Key points

  • The coronavirus (COVID-19) pandemic has had a profound impact on people receiving social care. As of July 2020, there have been over 30,500 more deaths among care home residents in England than we would normally expect. A further 4,500 excess deaths have been reported among people receiving domiciliary social care.
  • While fewer domiciliary care users have died than care home residents, in proportional terms the increase in deaths has been higher in domiciliary care than care homes (225% compared with 208%). Domiciliary care users continue to die at a higher rate than has been reported in previous years. Many of these additional deaths have not been linked explicitly to COVID-19. It is unclear whether these additional deaths are due to the indirect impacts of the pandemic or as a result of undiagnosed cases.
  • It is not just those receiving social care who have lost their lives during this pandemic. Social care workers are among the occupational groups at highest risk of COVID-19 mortality. Among this group, care home workers and home carers account for the highest proportion (76%) of COVID-19 deaths. We do not know exactly when these deaths occurred, so it is not possible to understand the extent to which more recent policy changes and infection control measures have improved safety for staff.
  • COVID-19 outbreaks in care homes may be driven by multiple factors, including community transmission as well as infections picked up during hospital stays. Our analysis shows that between 17 March and 30 April, discharges from hospitals to care homes decreased in England to 86% of the historical average. 46,700 people were discharged from hospital to care homes between 17 March and 30 April – 7,700 fewer than previous years. The data available do not allow us to examine whether these discharges led to subsequent outbreaks in care homes.
  • We found that while discharges from hospitals to residential care homes were 75% of the historical average, discharges from hospitals to nursing homes increased to 120% of the historical average.
  • During March and April, similar to the general population, there was a substantial reduction in hospital admissions among care home residents. Elective admissions reduced to 58% of the 5-year historical average during this period and emergency admissions to 85% of the 5-year historical average. During this time, 14% of admissions had COVID-19 as the primary cause. By reducing admissions, care home and NHS teams may have reduced the risk of transmission. There may have also been an increase in unmet health needs but the data currently available do not allow us to assess whether this was the case.
  • Long-standing structural issues have exacerbated the crisis in social care and hindered the response to the pandemic. But action is needed to prevent further harm, and this includes the need for data to fill the gaps highlighted in this briefing. Many of the most pressing data gaps concern domiciliary care, as it is not currently possible to track and understand the spread of infection in these settings. We also need more data on the health and care needs accumulated during the pandemic, and how well social care users are able to access essential services.
  • The Health Foundation is undertaking a wider programme of work to improve social care data. Our work so far has pointed to deep-rooted structural and cultural challenges that impact how data are collected, shared and used. A new data strategy is needed for social care that first and foremost enables the provision of better care.