Impact of COVID-19 on social and intermediate care: report on data analysis and stakeholder workshop

Abstract

Social and intermediate care is under stress, with COVID-19 adding to existing pressures. It is clear that a variety of factors are at play, and whilst many of these factors are already well known to those providing these services, the overall situation is complex. The overall aim of this project is to better understand the impact of COVID-19 on social and intermediate care in Lanarkshire and to provide guidance on how those tasked with delivering this care can best plan and prioritise for the future in light of current uncertainties. This report details preliminary analytical work on the issues underlying CIOVID-19's impact in both the short term and longer term. After an initial evidence review, quantitative data from South Lanarkshire and subsequently also North Lanarkshire were analysed to better understand the patterns and trends in care provided over the past five years. This analysis included data on variables such as the total hours supplied, package size, age, sex, SIMD and locality. In addition, a stakeholder workshop was organised to gather expert opinion from those responsible for care provision in South and North Lanarkshire, respectively, with a focus on three topics: analysis of care needs; analysis of care provision; and priorities and options going forward. Three key themes can be seen to emerge from the research so far, including both the quantitative data analysis and the qualitative outputs of the stakeholder workshop; namely: * Long-term and short-term changes in care needs * Current and future workforce availability * Expectations about the provision of care and support The workshop participants considered the ageing population to be the most important driver for long-term changes in care needs. The number of people with comorbidities and more complex care needs seems to be increasing, which is particularly significant in the highest age brackets. In the short term, the analysis of quantitative data – in particular, average care package size – shows an increase in social care needs as COVID-19 started to impact on the population. Overall, the combination of higher demand for home care and lower workforce availability has resulted in a level of unmet need among service users. However, accurate evaluation of unmet need is challenging. Workforce availability was identified by the workshop participants as the most important constraint in relation to care provision. This constraint is particularly severe in the short term because of the impact of COVID-19 on staff absences. However, lack of workforce availability is likely to persist into the longer term because of problems of staff retention and recruitment. Although different local authorities may have different staffing policies (focusing on independent providers or, conversely, on directly employed staff), the workforce availability problem affects them all to a greater or lesser extent. The view was expressed that assistive technology has not, so far, been used to its full potential. People's expectations of care provision may also be changing. In the short term, residential and respite nursing care have decreased significantly and nursing home vacancies have increased significantly from pre-COVID-19 levels. In consequence, the expectations placed upon home support teams may have increased. In addition, there may be a rise in expectations in the longer term. Older people appear to be more willing and able to carry out of daily living tasks themselves than people younger than them. There is a discussion of how services can be delivered in the most effective way, with better communication on the availability of other services and additional opportunities for people to better support themselves. Flowing from these findings are the following initial recommendations: 1. Measuring unmet need for care and support In order to effectively tackle current problems of unmet need for care and support, an appropriate and consistent measurement tool should be agreed and applied. South Lanarkshire staff have developed an initial estimate of unmet need, based on cases awaiting assessment and average package size. Whilst this is an approximate measure, it does appear to be useful and could be developed further. 2. Further work on a collaborative workforce strategy Social care in Scotland is highly dependent on a skilled and motivated workforce but staff are currently not properly rewarded or developed. Local authorities could exchange more information on different service models in operation and associated workforce issues. It may also be possible to jointly develop new opportunities for educational and professional development of care staff in collaboration with local institutions of further and higher education. Similarly, there could be joint projects to explore and pilot new approaches to care through innovation and technology. 3. Analysis of longer term changes in social care needs and provision Further analytics can be done to improve our knowledge about the needs of current and future service users and their carers in the drive towards continuous improvement. For example, the ageing population is regarded as the most important long-term driver for changes in care needs. Research in England suggests that some of this rising need is counterbalanced by a higher proportion of older people in the community being able to live independent lives – even if they suffer from an increased number of chronic health problems. (Conversely, individuals needing social care typically also have several long-term conditions.) Does this finding also hold for Scotland, in general, and Lanarkshire, in particular? And what will be the longer term impact of the many cases of long COVID?

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https://strathprints.strath.ac.uk/79223/