Not enough was done to protect people in adult social care settings between March and mid-April 2020: Covid Inquiry

Module 6, the sixth of the Inquiry’s 10 investigations, examined the impact of the pandemic on the publicly and privately funded adult social care sector in England, Scotland, Wales and Northern Ireland, including infection prevention, visiting restrictions, the experiences of the care workforce and decisions on discharge from hospitals.

The investigation found that a lack of proper planning, plus failures to implement lessons from earlier pandemic planning exercises, meant the UK government and devolved administrations took critical decisions in the early weeks “without the information they needed”.

The report, published today (20 October), describes the claim that “a protective ring” had been put in place around care homes right from the start of the outbreak as “unfounded”, adding that the adult social care sector appeared to be “something of an afterthought”.

The report found that a lack of personal protective equipment (PPE) meant staff had to resort to makeshift workarounds, including bin bags, festival waterproof ponchos and painters' overalls.

The report was also critical of the way hospital patients who may have been infected with Covid were moved to care homes to make space for others.

“The decision to speed up the discharge of patients from hospitals into care homes was necessary to free up hospital beds. But the decision to do so was taken in March 2020 when there was not enough testing capacity to know patients’ Covid-19 status,” it said.

Looking at the impact on mental health and wellbeing, the investigation found that care home residents were left feeling “isolated, abandoned and alone” as visiting restrictions cut them off from loved ones, in some cases for months.

The report observed that by mid-September 2020, there was no “strong evidence” of visitors posing a particularly high risk of transmission of Covid-19, and evidence did not suggest such visits were a dominant cause of outbreaks in care homes.

Research indicated that the risk presented by loneliness and isolation to residents was “likely an order of magnitude higher” than that posed by the risk of infection.

The four UK nations started to relax their guidance, but many care homes failed to implement this and visiting remained heavily restricted, the investigation found.

Ultimately, the report found that the failures stemmed from “an absence of proper pre-pandemic planning for the adult social care sector”.

It noted that ‘Exercise Cygnus’ - a pandemic preparedness exercise conducted in October 2016 - recommended developing ways to assess social care and surge capacity, but this work had not been completed by the time the Covid-19 pandemic struck.

As a result, ministers were left making decisions “without the information they needed about the sector”.

In light of the report’s findings, the Chair made eight key recommendations to ensure the adult social care sector is “better protected and better equipped to respond to the next pandemic”, including:

• Improving arrangements for pandemic planning to ensure clearer structures, roles and responsibilities;
• Better planning for the safe isolation of care home residents;
• Implementing financial support schemes ready to be rolled out to support adult social care staff to self-isolate or to limit staff movement;
• Publishing guidance on visiting restrictions;
• Maintaining inspection and oversight by developing protocols to enable inspections to continue, including, where possible, on-site inspections;
• Improving the collection of data about deaths in the adult social care sector;
• Establishing mandatory end-of-life care training for relevant health and social care workers;
• Introducing a voluntary register for the social care workforce in England, recognising and supporting a workforce that already benefits from such registers in Scotland, Wales and Northern Ireland.

Responding to the Covid Inquiry module six report, Cllr Eamonn O’Brien, Chair of the LGA, said: “The pandemic was an extraordinarily difficult time for people drawing on care and support, their families and those who care for them. Councils and their partners worked tirelessly to support vulnerable residents and communities in challenging circumstances. This report is an important opportunity to ensure lessons are learned.

“We’re pleased to now be working closely with government on preparation, should there ever be a future pandemic. Councils, working closely with care providers, the NHS and local partners, have a central role in supporting and protecting vulnerable people. Their experience and expertise must be at the heart of planning for any future pandemic, along with those with lived experience of care. It is essential that the sector is adequately funded and recognised as an equal partner to the NHS."

Cllr O'Brien added: “It is absolutely vital that nobody is discharged from hospital into residential or other care settings where clinically vulnerable people live, without fail-safe testing and isolation regimes, robust guidance, and workforce support.

“We stand with bereaved families in recognising the human cost of the pandemic. We continue to work with government, our members, and partners to ensure that lessons of Covid-19 are acted upon.”

Leigh Day solicitor Carolin Ott, who represented Covid Inquiry Core Participants John’s Campaign, Care Rights UK and the Patients Association, together with Leigh Day partner Emma Jones, said: "Our clients welcome the Inquiry’s findings that restrictions on access by people relying on care to professionals and loved ones were ‘catastrophic’, caused ‘incalculable harm’ and ‘resulted in a significant decline in both their health and wellbeing’, especially for those with cognitive conditions such as dementia.

"The recognition that for many the harms caused by the absence of access outweighed the potential risks of infection is crucial and must translate into concrete action by the Government now to ensure that people relying on care have a right to nominate a partner in care whose continued presence is always facilitated and supported.”

Lottie Winson