Part 3: The availability of essential health and social care services during the pandemic

In both health and social care, services have been reconfigured rapidly to control infections and respond to staff absences. In this section, we present what the data are telling us about the availability of some health and care services during the pandemic. Unfortunately, we have too little data about the impact of these changes on people using social care to take a comprehensive view of the impact.

Changes in access to social care services

There are limited robust data on how the pandemic, and the responses from local and national government,, have affected access to social care. Data on the capacity of social care providers have not been made public (see Box 2), but Skills for Care has reported that staff absences have risen. It should be noted that these issues not only affect organisations providing care, but also individuals or families who directly employ carers. The burden is often falling on unpaid carers to cover the gap.

There are also limited data on how the demand for social care has changed. 26% of care providers reported an increase in demand for social care in May, however, 46% reported a decrease. This reduction in demand for services is particularly worrying in the context of significant unmet and under-met social care needs that pre-date the pandemic. Falling demand for care may be driven by concerns among people needing care, or their families, about the infection risk.,

Changes in access to hospital services for care home residents

Due to lack of available data from domiciliary care recipients, and data from primary and community care, we have focused this section on changes to hospital care among care home residents.

During the pandemic, various measures were introduced to reduce the risk of spreading infection, and ensure hospitals had capacity to deal with COVID-19 cases. NHS England and Improvement requested that all non-urgent elective operations were postponed from 15 April for a period of at least 3 months. These were then requested to resume, in a letter dated 29 April.

Through carrying out novel analysis of all hospital admissions in England (the methods for identifying care home residents are described in part 2 and the technical appendix), we can show that hospital admissions from care homes were higher than the historical average before the pandemic. Admissions then decreased to 79% of the historical average, corresponding to 11,800 fewer admissions during March and April. In this period, admissions from care homes to hospital rose as a share of all hospital admissions (Figure 4) and 6,200 of admissions from care homes (14%) had COVID-19 listed as the primary diagnosis. Admissions from residential care homes decreased more substantially for the same period to 73% of the historical average (6,700 fewer admissions), while admissions from nursing homes only fell to 91% (2,000 fewer admissions).

Unsurprisingly, elective admissions dropped more dramatically (to 58% of the 5-year historical average, equivalent to 5,300 fewer admissions) than emergency admissions (to 85% or 6,500 fewer admissions).

The context for these changes is complex, as there have been substantial shifts in how health care is provided during the pandemic. For example, guidance was issued to care homes about how to support residents who require hospital care, and primary and community care teams were advised to conduct weekly check-ins, examine patients and facilitate the supply of medication. Some care needs therefore may have been met by these additional measures. Previous analysis by the Health Foundation has shown that avoidable emergency admissions can be reduced through enhanced primary care in care homes. Infection risks in hospitals may have also affected decisions around care during this period. For example, care delivered by primary or community care, or staff in care homes, may have been preferable to a hospital admission during this period.

Nevertheless, these data highlight that there may be substantial unmet health needs among care home residents for elective care. Further research is needed to quantify the impact, if any, on mortality and other outcomes, which will need to be addressed as the system moves into long-term planning.

§§§ 16.4% of care homes could not be categorised as residential or nursing homes; admissions fell to 70% for this unknown group.

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