A new report from the Care Quality Commission (CQC) lays bare the impact of COVID-19 on domiciliary care providers and their staff across England.
The COVID-29 Insight report is the first in a series of discussion documents assessing key issues affecting health and social care during the crisis.
Citing the latest data from the CQC’s domiciliary care tracker conducted from May 2-8, the report shows that around a fifth (19%) of the 6,258 agencies that responded were caring for at least one person with COVID-19.
London had the lowest response rate to the tracker (57%) and, of those that responded, had the highest proportion of agencies (27%) with COVID-19 present among the people being cared for at home.
The report highlights the shortage of PPE among social care providers as a “big concern”. In domiciliary care, of those agencies that responded to the tracker, 6% of agencies in London only had enough PPE to last two days or less and 28% of agencies in London and the North West had only enough PPE to last up to a week.
There have also been instances where the wrong items have been delivered or the quality of items was poor.
Commenting on how the CQC has been working to address these issues, the report said: “Our inspectors have been contacting providers to support them to keep people safe. We’ve been working with local authorities to try and ensure that providers get the supplies they need. Our inspectors have even arranged loans of PPE from other providers to cover immediate need. Concerns are also shifting towards the cost of PPE for all adult social care providers and the impact of this on the financial viability of their businesses.”
In terms of staff absences, London had the largest proportion of care staff (10%) absent from domiciliary care services between 2-8 May.
But the absence data specifically relates to staff not working because they are self-isolating due to COVID-19, so it is likely that overall domiciliary care staff absences could be much higher than reported, the CQC said.
Impact on care staff
The report also highlights the impact of COVID-19 on staff wellbeing and the financial viability of adult social care services.
Drawing on data collection from staff, the CQC says that “morale is low in adult social care”, and care staff have felt “undervalued compared with their healthcare counterparts”.
This has also played out in practical terms, for example when trying to access priority shopping for their clients.
The report also notes that some registered managers of adult social care services are suffering from “burn out and extreme anxiety”.
In addition, the COVID-19 crisis is having a “significant impact” on the financial viability of adult social care services, the report said.
“The troubling financial reality for some providers is that they may now face a shortfall in people using their services due to increased deaths and not being able to admit new admissions. Also, some providers are struggling financially with the cost of PPE, including having to pay inflated costs to source what they desperately need,” the CQC said.
The CQC has also heard concerns over insurance companies informing providers that, if they knowingly take COVID-19 positive patients, they are in breach of their insurance. Other providers have also been unable to renew their insurance, posing a risk to their ability to care for people.
The report notes that testing frontline care staff has also been a “huge challenge”, and there is an ongoing need for “clarity” about who is leading on testing and where to go for it.
The CQC said it used technology, call centre staff and our databases to book tests for more than 25,000 care staff before handing this work to Department of Health and Social Care for longer-term delivery.
Kate Terroni, CQC’s Chief Inspector of Adult Social Care, said that as acute services start to move towards a more stable position, the community health offer – both to care homes and people who have care and support needs met in their own homes – must be “a priority”.
She noted examples of “good joined-up” care between health and social care professionals to keep people safe, but said community health support has reduced in some areas as the coronavirus response resulted in resources being diverted elsewhere.
“It is critical that the right focus is placed on social care to ensure that those on the front line get the assistance they need to protect the people they care for. We’ve seen what can be achieved and the impact that this has on people’s care – the challenge now is to make sure it is achieved consistently,” Terroni said.