Three years have passed since the UK government implemented emergency legislation in response to the COVID pandemic. The Coronavirus Act 2020 made amendments to laws affecting many aspects of society, including the duties and powers incumbent on England’s local authorities to provide adult social care under the Care Act 2014.
The Coronavirus Act 2020 set out legislative changes to statutory requirements, known as Care Act “easements”, which provided local authorities with a legal avenue to operate with reduced workforce capacity. The easements allowed care and support provision to be changed or, in extreme circumstances, withdrawn to meet more urgent needs elsewhere in the system.
While it was important to respond to the unique pressures the pandemic was placing on adult social care, these swiftly introduced changes prompted concern. Easements and other changes to support provided by local authorities were meant to be temporary and a last resort. But campaigners feared they could “set a dangerous precedent”, permanently affecting standards and expectations of care.
Three years on, we can see that some of these changes, combined with the subsequent cost of living crisis, have indeed had far-reaching consequences, both for those receiving social care support and the care workforce.
People receiving adult social care and support
Care Act easements – and other similar, less formal adjustments to processes – meant in some cases longer waits for assessments, or for decisions on and reviews of packages of care. Certain processes, such as hospital discharge, moved faster. But this prompted concerns about hasty decision-making and the effects of discharging COVID-positive patients into residential care homes.
A growing body of research highlights many people’s difficulties accessing information and support. Phone lines were often closed as staff began working from home. Inequalities around digital access became apparent as appointments moved online. Many service users, especially older people and those with learning disabilities, struggled to request or access help once social support services and day centres were closed.
Some care users – and also carers – reported feeling increased anxiety and reduced wellbeing, heightened by the greater responsibility that was placed on unpaid carers and a simultaneous loss of respite opportunities.
Meanwhile, “hidden harms” such as neglect and domestic abuse were harder to spot and address while social workers were required to work remotely.
Further, public health rules around social distancing meant many people were faced with restrictions on face-to-face visits from health and care professionals, as well as friends and family who might ordinarily offer support. All of this had a significant effect on the wellbeing of many citizens with social care needs.
Adult social care was hit hard during the pandemic – it will need help to recover
Despite workers doing what they could under intense pressure, the government’s response to the crisis in the sector – in terms of guidance, and practical and financial support – was deemed insufficient and too late by senior social care professionals.
Even as the world reopened following vaccination campaigns, things didn’t return to “normal” for people requiring social care in England. If anything, it’s becoming more difficult to meet their needs.
The social care workforce
High numbers of care workers surveyed during the first year of the pandemic reported mental and physical burnout. Contributing factors included working extra hours, reduced staffing ratios, a lack of PPE, poor support, and ever-changing safety guidance. All of this was compounded by the risk of infection.
Social workers and others employed by local authorities reported similar levels of stress, with three-quarters of social workers in one survey stating that they were “mentally and emotionally exhausted” after working through the height of the pandemic.
Operational changes in working practices such as remote working, and increased delays and waiting lists, sometimes prompted a sense of moral injury when workers were unable to deliver services in accordance with their professional values and standards.
The social care workforce was already under stress before COVID, with low pay, precarious contracts, and chronic under-resourcing. In 2020, frontline staff were “rewarded” with applause and badges rather than pay rises and improved working conditions.
As the public memory of the worst days of the pandemic recedes, many in the social care sector are seeking work elsewhere. This is understandable but increases the burden for those who remain, which consequently risks standards for service users.
There are currently around 165,000 vacancies to fill in the care sector in England, with the majority of councils struggling to recruit and retain social workers. Yet a 2021 government pledge of £500 million to boost recruitment and retention in the social care workforce has been reduced by half.
A damaging legacy
Life changed dramatically for everyone at the height of the pandemic, but some felt the effects disproportionately. People who were financially disadvantaged, older or had a disability, for example, were more vulnerable to higher rates of infection, worse outcomes from illness, and greater social isolation and poverty.
Although they were formally withdrawn again in 2021, certain legislative and operational changes introduced during the initial peaks of COVID, on top of an already stretched system, have arguably left a damaging legacy on the availability and quality of care and support for disabled and older adults.
After COVID: why we need a change in care home culture
Professional health and social care organisations, charities, and many frontline workers view the situation today as more perilous than ever.
While COVID arguably shone a light on the critical value of the care sector, and the tribulations of those living and working under its auspices, there has been little substantial improvement to conditions. Three years on from the start of the pandemic, the scars left on the sector and the communities it serves are still raw.
Laura Noszlopy is a research fellow in the School of Social Policy at University of Birmingham. Until June 2022, she was research fellow on a project examining the impact of Care Act easements, funded by the Economic and Social Research Council COVID-19 Rapid Response Grant ES/V015486/1. This work was supported by that grant.
Jean McHale was principal investigator on the Economic and Social Research Council COVID-19 Rapid Response Grant ES/V015486/1, November 2020- July 2022. This work was supported by that grant. She is also a Trustee of Central England Law Centre.