Member Article

In this article we look at the impact the COVID-19 pandemic has had on the social and health care sector in the build up to the upcoming Public Inquiry, due to commence in Spring 2022.

Upsetting scenes arising from the COVID-19 pandemic included photographs of bereaved families with only six people in attendance at family funerals. These images, coupled with the knowledge that the family also may not have been able to see their loved one to say goodbye, are deeply moving and an experience nobody would wish to go through.

The health and social care sector was hit hard especially during the early stages of the pandemic with a significant number of COVID-19 related deaths. Between 16 March 2020 and 30 April 2021, 41,675 care home residents died of COVID-19 – nearly a quarter of deaths from all causes among care home residents. This also amounts to over a quarter of all COVID-19 deaths in England over the same period of the pandemic.¹

The number of deaths of people receiving domiciliary (at home) care between 10 April and 19 June 2020 was more than 120% higher than the three-year average over the same period between 2017-2019.²

In this article, we look at the real impact the COVID-19 pandemic had on the social care sector and why the impending COVID-19 Public Inquiry ought properly to look at how and why the most vulnerable of people in our society appear to have suffered disproportionately.

Discharge of patients to care homes

At the start of the pandemic, the government’s primary focus was on freeing up hospital beds to ensure that those requiring acute and critical care were provided for. As infection rates grew, the anticipated pressure on the NHS was huge. Nightingale hospitals were constructed at a rapid rate to cope with the expected demand on the NHS. But what support was provided to the social care sector to help reduce the risk of spread of this highly transmissible disease?

The government’s apparent expectation was that the health and social care sector, an industry already reportedly at breaking point, would be able to cope with the overflow of patients that did not require clinical hospital care. In order to prevent the spread of this disease, guidance was given to the sector to ensure patients were segregated ‘where possible’. The reality appears to be that many care homes simply didn’t have the space or additional facilities whereby they could easily and effectively implement segregation measures to reduce the spread of the disease amongst this vulnerable group.

Lack of testing

In the early stages of the pandemic, care homes saw patients being discharged into their care at a time when PCR testing was at an extremely limited capacity and lateral flow tests were an unknown. This lack of testing created a significant risk for the social care sector by exposing not only other residents to the disease but also their families and the support staff that looked after them.

Unlike NHS staff, staff working in the social care sector did not have the same regular testing regime available. This was put in place much later when the devastating impact COVID-19 was having on this sector became apparent.

The early stages of the pandemic were undoubtedly difficult and challenging — for government, for business and for the public. There was a lack of clear information; there was an element of ‘moving target’; being sure-footed in decision-making was undoubtedly very difficult; services (public and private) were severely strained and effective treatments and effective measures were not always clear. But there appears some consensus that the unique challenges faced by the social care sector were not recognised early enough and therefore may not have been given the priority which hindsight demonstrates they should have.

House of Commons Science and Technology and Health and Social Care Committee Report

On 12 October 2021, the House of Commons Science and Technology and Health and Social Care Committees published their report (the “Report”) into the UK Government’s handling of the Coronavirus Pandemic.

One of the areas considered in the Report was the impact of COVID-19 on the social care sector. It was recognised that, at a time when no vaccines were available, the health and well-being of the elderly and vulnerable was of extreme importance. It was also recognised that this category of people was much more susceptible to the disease and had a much higher mortality rate.

The Report indicates it is not clear whether the decision to discharge patients to care homes was taken in the full knowledge that there was not sufficient testing available. It was apparent that there was a desperate need to free up NHS beds but that it was not clear whether patients were actually required to be tested before being discharged.

In his evidence to the Committee, Dominic Cummings (which may need to be treated with a certain circumspection) said:

“It was not thought through properly. There wasn’t any kind of proper plan. It is clear in retrospect that a completely catastrophic situation happened, with people being sent back untested and then seeding it in care homes”

For people who lost loved ones in care homes those must be particularly difficult words to read.

Lack of PPE

We can’t overlook the initial lack of PPE (or certainly lack of consistent availability or consistent quality). Recognising and acknowledging again the challenges highlighted above, the obvious focus was on the NHS and ensuring that it had a full supply where possible. It is apparent that availability of PPE in the care sector was inadequate. Initially there is little doubt that supplies were erratic and when available, it was found out later that not all PPE obtained was compliant with the relevant standards.

The knock-on effect of a level of control within care homes which was below the optimum achievable inevitably led to severe staff shortages. This compounded the issues yet further. The social care sector is known for its relatively high staff turnover and use of agency and/or bank staff. This inherent staffing issue was further compounded by the requirement to self-isolate whilst waiting for a PCR test or as a result of sharing the same home as somebody who had tested positive. This added a significant amount of pressure on a sector that was already under strain.

COVID-19 Inquiry

While the scope of the inquiry is still to be determined, it is anticipated that the Covid Inquiry will examine the government’s role in relation to the impact of COVID-19 on the social care sector. At the start of the pandemic, it seemed the government’s primary focus was on the NHS and ensuring that acute and critical care was not severely compromised by the growing number of infections and hospital admissions.

It seems evident that the social care sector did not get the attention or priority it deserved. This undoubtedly led to infections spreading faster through care homes which was a problem further compounded by the lack of testing and lack of PPE.

Returning to the sad theme of families being unable to say goodbye to their loved ones who were being cared for in the social care sector, it is hoped that the COVID-19 Public Inquiry will play a role in seeking to provide answers to some of the questions they may have.

¹ Paragraph 249, Coronavirus: lessons learned to date - Health and Social Care, and Science and Technology Committees - House of Commons (parliament.uk)

² Paragraph 250, Coronavirus: lessons learned to date - Health and Social Care, and Science and Technology Committees - House of Commons (parliament.uk)

³ Oral evidence: Coronavirus: Lessons learnt, HC 95