Unaddressed weaknesses of social care sector impacted the ability to respond to COVID-19

Our research shows that social care in England needs a system-wide reform
- Adelina Comas-Herrera, Care Policy and Evaluation Centre (CPEC) at LSE
Jievani Weerasinghe/Unsplash

Structural weaknesses left social care struggling to provide the service and protection that people needed during the initial waves of COVID-19, according to a new report from LSE and the Nuffield Trust.

Lack of visibility of the sector, unclear accountability, insecure funding and poor workforce pay and conditions impacted the sector’s ability to implement protective measures in a timely way.

The report looks at issues which emerged with the COVID-19 response in the social care sector in England. Focusing on the initial four months of the pandemic response (February-May 2020), it finds that the fragmented nature of the system and a shortage of civil servants working on social care contributed to confusion over who was responsible for decisions and implementation in the COVID-19 response, which, for example, undermined the effective distribution of PPE and testing for care staff.

Drawing on interviews with sector experts, workshops with social care stakeholders including people who use care, policy documents, and literature, this research has pinpointed areas that could put social care on a more resilient footing in the future. Key findings include:

  • The government, NHS England and Public Health England missed opportunities to prepare the sector for a pandemic, or other crises, in the years immediately before COVID-19. They excluded social care from pandemic-planning exercises such as Exercise Alice. After exercises that did include the sector, such as Operation Cygnus, action was not taken to address the problems that were identified. Once infections took hold in England, the government did not sufficiently apply pre-existing knowledge of infection spread in care settings.
  • There had been no dedicated director general for social care in the Department of Health and Social Care (DHSC) since 2016. No adult social care representatives sat on the Scientific Advisory Group for Emergencies (SAGE) in the opening weeks of the pandemic. This meant social care leaders felt largely invisible, despite the critical role of the sector.
  • The wider COVID-19 response, which was perceived to be hospital-focused at the outset, caused many issues for social care staff because the structure of the workforce and what their jobs involved were not well understood. For example, a lack of access to COVID-19 testing and sick pay had far-reaching consequences for staff when self-isolation policies were in place, especially for those on zero-hours contracts.
  • The long-term tendency of governments to allocate funding to social care in the form of sporadic injections of cash limited the scope for strategic investment and had implications for how robust the sector, and its infrastructure, were when entering the pandemic. Many providers of care, which are often small businesses, entered the pandemic with little or no cash reserves.
  • During the pandemic, the succession of emergency funding pots offered to social care initially took a long time to reach the front line, and their short-term nature prevented strategic planning. While seen as a lifeline for care providers, extensions to the funding were frequently announced with only weeks, days or in one case hours before the end of the scheme and did not allow those on the front line to spend it to meet the needs they could see.
  • There was a lack of data and information about who uses and provides adult social care services and how to communicate with them. COVID-19 has accelerated efforts to collect data, and this is helping to lay the foundations of a robust source of standard data.
  • The government did not adequately consider the fragile state and the complexity of the adult social care infrastructure, in particular residential care buildings and equipment. Small organisations that make up much of the sector lacked the back office capacity to interpret continually updated guidance and outdated care home buildings struggled to isolate or group together infected residents and to accommodate wider infection control measures.

There has been some positive progress in learning from these problems, with the Department of Health and Social Care (DHSC) bolstering its social care capacity and expertise and the signalling of it as a priority area with the appointment not only of a specific director general but also a chief social care nurse. Following the first four months of the COVID-19 response, progress was made to plan for ongoing outbreaks in the short to medium term, for instance with the establishment of the social care taskforce in June 2020 and the decision to continue to provide PPE purchased centrally. The smoother subsequent rollout of vaccinations in social care settings pointed to improved collaboration between the government and social care partners, and the prioritisation of carers in the vaccination rollout was widely regarded as a positive step forward.

Natasha Curry, Deputy Director of Policy at the Nuffield Trust, said: “What happened to social care at the start of the pandemic represents the consequences of letting one of our most important public services languish in constant crisis for years. Those early months exposed an array of weaknesses within social care that impacted the shape, speed and effectiveness of the response. Many of these difficult challenges could have been eased had warnings been heeded.

“Governments of all hues have failed to make social care and those who need it a priority. Despite the pain endured during the pandemic, we now have the ominous sight of reforms being yet again delayed. As the COVID-19 Public Inquiry begins to reflect on the tragedies we saw, I hope one positive legacy might be that we will realise how much we need strong, healthy social care services, and act accordingly.”

Adelina Comas-Herrera, report co-author from the Care Policy and Evaluation Centre at LSE, said: “The pandemic has had a tragic impact on people who use social care and those who provide care, unpaid and paid. This has been a shared experience internationally but the evidence suggests that some countries were able to cope better than others. As part of the same project we are looking at the experiences of Denmark, France, Japan and the Netherlands.

"We now have an opportunity to learn from this international experience to strengthen the English social care system to address long-standing structural problems. We are seeing how countries such as Ireland, Finland and Spain are using lessons from the pandemic to reform their care systems. Our research shows that social care in England needs a system-wide reform to be able to respond not just to emergencies, but to the implications of longevity and competition for workforce with other sectors.”

Behind the article

Read the full report here:

This report draws on some of the findings from the "COVID-19 and Social Care Recovery and Resilience" study funded by the National Institute for Health and Care Research (NIHR), Policy Research Programme (PRP) – Recovery, Renewal, Reset: Research to inform policy responses to COVID-19 in the health and social care systems. Reference number: NIHR202333. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate: