By Christian Kerr and Michelle Janas
In normal circumstances many people move from hospitals into care homes, either temporarily or permanently, with the support of social workers. Yet Covid-19 has proven, devastatingly, to be near impossible to contain in those settings.
Care homes are not by nature set up to provide appropriate care, support and treatment to Covid-positive patients. Throughout the pandemic, care home workers have shown incredible dedication and compassion toward those they care for. However, they don’t have the expertise or resources needed to effectively nurse Covid-positive or Covid-recovering chronically ill and disabled people who have been deemed fit for discharge by hospitals under immense strain. And nor should they be expected to, having long been undervalued by government and society, expressed in poor pay and few development opportunities.
At the height of pandemic, one of us volunteered in a care home and witnessed frantic, inexpert care of Covid-positive older people. The perennial issue of low staff-to-resident ratios – again driven by the need to make profit in the care market – meant that when some people needed more intensive attention just to meet their basic needs to eat and drink while suffering from Covid, others were simply left alone in their rooms for prolonged periods.
Those working in care homes have described scenes of isolated suffering and dying, of distress compounded by the challenges to comprehension presented by cognitive illness such as dementia. For a person in care, prolonged isolation and separation from the people they know and love can lead to near-absolute disintegration of the world they know, a world containing all the anchors and cues and routines and assurances that give shape and meaning to the day, and support their identities, even as those identities are under threat by medical conditions and by life in a group home.
Unjust burden
These issues are not limited to older people. People with physical and learning disabilities, mental health issues and brain injuries also face these risks. It is an unjust society, indeed, that expects those who have already borne the brunt of the impact of pandemic to face further isolation, separation from family and friends, denial of daily activities and routines on the basis of resource allocation that favours one public service over another.
The Department of Health and Social Care’s (DHSC) winter plan, published last month, states “[n]o one should be discharged from hospital directly to a care home without the involvement of the local authority”. This again highlights social workers’ key role in supporting and coordinating discharges. One of us is a practising social worker and the other an experienced immunologist, student social worker and recent care home volunteer. We are concerned about the plan’s implications for older and disabled citizens, and the social workers who are responsible for their welfare.
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The plan says the government is working with the Care Quality Commission (CQC) to designate “premises that are safe for people leaving hospital who have tested positive for Covid-19 or are awaiting a test result’. Any “safe premises” for Covid-positive people would, by definition, require separate facilities and a separate, live-in workforce with access to the same types and levels of PPE that hospital staff have access to.
The plan also calls for hospital discharges 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” (emphasis added). Both the above statements could be interpreted a number of ways at a time when clarity and consistency are crucial.
Supporting people to go home after hospital should always be the primary consideration, if that’s what the person wishes. This has been given added impetus at a time when the risks associated with going into residential care are higher than ever before. However, the practicalities of delivering care at home – driven by the need to make profit in a care market – require workers to visit multiple homes in a day, providing close-quarters care to people who could, under the winter plan, conceivably be Covid-positive.
There are many practical and ethical issues to be considered when planning discharges from hospital back into the community. Social workers are key to this process and, as an exceptionally challenging winter approaches, will be under considerable pressure to source and arrange care and support for people who have been receiving hospital care, some of whom will have had, or even still have, Covid. Social workers have a duty to protect those whose welfare and wellbeing they are statutorily and professionally responsible for. They also have a duty to protect the general public. In pandemic the stakes are extremely high and the situation complicated by a number of factors.
‘Scrap the easements’
With all that in mind, we were dismayed to read in the plan that the joint interim chief social workers advised government to continue with the controversial Care Act ‘easements’, enacted by the Coronavirus Act 2020, through the winter, in anticipation of ‘triple whammy’ of the usual winter pressures on the NHS and a second wave of Covid at a time when the NHS is still recovering from the first. Following the plan’s publication, MPs voted to continue the Coronavirus Act, including these provisions.
The easements allow councils to temporarily suspend legal duties to assess needs, develop or review care and support plans, carry out financial assessments and meet eligible needs – other than where this would breah a person’s human rights – and are designed to enable councils to, where necessary, prioritise care and support in order to meet “urgent and acute needs”.
Again, social workers will be central in this process. In a time of politically chosen austerity, in a country that spent over £500m on encouraging people to eat out in a pandemic and which spends billions on management consultancies that time and again fail to deliver the results they promise, there is no valid moral argument for cutting or denying care and support to one person in order to provide for another.
We urge social workers at every level to stand in solidarity with the disabled and older citizens who are pressuring for the easements to be scrapped and in comradeship with the care workers facing the devastating impact of Covid every day, and send a strong message that the right way to address the looming pressures of the coming winter is to properly fund both social care and the NHS.
Christian Kerr is a social worker and Michelle Janas a social work student and former immunologist
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CC in light of this article I retract my previous statement in relation to CPD/registration and apologise. However, in my view, CC could engender more political leverage since it is vital we challenge this government at every opportunity.
“Easements” seems to mean ways of reducing the support to some clients.
I would expect more support to be deliverer to clients who have specialneeds.
Seems contrary to teh whole basis of teh legislation to me!
I completely agree with Christian Kerr and Michelle Janas for this and previous Government have been despicable in their actions or more so their inactions to all of Social Care.
In fact Social Care has never been fully financially supported since, at least 1970 and more than likely before, when Social Care was brought into the management of Local Authorities from the mishmash of care before from a vast variety of settings.
This was further compounded with the austerity cuts imposed on Local Authorities and then came COVID-19.
The big surprise is that Social Care has managed to exist, but then, in many, instances is has not and the easements introduced by the Coronavirus Act 2020 has made matters much worse, when I felt it was impossible to do so.
It is down to the dedication of care workers, that social care is still with us, but for how much longer, for the final break will come.
At that time Safeguarding will be pushed to the extreme and could even falter, the eventual strain on health care, (NHS), could then be the final straw for our NHS and the death and suffering will then far exceed all we have and are experiencing with COVID-19.
Many hospices are already feeling the strain and this will cause many to cease to exist.
Solving the crisis in Social Care is extremely urgent and can not be ‘pushed further down the Road’, has as occurred many times under various UK Governments.
i, therefore created the petition, Solve the crisis in Social Care,
https://you.38degrees.org.uk/petitions/solve-the-crisis-in-social-care.
There is further information at https://1drv.ms/w/s!Aq2MsYduiazgoBR1KT2qWV9SEX0U?e=kWNE1J, even then this is not exhaustive.
Since COVID-19 this Government has been throwing money around as though it is going out of fashion and Social Care has only received a meager amount, no where near the £12 million
needed to bring the finance back to 2010 levels, which even then was wholly insufficient.
But does this Government, really care about Social Care and those persons in need of Social Care, from their current and past inactions it would appear that they do not.
The Government needs to start to listen and in a way that they understand to what they are listening to, for, if they do not, then there is no hope for Social Care and the persons working in Social Care and those in need of Social Care.
You can help by signing the petition and then sharing.
https://you.38degrees.org.uk/petitions/solve-the-crisis-in-social-care
Is there really no hierarchy of need? Is it ok for people to be going on day trips when other are forced to sit in feces because care has already been committed. The lack of funds is an issue, but so is recruitment.
ADASS, BASW, our self elected leaders: anything to say?
Opposition to the easements is the right position for the profession to take. However, our lack of resistance to the general restrictions on people’s liberties and the devastation caused by the government’s Covid policies on the marginalised in this country is shameful. This is the most anti-poor, anti-human rights and anti-liberty government that there has ever been, and we are silent.
But the profession supports and advocated for easements to continue. As the authors say time for solidarity and comradeship.
As someone very much involved in the governance of Care Act Easements for our local authority I’ve felt they have been helpful to support the profession, and we have used the government’s guidance to support us in monitoring how our services have coped so far. We have not enacted easements, I believe only 6 local authorities took those steps, and even then these were stage 3. Stage 4 are the easements which would allow professionals to make decisions to prioritise aspects of one person’s care over another (a horrendous thing to have to do).
The underlying principle is that easements are only enacted when the local authority is at it’s knees, so to speak. Here, we have emphasized the necessity to maintain the principles and values of the Care Act and the Ethical Framework during this time, which has also been stressed in the government guidance. We have introduced a strict framework in the event the we would have to consider easements, and the basis is that they are not enacted unless there is absolutely no alternative. I’d hope (though can’t know) that other LAs are taking a similar approach.
From working quite closely with the government guidance on easements, I see it as a tool to support LAs to mitigate against the risk of having to put easements in place – and to ensure, should a LA find they are at the point of breakdown, that the situation is managed in a way that reduces the risk for the people we work for. There needs to be governance to ensure a situation doesn’t spiral and, more importantly, ensure that if there are any changes to what we provide these don’t become the ‘new normal’ – that we get services back to business as usual.
To be clear, I am not against holding the government to account for it’s chronic under-funding of social care and in no way should the Coronavirus Act be a tool to put pressure on LAs to enact easements.
I’d love it if we had the funding to be able to cope with the oncoming winter, but this doesn’t seem forthcoming. And I feel that even if we had a sudden and significant injection of money, we would not have the time to ensure this protects the people it is for. I wish there was no need to have the concept of care act easements, but unfortunately I think this is the reality of the situation we’re faced with.
Hi
I really appreciate this response which helpfully sets out the difficult position of LAs at this time. It does pose the question again of who the easements are actually for.
As a social worker I believe it important to constructively challenge policy that runs counter to the rights, interests, wishes and hopes of those we support.
Following on from the above piece, Michelle Janas and I have been discussing between ourselves and some others our concerns about the DHSC winter plan, some of which we set out below. We also suggest some alternative measures aimed at supporting social workers to support the people already bearing the brunt of the impact of Covid:
https://medium.com/@SocialWhatNow/an-alternative-winter-plan-for-social-work-91d846776a4d?_branch_match_id=841755469217678935
Social work must as far as is possible take its lead from those whose lives it is intended to improve. Many of those people are deeply concerned about what the easements mean to them. It is a key function of the profession to listen and to work to effect positive change for those people even when – perhaps especially when – that brings us into conflict with national and local policy.
Best,
Christian
I am confused: easement possibilities are a mitigation against easement? Possibility of cutting provision is a safeguard against denying provision? If there are cuts and denial of services these are in fact for the benefit of service users? Arbitrary decisions based on lack of local authority budgets are a possibility but we have to see this as a governance tool? Alice in Wonderland masquerading as caring social work.
Why are Local Authorities paralysed when faced by the demands of provider agencies but lion brave when denying services to the rest of us? The justifications and the hand wringing are sickening. I suppose LA’s can’t really say much having embraced privatisation with relish.
Easements may not have been formally enacted but covert pressures on us to shoehorn our assessments to deny provisions is real now. I have had numerous assessments sent back for revision. Pressures on my colleagues are constant. We are confronted with threats that not revising assessments and recommendations call into question our competence with all that is implied by that. The complicity of BASW in all this is astonishing.