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(Sheila Peace, Emeritus Professor of Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University).

Today’s Evening Standard in London, headlined: ‘Care Homes: Don’t Leave them to die’. As of, April 15th Health Secretary, Matt Hancock announced a strategy for social care including:

  • a new ‘brand’ for social care with workers badged alongside health care staff;
  • all care home staff and residents to be tested for coronavirus;
  • forbidding use of ‘blanket’ ‘Do Note Resuscitate’ agreements without access to proper treatment for Covid-19;
  • relatives should have ‘right to say farewell’ to aged relatives who are terminally ill and isolated;

I came to Ageing Issues this morning looking for somewhere to report on findings from a webinar that I took part in today. This was a conference event run by Laing & Buisson, whom many of you will know publish the annual Care Home Market review and whose stats. are used by many of us. This provided comment from a range of people listed at the end of this piece and having read Chris Phillipson’s piece from April 8th ‘Covid-19 and the crisis in residential can nursing home care’, I wanted to respond.

First, William Laing reported on a poll of Care Homes and Home Care agencies which they have carried out over the last few days from which they were able to extrapolate figures. He said that they were able to show 5,300 deaths outside hospital in Care Homes for older people. Given that today’s death toll rate has risen by 870 people to 13,828 – the care home figures’ could be seen to represent another third. In closed environments infections spread. Laing also reported that the deaths reported through Home Care agencies showed a much lower rate of infection.

Discussion through comment from the Care Quality Commission, private sector care home and home care operators, Local Authority providers, local care homes association and Care England outlined current challenges, innovative ways of working that been developed ,and how to take systems that have been developed in an emergency forward for the future of this sector.  I am outlining some issues here and slides will be available from this meeting. Hundreds of questions were raised from an audience of over 900 but the meeting ran out of time and so were never discussed. Laing and Buisson said they would be convening more webinars and so it may be worth looking at their website.

The following points were raised. First, on current issues:

  • Adequacy of PPE varied. The Laing poll showed 67% adequate PPE; 33% inadequate. Many Care Homes were sourcing their own provision;
  • There is confusion over guidance on how to use PPE appropriately;
  • Testing of care staff and service users is developing slowly. Deloitte’s is running testing centres for Adult Social Care and they now have 12 sites. It was noted that staff from BME groups were particularly affected;
  • Since April 1st Care Act 2014 easement guidance has been issued to local authorities. The CQC commented that they are providing support over managing decision-making.
  • Large providers such as Barchester Healthcare had found that they could redeploy staff and recruit volunteers including relatives to cover for staff that were sick or in isolation. The DBS system has been fast-tracked and they are using e-learning training and Skype to observe practice.   They were using ZOOM for regional and national meetings. There was some additional funding for supporting new staff.

Future issues:

  • Both Care Homes and Home Care providers noted increased interest in recruitment to the sectors and considered some of the innovative solutions to taking on new people could be used in future. The importance of technology was seen throughout in relation to training.
  • There has been a growing awareness of social care and there is a need to keep this awareness in public minds. It was noted that NHS and now Care Homes get more press than Home Care.
  • There is a need to focus on population health management and a continuum of care including all alternatives.
  • In the Care Homes sector – the divide between self-funders and LA supported residents needs to be addressed. The housing market is flat at present and this will impact the sector.
  • There are still local authorities supporting Home Care on a ‘paying for minutes of care’ basis and not block payments.
  • At present there seem to be a plethora of QUANGO’s addressing different issues with no over-arching direction. The difference between local and national issues need to be acknowledged.
  • Social care and clinical treatment need to be treated equally. A single national care plan shared across the sectors was raised.

Finally, Martin Green from Care England: representing independent care providers of all sizes, reported that they would be developing an audit of innovative solutions developed through this pandemic that would be presented to Government.

Returning to Chris’s paper, it was agreed that issues were financial, social and political and had to be addressed on all levels from underfunding to the status of social care. However, this meeting kept to the level of organisational systems. The poor wage levels for staff was not debated neither was a future alternative to the current form of collective care. Laing and Buisson’s own analysis (2018, 2019) prior to the outbreak of Covid-19 has shown that dementia care and end of life care have become central to the Care Home sector, the current situation has foregrounded this situation.

 

References

Laing & Buisson Conference Event, April 16th 2020. Social Care: the Long View.

Speakers:

Chair: Henry Elphick

William Laing, Chairman, Laing & Buisson

Chris Day, Director of Engagement, Care Quality Commission

Peter Calveley, CEO, Barchester Healthcare

James Thorburn, CEO, City & County Healthcare Group

Martin Green, Care England

George Tuthill, Oxfordshire Care Home Association (retired)

Cathy Winfield, Chief Officer, Berkshire West CCG

Ian MacBeath, Director Adult Care Services Oxfordshire

 

Laing,W (2018) Care Homes for Older People. UK Market Report, 29th Edition. LaingBuisson. Healthcare intelligence: London.

 

Laing,W (2019) Care Homes for Older People. UK Market Report, 30th Edition. LaingBuisson. Healthcare intelligence: London.