Adult Social Care under Pressure: Lessons from the Pandemic

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“Our research suggests that the creation and establishment of Care Act easements in the West Midlands can only be understood when properly situated in its emergence as part of successive pandemic planning exercises.”

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Adult social care provision has been under considerable strain for many years. It is widely acknowledged that funding cuts have affected the range and quality of the services and support that many adults rely on in order to live full and active livesi. This has in turn had an impact on those working in the social care sector, with social workers also reporting that austerity has had “a direct impact on citizens who use social work services, on the social work task and on social workers themselvesii.” From this baseline, it quickly became clear at the start of 2020 that the Covid-19 pandemic would have a disproportionate adverse impact on people living with disabilitiesiii, older peopleiv, or those living with chronic illnesses. These people were often identified as clinically vulnerable or extremely clinically vulnerable, and were therefore required to ‘shield’ themselves from the threat of infection, exacerbating social isolation and difficulties in accessing support. 

Successive pandemic planning exercises had identified that the social care sector would likely be under extreme strain in the event of a significant pandemic event, including major pressures on workforce capacity. It was suggested that what was needed were “easements” - mechanisms to enable departure from existing provisions under the Care Act 2014. These were introduced in March through the Coronavirus Act 2020.  The 2020 Act enabled local authorities to depart from existing requirements concerning assessment of support needs, financial assessments, and provision of care and support for individuals and carers. These easements were intended as a “last resort” should pressures on workforce capacity become too great due to illness, absence, or increased demand. Any departure from meeting individual service users’ care and support needs or the support needs of carers was subject to the limitation that the local authority must do what it considered necessary “to meet those needs for the purpose of avoiding a breach of the adult’s Convention rights.”v

Grave concerns were immediately voiced by disabled people’s organisations, civil rights groups, and the wider community about the implications and possible impacts of Care Act easements. Would this new legislation mean that service users’ rights and/or standard of support would drop? Some argued that the principle itself was faulty at a time when service users required more support and reassurance than ever. 

In Government Guidance the “easements” were categorised into four stages of seriousness, with only the highest two - Stage 3 and Stage 4 - officially notifiable to the Department for Health and Social Care (DHSC). In the event, only eight local authorities across England (including a notable ‘cluster’ of five in the West Midlands, the focus of our research) formally activated the higher-level easements. This caused controversy and these local authorities were subject  to freedom of information requests and media attention that suggested that their actions were “[paving] the way for vital safeguards to be stripped away just when people have become even more vulnerablevi.” Less than two months after these local authorities had activated the higher-level easements, they each in turn announced that they were no longer in use, and no further such easements were notified to the DHSC. The provision was formally withdrawn from the Coronavirus Act in July 2021.

So was this simply a matter of few weeks’ departure from the norm? Were these easements destined to be an aberration, a footnote in accounts of the pandemic by legal historians in decades to come?  Our new report - Social Care Provision under Pressure: Lessons from the Pandemic - which contains the initial findings from our 18-month long ESRC-funded research on the development, implementation, and impact of Care Act easements suggests that this is a much more complex story with the potential for longer term implications. The report scrutinises the development, legislation and associated guidance and implementation of Care Act easements in the West Midlands, drawing on some 40 interviews with key stakeholders at local and national level. It provides insights into how those working in local authorities and the voluntary sector faced the challenges and heavy responsibility of supporting their communities through the worst of times. 

Our research suggests that the creation and establishment of Care Act easements in the West Midlands can only be understood when properly situated in its emergence as part of successive pandemic planning exercises. In contrast to recent suggestions in the House of Commons Health and Social Care Select Committee, social care was part of pandemic planning from early in 2020, with leading actors in social care involved in developing policy before the Social Care Sector Covid-19 Support Taskforce was set up in May 2020. Secondly, the operation of easements was impacted by insufficiently clear messaging from DHSC as to the approach to communication by local authorities and as to what actually constituted an “easement”. This in turn translated into what appeared, from the perspective of stakeholders, to be a “grey area” regarding their implementation. Thirdly, while major attention was focused in the early months of the pandemic on the five West Midlands authorities that had formally activated easements, a much more complex situation was in fact emerging across the region. A large group of local authorities that had not formally activated higher-level easements or which had not indicated at all that they were departing from normal Care Act practice were in fact behaving in similar ways to those that had - with, for example, simplified or delayed assessments, a move to online or telephone working, and closures of day care centres and opportunities. Fourthly, the operation of “easements” in the broad sense was something which went far beyond the first wave in Spring 2020.

The introduction and departure of the Care Act easements has perhaps helped draw attention to the acute pre-existing pressures facing adult social care provision, and the shortfalls in its budgets and workforce; they may also have emphasised the in-built limitations or potential “flexibilities” of the Care Act 2014. The problems that the easements were designed to alleviate have by no means abated, and arguably the conversation about reform of adult social care is just now reopening with the launch of the Government’s Build Back Better: Plan for Health and Social Care.vii 

Even after the official end of the lockdowns and public health restrictions of 2020, campaigners claim that many people who draw on support risk remaining in a state of “permanent lockdown,” without fundamental reform and control of the resources needed to shape their own lives. As stated by #socialcarefuture:

There is a lot of talk about “fixing” social care but it is mostly limited to the question of funding without asking what the funding is for, or how social care could be better organised to use the resources we have most effectively. We strongly agree more money is needed, but we worry that even with extra funding, it won’t end our permanent lockdown if spent on the wrong things.viii

Social care provision is at a critical juncture. Will the legacy of the pandemic be more lasting than perhaps first thought? To explore the issues raised in our report in more depth, please join us for a webinar on Friday 5th November, 12 noon – 2pm. We will be discussing these issues, along with lessons learned and possible futures for social care, with a  leading panel of speakers: Jon Glasby, Professor of Health and Social Care, School of Social Policy at the University of Birmingham; Naomi Madden, Director of Projects at Grapevine, Coventry and Warwickshire; Catherine Needham, Professor of Public Policy and Public Management, Health Services Management Centre at the University of Birmingham; Anna Severwright, campaigner and co-convenor of #socialcarefuture; and Dionne Williams, Managing Director of Forward Carers, a not-for-profit social enterprise that supports carers in the West Midlands.

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