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21 September 2020

Government care home plans were sneaked out late Friday night – here’s what they miss

Uncertainties around funding, workforce protection and patient safety suggest why the Winter Plan might have been delayed.

By Anoosh Chakelian

On Friday 18 September, the Health Secretary Matt Hancock was doing the breakfast broadcast rounds, boasting about the government’s plan to protect care homes against Covid-19 this winter.

The top lines of this plan were press-released by the Department of Health and Social Care that day, and confirmed by Hancock in the studios: free PPE for care workers, no movement of staff between care homes, a dashboard to monitor care home infections, the appointment of a new chief nurse for adult social care, and an extra £546m (extending the Infection Control Fund, announced in May, to March 2021).

See also: How the UK’s care homes were abandoned to coronavirus

After a disastrous first wave of Covid-19 devastated many of the UK’s care homes, these policies were welcomed. The chief executive of Care England, Martin Green, vowed to work with the government “to implement the winter plan to ensure the best outcome for residents of care homes and their families”.

However, the document itself had yet to be published. It only arrived at around 9.30pm that night – the witching hour for policy coverage.

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With a 52-page plan to digest, it looked very much as if government policy was being released in a manner designed to gather positive headlines on its highlights, while any scrutiny of its details would be buried over the weekend.

Although the plan’s focus on the quality and safety of care services and recognition of the workforce’s contribution – plus the extra funding – was welcomed throughout the sector, gaps were also identified soon after its long-awaited publication.

One of the main concerns is the resilience of the social care workforce through this winter. The average wage for a care worker is £8.10 per hour, more than £1 per hour below the real living wage of £9.30, and almost 25 per cent short of the London living wage. Statutory sick pay remains at an even more precarious £95.85 a week (the average rent in the UK is £227 per week), and many thousands of social care staff are employed on part-time, temporary or zero-hours contracts that mean they do not qualify even for this amount.

Those attending the most vulnerable have been forced to choose between the safety of care home residents, and their own ability to house and feed themselves and their families. The result of this became clear in July, when figures from the Office for National Statistics revealed care homes in England that use above-average numbers of agency staff, or do not offer sick pay, were found to have higher risk of Covid-19 infection levels among residents.

See also: Agency England: How casual labour and lack of sick pay exposed care homes to coronavirus

The winter plan says the extra Infection Control Fund money “can be used by providers to help cover the costs of ensuring that staff who are isolating in line with government guidance can safely stay at home” on “their normal wages while doing so”. It also outlines other areas where this money should be spent: stopping workers moving between care homes, and generally helping care providers reduce the rate of coronavirus transmission.

Because the criteria for how this extra Infection Control Fund money can be spent have not yet been published, it is not clear how much can go toward staff pay. This has led to concern that the money pledged may not reach the pockets of care workers themselves – or that it will only do so at their employer’s discretion.

“It is good to see the contribution of the 1.5 million people who provide care and support to older and disabled people being recognised,” writes James Bullion, the president of the Association of Directors of Adult Social Services.

“It is vital that they are also rewarded and that money which is being given to providers makes its way into the pay packets of care staff and acts as an incentive for them to stay with us over the winter and beyond.”

With such a tough winter ahead for these workers, there is also concern for their own well-being – something the winter plan acknowledges, but which is in practice only addressed with a promise to “review current occupational health provision”, online charity resources, a crisis text service, and free access to a handful of wellness apps.

“The plan feels very light in relation to the social care workforce,” writes Vic Rayner, executive director of the National Care Forum. Apps and advice, says Rayner, are “no substitute […] for a bespoke occupational health scheme to support the workforce”.

See also: How Britain’s essential but most vulnerable workers were exposed as the virus spread rapidly

One of the key problems for care homes during the first wave was that many received patients, discharged from hospitals, who had not been tested beforehand for Covid-19. Although all patients are now tested upon discharge to care settings, and care homes have a right to refuse admissions if they can’t isolate effectively, there is still allowance in the winter plan for patients to be discharged to care homes before their test results have been ascertained [my emphases]:

“… enable discharge to be safe and timely, ensuring that testing takes place before every discharge to a care home, and results are available and communicated before discharge, unless otherwise agreed.”

“We are working up a designation scheme with CQC for premises that are safe for people leaving hospital who have tested positive for Covid-19 or are awaiting a test result.”

Where possible hospitals should plan 48 hours in advance of discharge to ensure test results are available and care homes have a chance to plan for a timely discharge.”

“In several places within the plan it refers to the possibility of homes taking patients from hospital without the home knowing the outcome of their test”, writes Rayner. “The only reason this is being considered is because the testing regime is not sufficiently robust to ensure timely results.”

At the beginning of July, the government announced it would roll out weekly tests for care home staff – but this has been beset by delays, with Care UK saying some care homes were experiencing five-week waits for staff testing, and the Royal College of Nursing reporting “testing results are consistently delayed, inconclusive or even get lost”.

Despite its emphasis on testing, the winter plan does not address these issues. Yet a recent letter from the Department of Health and Social Care recognised “that rollout of the repeat testing programme for care homes was unfortunately delayed”, as reported by the Nursing Times.

The biggest gap of all, however, is something the winter plan does acknowledge: how our broken social care system should work in future.

“Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges our society faces,” it notes. “We are looking at a range of proposals as part of our commitment to bringing forward a plan that addresses these challenges for the future.”

While this sounds sensible, it merely exposes a failure by Boris Johnson to deliver on one of his key policy promises. In his first speech last year as Prime Minister on 24 July, Johnson said, “I am announcing now – on the steps of Downing Street – that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”

Yet this “clear plan” did not materialise in the Conservative manifesto in November 2019. A few months later, the lack of a plan became more apparent with Hancock’s letter to MPs across parties on 6 March, which invited them to submit “proposed solutions”.

A green paper to review the policy, announced by former chancellor Philip Hammond in March 2017 for the end of that year, has been delayed more than five times and has still not materialised.

While the winter plan puts funding behind a renewed focus on the care sector in the coming months, its loose ends show that how to solve the social care crisis remains an issue on which this government lacks answers.

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