweep the ashes whilst the NHS goes to the ball? I think it is very hard to predict precisely where the sector might emerge at the end of this crisis, but it is absolutely important to be planning for this.
There are some important markers that have happened that give some hope for a shift in the narrative. Whilst the headline on the Prime Minister’s podium talks of saving the NHS, the spoken words often reference care workers and the provision of care. When the Queen addressed the nation for only the fifth time in her 68-year reign, the second group of staff she thanked was care workers. When the new Labour leader took power, a key focus of his critical narrative was around how the care sector had been treated.
However, the message is being hard fought with the media, which still seems unable to recognise that without a robust and functioning social care sector, the feted NHS would not be able to provide the stories of heroics that continue to dominate the headlines. Relations between key commissioners such as CCGs and local authorities remain very localised and individual, and whilst there is some exemplary partnership practice, it does not dominate the landscape.
The approach to truncate assessment information for those being discharged from hospital, and increasingly for those entering the care sector from the community, shifts the risk directly onto providers, who are often being pressured to take people and then having to assess them once in situ, without a clear understanding of whether or not they will be able to meet their needs.
We are not yet at the stage of determining bounce back. I suspect there are many more months to go until we fully understand just how low things will have got, and therefore how far we need to travel in order to return to steady state.
Early lessons from other countries suggest that some of the long-term implications for care and the people we support are brutal. High numbers of deaths in care homes dominate the media in continental Europe (and now in the UK too); stories of military intervention to support the deep cleaning and provision of care; and wholesale abandonment of services by staff too frightened or exhausted to continue.
It is hard to feel optimistic about how our fragmented sector will survive this, and there are undoubtedly very real challenges for all, but particularly the small providers. Scale does appear to be your friend with this virus. Those who can buy big have advantages within the supply chain. Those with a logistical task force can more effectively redeploy resources. Those with a larger workforce can move staff between services, and those with a head office can take some of the day-to-day strategic decision-making away from the immediate frontline. These advantages allow just a little more headspace to plan day by day, rather than minute by minute.
How that plays out in the long term will be one to watch – but in the interim, it is incumbent that as a sector we play our part in sustaining and supporting services of all shapes and sizes. There will be a growing need for both national and local resources to flow towards those bowing under the weight of fighting a sustained daily battle to provide safe care, and mechanisms such as the Local Resilience Forums will need to up their game in working directly with the sector to keep services going under extreme duress.
Without a doubt, the real heroes of this story are the social care workforce. They are showing a level of resilience that far belies the way in which wider society values their contribution. They are living through the real front line of resistance to this virus, offering ongoing care and kindness in the face of huge adversity.
For the last couple of months, they have had to become the substitute family for many, as care homes shut their doors to relatives and friends and social distancing took its toll on the numbers visiting those in their own homes. They have had to learn how to work in an environment where the wearing of PPE has gone from a part-time pursuit, to being as natural as the donning of any uniform or work attire. They have had to cope with the heartbreak of losing people that they have cared for for many years to this cruel and undiscerning disease. In some cases, they have had to endure the fear of the wider population, who – rather than revering them for their compassion and continuing care – have vilified them as being potential carriers of the disease. In short – they have proven once again just how professional they are under the most extreme pressure.
If nothing else good comes out of this awful situation, then the increased understanding of exactly what social care offers and how vital its work is to support the most vulnerable in communities must change. We need to ensure that we never return to these staff being viewed as low-skilled, and that we demand that the resources flowing into care enable people’s pay to reflect their skills, passion and dedication to providing care each and every day – come rain or COVID-19.
What will tomorrow bring?
There are few certainties to hang onto in this crisis. The only certainty seems to be that there are greater challenges on the horizon than those that sit behind us. We know that, as the rest of society gets back to some semblance of normality, we will still be feeling the impact of the virus in care settings across the country.
Many voices have come together, including that of the National Care Forum, to call out some of the more insidious assumptions that underline the response to this crisis – that appear to have justified the rationing of services to the fit and healthy, that have waived the rights of the some of the most vulnerable under the auspices of Care Act easements, and that have sustained the focus on the NHS as the only front line where the virus is being fought.
When the sun shines, and the shops are full again, these presumptions and legal shifts are likely to remain in force, sustaining the disadvantage of older people and those with disabilities. We will have to fight together and fight hard to ensure that the people who we care for and support, our workforce, our sector are not forgotten – and, as the rest of the world scrabbles to assemble a new order and new sense of living, that the people who need care and support are not pushed yet further down the priority pile.First published in the CMM ebook