Key points

  • A key question for any future inquiry into the government’s handling of COVID-19 will be how well government protected people using and providing adult social care.
  • COVID-19 has had a major and sustained impact on social care in England. There have been 27,179 excess deaths among care home residents in England since 14 March 2020 (a 20% increase compared with recent years), and 9,571 excess deaths reported among people receiving domiciliary care since 11 April 2020 (a 62% increase). Social care staff have been at higher risk of dying from COVID-19 than others of the same age and sex. The wider health impacts – from reduced access to care, social isolation, increased burden on carers – are harder to measure but also significant.
  • The policy response to COVID-19 is complex and evolving. Challenges in protecting people who use and provide social care during the pandemic have not been unique to England. The task of protecting social care is closely tied to the broader task of protecting the population from COVID-19.
  • During the first wave of the pandemic, central government support for social care in England was too slow and limited, leading to inadequate protection for people using and providing care. In this briefing, we analysed national government policy on adult social care in England after the first wave of COVID-19 – between June 2020 and March 2021.
  • Overall, we found a mixed picture. Support in some areas improved, such as access to testing and PPE, and the priority given to social care appeared to increase. Groups using and providing social care were prioritised for COVID-19 vaccines, alongside the NHS. This is likely to have offered much greater protection to care home residents and others.
  • But major challenges remained. Government policy on social care was often fragmented and short-term, creating uncertainty for the sector and making it harder to plan ahead. And policies in key areas, such as on regular testing in social care, still came slowly – including over the summer of 2020, when COVID-19 outbreaks continued to occur in care homes, despite very low prevalence of COVID-19 in the community.
  • There have also been persistent gaps in the national policy response, including support for social care staff and people providing unpaid care. Government policy also risked leaving out people using and providing care in some settings, including younger adults with learning disabilities and autism. These gaps risk exacerbating inequalities.
  • A lack of publicly available data means that we only know so much about the impacts of the pandemic on social care, and the success of policies to support the sector. Data on care provided outside care homes are limited and hard to interpret. This is concerning, given the sustained increase in mortality reported among people receiving care at home.
  • Major structural issues in social care have shaped the policy response and effects of COVID-19 on the sector. These include chronic underfunding, workforce issues, system fragmentation, and more. COVID-19 also appears to have made some longstanding problems worse, such as unmet need for care and the burden on unpaid carers. The longstanding political neglect of social care in England has been laid bare for all to see. Continued neglect would leave the system vulnerable to future shocks.
  • Fundamental reform of adult social care in England is needed to address the longstanding policy failures exposed by COVID-19. This reform must be comprehensive and long-term – not narrowly focused on preventing older people selling their homes to pay for care. Immediate policy action and investment is also needed to support the system to recover from the pandemic and prepare for potential future waves of COVID-19.