The impact of the COVID-19 pandemic among those who rely on social care, and those working to care for them, is becoming clear. There have been more than 30,500 excess deaths in care homes alone during the pandemic in England. High rates of mortality among care home residents have been observed in multiple countries. Compared to 10 other European countries, residents of care homes in England and Wales account for a lower proportion of total COVID-19 deaths. But when measured as a proportion of deaths of all residents in care homes, the UK has one of the highest proportions of deaths attributed to COVID-19 in comparison to 15 countries with equivalent data.

The first confirmed case of COVID-19 was reported in the UK on 31 January 2020. The SPI-M-O committee provided a consensus view of the evidence (dated 16 March) that isolation of cases (and their households) and social distancing of vulnerable groups was unlikely to prevent critical care facilities in the NHS being overwhelmed.

On 16 March, the government announced strict social distancing measures for all, followed on 23 March by the Prime Minister’s televised address announcing additional measures (including the national lockdown). But UK figures on COVID-19 cases and deaths were initially not broken down by those receiving social care, either in care homes or the community. The number of COVID-19 outbreaks in care homes was first made public by Public Health England at the end of March, but the scale of the mortality only became clear as the Office for National Statistics (ONS) began to report place of death in April. Until then, the alarm had been sounded in the media by those working in the sector.

In this briefing we give an overview of the impact of the COVID-19 pandemic on social care (as defined in Box 1) in England. In part 1 we describe how the pandemic unfolded in the social care sector from March until June 2020, and in part 2 we examine the factors that contributed to the scale and severity of outbreaks in care homes. In part 3 we attempt to quantify the disruption to health and social care access from February until the end of April 2020.

We use a mixture of national data sources from England, individual level data from the health care service, and publicly available data reported by Public Health England, Care Quality Commission (CQC) and ONS. We carried out novel descriptive analysis, with all code available and further description of the methods set out in the technical appendix to this briefing.

The impact of the COVID-19 pandemic in social care unfolded in a wider policy context. Issues such as what testing capacity was available, where resources were focused, and when government action was taken are essential to understand how the pandemic unfolded. These issues and the long-term neglect of social care, are addressed in Adult social care and COVID-19. Assessing the policy response in England so far.

Box 1: The context of social care

Settings: Social care might be provided within the context of:

  • care homes (residential or nursing care homes with 24-hour nursing available)
  • domiciliary care (supporting an individual living in their own home)
  • day care or community care (such as community outreach and carers’ support).

Social care workers: Data on the social care workforce indicate that of the 1.62 million jobs in social care, 42% are in care homes, 42% are in domiciliary care and 15% are in community-based or day care services. These data do not include those who are self-employed as personal assistants. There are also approximately 8.8 million adults providing unpaid care in the UK.

Social care users: There is a lack of accurate data on the number of people receiving each type of care. However, 842,000 individuals receive long-term support at any time of the year from local authorities. 35% of this group are younger adults (18–64 years old).

Those receiving social care will often have additional support needs, health conditions, frailty, or disabilities that mean they need additional assistance with day-to-day living. Similar information is not available at a national level for those receiving domiciliary care.

Paying for care: Care can be self-funded, but funding from local authorities is means-tested. Those receiving funding can elect to use direct payments to organise their own care. Therefore, care can be state or self-funded and state or self-organised. Those who self-fund and/or self-organise their care are often missing from much of the data on social care. In addition, a large number of adults receive unpaid care (in 2016, this totalled around 7.9 billion hours)., Finally, there is significant unmet need – there are people with a need for social care who are not receiving it and there are little data available on this group.

* Proportions have changed substantially since, but in May, this ranged from 26% in England and Wales to 66% in Spain, as reported in Eurosurveillance in a comparison of European/European Economic Area (EEA) countries:;jsessionid=3J2C0s4lvuDr3TVRh0h3b3Og.i-0b3d9850f4681504f-ecdclive#html_fulltext

SPI-M-O is the Scientific Pandemic Influenza Group on Modelling, Operational sub-group for the Scientific Advisory Group for Emergencies (SAGE). Full text of the consensus statement is available here:

The technical appendix can be viewed at

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