How local government has responded to Covid-19: adult social care

The local government response to Covid has been wide-ranging and involved all elements of council services. In a series of five pieces this week, the Labour leader of Trafford Council, Cllr Andrew Western, will set out what the response has looked like in a range of key areas. This piece, on adult social care, is the first.

When Labour took control of Trafford from the Conservatives two years ago this month, it was rightly a huge cause for celebration for the party both locally and nationally. Trafford had long been that jewel in the Tory crown: a northern, metropolitan authority fully on message and totally behind the programme of austerity – despite its impact on local services.

I knew then that becoming leader of the council was a huge responsibility and would be an incredibly difficult job in times of austerity, during which local government has been ruthlessly and politically targeted to bear the brunt of cuts. I had no idea, however, that two years later I’d be leading the council’s response to Covid-19, a crisis that touches every aspect of what we do and impacts everyone in our community. I wanted to write about just some of what we in the local government family are having to contend with at present, starting with one of the key areas of our response: social care.

Social care has been creaking for a decade. The private sector dominates the market and whilst the cost of care has increased significantly, government funding has not matched this, nor has it met the increased demand that our ageing population has required. There is a general acceptance that the system is broken, yet we are still in limbo ahead of the publication of the long-awaited green paper on social care. It stands to reason that coronavirus has added to this considerable pressure within the system, given the disproportionate risk the disease poses to older people – the majority of care home residents.

I have been blown away by the commitment and dedication of our social services team in coordinating the care response to this crisis, as well as by the compassion and love shown by frontline care workers. It’s been a huge challenge: managing coronavirus in care homes, arranging testing, working with colleagues across Greater Manchester to bolster our response and share good practice, and most importantly ensuring the high-quality and personalised care people deserve. These are tasks that have been made more difficult by the ongoing scandal that has been the shortage of appropriate personal protective equipment, the slow shift to the level of testing required, and the funding challenges brought about by coronavirus that has left a £37m in year hole in our budget.

Despite all of these challenges, in Trafford – as with so many Labour authorities – we have been leading the way. One of the huge lessons all local authorities and partners in health and more widely can take from this period is the breaking down of silos and the genuinely integrated working that has helped to get things done quickly and safely. It is this innovative and creative work that has led to Trafford having so few care homes with Covid-19 in relative terms, whilst still getting people out of hospital quickly to increase NHS capacity. Whilst some areas have seen coronavirus in as many as 60% of their care homes, in Trafford we have seen a much lower percentage, at around 25%. Whilst this is still too many, how has this comparatively low figure been achieved?

From the outset, social care providers were rightly concerned about accepting patients discharged from hospital without a test. Health colleagues therefore began community testing for people leaving hospital before it was required by government guidance. This meant people could leave hospital more quickly, but that homes had reassurance they were safe to accept the patient. We also moved to block-book two entire care homes in the borough to ensure that if there were issues with either capacity in or admission to care homes we had scope to make sure we could still get people out of hospital.

Increasing capacity whilst testing early has been a huge success: getting those most at risk of the virus out of hospital quickly whilst giving business to care homes who are struggling through this crisis. The ironic bonus providing the icing on the cake is that we have also hit our Delayed Transfers of Care target for the first time in years. A brilliant approach using strong partnerships and the influence our buying power gives us to keep Covid-19 out of care homes where possible and capacity available for those who need it.

Protecting staff has also been key in this, as has ensuring staff availability in council-run facilities. This has been particularly difficult given the PPE situation nationally, but the work seen at a Greater Manchester level has been fantastic in helping to secure additional supplies and protect frontline workers, their families and of course their patients. We’ve also been incredibly grateful for the donations we’ve needed for key partners at Trafford Housing Trust and Trafford College – amongst others – whose support has been greatly appreciated. 

On the staff availability side, I have been stunned to see the amazing actions of council staff in all areas. A special mention though must go to those staff who have been voluntarily redeployed – from posts as varied as HR to UNISON Convenor – into roles on the frontline of social care. These are true public servants putting themselves at risk to look after the people of Trafford, far above and beyond the call of duty. Equally as heartwarming have been the stories of care home staff who have moved into their homes when Covid-19 has hit so that they can continue to provide care to their residents whilst protecting their own families. This is amazing commitment and astonishing bravery, and I salute them all.

I’m rightly proud that in Trafford we’ve led such a coordinated response, especially now that we are seeing the benefits of our actions with good capacity and relatively low rates of Covid-19 in care settings, along with swift transfers of care. But the sector desperately needs more support. When Robert Jenrick’s narrative as Communities Secretary shifted from “everything you need” to “I don’t believe you need all that”, he showed a remarkable lack of understanding about the cost of this crisis, and one of the areas that will suffer most is social care. 

Many authorities are unsure how we will meet our statutory duties in the months ahead, with some councils facing bankruptcy and all in dire straits – and that’s a pressure being felt by providers, too. Without proper financial support – sustainable and long term, as well as crisis response – some providers are facing a cliff edge, and it is coming soon. We’ve tried to help in Trafford: block-booking where appropriate and paying weeks in advance to give the market certainty. But the structural issues within the sector are getting in the way. We can only hope the long awaited green paper is imminent and provides the funding and certainty we need whilst learning the lessons of this crisis. Those who need our support – both now and in the future – deserve no less.