Community health and care discharge and crisis care model: an investment in reablement
Local Government Association
This paper sets out the view of the Local Government Association (LGA) and Association of Directors of Adult Social Care (ADASS) that the 'discharge to support recovery and then assess' approach is a key component of a person-centred community health and care model. The experience of responding to COVID19 has demonstrated the importance of this care being centred on the individual, providing safe, proactive care that maximises independence and wellbeing. The paper argues that people have the best outcomes when they are helped to avoid having to go to hospital or return home from hospital safely and without delay, with support targeted on their needs. Once settled back into their homes, and after a period of reablement or rehabilitation if needed, only then should they have a care and health assessment for any ongoing needs. However, the paper suggests that but there are not enough community-based services to support people at home – the 2020 ADASS Budget Survey highlights that only 4 per cent of directors of adult social services are confident their budgets will enable them to meet statutory duties. The Covid-19 crisis has confirmed the need to reshape health and care, embedding positive developments and preventing a return of fragmented and untimely care and support, especially on discharge from hospital. This will require government and national partners to support local place-based leadership, to continue to shift resources towards community-based services, and to support the recruitment, retention and retraining of the workforce.
The future of commissioning for social care
SCIE's latest commissioning guide that focuses on the immediate future of commissioning in light of COVID-19.
How Covid-19 has magnified some of social care's key problems
Examines eight key problems facing social care and the extent to which Covid-19 has exacerbated these challenges. These include: means testing – social care is not free at point of use like the NHS; catastrophic costs – some people end up paying large amounts and even selling their homes to pay for care; unmet need – many people go without the care and support they need; quality of care – a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control; workforce pay and conditions – staff are underpaid, leading to high vacancy rates and turnover; market fragility – care providers go out of business or hand back contracts; disjointed care – health and care is not integrated around the individual and causes issues such as delayed transfers of care from hospital; the 'postcode lottery' – there is unwarranted variation between places in access to care and its quality. This piece discusses how the emphasis on them has shifted as a result of the pandemic – while the first two issues have barely been mentioned during the past few months, in the remaining six areas, Covid-19 has brought significant change and, if anything, exacerbated these challenges.
What enables or hinders people in the community to make or update advance care plans in the context of Covid-19, and how can those working in health and social care best support this process?
Centre for Evidence-Based Medicine
An evidence review of the enablers and barriers to advance care planning (ACP) in the context of Covid-19 and best support approaches. The review identified 21 research studies and 10 systematic reviews that met the inclusion criteria and were classed as highly relevant. In addition, it identified 12 guidelines related to ACP in the UK during COVID-19. The analysis shows that in the context of COVID-19 some known barriers to ACP in community settings have worsened, while others have improved. COVID-19 has raised public awareness of ACP, increased the importance of and attention to IT systems, motivated the development of new guidelines and templates, and rapidly shifted 'business as usual' processes and protocols. This presents opportunities to improve ACP in the community. However, existing guidelines and resources are to a major extent clinician-focused; there are few video- and web-based ACP resources for the public and those that exist are scattered and piecemeal. This is a concern given good quality evidence that online and video ACP interventions are beneficial, particularly among people with limited English proficiency, poor health literacy and/or from otherwise disadvantaged communities. In the context of COVID-19, and to reduce inequalities in access to ACP, the report recommends national investment in evidence-based, public-facing resources and integrated systems to support ACP, building on existing resources. Alongside this investment, simultaneous, interconnected strategies are needed, underpinned by healthcare policy, including training for those working in health and social care, better coordination of electronic medical record systems, and public education and awareness raising.
A structured tool for communication and care planning in the era of the COVID-19 pandemic
Residents in long-term care settings are particularly vulnerable to COVID-19 infections and, compared to younger adults, are at higher risk of poor outcomes and death. Given the poor prognosis of resuscitation outcomes for COVID-19 in general, the specter of COVID-19 in long-term care residents should prompt revisiting goals of care. Visitor restriction policies enacted to reduce the risk of transmission of COVID-19 to long-term care residents requires advance care planning discussions to be conducted remotely. A structured approach can help guide discussions regarding the diagnosis, expected course, and care of individuals with COVID-19 in long-term care settings. Information should be shared in a transparent and comprehensive manner to allay the increased anxiety that families may feel during this time. To achieve this, this paper proposes an evidence-based COVID-19 Communication and Care Planning Tool that allows for an informed consent process and shared decision making between the clinician, resident, and their family.
Editorial: unprecedented times? Social work and society post-COVID-19
British Journal of Social Work
Sets out the key messages from the latest issue of the British Journal of Social Work and emphasises how, in response to the Covid-19 pandemic, social work, along with allied professions, must adapt and change without losing sight of its core ethos and skills and drawing on the lessons from both research and practice.
COVID-19 and English council funding: how are budgets being hit in 2020-21?
This report examines the scale and nature of forecast impacts of the Covid-19 pandemic on local authorities spending and income. It explores how impacts may vary across council types, regions and council characteristics; compares the impacts with the financial resources provided to councils by central government and with the resources available to them in the form of reserves; and considers the implications for future funding policy. Councils forecast spending pressures of £4.4 billion and non-tax income pressures of £2.8 billion in 2020–21. Taken together, this equates to a financial hit equal to 13.0% of pre-crisis expenditure. Adult social care accounts for £1.8 billion of the spending pressures, with unspecified unachieved efficiency savings accounting for the next-biggest chunk, at £0.6 billion. Taken together, councils' forecasts for spending and non-tax income and the baseline scenario for funding imply a funding shortfall of approximately £2 billion this year, although uncertainty about pressures and funding availability means there is scope for the gap to be much bigger or smaller. The report argues that several options are available to the Government. The simplest approach would be to increase the general grant funding it gives councils but targeted support to those councils facing the greatest problems would be more affordable. One option would be to follow the example of Wales, where councils submit claims based on the additional costs they have incurred, subject to some vetting. Temporary powers to borrow to cover day-to-day spending could also be considered, and have been identified by the OECD as a sensible way to give local areas more flexibility and autonomy to respond to the crisis as they see fit.
Experiences of child and adolescent to parent violence in the Covid-19 pandemic
This report draws upon the findings of online surveys of 104 parents who have experiences C/APV from their child aged 10-19 years and 47 practitioners who work with families experiencing C/APV. It also draws data provided by all 43 police forces across England and Wales on total numbers of reported C/APV incidents over the one-year period from 1st April 2019 to 31st May 2020. The analysis reveals that 70% of parents reported an increase in violent episodes during lockdown; 69% of practitioners said they had seen an increase in referrals for families experiencing C/APV; 64% of practitioners identified that the severity or incidence of violence had increased; 29% of parents identified a decline in C/APV during the lockdown period which was explained by a reduction in the stresses and triggers for violence in this period. Respondents identified some lockdown-specific reasons for the increase in C/APV, which include spatial confinement and coerced proximity, changes in structure and routine, fear and anxiety and lack of access to formal and informal support. The report makes ten recommendations to services, local authorities, and government in planning a response to C/APV, including ensuring robust safeguarding measures for young people and families experiencing C/APV; planning for a rise in demand for support as lockdown lifts and schools and workplaces reopen; avoiding over-criminalisation of young people using violence; and providing safe spaces for families at crisis point and respite care for young people.
Homelessness monitor England 2020: COVID-19 crisis response briefing
This briefing reflects on the early lessons from the Covid-19 crisis response to some of the most extreme forms of homelessness and looks ahead to the exit strategy. With government financial support and guidance, local authorities have sought to get 'Everyone In' as rough sleeping in England has been reframed as an urgent public health issue, and emergency measures have sought to prevent other forms of homelessness as well. Key findings include: levels of infection seem very low amongst homeless people accommodated under the Everyone In initiative, indicating a relatively successful public health strategy with regards to this vulnerable population; the speed and clarity of the early central Government response was widely welcomed, with local authorities and homelessness charities also praised for rapidly rising to an unprecedented challenge; however, subsequent 'mixed messages' from central Government on the medium to longer-term response became a matter of acute concern amongst local authorities and their third sector partners. The report argues that a decisive shift away from communal forms of sleeping provision would be a positive outcome, as well as more broadly a direction of travel that encompassed less emphasis on hostels with shared facilities. It notes that the (understandable) emphasis given to immediate crisis response during the pandemic has squeezed out prevention activity at many levels, and that a 'spike' in family homelessness in particular is expected as the evictions ban and furlough schemes come to an end.
Coronavirus and depression in adults, Great Britain: June 2020
This article looks at depressive symptoms in adults in Great Britain before the coronavirus (COVID-19) pandemic (July 2019 to March 2020) and during the pandemic (June 2020). It looks at the same group of adults over a 12-month period, providing a unique perspective of how depression has changed over time. The analysis shows that almost one in five adults were likely to be experiencing some form of depression during the pandemic in June 2020; this had almost doubled from around 1 in 10 before the pandemic. Adults who were aged 16 to 39 years old, female, unable to afford an unexpected expense, or disabled were the most likely to experience some form of depression during the pandemic. Feeling stressed or anxious was the most common way adults experiencing some form of depression felt their wellbeing was being affected, with 84.9% stating this. Over two in five adults experiencing some form of depression during the pandemic said their relationships were being affected, compared with one in five adults with no or mild depressive symptoms.