The impact of the COVID-19 pandemic on the UK residential social care sector has been immense and tragic. Elderly, vulnerable and frail individuals living in residential care settings who should have been ‘shielded’ from the virus have died in disproportionate numbers. There are multiple and overlapping reasons for the very high rates of COVID-19 infection and death in residential adult social care settings. Some are immediate policy decisions relating to the management of the pandemic including to discharge older people from NHS hospitals into residential and nursing homes without a negative COVID-19 test result, and to prioritize the supply of (scarce) Personal Protective Equipment (PPE) to NHS providers. Others are endemic to the regulation of residential and nursing care, including the financial models that allow private equity firms to make significant profits while local authority funded placements pay at below cost, family members are required to pay care ‘top-up’ fees, and self-funded residents are expected to cross-subsidize those funded by the state. Low pay and low status for care workers in this impossible financial context then translates into high staff turnover and a reliance on agency care staff (who work for multiple providers). Brexit has compounded this issue, with estimates suggesting there were over 120,000 vacancies in adult social care in late 2019. In this chapter, I will argue that a new model for adult social care, which focuses on fairness rather than profit is the only way to create a stable, safe and sustainable social care sector for the future.

Introduction: COVID-19 in care homes

Residential care settings in the UK were hit particularly hard by the initial outbreak of COVID-19. At the regular Downing Street daily briefing on 15 May 2020, Matt Hancock, Secretary of State for Health and Social Care, claimed that the government had thrown a “protective ring” around care homes “right from the start” of the pandemic. Statistical data collated on deaths involving COVID-19 during the first wave of the virus unfortunately tell a very different story. Far from protecting care homes from the outbreak, some 6,811 care homes in England (44 per cent) had reported suspected or confirmed outbreaks of COVID-19 by 23 July 2020. Similar outbreaks were experienced elsewhere in the UK, with 66 per cent of care homes in Scotland reporting outbreaks, and several care homes reporting multiple COVID-19 deaths in quick succession.