We must start to learn the lessons now: As if Expendable – Amnesty International report into the fate of care homes in Covid 19.

As we look towards the risks of winter and the pressures these will bring across health and social care, we must start to learn the lessons from what has happened so far in the pandemic; not just reactive and superficial fixing, but recognise where we need a change of tack to get to the underlying reasons why we have had such inequality and human rights challenges in Covid 19.  This is nowhere more true than in the care home sector – and in the social work that needs to be empowered to support those homes, those residents and their families.

Since early in the pandemic, BASW has identified failings in national guidance and resourcing leading to excessive risks and scandalously high death rates amongst people in residential and nursing homes, particularly (but not exclusively) older people and people with learning disabilities. On April 29th, we wrote:

‘Until recently people who died from Covid – 19 while in a care home were not even included in the daily figures of Covid - 19 deaths.  We now see an escalating crisis which may outstrip deaths in hospitals through the course of the pandemic outbreak.’

Our concern has escalated throughout the pandemic as the highly centralised and NHS-focused approach of government to pandemic response particularly in England has largely persisted, side lining social care, local coordination and local public health initiatives, and failing to recognise the safeguarding and welfare oversight roles of local authorities, social workers and the Care Quality Commission.

Informal carers have also been side-lined with care home residents and their families and friends kept apart by restrictions not equally applied to (certainly in the earliest months) a largely untested workforce of poorly paid and poorly treated care home staff, without access to personal protective equipment (PPE)and often working long shifts over multiple sites to make ends meet.

We appreciate these failings have had more governmental recognition and attention in recent months with some extension of funding, more PPE, support for underpaid care workers to take paid sick leave and (slow) roll out of care home worker testing.  There have also been diverse responses across the governments of the UK and more action in some than others. But the themes and failings in the first months of the pandemic have been similar

Amnesty International’s new report, As If Expendable (5th October)  provides a vital, in depth analysis of the failings of national and local strategies to date in England, their avoidability and the absolute need for further inquiry, accountability and learning. The report calls for a full public inquiry.

Governmental and Public Health England failings - described as, at best ‘heedless’ of expert and international evidence early in the pandemic – are presented as leading to 18,562 deaths in England between 2 March and 12 June 2020, 40% of all reported Covid1 19 deaths in that period.

The report focuses on failings amounting to avoidable human rights abuses, particularly on the basis of age. ‘Expendable’ older people placed at knowable risks from infection, denial of access to universal healthcare, use of ‘Do Not Attempt to Resuscitate’ notices without legal and ethical processes and being denied access to family and friends.

The report also identifies the failure of oversight of care homes, identifying the inability of local authorities, the Care Quality Commission and the Social Care and Local Authority Ombudsman to carry out their respective roles in ensuring care home residents are safe.

What the report doesn’t do is recognise the specific role of social workers in delivering the Care Act and in safeguarding residents. We have campaigned throughout for social workers to have the resources, equipment and guidance to be able to carry out their statutory and non-statutory roles to protect people of all ages from harm.

Social workers need to be able to access people in institutional and personal home environments, to help them be and stay safe, to identify and reduce risks, to support families and to bring hope into difficult circumstances.

We welcome this hard hitting report and its recommendations, but we will also be going back to Amnesty International to ensure they know as they take this work forward that social workers are key partners in resolving the urgent and painful failures they have compellingly laid out.