One in eight councils moved to ‘life and limb care only’ for at least some people over Christmas, warns ADASS

One in eight councils moved to delivering “life and limb” care only for at least some people in need over the Christmas period as a result of the severe pressures arising from the Omicron variant.

Over half have taken the “least acceptable” actions in response to the situation including prioritising life-sustaining care, being unable to undertake reviews of risk,  relying on family members, carers or providers for these or leaving vulnerable people isolated for longer periods than usual.

The findings come from a snaphot survey from the Association of Directors of Adult Social Services (ADASS) released today, in the context of what the association described as a “national emergency”.

Relaxing Care Act duties mooted

Some directors raised the question over whether Care Act duties should be relaxed as they were between March 2020 and July 2021 to ensure councils could manage pressures legally – which eight of the 152 councils made use of.

It found some councils were devising locally “a legally compliant” way of easing Care Act duties but directors questioned whether the flexibility within the legislation was sufficient to manage current risks.

The survey, carried out from 24 December 2021 to 5 January 2022, reflects the impact of the Omicron variant of Covid-19 – particularly in relation to severe levels of staff absence across the provider sector. This was laid bare by a National Care Forum survey, also released today, showing members in the home care and residential care sectors were running vacancy rates of 18% in addition to 14% absence rates last week.

However, staffing problems – in the shape of rising vacancies and falling numbers of filled posts in provider organisations – have been mounting steadily since March 2021, leading the government to plough £462.5m to redress the situation over the winter and relax immigration restrictions for the sector.

The latter involves placing all care workers on the ‘shortage occupation list’, meaning employers with a skilled worker sponsorship licence can recruit staff to jobs paying at least £10.10 an hour, aided by the so-called ‘health and care visa’, which removes barriers to entry.

‘Underlying fragility’

But the level of investment has fallen well short of what ADASS and others have called for to tackle issues including poor pay and conditions for care staff and a lack of support for informal carers.

The association said its latest findings demonstrated the “underlying fragility and under-funding of the sector – which has been raised repeatedly over many months and years”.

In response to the NCF survey, a Department of Health and Social Care spokesperson said: “Care staff are working incredibly hard and we are doing everything we can to support them including with a £462.5 million recruitment fund, expanding the Health and Care Visa scheme and our ‘Made with Care’ recruitment campaign.

“More than 50 million PCR and 142 million LFD kits have been delivered to care homes and we have invested a further £478 million to support safe and timely hospital discharges to get patients into the best place for their care and support to continue.”

The latter figure refers to funding from September 2021 to March 2022 for the hospital discharge scheme, which funds up to six weeks’ social care for people discharged from hospital who need it.

‘Serious but volatile situation’

ADASS said the situation, though serious, was volatile with those directors reporting severe problems over Christmas potentially facing less acute pressures now and vice versa.

It also said that those directors who had rationed care to “life and limb” only – limiting help to eating, hydration, toileting and changing continence laundry – will have done so temporarily, due to shortages. But it said the fact that it was needed at all was “very concerning”.

Beyond the 13% who had carried out this most extreme form of rationing, 43% of councils were re-prioritising support to those most at risk and essential activities only, and 42% were reviewing risk on a reduced basis. This including accepting providers’ view of risk, relying on people receiving services, carers or providers to flag issues, and responding only to requests for reviews, rather than carrying them out as a matter of course.

Also, 11% had paused support for facilitated social contact, leaving people with dementia, learning disabilities or mental health problems isolated or alone for longer periods than normal.

Assessments – which previous ADASS surveys had found were subject to increasing delay – were being prioritised for obvous safeguarding cases, life and limb issues and reablement, to ease the flow of people out of hospitals.

Over a quarter (27%) of authorities had reduced assessments under the Deprivation of Liberty Safeguards – an area already subject to long waiting lists – while 24% were delegating some assessments and reviews to providers.