Introduction

England is slowly emerging from its third national lockdown and numbers of daily COVID-19 hospitalisations and deaths have fallen considerably since late January 2021. But people across the country have been hit hard by COVID-19. Excess deaths during the pandemic in 2020 were among the highest of any country., Total deaths directly related to COVID-19 have passed 112,000 in England alone.

The impacts of COVID-19 on people using adult social care – adults of all ages who need care and support because of disability and illness – have been significant. By 2 April 2021, there had been 27,179 excess deaths among care home residents in England since the start of the pandemic. And there had been 9,571 excess deaths reported among people receiving domiciliary care since 11 April 2020 – an increase of 62% compared with recent years. Social care staff have been more likely to die from COVID-19 than others of the same age and sex. The burden on unpaid carers – mostly women – has increased, affecting their health.,,

The national policy response to COVID-19 is complex and evolving.,, Policy decisions have been made in an urgent and uncertain context. But it is clear that there have been major problems with the government’s approach to supporting adult social care in England.,,,, During the first wave of the pandemic, social care services experienced shortages and slow access to personal protective equipment (PPE) and testing, insufficient financial and other support, and relative neglect by policymakers in favour of the NHS. Overall, our assessment – based on analysis of policies between 31 January and 31 May 2020 – was that government did too little too late to protect people who use adult social care and those who care for them.

The government’s policy response to COVID-19 has been shaped by underlying structural factors. The social care system that entered the pandemic was underfunded, understaffed, and undervalued. Funding per person adjusted for age fell by 12% in real terms between 2010/11 and 2018/19. Fewer people are receiving support from local authorities, despite rising needs. Workforce shortages going into COVID-19 were estimated at 122,000. And many social care staff work for low pay and under poor terms and conditions. The organisation of social care in England is also complex and fragmented., Successive governments have promised reform of England’s broken system of social care and support, but none have delivered it.

In this briefing, we analyse central government policies on adult social care in England after the first wave of the COVID-19 pandemic – from 1 June 2020 to 28 February 2021. This includes policies to support adult social care during the height of the second wave of the pandemic in January and February 2021, and in the months leading up to it. We provide a narrative summary of central government policies related to adult social care in different areas, such as policies on testing and support for the workforce. Where possible, we use publicly available data to describe how these policies were implemented. We also provide a summary of the latest publicly available data on the impacts of COVID-19 on adult social care. In the final part, we make an assessment of the policy response following the first wave, consider how policies changed over time, and identify priorities for the future.


* For excess deaths among care home residents, we compared deaths to the 5-year average (2015–2019). For excess deaths among people receiving domiciliary care, this was compared to the 3-year average (2017–2019).

The number of excess deaths for the whole period (since the start of the pandemic) is lower than the number of excess deaths in the first and second waves combined, depending on when the start and end date of these two waves are defined (and if this definition involves a gap between the two waves). During July and August 2020 – what we have taken as the period in between the two pandemic waves – there were fewer deaths than expected, so this decreases the total for the whole pandemic period.

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