Fixing social care

How do we learn from the unfolding reality of Covid 19 in care homes? Can this help inform a new future for adult social care? What is the role for data and Civil Society in this context? I raised and debated these questions with colleagues during an IFG Event earlier this week.

There is a risk that nothing changes for social care as result of this crisis. In fact, things could get worse, if the post wave one focus is mainly on economic growth and getting people back to work. Social care could remain stuck in the long grass. I remain unconvinced that social care is a priority for this government.

At 10 Downing St on 24th July 2019, the Prime Minister said “we will fix the crisis in social care once and for all” and yet most recently he has expressed “bitter regret” at the incidence of Covid 19 infection and death in care homes. The government’s strategy from the outset has been to protect the NHS – which appears to have worked so far. But the consequences for social care, even if unintended, have been tragic and significant. As we headed out of April, the Office for National Statistics reported that the number of weekly care home deaths exceeding the 5-year average (2013-17) was over 5400 during the fifth week of lockdown. The most recent statistics show that, since then, deaths involving Covid-19 as a percentage of all deaths in care homes rose from 35.3% to 37.8%. These are not just numbers. These are people – with loved ones, whose grief will have been exacerbated by the current circumstances.

Of course, this crisis has also highlighted that social care is broader than the elderly frail or those with dementia living in care homes. It is about children (consider the reports of an upsurge in domestic abuse during this crisis and the effect of that on children and those with mental health and anxiety issues). It is about adults with learning disabilities and disabilities. There are different domiciliary and residential social care settings as well, plus providers of different types and sizes.

So, yes, this is a complex and fragmented ‘system’. But it is first and foremost about people. So, what of data and civil society?

Well – a lack of timely and sufficiently granular data costs lives and the government lacks a robust infrastructure for social care data collection, integration and analysis in the way that it has very rapidly developed one for health and our NHS. The gap has been obvious from the start of this first ‘data-driven’ pandemic and, in fact, Covid-19 has been a galvanising event, shining a spotlight on the urgent need to resolve associated issues. Some of the data is out there but, where it exists, it is locked up in commissioner and provider databases and neither standardised nor readily unified for the purposes of analysis and, crucially, national and regional pandemic modelling at pace.

At Future Care Capital we understand the implications of these gaps in practice. So, when the government demands mortality data at the same speed from social care and health providers, it is challenging. Through our research, my organisation has called consistently for better access to, and analysis of social care data to inform planning and for the need to develop national data analytic capability in this respect. We have also been an advocate for investing in and improving the life-critical technological infrastructure to positively impact on outcomes for those in receipt of care. Covid-19 has demonstrated that people have flocked to use technological solutions but there is still a very palpable digital divide, with a lack of digital maturity, inclusivity and access for too many.

My organisation is a charity and part of civil society – the ‘third sector’. Civil society also includes voluntary sector organisations and social enterprises. But communities and individuals are also part of this third sector. During this crisis, we have seen the power of community spirit, good neighbours and flourishing mutual aid groups across the country. I have a friend in my rural village who has delivered hundreds of prescriptions to fellow villagers over recent weeks. Local examples remind us of the critical role that charities, communities and citizens play in maintaining the social fabric upon which we all rely – in particular, where Covid-19 has laid bare the health inequalities that remain in our society which were highlighted once again only recently by Sir Michael Marmot.

I would argue that successive recent governments have not taken the value of civil society organisations seriously.  A few weeks ago, the Chancellor announced his Covid-19 package of financial support for charities. There was good news for hospices – and I welcome this as a trustee of Hospiscare in Devon. However, the support did not go far enough to protect and support the vital work of many civil society organisations who have already lost vital income generation and fundraising opportunities as well as volunteer capacity during this initial phase of the crisis. If these organisations fold, there are unlikely to be other organisations lined up to grab the baton and run with it.

That said, regardless of the potential existential threat arriving at the doorstep of many civil society organisations, the commitment of people working in the third sector is undiminished.  Representing user voices, advancing user involvement, holding a mirror up to government and speaking truth to power – these remain critical roles for organisations like mine.

The recent lockdown period has impacted every member of our society. Whatever the circumstances of each and every citizen, I suspect there is a growing understanding of the issues associated with loneliness and isolation. It has also highlighted that without better social care data and a fully functioning third sector, the balance between health and social care is not in equilibrium.