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19 May 2020 (updated on 22 May 2020)
This article looks at the issues facing the adult social care sector in Wales as a result of the coronavirus pandemic.
There is a general consensus that the social care system is underfunded, under pressure, and financially fragile. Social care workers are seen as undervalued and underpaid, and there are difficulties in recruiting staff.
Additionally, it is estimated that 96% of all care in Wales is provided by unpaid carers (typically families or friends), many of whom are struggling and in need of further support.
Analysis by the Office of National Statistics highlights that care workers currently face significant risk. In England and Wales residential care and home care workers are dying from coronavirus at roughly twice the rate of the general population. This contrasts with healthcare workers, who do not have higher death rates involving coronavirus compared with people of the same age and sex in the general population.
Concerns about lack of testing in the care sector are well documented, with particular alarm about the virus spreading in vulnerable care home populations. Reporting of coronavirus death figures has been criticised, as until recently only hospital deaths were included, leading to accusations of older people being ‘airbrushed’ out of UK figures. As a result, the Welsh Government is being investigated over concerns about possible breaches of older people’s human rights in care homes.
There have also been difficulties in accessing Personal Protective Equipment (PPE) for social care workers. According to stakeholders, such as Care Forum Wales, the situation has recently improved, but there are still pressure points and rising costs remain an issue. Our PPE article provides more general information across health and social care.
The Welsh Government published information on 29 April summarising what it is doing to support social care during the outbreak.
Financial pressures for care homes
Care homes are facing significant financial pressures. The Chair of Care Forum Wales, Mario Kreft, reported that Wales could lose half of its care homes within a year unless urgent action is taken. He warned if care homes close, the NHS would be ‘completely overwhelmed by a tsunami of need’, and stated:
Unless urgent support is forthcoming we will be seeing care home closures week on week over the summer months.
We’re seeing falling occupancy as people pass and as other homes choose not to admit people, because they’re terrified that it’s going to introduce the virus into those homes and obviously affect the residents they have.
Mr Kreft stated that if occupancy falls below 85% per cent it means the care home is not viable and Care Forum Wales is seeing cases with occupancy around 45%, and in one case 20%.
On 14 April the Minister for Health and Social Services announced an extra £40 million to support adult social care during the pandemic. This was intended to help meet increased costs incurred on basic PPE, food, staffing and ICT. The Minister said local authorities will work with adult social care providers to draw down this funding based on the new identified costs. He also said the allocation would be reviewed and additional funding may be made available if needed. The First Minister stated that the Welsh Government is discussing with local authorities how to re-deploy some of the funding to support care homes where occupancy levels have fallen.
Care Forum Wales welcomed the announcement, but told the Health, Social Care and Sport (HSCS) Committee that ‘very little, if any, of that money so far has made it to the front line’.
On 1 May 2020, the Welsh Government announced a £500 extra payment for all social care workers in Wales, as further recognition for an often ‘undervalued and overlooked’ workforce.
Care Forum Wales also highlighted to the HSCS Committee that it is not yet known how many recovered coronavirus patients will need additional care , and that the whole system needs to be more sustainable:
We see local authorities and health board commissioners using toolkits that assume that everybody is paid the legal minimum wage, or very marginally above, and we can’t carry on like that. We’ve got to recognise the skills and training that are already needed, let alone the additional work we’re going to have to look at in terms of rehabilitation for people recovering from COVID.
Testing, particularly in care homes, has proven to be a controversial issue. Both UK and Welsh Governments have been criticised for a lack of testing in care settings, and particularly for not testing hospital patients sooner on discharge to care homes (this came in on 15 April in England and 22 April in Wales). Testing was only made available for all care home residents and staff on 28 April in England and 16 May in Wales.
On 21 May the Older People’s Commissioner for Wales called for the Welsh Government to be investigated by the Equality and Human Rights Commission (EHRC) over concerns that older people’s human rights may have been breached in care homes. The Commissioner has concerns that older people’s rights may not have been sufficiently protected, in these settings and across health and social care more widely. The EHRC responded to say it ‘remains deeply concerned about serious potential breaches of older people’s human rights during this pandemic’. The EHRC said it is working closely with the Commissioner and ‘is considering the use of all its powers to protect older people’s rights’.
Care Forum Wales told the HSCS Committee that it understood virus cases were introduced into care homes by early admissions of asymptomatic people. It explained:
[…] the barriers seem to us to be that we started from this position on testing where there was not going to be any. We were told, quite categorically, unless they’re showing symptoms, they’re not going to be tested.
Care Forum Wales reports that it called for wider testing in February. On 10 April, the chief executive of Care Forum Wales wrote to the First Minister highlighting severe concerns regarding hospital discharge into care homes. She said members reported being pressured into admitting patients from hospital, but felt they could only safely do so with adequate PPE and appropriate testing.
The Welsh Government stated that since 22 April, it had been testing everyone in care homes with coronavirus symptoms, and a new testing and discharge pathway had been developed for people leaving hospital to go into a care home.
In Plenary on 29 April, the First Minister defended the previous decision not to test people on discharge from hospital into care homes before 22 April, stating the Welsh Government followed clinical advice.
On 28 April 2020 the UK Government announced it was rolling out testing of all asymptomatic NHS and social care staff and care home residents, so thatall staff and residents would be tested regardless of whether they have symptoms.
On 2 May the Welsh Government extended testing to all residents and staff in care homes with outbreaks of coronavirus, and in the largest care homes with more than 50 beds. The Welsh Government said at the time that the scientific evidence still did not support blanket testing of all staff and residents.
However on 16 May the Welsh Government announced it was extending testing to all care home residents and staff in Wales, following the latest scientific evidence.
Care Forum Wales told the HSCS Committee that it believes ‘regular and prompt testing, and speedy revelation of the results’ are key to improving the situation in Welsh care homes.
In terms of domiciliary/home care, currently care workers with symptoms can get tested, but unlike care home residents, people receiving home care (and those they live with) with symptoms cannot get tested. Some care packages are being suspended if a person in the household has symptoms; arguably this could be resolved sooner if testing was available to determine whether or not the person has coronavirus. This situation could change in the future with the Welsh Government’s new ‘test, trace, protect’ strategy.
Both the UK and Welsh Governments have been criticised for failing to include deaths outside hospital (at home and in care homes) in the official coronavirus death figures. This only changed very recently, and most public health data is still heavily focused on hospital settings. See our article on registered deaths for further information.
The Office for National Statistics (ONS) suspected and confirmed COVID-19 deaths in England and Wales data, reports higher numbers of deaths related to COVID-19 in care homes in Wales than the Care Inspectorate Wales and Public Health Wales data sets.
New research from the London School of Economics (14 May) estimates that over half of all excess deaths in England and Wales during the COVID-19 pandemic are care home residents (significantly higher than the ONS reports).
Provisions in the emergency UK Coronavirus Act to temporarily relax local authorities’ care and support duties have been brought into force. In Wales this means that local authorities no longer have a duty to meet adults’ care and support needs, or adult carers’ support needs. They now only have to meet needs in the most serious cases where someone is at risk of, or experiencing, abuse or neglect. This means that care and support packages can be reduced, and some services withdrawn. There are concerns about the burden this places on unpaid carers potentially at the same time their own support services, such as respite care, are removed. See our article on these changes for more information.
The Welsh Government’s guidance on implementing the ‘modifications’ says there is evidence that local authorities and social care providers are already experiencing significant workforce absences as a direct result of the pandemic.
The Older People’s Commissioner for Wales is concerned that a significant number of older people may no longer be able to receive the social care support they need to maintain their health, well-being and independence.
According to the UK Home Care Association (UKHCA), seven local authorities in England have so far enacted the changes (so-called ‘easements’). There have been reports in the media of some Welsh councils prioritising care, with possible reductions to some care packages, and an expectation that families, friends and ‘voluntary support’ will fill the gaps in care. However the leader of the Welsh Local Government Association (WLGA) told the HSCS Committee on 21 May that while every local authority looked at plans on how to reduce care packages and prioritise, as far as he was aware, no local authority in Wales had to introduce those plans.
Research by Carers UK found that 79% of carers in Wales are now providing more care due to the coronavirus outbreak. This has resulted in carers providing an average of 11 additional care hours per week. The survey also showed that over a third (36%) of carers in Wales are providing more care as a result of local services reducing or closing.
A statement by the Deputy Minister for Health and Social Services on 4 May highlighted that support provided by unpaid carers has become even more crucial during the coronavirus pandemic. It noted that in the last two months, more people have taken on a caring role – people have moved homes, left their families and, in some cases, given up work to care for and protect relatives or friends. The Deputy Minister acknowledged that the emergency Coronavirus Act has caused anxiety that carers’ legal rights may be compromised and that arrangements to support them and those they care for may be withdrawn. She reaffirmed that any changes will be temporary and that the Welsh Government remains committed to carers rights.
Reflecting on the situation facing the care sector in Wales, Mario Kreft, Chair of Care Forum Wales noted to the HSCS Committee:
I do hope that, when we come through this, one of the key things we learn is that we never look down on social care and social care workers again.
Article by Amy Clifton, Senedd Research, Welsh Parliament
We’ve published a range of material on the coronavirus pandemic, including a post setting out the help and guidance available for people in Wales and a timeline of Welsh and UK governments’ response.
You can see all our coronavirus-related publications by clicking here. All are updated regularly.