References

Bottery S for The Kings Fund. 2019. https://tinyurl.com/yxqnl4zc

Bottery S for The Kings Fund. 2020. https://tinyurl.com/yy3xtz8d

Department for Health and Social Care. 2020a. https://tinyurl.com/y69u64vz

Department for Health and Social Care. 2020b. https://tinyurl.com/y662pyyv

Government announces new adult social care chief nurse role. 2020. https://tinyurl.com/yxnufabf

NHS England. 2020. https://tinyurl.com/y6n75q23

Covid-19: Social care's forgotten workers— they matter too. 2020. https://tinyurl.com/y62xj823

We can't leave social care in the cold

22 October 2020
Volume 29 · Issue 19

Abstract

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the challenges facing the social care sector and the need for more joined-up working between health and social care

I joined a panel on the local radio recently to discuss how health and social care teams were working together to plan how we deliver care over winter. Over the last couple of years my understanding of adult social care and my working relationships with colleagues across the sector has developed into a true partnership. Throughout the COVID-19 pandemic there has been criticism that much attention has been paid to the NHS acute provider nurses, but that colleagues in social care have been forgotten.

Stewart et al (2020) highlighted that of the 1.5 million people employed in the care sector, approximately 840 000 general care workers are caring for approximately 420 000 vulnerable people in care homes. They made the point that social care workers often feel undervalued, being referred to as ‘low-skilled and low-paid’ staff, typified during the pandemic when it has been suggested that the poor response by the government to support staff in the social care sector may have contributed to excess deaths.

Bottery (2019) writing for The King's Fund flagged eight key issues that are consistently identified by service users, carers and families, policymakers and people working in the social care sector:

  • Means testing
  • Catastrophic costs
  • Unmet needs
  • Quality of care
  • Workforce pay and conditions
  • Market fragility
  • Disjointed care
  • The postcode lottery.
  • For each of these issues, Bottery highlighted an added dimension: ‘for how long?’. The realities of an ageing population and more working-age adults living with complex disabilities mean any response will need to look decades ahead, not just consider the short term.

    Writing again in 2020, Bottery highlighted that in six of those eight areas, COVID-19 has brought significant change and, if anything, exacerbated these challenges— quality of care, excess death rates, unmet needs and unwarranted variation. Although the social care workforce has latterly received recognition from the public, market fragility has been exacerbated, leading to an increased risk of disjointed care. In summary, Bottery (2020) argued that social care is emerging from the initial stages of COVID-19 with:

  • A sector, and those working in it, struggling to come to terms with thousands of deaths
  • Services trying to get back to some semblance of normality, or even just stay in business
  • Local authorities facing increased levels of demand but uncertain finances
  • (Probably) wide local variations in demand, access and provision of care but no reliable data about this
  • A legacy of sometimes bitter disagreement about national policy and implementation. In February this year the Chief Nursing
  • Officer (CNO) for England appointed an advisor on improving support for care home nurses, to provide expert advice from those nurses working to deliver the high-quality clinical care for people living in care homes, helping them to stay healthy, happy and independent for longer (NHS England, 2020). The aim of the post is to ensure that the voices of nurses in care homes are heard at the very top of the nursing profession. The development of this post aligns closely to one of the NHS Long Term Plan ambitions to support more people to age well, which includes offering more support in care homes through making sure they have strong links with local general practices and community services.

    In September 2020 there was a further development that clearly signified the support for strengthened leadership in the sector with the announcement of plans for a new Chief Nurse for social care. This was one of the measures included in the Department for Health and Social Care (DHSC) adult social care winter plan for England (DHSC, 2020a; Mitchell, 2020).

    According to the press release from the DHSC (2020b) ‘The new chief nurse for adult social care role will provide clinical and professional leadership, while upholding and raising standards among the care workforce.’

    In my view, to separate health care and social care for the majority of citizens is less than helpful. There are a number of synergies from Bottery's eight key areas that require leadership and system working. The appointment of a senior nursing post at this level signifies many opportunities for us to work together to make the improvements that the public deserve.