Thousands of Scotland's most vulnerable hit by "invisible pandemic" of coronavirus homecare failings

The umbrella group of 400 social care organisations said there was a crisis in home care, as tens of thousands of packages of support were withdrawn at the start of the pandemic with many not restored.

They say it was in part caused by local authorities and health board partnerships seeking to prioritise resource and in part by families who feared that staff going from home to home would bring in the virus.

And it called for changes to what it described as the "shameful, pathetic and rotten" home care system.

Their human rights concerns are echoed by Scotland’s leading charity for older people Age Scotland which is concerned that the removal of social care packages or reduced access to medical care contributed to a rise in excess deaths and has called for an investigation.

National Records for Scotland figures revealed that as NHS services re-diverted to tackle Covid-19 and treatment for other conditions significantly curtailed, deaths from dementia and Alzheimer’s disease increased by 24.5% between April and June.

In a Care Inspectorate analysis of 23 of Scotland's 31 Health and Social Care Partnerships (HSCPs) - a union of local authorities and health boards - all but two had changed care packages up to June, this year, and 19 indicated that changes had involved cuts to provision.

The proportion of people experiencing care affected by these reductions ranged from as low as 0.3% to as high as 71%.

READ MORE: Home care services for vulnerable elderly in Glasgow slashed by 60%

In March, the Herald revealed that home care services for some of Glasgow's most vulnerable had been slashed by 60% as the city faces a crisis as a result of staff absence in the midst of the coronavirus pandemic.

The Glasgow City HSPCS which covers the city like others moved to Priority 1 cover for all areas - which will were to hit older people requiring personal care.

In May, the Scottish Government requested that health and social care services that had been stopped as a result of the pandemic should be resumed. They provided an initial £50 million to HSCPs to help the social care sector deal with the financial implications of coronavirus.

But new Care Inspectorate analysis of the care at home sector, found just one of Scotland's HSCPs planned to restore care packages to previous levels while others referred to reviewing and revising them.

Donald Macaskill, chief executive of Scottish Care warned: "There is much talk of winter planning – but if we do not plan to tackle this pandemic in our communities and in the homes of those who require support and care then we will reap a terrible harvest of regret in the spring. We need to renew the soil, replace the rotten practices of the past with refreshed vision and humanity. We can only sow hope and healing in conditions that allow it to grow."

In a new analysis he added: "We stripped away thousands of packages of support and it is clear as we start the possibility of yet more restrictions moving into autumn and winter that many of these have not been restored.

"Some undeniably because family are still caring because their work has not re-started. But I fear that many more have not been re-started because of a decision to save money and a presumption that if people coped during the pandemic then they can cope now. I have heard such folly voiced and foolishness it is indeed.

"If for no other reason we have to reckon into that calculation the truth which tells of a 25% increase in ‘excess deaths’ in our communities of people living with dementia, diabetes and other conditions."

The care body has warned that many older people are as a result finding that their mental health has been shattered by lockdown while living with increasing isolation and loneliness.

"Across Scotland today there are thousands of people in urgent need of support to rehabilitate their physical bodies after months of decline, there are hundreds in need of psychological and emotional support after isolation and emptiness; there are yet more in need of being made to feel that they matter, that they are noticed, that they are valued," he said.

He highlighted the experience of one homecare worker who spoke of older folks she had known for a long time showing "visible signs of decline and deterioration; of a gripping sense of isolation and loneliness because with restrictions some people living with disabilities were cut off from friends and family".

He added: "She recounted the growth in cases of body sores because folks had become immobile without exercise and unable to go out into the community; and most worryingly she told of the dozens she knew whose mental health had been shattered by lockdown. The stories of thousands of individuals who receive homecare supports will not often be heard or told but their pain during the pandemic is no less real for the lack of telling."

But he said that even before the pandemic homecare in Scotland was already in crisis, "rooted in rotten soil".

"That rottenness was for many reasons. Chief amongst them was because we have failed to embed ground-breaking legislation which gave citizens control and choice of their care, instead the ‘system’ has held on to its power and resource by refusing to inform, to give people control over their budgets, and to really empower people to take control of their lives. The system has played the game of ‘self-directed support’ but not released its spirit, vested interest has cut off the shoots of real change before they could flourish," he said.

He also highlighted the that before the pandemic there was the "perversity" which came from presuming that care can be delivered in "fragments of time" created by "number checking commissioners of care without regard to the urgent need for people to be treated as human beings rather than coins in a machine".

He added: "The pre-pandemic state of homecare in Scotland – and therefore by volume – social care as a whole was shameful, pathetic and rotten. And it still is. Radical change is needed. If we are to flourish and come to a spring of renewal the soil needs to change and the system needs to be overhauled."

He spoke out as Scottish Care prepared for a three-day Homecare Festival which starts on Wednesday, billed as an attempt to focus on the tens of thousands of more people who are being cared for and supported in communities than in care homes and hospitals combined.

He hoped the festival would provide oxygen to a vision focused on "giving control and power to the citizen who is supported and who uses care rather than to commissioners and bean-counters".

"I hope we will hear a vision where prevention rather than reaction is at the heart of the packages of support we create. And most of all I hope we hear of a vision which adequately resources the care of people in their own home rather than seeks to buy care on the cheap. All of this would show we care about care rather than empty slogans," he said.

Age Scotland said that the removal of social care packages was a "shock to the system" for many older people who relied on them and that "almost overnight" people whose health and wellbeing depended on the extra support offered by carers in their own home were left "high and dry".

Between March and May, Age Scotland’s helpline was bombarded by worried and anxious older people and their families who did not know what to do.

Age Scotland chief executive Brian Sloan said: “It is absolutely not good enough that many months later these services have not been restored to their original levels. After all, their needs assessment won’t have changed. If anything, many could need more support than they did at the start of the year as their health has deteriorated as a result of their packages being reduced and they have been coping with long periods of isolation, loneliness and loss of mobility.

“We know that the social care sector is under immense pressure, and had been the case long before COVID-19 landed on our shores, which is why it must be bolstered and invested in further. As we head into winter and proposals of further lockdowns are floated, it is imperative that the Scottish Government develop an action plan to support older people to live well through the coming months.”

A Scottish Government spokesman said: “We recognise that the Covid-19 pandemic has been incredibly difficult for both those receiving and providing adult social care. It is critical that social care support is maintained as far as possible to ensure the safety, dignity and human rights of people who already receive support, and that of their unpaid carers. We’ve allocated £150 million for social care as part of our additional Covid funding this year to help the sector mitigate the financial implications of the pandemic.

“Unavoidable short term changes in people’s support have been necessary due to a reduction in workforce capacity as a result of workers self-isolating or being unwell, or many group-based supports running at reduced capacity due to physical distancing measures. In some instances the support needs may also have changed and required review or amendment.

“The Scottish Government has established an independent review of adult social care with a human-rights based approach to consider what changes are required to achieve the highest standards of support for the independence and wellbeing of people who use adult social care support.

“We remain committed to the reform of adult social care. Prior to the pandemic we began work on a reform programme with a wide range of partners. This work will continue in parallel to the Independent Review of Adult Social Care.”