The UK Covid-19 Inquiry’s Care Sector report confirms what many care-home residents, relatives and staff already knew: adult social care was treated as an afterthought during the pandemic. The promised so called “protective ring” was not supported by the reality, protection for care homes arrived too late and the consequences were devastating.

I was a care home registered manager at the time of COVID-19 and from that perspective, the findings are painful but unsurprising. Care homes faced an unfamiliar, lethal virus while guidance changed almost daily, personal protective equipment was scarce and reliable testing was unavailable. Managers made immediate decisions affecting life, liberty and family contact often without the information or support required to make such decisions.

The report is more than a record of institutional failure, it exposes an imbalance that has shaped health and social care for decades; hospitals are nationally organised and politically prominent, care homes are not. During COVID-19, that structural neglect became a national emergency which in many cases was recognised too late.

Following the Inquiry, there is a danger that solemn words will be followed by business as usual. An inquiry should not merely describe failure; it should make repetition less likely. For social care, that means turning uncomfortable conclusions into funded, tested and workable contingencies against future emergencies.

During the pandemic, social care teams were working with incomplete evidence in what was a widespread and a fast-moving crisis and it is fair to say that not every poor outcome resulted from a poor decision.

The sharp criticism is however, that predictable weaknesses – fragmented responsibility, fragile staffing, limited data and unequal access to resources – were already known and had not been resolved before the pandemic arrived. The concern is that they remain issues even now some five-years later.

What the Inquiry found

The COVID-19 Inquiry concluded that pandemic planning had failed to address the specific needs of adult social care. Successive governments knew that care-home residents were especially vulnerable to respiratory viruses, yet there was no meaningful forward planning, this resulted in the sector receiving insufficient protection when it mattered most.

More than 43,000 deaths involving COVID-19 were recorded in care homes between March 2020 and July 2022.

The drive to protect hospital capacity undoubtedly shaped the early response. People were discharged into care homes when testing was limited and while the guidance did not require isolation.

Notably, the infection-control advice at the time also ignored a key reality of care: personal care cannot be delivered from two metres away!

Hospital pressures explains the decision but in no way excuses it. Moving risk from a ward to a care home transferred it to a setting with every clinical resource to one with, at best, few resources and, in many cases, no resource at all. Taken together with limited isolation space and residents made especially vulnerable by age, frailty and ill health it was a recipe for disaster.

PPE shortages were equally telling. Care workers provide intimate support including washing, dressing, feeding and comforting people in the same way that staff in hospital do and yet supplies, and guidance, often reflected healthcare assumptions. Providers and managers spent precious time sourcing PPE, interpreting changing advice and reassuring staff who knew they were exposed by virtue of their job.

The Inquiry also exposes weak information systems. Without timely data on staffing, outbreaks and isolation capacity, national decisions were inevitably blunt. Data can only be used to informed professional judgement, but poor data makes good judgement harder.

The view from a registered manager

Registered managers did not need hindsight to see the danger. Our reality was residents returning from hospital, staff moving between services because low pay made it necessary, PPE shortages and guidelines changing faster than they could be implemented.

Registered Manager reassured staff and residents, supported families at a distance and kept services running while fearing for their own health and that of their families. It was for many a very isolating experience fraught with conflicts of interest and a lack of coherent guidance.

Responsibility did not pause while national policy caught up. Rotas had to be filled, medicines administered and residents living with dementia supported with familiar routines. Families needed honesty even when managers had few answers. Infection control had to improve without turning a home into an institution; the clue is in the name we worked in homes.

Managers carried regulatory, legal and moral duties that did not always align and all the while were assailed with guidance that was all too often ill-conceived and well-meant training videos which were hospital centric and often palpably wrong.

Care workers provided close personal care while fearing illness for themselves, their families and transmission to residents. Some could not afford to isolate; others worked across settings because fragmented employment and low pay left few alternatives. Sadly, applause did not provide secure sick pay, sufficient staffing or professional status; nor did it evolve in to “protect the care sector” as it did for the NHS.

That all said, it is also important here to recognise that many providers and managers failed to try, let alone implement guidance in a meaningful way and many others ignored it. While the Inquiry rightly takes aim at central government and planning there are those in social care who must also shoulder some of the responsibility for the scope of what happened in their homes.

The human cost of protection

Visiting restrictions were introduced for understandable reasons but caused immense harm. Relatives are not simply visitors; in many care homes they are a part of the team, they know the resident, notice subtle changes and provide comfort and support. Prolonged exclusion left residents isolated and families distressed, all too often including at the end of life.

The lesson is not that infection control was unnecessary, but that safe and effective care is about more than keeping a virus out. Good care must also protect dignity, relationships, emotional wellbeing and compassionate contact.

Future plans should presume that family contact is part of care. Any restrictions must be proportionate, regularly reviewed and supported by arrangements for essential caregivers, end-of-life visits and individual risk assessment. Blanket rules are simple; people are not, however, standardised units of risk. Future plans need to have an evidence-base that takes in the lived-experience of people in receipt of care and those important to them.

What must change

The Inquiry recommends clearer pandemic planning for adult social care, practical arrangements for isolation and financial support that enables staff to self-isolate or avoid working across multiple sites. These are sensible measures. Financial support for staff is in these circumstances a public-protection measure. They are also the minimum that should have existed before the crisis.

Plans must be tested with those expected to deliver them. Government, commissioners and health services need reliable information about capacity, staffing and infection risk. Providers need timely supplies, coherent guidance and funding that reaches the frontline. Social care must have an equal voice in emergency planning rather than a late invitation after the hospital plan is written.

Social care is in many ways bigger than healthcare in the UK and this needs to be remembered.

Accountability is essential. Recommendations need owners, deadlines, transparent reporting and independent scrutiny. The Care Quality Commissions (CQC) require providers show lessons are learned after an incident, government should meet the same standard. “Lessons learned” must mean changed practice, not yet another document on a shelf.

Implementation should therefore be judged against practical questions. Can a home obtain PPE immediately? Can it isolate residents without compromising care? Can staff stay away when infectious without losing income? Can relatives remain safely involved? If the answer is uncertain, preparedness remains theoretical.

Conclusion

The report’s central message is blunt: protecting the NHS sometimes came at the expense of people who relied on social care. That must never happen again. A care-home resident is not less important because their bed is in a care service rather than a hospital.

For registered managers and care workers who lived through the pandemic, the report provides overdue recognition. Recognition, however, is not reform. The real test is whether its recommendations are implemented, funded and rehearsed before the next emergency.

The Inquiry has supplied the diagnosis. The response must now address the underlying condition: a social care system expected to carry immense responsibility without equal influence, resilience or recognition.

Bettal works with adult social care providers to strengthen quality assurance, compliance and service improvement. Its digital systems and practical guidance help care organisations evidence good practice, prepare for inspection, manage risk and maintain continuous improvement.

If you are a social care provider and are looking for ongoing support with policies and procedures, browse our website or get in touch:
Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy