Feature: Pandemic response prioritised health over social care

The government’s pandemic response placed a ‘greater emphasis on health than on social care’, a report by the National Audit Office (NAO) has revealed.

The report, which examined the government’s Covid-19 response, found that the UK was not as prepared for the pandemic as it could have been and that it lacked detailed contingency plans to manage the unfolding situation.

The NAO said Covid-19 has laid bare existing fault lines, including the unreformed adult social care system, workforce shortages, issues caused by legacy IT systems and the financial pressure, within society and has exacerbated inequalities.

Certain aspects of the initial pandemic response reflected a greater emphasis on health than on social care. For example, national bodies initially provided more PPE support to hospitals than to social care.

NHS trusts received 80% of their estimated PPE requirement through national schemes between March 20 2020 and July 31 2020, whereas social care providers received 10% of their estimated requirement.

The report found that DHSC took different approaches to providing PPE to social care and trusts during the pandemic. Social care providers either obtained PPE from wholesalers (as they did prior to the pandemic) or from local resilience forums and DHSC’s helpline, whereas trusts received PPE directly from the cross-government PPE team set up by DHSC.

Mental health under strain

The NAO also found that the pandemic placed great stress on social care workers who were already under pressure before the Covid-19 outbreak.

In May 2020 some registered managers in social care responding to a survey by the British Medical Association reported the mental health of workers was under massive strain, with individuals particularly concerned about getting ill and unknowingly passing the virus on.

Some care workers considered that they were not adequately protected during the height of the pandemic’s first wave and many social care providers highlighted being extremely close to running out of personal protective equipment. This created uncertainty, anxiety and stress.

Existing workforce issues also added to the challenges of responding to the pandemic. In a survey of the adult social care sector in late March 2020, 34% of providers responded that they urgently needed more staff.

To deal with the crisis, the government had to streamline decision-making and coordinate efforts across multiple departments, public and private sector bodies.

Danny Mortimer, chief executive of the NHS Confederation, said the report highlights the pressing need to make sure reform of the social care sector is swift and far-reaching.

‘This report reinforces the long-term issues that severely weakened the foundations of health and care, which meant the country was not better prepared to deal with the pandemic and its fallout.

‘Chronic workforce shortages across the NHS, coupled with ongoing financial pressures, have contributed to the devastation wrought over the past year, something the government should have worked harder to alleviate before the pandemic took hold and which still remain a profound challenge.

‘There are also many vital lessons for the government to learn from the past fourteen months, including the need for speed in imposing lockdowns, something that is particularly important to bear in mind as we are seeing a worrying rise in the number cases of the variant of Covid-19 first identified in India.

‘Importantly, this report also highlights the ever more pressing need to make sure reform of the social care sector is swift and far-reaching. The two are sister services, and when one is hit hard, so is the other.

‘Our members stand with their colleagues in social care in their dismay that the experiences highlighted so starkly in this report did not result in the promised action by the prime minister and chancellor.’

Lessons need to be learned

The report has highlighted the importance of adopting a more systematic approach to preparing for crises, improving the resilience of key services and making better use of data.

The NAO said working at pace naturally introduces greater levels of risk, but being transparent, properly documenting decisions and managing conflicts of interest is essential if the government is to maintain public trust that taxpayers’ money is being spent appropriately and fairly.

And, given the human and financial investment required in a response such as this and the continuing risk of further outbreaks, it is essential that lessons are identified, learned and acted on as swiftly as possible.

It said DHSC will need to identify lessons that can be learned. Specifically, the unplanned and unprecedented actions DHSC and its partners had to take to obtain PPE during the emergency.

The NAO recommends a comprehensive lessons-learned exercise involving all the main stakeholders, including local government and representatives of the workforce and suppliers, would inform the planning for future emergencies.

This should include consideration of whether any issues with PPE provision or use might have contributed to Covid-19 infections or deaths, how to determine the priorities when there are shortages of essential equipment such as PPE and how events are recorded during an emergency response to help learn lessons for the future.

The NAO said emergency plans for dealing with a pandemic must provide for appropriate stockpiles of high-quality PPE together with comprehensive and resilient arrangements for the rapid procurement and distribution of PPE, based on reliable information.

Plans need to include the distribution of PPE to social care and all parts of the health system. Organisations responsible for maintaining and testing their plans must actively monitor for new threats that might overwhelm their plans.

The NAO said the government needs to understand why national bodies provided more support to hospitals than to social care and stop it happening again.

Gareth Davies, the head of the NAO, said: ‘Covid-19 has required the government to respond to an exceptionally challenging and rapidly changing threat.

‘There is much to learn from the successes and failures in government’s response and this report is our initial contribution to that process.

‘Applying these lessons is not only important for the remaining phases of the current pandemic but should also help better prepare the UK for future emergencies.’

A government spokesperson said it is committed to transparency and accountability and will review this report and all of its recommendations closely as it considers how, as a government, it plans for the threats of the future.

‘Throughout the pandemic, our approach has been guided by data and the advice of scientific and medical experts.

‘As new evidence emerged, we acted quickly and decisively to protect lives and livelihoods.

‘We have committed to a full public independent inquiry to look at what lessons we can learn from our response to this unprecedented global challenge.’

Photo Credit – Pixabay