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Into Perspective: implications of the Delta variant

If the government imposes restrictions due to the Delta variant, what might the impact be?

At the time of writing, it is known that the Delta variant of coronavirus is approximately 40% more transmissible than other strains. Whilst a startling figure, the latest data available indicates that only 2% of the people who have been hospitalised in England as a result of the Delta variant had received both doses of a vaccine.

Coupled with the fact that Public Health England’s estimation that 13,200 deaths have been averted in people aged 60 years or older in England (up to 13th May 2021) as a direct effect of being vaccinated, this suggests that vaccines are having their desired effect. Despite this, in areas worst affected by the Delta variant, namely Bolton, Blackburn and Bedford, the Health and Social Care Secretary has not ruled out re-introducing local lockdowns. What might the impact be of re-introducing such measures?

Local lockdown limits

The effectiveness of local lockdowns has been scrutinised since the introduction of the three-tier system in England last October. The Guardian reported in September 2020 that COVID-19 cases doubled in most major English towns and cities where long-term lockdowns were in place. In the case of care homes and their residents, there are clear limitations to re-introducing local lockdowns. Healthwatch UK outlines five key examples drawn from provider experiences – confusing Government guidance, additional costs associated with PPE, reduced admissions and covering staff absences, removing access to face-to-face healthcare appointments, increased delays in conducting routine assessments and revised access for visiting residents. Government must step up and provide adequate guidance and support to care providers.

Mental health concerns

There are clear lessons to be learned from the last 12 months. Extended periods of isolation in residents’ own rooms, limited opportunities to interact socially with staff and other residents, and removing access to visits from friends and relatives have all contributed to widespread feelings of loneliness, boredom and distress. The impact of visiting restrictions has been particularly pertinent in the reported decline of residents’ mental health during lockdown. Visits from friends and family are integral to life in a care home and should local lockdowns be re-introduced, suitable provisions must be put in place to facilitate social contact of this kind, wherever it is safe to do so. Whilst the use of technology, such as making a video call, has served as a compromise for some homes in the last 12 months, many have suffered from poor internet connection and residents with sensory and/or cognitive impairments have struggled to get to grips with this method of communication.

Don’t forget the staff

For many care home staff, especially those providing end of life care to residents and their families, typical working days can provoke feelings of sadness and stress, and this is without the lingering threat of COVID-19 to contend with. Since the beginning of the pandemic and subsequent lockdowns, care home staff have had to endure a rapid increase in the volume and intensity of their workloads, all whilst balancing evolving guidance and protocols from Government. Circling back to visiting restrictions as a fundamental consequence of re-introducing local lockdowns, it is understood that care home staff have, in some cases, had to carry out additional caring responsibilities that may have previously been undertaken by visiting relatives. In addition, it has not been unheard of for staff to take up temporary residence in the care home, out of fear of spreading the virus to their loved ones. Often leading to round-the-clock working, residential care providers must be supported to introduce initiatives designed to protect the physical and mental wellbeing of their staff should the Delta variant continue to pose a threat to the lifting of restrictions in England.

Put people receiving care at the heart of decision making

One of the lessons that has to be learned from the pandemic is that social care, including care homes, needs to be involved in the planning both at national and local level.

If local lockdowns are imposed as a result of the Delta variant, or future crises, care homes need to be supported locally and have the confidence to act in the best interests of those whom they strive to look after.

There must be a clear national framework in place if local lockdowns are to be reinstated. Evidence from previous local lockdowns demonstrated that adult social care providers were often disadvantaged by the local variance in approaches from commissioners and local directors of services.

Indeed, decisions and actions must continue to be made in the best interests of those in receipt of care. It is vital to ensure that these individuals are enabled to enjoy their rights to live purposeful lives as active members of families and communities.

I am really proud of adult social care staff, our best resource, who have worked tirelessly throughout this pandemic with very little let up.

It is high time that this cohort is regarded as the professionals that they are and this needs to be harnessed into a ten-year plan for the workforce akin to that of the NHS. Care homes want to reclaim their role as hubs of the community, a notion which has been very hard over the last year or so.

Care England, as the largest representative body for independent providers of adult social care, is determined to ensure that the much-heralded reform is actually delivered upon. The political consensus is in existence but political will is lacking.

The omission of social care reform from the Queen’s Speech was a hugely missed opportunity by the Prime Minister; however, he is in keeping with a swathe of former leaders who similarly dodged the issue.

The pandemic has shone a spotlight on social care and I believe that reform is within touching distance; therefore, frustration aside, let’s harness the political consensus and ensure that reform becomes a buzz word associated with the 2021 parliament – our 2021 moment.

Professor Martin Green OBE, Chief Executive, Care England

Access to family is fundamental

People living in care have now faced 15 months of restrictions on their movement and contact with those most important to them. These controls have been stricter and longer lasting for care home residents than for any other group in society.

Whether national or regional lockdowns, or local closures of homes, the impact of isolation on physical and mental health has been devastating. Our helpline hears of increased distress, anxiety and depression of residents who think they have been abandoned, who have stopped eating, drinking or taking medication and given up on life.

Since visiting guidance was changed on the 8th of March many residents have been able to have more meaningful contact with their relatives and friends. This led to heart-warming stories of families being reunited. The fear now is that a local lockdown could bring an end to this contact, so vital for the health and wellbeing of residents. For those with dementia, suddenly losing access to their family again would lead to yet more confusion and distress. There is concern about how much more some older people can take.

Local lockdowns may seem the fairest way to deal with local surges in coronavirus cases. Otherwise, how do you explain to a resident with dementia in Norfolk why her husband down the road can no longer visit because of high case rates in Blackburn?

In reality, regional restrictions have been confusing, leading to a complicated series of different rules for different areas. They have been particularly bewildering for those who have to travel some distance and cross boundaries to see relatives. Lockdowns – national and regional – have led to blanket approaches which fail to take individuals into account. Many people visiting care homes are older, and have been shielding and doing everything they can to keep themselves and their relative/s safe.

Throughout the pandemic, relatives and friends of those in care have too often been seen as an optional extra. They are more than just ‘visitors’. They are an essential part of residents’ lives. The love and support they provide is vital for residents’ wellbeing and quality of life.

Our ongoing management of the virus must recognise access to family as fundamental. Using the tools for good infection control, we can end the damaging impact of isolation in care.

Helen Wildbore, Director, Relatives & Residents Association

About Professor Martin Green OBE

Martin Green OBE is Chief Executive of Care England, the largest representative body for independent social care services in the UK….

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About Helen Wildbore

Helen joined the Relatives & Residents Association in 2019. She has over 15 years’ experience of working in third sector and academic organisations on human rights and equality including at the LSE …

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and the British Institute of Human Rights. Her expertise lies in using human rights law to improve care and health services.

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