The social care workforce is amazing.  It is responding to the current challenges with passion and selfless dedication.  As hospitals are stretched beyond capacity and every single bed is needed, the social care workers are supporting with rapid discharges whilst ensuring the safety of individuals.  Discharge to assess and hospital social work teams are working constantly to ensure beds are available to support the fight against the Coronavirus. Local authorities are mobilising their social care work force to respond to these challenges and are supported with the changes in the Coronavirus Act 2020 which are intended to enable authorities to prioritise resources.

To enable local authorities to respond to the most urgent and serious cases, most of the duties contained in the Care Act 2014 have been temporarily suspended during the COVID-19 pandemic, under changes to adult social care which are contained in Schedule 12 of the Coronavirus Act 2020.  Local authorities are already experiencing an increase in demand from vulnerable people and whilst battling the challenges of hospital social work and discharges to support an overwhelmed NHS, councils are being proactive with the early identification of people potentially most at risk and looking to create prevention and early intervention strategies to avoid further crisis.  Many local authorities are using targeted support models and identification tools to help them identify and engage with people to provide information, advice and support.  We can see volunteers, charities and third sector organisations coming together to respond to the crisis; food banks, befriending services, distributing packages, sharing creative ideas to reduce social isolation, etc.  People are uniting to battle the crisis.  Organisations are unifying.  We are trusting one another and relationships between sectors are strengthening.  The third sector are proving, beyond doubt, the massive value they add to the community. 

The extent of the impact of COVID-19 is not limited to the more obvious hospital crisis but extends to the community as peoples’ mental health and the impact of social isolation is being recognised as a major risk to people.  Many councils have identified that, as a result of the restrictions imposed due to COVID-19, there is risk of social isolation for vulnerable people who would normally access community-based support to meet their personal outcomes. It has long been acknowledged that ‘community life, social connections, and having a voice in local decisions are all factors that have a vital contribution to make to health and wellbeing’ (gov.uk) Much work has been undertaken over the years to develop community based support, ensure integration with people who use services and the local community, personalisation and breaking down barriers to those with disabilities, much of which has been halted by this unprecedented challenge. Support plans which have been codesigned with people who use services and include daily use of community resources have been placed on hold due to the new rules around social distancing and only accessing the local community for essential purposes. 

One of my first thoughts was for people with learning disabilities and the often-complex packages of support which blend formal services with community resources. By the very nature of some disabilities, routine and structure are everything.  These suddenly imposed changes to routine support to access the community, participation in social activities and attending volunteering and learning opportunities could be difficult for some people who use services to understand and may result in changes to behaviours. 

Let’s meet Fred.  Fred is 49 years old and lives in a shared living scheme with 3 other people who use services.  One of Fred’s personal outcomes is that he requires support to access community resources for physical exercise and mental stimulation. Once a week he goes to see his parents, both of whom are in their 70s with underlying health conditions.  Fred is currently supported to access the community with 1:1 support due to risks around road safety and a history of behaviours of concern.  The care and support provider receives contact from the local authority who provide information and guidance around community support for shopping, medication, how to stay safe, contact information in the event of an emergency etc.

The implications of COVID-19 mean that Fred can only go out once a day for exercise. He is unable to access cafes or see his parents.  Fred is unsettled and is displaying behaviours of concern which has made accessing the community difficult. Fred is spending more time at home and there are difficulties in his relationships with the other people he lives with as everyone is forced to socialise within the home environment for long periods each day. Fred now requires 2:1 support both in and outside the home. This becomes an urgent and serious case for which social worker support is required; a new assessment due to significant change in need, an increased package of support etc, etc. It is here that we find our new wave of crisis.  Because Fred isn’t alone.  There will be many, many people with complex needs who will struggle to adjust to these sudden changes and severe restrictions to their everyday life.  Social Care is faced with increasing demand due to COVID-19 so how are councils responding to these situations? TRUST!  Providers are contacting social care and reporting these changes in need and workers are trusting their knowledge and insight, they are trusting their existing relationships with people and that they know the individuals and what support is needed. Councils are implementing the changes to the support over the phone, recording the outcomes and trusting the providers to arrange and amend the support package to ensure the wellbeing of individuals.

The ‘lockdown’ rules present a risk of social isolation for many of us and as many of us will indeed struggle with isolation. For those people who require support and services, it would seem, the impact could be far worse.  However, councils are going further, by recognising the impact of social isolation to those people who are not receiving services, the people who are ‘managing’ with the support of family, friends, other informal networks or have very small packages of support.  What happens to their ability to cope when socialising is removed from their daily life? It has long been recognised that social isolation and loneliness is associated with a range of mental and physical health impacts: strokes, heart disease, weakened immune system, increased risk of falls, Alzheimer’s disease, depression, anxiety and suicide.

Now we meet April.  April is 78 years old and has been asked to self-isolate.  April would normally go to her local shops daily to buy food and get exercise. April is known in her local community and enjoys speaking to people, many of whom she has known for years.  April has reduced mobility due to osteoarthritis and has a history of falls. She has OT equipment in place to support her around the home such as a perching stool and grab rails.  April uses a walker to access the community. She likes to be as independent as possible and has a stand up wash every day and a minimal package of support for a bath and hair wash once a week.  Family help with cleaning and laundry and April goes to her daughters for a roast dinner every Sunday and to her son’s for dinner every Wednesday.  April visits her local library every Tuesday for a book club and attends a weekly coffee morning at her local church. April’s daughter takes her to church every Sunday.  Since self-isolating, April has lost her routine, her social interactions and has become depressed.  Since losing her opportunity for daily exercise, April is experiencing an increase in joint pain.  April’s community and family have rallied round, and food is delivered. Her family have provided an i-pad so she can video-call family members and see her grandchildren which April says has helped.  However, April’s carer has expressed concerns to the family and council around her mental wellbeing and some signs of self-neglect within the home. The carer describes some decline in April’s mobility, that she seems unsteady on her feet and the carer is worried that April is at an increased risk of falls.  The carer is not sure if April is eating or managing medication and she seems muddled.  The family stated they would be happy to support with personal care and would explore assist technology to support with medication however, they are unable to action this now due to self-isolation.  The council record the risks and agree to implement a daily visit to support April with her personal care and to prompt with medication.

Prior to the Covid-19 crisis, both case studies would likely have required a home visit from adult social care due to the change in need, however we can now see councils responding from a position of trust.  It is fair to say that this trust has come about from a lack of resources and a need for social care to prioritise urgent and severe cases, but the trust is there and it is resulting in quicker and smoother solutions to immediate need.  Moreover, gone are the delays in responding due to waiting lists and a need to prioritise risks.  Gone are the panels and other formal approval processes for funding.  Gone is the, often clunky, assessment and review documentation, which has been reported as a blocker to conversations and timely interventions. In their place we can see conversations between individuals and those who know them best.  We can see communities, volunteers and third sector organisations being trusted to engage and respond with people they know. We can see less demand for statutory services, formal processes and social care interventions.  Which means our skilled social care workforce can continue to respond to urgent needs within hospitals, supporting the NHS in this unprecedented crisis.

For the reasons identified above, it is likely that we will see continue to see significant increases in packages of support and an increase in people requiring support in the community as they lose their informal networks of families, friends and communities. The changes to the Care Act are reported to be in place for up to 2 and a half years, and therefore reviews and assessments are a power rather than a duty. However, reviews and assessments will need to be carried out- a function that was already stretched within adult social care.  So how will councils cope with the increase in demand, in business as usual community reviews and in people who use services? The truth is, we don’t know.  Many councils are not able to consider this as the respond to the current increasing demand. It seems the fitting answer is to build on these new approaches of trusting providers, trusting care agencies and third sectors who have existing relationships with people.  If we can trust them in crisis, can we extend this trust into the future therefore extending and continuing this sense of community and togetherness we see now?  As we utilise the resources and knowledge these organisations and providers have to respond to the crisis, can we see this as a new approach to implement in our services and practice? Can we simplify processes and remove some of the formalities and structures that serve as time consuming and potential blockers to true conversation-based approaches?

It would require training and upskilling of voluntary and third sectors as the Care Act is clear that those undertaking assessments and reviews should be skilled to do so.   It would require ongoing support and joint working.  It would require a unified approach and trust.  But we can already see that it is possible.

Author: Charley Maher, charley.maher@redquadrant.com

Charley is an experienced adult social worker who has developed into a highly effective Change and Transformation Consultant. Charley has experience of organisational change, while supporting Operational Managers to improve the quality of practice. Her most recent project involved helping a local authority design a new pathway for adult social care that incorporated third sector and voluntary organisations.