Reports & recommendations

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should each establish clear arrangements for pandemic planning in adult social care. Those arrangements should facilitate the production of pandemic plans for adult social care at the government, local and provider levels.

Plans at a government level should identify:

the roles and responsibilities of each government in relation to adult social care during a pandemic;
the requirements for local-level plans, including the roles and responsibilities of local authorities, Health and Social Care trusts, and health and social care partnerships in producing those plans;
the requirements for provider-level plans;
how and by whom the adequacy of local and provider-level plans will be assured;
how bed capacity and staffing levels will be tracked in care homes and domiciliary care; and
how the adult social care sector will be represented in the pandemic planning of the four governments.

Government pandemic plans for adult social care should be regularly reviewed and tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should ensure that pandemic plans for adult social care contain practical steps rapidly to scale up isolation facilities for care home residents in a future pandemic.

As a minimum, plans should:

establish mechanisms to record systematically the availability of isolation facilities in care homes in each nation and keep these up to date;
identify settings that can be used in a future pandemic to isolate and meet the needs of residents, including those who need to be discharged from hospital into a care home; and
establish guidance for how these settings can be run to ensure high-quality, safe care and effective infection prevention and control.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should put in place financial support schemes that should be made available and that can be implemented at the start of a future pandemic:

to protect adult social care staff against financial loss as a result of compliance with mandatory self-isolation rules; and
to ensure that adult social care providers and staff can comply with rules or guidance restricting the number of sites at which adult social care staff may work during a pandemic.

The following principles should apply:

There should be clear and straightforward guidance about eligibility criteria, application processes and payment arrangements for the support schemes.
Information about the introduction of support schemes and how adult social care staff and providers can receive support should be communicated clearly and made available in accessible formats.
Mechanisms should be in place to monitor the effectiveness of the support schemes.

These financial support schemes should be designed in partnership with representatives from across the adult social care sector.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should publish guidance for the implementation of visiting restrictions in care homes in a future pandemic.

The guidance should be led by the following core principles:

Measures applied should be the least restrictive possible, both in terms of severity and the length of time for which they apply.
Residents should have the right to in-person visitors, except in the most grave or exceptional of circumstances.
Restrictions should be decided upon and applied at the most local level possible, based on local risk assessments and considering individual circumstances.
Communications with the public, care home residents and loved ones must clearly explain the measures in place and their purpose.

People who work in and use social care should be closely involved in developing this guidance.

The Care Quality Commission in England, Care Inspectorate Wales, the Care Inspectorate in Scotland and the Regulation and Quality Improvement Authority in Northern Ireland should each develop adaptable protocols for carrying out on-site, hybrid and remote inspections in a future public health emergency.

These protocols should be guided by the core principle of continuing on-site inspections where possible. They should also clearly identify processes to minimise:

the risk of transmission when on-site inspections are carried out; and
the risk of safeguarding issues going unidentified where remote or hybrid inspections are carried out.

Regulators should regularly review these protocols to ensure that they remain practical and effective.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should develop mechanisms to collect, analyse and publish data systematically about the deaths of adult social care workers during a pandemic. The data must be comparable across the four nations of the UK.

The mechanisms should be developed with the adult social care workforce regulators, public health agencies and employers of care workers.

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should establish mandatory training for health and social care professionals looking after people in the adult social care sector who are nearing the end of life.

The training should be developed in conjunction with health and social care regulators and provide, at a minimum:

an understanding and enhanced knowledge of how to deliver high-quality end-of-life care as well as the support available; and
communication skills to be able confidently to conduct and document conversations about advance care and, where appropriate to the professional’s role, decisions on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR).