This morning, leaders from the care sector will be giving evidence to MPs about the management of the coronavirus outbreak. The sector has been devastated by the pandemic: in April, there were 18,000 more care home deaths than would usually be expected for the month, of which 8,000 have been attributed to coronavirus. Care home leaders have criticised the government’s testing regime and the inadequate supply of personal protective equipment (PPE) for staff.
At 10:30am, MPs on the health and social care select committee, chaired by Jeremy Hunt, will hear from Professor Martin Green, chief executive of Care England, Vic Rayner, executive director of the National Care Forum, and James Bullion, president of the Association of Directors of Social Services.
You can follow updates from the hearing live on this blog.
11:31am – The committee asks whether the families of care home staff that die are receiving the £60,000 payments promised by the government?
Green says there is some confusion on the matter. Families of staff in care homes that do not have publicly funded residents do not know whether they are eligible to receive the money. The government should provide clarity “as a matter of urgency”, he says.
And that’s the end of the hearing.
11:27am – The committee, which will wrap up shortly, asks how residents in care are faring, given their isolation.
“People are fearful, anxious”, Rayner says. Residents are unable to see their families, and there are a “lot of lonely people”. The sector needs to work out how to provide better quality of life for residents, and allow them to have contact with the outside world.
Are there any good examples that might make a difference going forward, allowing people to see visitors?
Rayner says we should look to the international community. Fundamentally, people need to have quality of life when they’re in care homes, she says, and the sector needs to share best practice.
11:24am – Hunt asks what long-term changes are needed in the care sector, to ensure future pandemics don’t devastate the system.
Green says there are “big issues”: around funding, around career progression, and around integration with the wider NHS.
Bullion says the government needs a “long-term social care plan” to sit alongside an NHS plan. He also says working conditions of staff need to be improved, alongside the rights of people using the system, who are often being moved between care homes or discharged home.
He also calls for a “prevention plan” to stop people requiring long-term care is important.
Rayner also calls for better data being provided, in real time, for the sector. It’s impossible for care homes to plan without that data, she says.
11:18am – The committee asks what morale is like among care home staff, and whether the coronavirus crisis has affected mental health in the workforce.
Additionally, the committee asks what impact the high level of absence (such as staff self-isolating) is having.
Green says care home staff have had to step up to plug gaps in the system. We need a national system to ensure holes are identified and filled, he says.
On morale, he says staff are very good at “self-support”, but we need a system for mental health support among the workforce, he says.
Staff are under “huge pressure”, and going through a “constant cycle of bereavement”, he says.
11:14am – Asked whether the Care Quality Commission, the care home regulator, is piling more regulations on top of old regulations that are not themseleves being followed (such as requiring an isolation unit in each care home), Bullion says some of the advice is “unrealistic”.
Green says that the CQC is making guidance “for a perfect world”, and is disconnected from the current state of the sector.
11:11am – Guidance says all staff must be trained in infection control. Is that currently the case, given the reliance on agency workers? Are guidelines being followed?
Rayner says she’s confident that’s in place for staff, including agency staff. But Covid-19 requires its own expertise and equipment, she says, and staff need extra training (and care homes need extra money) to facilitate that.
11:09am – The committee asks what would be required for the country to reduce its reliance on agency staff (the government has said agency staff should now only work at one location if possible to stop the spread between locations).
Green says we need to “completely redefine social care work”. the sector needs a proper qualifcations ladder and more alignment with the NHS. If agency staff are only allowed to work at one location, they will need to be properly compensated, he says.
Rayner stresses the need to make care work a “career of choice”. Pay, recognition and a clear career structure are important, she says.
11:04am – The committee asks what the main concerns are among the care home work force.
Green says staff are worried about bringing coronavirus into care homes, as well as bringing it back to families.
They are also very worried about the supply of PPE, which has been “in some areas, extremely problematic, and still continues to be”.
They are also having to follow everchanging guidance, he says, and it’s clear that PHE “does not understand the social care workforce”.
Rayner adds that staff are having to deal with the grief of lost colleagues, and having to provide end of life care far more than usual.
They are also having to learn new skills very quickly, and temporary staff are having to get up to speed very quickly.
The crisis shows that care home staff need more recognition for their skills, she says. She is “very disappointed” about the lack of recognition for carers, including those coming from abroad to work in the sector.
10:58am – The committee asks whether care homes have adequate funding to cope during the pandemic.
“The short answer is no,” Green says (the experts have previously described how care homes may have to reduce resident numbers to cope with the crisis, and therefore receive less income. They are also spending more, such as on PPE).
One of the problems is that local authorities are not releasing money to care homes, he says.
Bullion says he believes that local authorities are getting as little as a quarter of the money they need from central government to help fund social care.
His organisation represents local authority social care leaders, and he admits that there have been delays getting money to providers in some cases. But councils are, overall, paying 10 per cent more to care homes, he says. The situation varies between local authorities.
“We haven’t seen the collapse,” he says. Local government has “stood up well” to co-ordinate testing and PPE. Where testing and PPE strategies have worked well, they have been co-ordinated by local leaders, he says.
10:52am – Green adds that previous pandemic planning was focused on the NHS, and there was “not a recognition” that the most vulnerable people were in care homes. We should’ve prioritised care homes in our pandemic planning, he says.
When you focus on care homes because of their high risk, you can slow the spread of the virus, as evidenced by what’s happened in other countries, he says.
What changes need to happen to stop a second wave, he’s asked?
First, there needs to ba a “significant upscaling” of support from the NHS, both from community nurses and GPs (some GPs have stopped coming to care homes, he says).
We need to get the PPE situation sorted, he says. We need clearer guidance from government on testing, PPE, and how care homes will be funded longer-term.
10:47am – Green says the physical premises of lots of care homes are at the “end of their shelf life”, and require investment in order to be fit for purpose to isolate residents. We need better knowledge of which care homes can properly isolate infection cases, and co-ordinate a national response, he says.
10:44am – Rayner stresses the importance of repeat testing of staff, which isn’t happening enough. Staff need regular testing, with rapid results, to let care homes make informed decisions. Currently, they’re deciding based on inadequate data.
As an aside, some countries have banned agency staff from working in more than one care home.
10:42am – Green says that, in future, agency staff might have to be restricted to one care home to stop them spreading the virus between different locations. But there are challenges with this, he says. Permanent staff may be self-isolating; reducing movement of agency staff costs money; and there were already lots of vacancies in the care sector. We need to “upscale our approach to filling gaps in the system”, he says.
10:39am – Bullion says discussions around care support at home, rather than in a care home, are being ignored. Current strategy for at-home care and coronavirus is “inadequate”, he says. Carers going into people’s homes need to be tested more to give those receiving care confidence that they will not catch Covid-19: around 10 per cent of people who are cared for at home have stopped their care, he says, and this has potentially caused deaths.
People are prioritising reducing their risk of infection over their health and wellbeing, he says.
10:35am – Bullion says he is “still concerned” about PPE, which is the “single biggest and expensive factor” in dealing with Covid-19 in adult social care. “We still don’t have a stable supply chain,” he says.
“If we’d have had a national position on PPE… we would’ve been far ahead of where we are now,” he said. Some of the care home deaths are down to a lack of PPE, he says.
10:30am – Green says that some patients were discharged into care homes from hospitals while they had Covid-19 symptoms.
Also, care home residents weren’t going into hospital when they should’ve, not just for Covid-19, but for other illnesses too.
Rayner, whose organisation represents not-for-profit care homes, says partnerships between care homes and wider health bodies have not always been coherent. Individual care homes are ensuring the safety and support of their residents, but that hasn’t been picked up “on a national basis”, and care homes have not been properly resourced, she says.
Care homes are designed to bring people together, she says, and so to properly isolate people they need to reduce their resident numbers. That will reduce funding for a given care home, and therefore the government should’ve ensured more money flowed to care homes.
10:25am – Slightly earlier than scheduled, committee chair Jeremy Hunt brings in Green, asking whether the “R” value in care homes with the virus is above 1. Are cases growing exponentially?
Green says we’re “probably at the top of the curve, and hopefully heading downwards”. But data has not been timely, meaning the reproduction rate is difficult to calculate in real time.
Hunt asks whether testing in care homes is on the rise, in line with the government’s expansion of its testing regime.
Green says testing is on the rise, but there have been “logistical issues”. Some tests are being lost, others aren’t arriving or being taken away on time, and some care homes are waiting eight to ten days for a result. “We need to have regular testing, it’s got to be done two to three times a week,” he says.
In summary, the government announcements have not been fully replicated on the ground.
(Image credit: LINDSEY PARNABY / AFP)