Care homes had ‘fragile’ workforce at start of pandemic

Northern Ireland’s care home sector had a fragile workforce compounded by tight budgets as it entered the pandemic, the UK Covid-19 Inquiry has heard.

There were evident pressures in social care at the start of 2020, with an estimated 1,400 care home workers needed each year to maintain staffing levels, Professor Sean Holland said.

He was chief social work officer with the Department of Health at the time of the pandemic.

The inquiry is currently examining adult and residential care as part of its scrutiny of the response to the pandemic.

Prof Holland said social care had been characterised as low-wage, with workers often on zero-hours contracts and a high turnover of staff.

Efforts had been made to make the sector more appealing as a long-term career option, he said.

Asked about the state of the sector as it entered the pandemic, he said: “There would have been a fragility in the workforce and there would have been pressure on budgets, because the relationship is that the budget buys the service, which drives the workforce.”

The inquiry heard that many care homes in Northern Ireland had struggled to ensure they had proper isolation policies in place for elderly patients who were being discharged from hospitals into their care.

A report from the Regulation and Quality Improvement Authority (RQIA) had suggested that only about 80 care homes out of the 480 across Northern Ireland had isolation availability.

Prof Holland said this had been “a desktop exercise” review and had not been done in person, and he estimated the number of homes with isolation availability had been higher.

Prof Holland said mechanisms for isolating patients should be thought about in planning for future pandemics.

“That then takes you to looking at the actual configuration of care homes,” he said.

“Building of care homes over the years has always been subject to standards, but those may benefit from being revisited to consider how the infrastructure would support a positive response to a future pandemic.”

The inquiry referenced one study which suggested patients discharged from hospitals to care homes were not substantial causes of Covid outbreaks.

Prof Holland said Northern Ireland’s lower number of care home deaths during the pandemic should be used as a learning tool to deal with future global outbreaks.

“When I say this, this is not in any way to minimise the experience of people who died in care homes in Northern Ireland, and it is not to suggest anything positive about the system… we know you were least likely to die in a care home in Northern Ireland compared to England, Scotland and Wales,” he said.

“Compared to England, by quite a margin. Many European countries did better than Northern Ireland.”

He added: “One thing for future learning is that we have to understand that better, because currently we don’t really know why.”

Prof Holland said at one stage during the pandemic, there was a suggestion of creating “a ring of steel” around care homes, with staff remaining there and sleeping over.

However, there had been no take-up when an expression of interest for the so-called Safe At Home model had been issued.

There had also been concerns raised by trade unions over the supply of PPE, staff feeling compelled to stay in the care homes and adequate payment for workers, the inquiry heard.

Prof Holland told the inquiry about difficulties in obtaining enough supplies of personal protection equipment (PPE).

He said he had personally told all the Northern Ireland health trusts that there should be “no boundaries” in the distribution of PPE between the public and independent sectors.

“I remember someone saying: ‘Are you saying we have to share our PPE?’.

“And I said: ‘It is not your PPE, this is a resource for Northern Ireland’.”