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Care homes received insufficient protection when they needed it most and were treated as an ‘afterthought’ in the early stages of the pandemic, according to the UK Covid-19 Inquiry’s sixth report.
In addition, the claim that “a protective ring” had been put in place around care homes “right from the start” of the Covid-19 outbreak was unfounded.
The report found that there were more than 43,000 recorded deaths involving Covid-19 in care homes between March 2020 and July 2022, and that action to protect carers and care users came too late, with devastating consequences.
It concluded that although the UK government and devolved administrations were aware, before the pandemic, of the extreme vulnerability of care home residents to respiratory viruses, they did not do enough to protect people in care settings between March and mid-April 2020.
Impact on millions who receive adult social care
The Inquiry found that in March 2020, the four governments decided to speed up the discharge of patients from hospitals to free up much-needed hospital beds. But the lack of available tests meant that patients were discharged from hospital to care homes without knowing whether they had Covid-19.
At this stage, there was also no vaccine. To stop Covid-19 from spreading in care homes, it was important to keep people separate and isolate them from others when they returned from hospital, in case they had been infected. However, this was not initially included in official guidance in March 2020 in England, Wales and Northern Ireland. This was a significant oversight.
It said these failures and others stemmed from a lack of proper pre-pandemic planning for the adult social care sector. The Prime Minister, Andy Burnham, has now said the government is “committed to learning the lessons” and pledged to develop an “action plan” for a future pandemic.
Recommendations for health and social care professionals
The Chair makes eight key recommendations to ensure the adult social care sector is better protected and better equipped to respond to the next pandemic, including:
- Improving pandemic planning arrangements to ensure clearer structures, roles and responsibilities.
- Better planning for the safe isolation of care home residents.
- Implementing financial support schemes ready to roll out to support adult social care staff to self-isolate.
- 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.
Use of DNACPR during Covid-19 pandemic
The report also examined concerns about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, echoing those raised in its Module 3 report that some decisions were made inappropriately or without proper consultation, based on a person’s age, health condition or learning disability.
While finding no evidence of a national policy encouraging blanket use of DNACPRs, the report recommends mandatory end-of-life care training for health and social care workers, who often lack the skills to have these conversations thoughtfully and compassionately.
Visiting restrictions also did not begin to ease until the summer of 2020. The report also concluded that the severity and duration of visiting restrictions caused “profound and enduring effects” inside care homes, particularly for residents with complex cognitive conditions such as dementia.
Action by Government came too late
Baroness (Heather) Hallett, Chair of the UK Covid-19 Inquiry, said: “At the critical early stages of the pandemic, not enough was done to protect those living and working in care homes. The mantra at the time of ‘protecting the NHS’ sometimes came at the expense of the users and providers of care. The adult social care sector as a whole appeared to be something of an afterthought.
“The profound isolation and sense of abandonment felt by residents as a result of the visiting restrictions resulted in immense emotional harm. Most distressingly, some people were not permitted to be with their dying loved ones. Many remain wracked by a guilt that they do not deserve to carry.
“During the pandemic, the action taken by the UK government and devolved administrations to try and protect workers and users of adult social care came too late. These failures resulted directly from a lack of proper pandemic planning for the adult social care sector. It underlines why my recommendations in this report must be acted upon now before the next pandemic strikes.”
Impact on care staff
The report also examined the impact on the adult social care workforce during the pandemic, which included almost 1.5 million people, including care in the home (domiciliary care). Many care workers suffered burnout, and some left the profession entirely.
In addition, many put their own lives at risk due to severe shortages of personal protective equipment (PPE), which was “wholly unacceptable”, with care workers left “without the protection they needed”. It concludes that while PPE shortages were a global problem, better planning could have ensured a much better supply from the outset.
The UK’s 5.8 million unpaid carers were also heavily relied on, providing complex care for longer hours with little or no respite. The Inquiry concludes that support for unpaid carers arrived too late and that, for too long, the adult social care sector as a whole has been undervalued and under-recognised.
