Yorkshire councils who risk exhausting emergency reserves to meet soaring adult social care bills have called on the Government to provide a sustainable long-term funding solution as a matter of urgency.
The funding gap for just eight of the 15 regional councils with social care responsibilities amounted to more than £80m this year - and the extra burden caused by the coronavirus pandemic has seen that more than double to £190m, an investigation by The Yorkshire Post can reveal.
The true figure is set to be even higher as costs associated with virus look set to continue into 2021, and councils such as Doncaster, Sheffield, Kirklees and York were unable to provide data.
The Government has provided Yorkshire councils with £370m in emergency funding in light of the pandemic - £61m of which is ring fenced for care homes and to support care staff, yet councils told The Yorkshire Post they costs “far exceeded” the help available.
It comes just months after Town Hall leaders said they could be forced to effectively declare themselves bankrupt this autumn because of the devastating toll the pandemic is taking on their finances.
In North Yorkshire, the county council estimates coronavirus will add an extra £28.3m to its adult social care bill, and £73.4m in total. Government support has reduced the strain to £38.5m, “but unless further funding is forthcoming” this will have to be met “at the expense of other services”, Gary Fielding, North Yorkshire County Council’s Director of Strategic Resources said.
It is “eagerly awaiting” the Autumn Spending Review but says pressures in adult social care will remain until a “sustainable” system is introduced by the Government.
Labour-controlled Wakefield used short-term funding and the social care council tax precept to plug a £19.8m funding gap this year. £4.6m of extra coronavirus pressures are expected to be met by the Government.
The Council’s cabinet member for adults, health and wellbeing, Coun Faith Heptinstall said: “However, when we are faced with ever rising challenges, particularly in the current climate, short term fixed solutions are not adequate - we need long term investment from the Government. There was an impending crisis before coronavirus and without real and meaningful investment it can only get worse.”
An underlying funding gap of £6.8m at East Riding Council is expected to rise by £9.6m due to coronavirus pressures.
A council spokesperson said the funding gap would “continue to grow” if no action is taken, and it is expected that funding reserves, which pre-coronavirus were forecast to exhaust in four year, will now run out sooner due to the “fragile” financial position caused by the pandemic.
Barnsley Council said it faced a “significant challenge” and will pause projects earmarked for funding from reserves to meet the £9.6m gap in adult social care funding caused by coronavirus. The additional costs of dealing with the pandemic and maintaining critical services “far exceeds the Government funding received to date”, cabinet spokesperson for adults, Coun Jenny Platts said.
Bradford Council, whose funding gap amounted to £5m before the pandemic, said it was “concerned” for the residential care home sector, which has high vacancy rates, and has asked the Government to fund empty beds to ensure the sector remains stable and that it is not forced to move elderly people to different homes this winter should their own residential care homes close.
Elsewhere, Calderdale faces a combined £5m funding gap in adult social care, Hull’s rose by £11.4m due to the pandemic, and Kirklees said a long-term solution was “urgently needed” as it faced a shortfall of £26m. Leeds’ combined figure was £23.2m and the council said a secure finding model needs to be “urgently developed”.
Sheffield was unable to give a precise figure but said it will run out of reserves in two years and faced a “significant shortfall” despite Government support, while Doncaster said it supported reform that “provides parity of esteem with the NHS”. Rotherham’s shortfall amounted to £18.3m.
The Local Government Association (LGA) said pre-Covid-19, the overall social care funding gap facing councils was £810 million in 2020/21, rising to £3.9 billion in 2024/25.
Chairman of the LGA’s community wellbeing board, Coun Ian Hudspeth, said: “Councils are doing all they can to support social care providers in their areas, but the fragility of our care provider market, exacerbated by coronavirus pressures, is a serious concern and this needs to be addressed as part of fundamental future reforms of the system.”
A Government spokesperson said it recognised the challenges facing the social care sector and was doing everything it can to support it. Cross-party talks on a future solution will take place “at the earliest opportunity”.
He added: “We have set out a comprehensive action plan to support the sector in England throughout the coronavirus outbreak, and we will bring forward a plan that puts social care on a sustainable footing to ensure the reforms last long into the future.”
"Everything points to these enquiries continuing to rise"
The campaign for an inquiry into coronavirus deaths of people in care homes is growing as bereaved families say the true death toll is still being underestimated.
Lawyers have said they have been seeing an increase in cases relating to care homes since the start of the pandemic and a petition from the campaign group Covid-19 Bereaved Families for Justice UK calling for a public inquiry has attracted more than 160,000 signatures.
Some families are looking for recognition of government failings while others simply want their loved ones’ deaths to be counted among the 40,000 suspected fatalities from the disease.
Steve Mitchell, whose father died at a Leeds care home on 20 April with suspected covid-19, said there was still a lot of confusion as no tests were ever carried out at the home.
Raymond Mitchell, 86, had coronavirus symptoms and died during the height of the pandemic but, as he was not tested for the disease, it is not on his death certificate.
Aspen Hill Village in Hunslet has had two recorded deaths from coronavirus but these both happened in the hospital and the home said it is impossible to know whether residents contracted the infection before or after being admitted to hospital.
Steve Mitchell said: “I spoke with the clinician at the home just about 45 minutes before dad died. I asked the clinician very deliberately ‘has he got coronavirus symptoms?’ and the clinician said yes.”
His father deteriorated very quickly and there was no opportunity to consider admitting him to hospital.
He said he received no condolences from Aspen Hill Village and that the home was defensive when Mr Mitchell asked for more information about his father’s death, though he managed to negotiate an account of his father’s last week, written by the clinician, which was “sketchy”.
The care home had a Facebook group for the families of residents to share news and pictures but after the deaths the group was deleted and another one set up which excluded families of the residents who had died.
Aspen Hill Village said the group was deleted because the member of staff who ran it left.
He said: “I’m really conflicted because the care home looked after dad for the better part of nearly three years, which makes it really difficult as my relationship now is one of unease about how they behaved afterwards and the sort of communications they put out.”
Mr Mitchell said he owed it to his dad to raise concerns that some deaths were still not being counted in the figures, despite having very clear and tangible links to the disease.
Aspen Hill Village said: “We recognise that this has been an exceptionally difficult time for families who have not been able to visit their loved ones or who have lost their loved ones during the pandemic. At all times we have maintained lines of communications with family members to ensure that all information is shared and relatives continued to be involved in the care of their loved ones.
“If any relative considers that they have unanswered questions about the care of their relatives during this time, we ask that they reach out so we can support them to find the answers they need or address their concerns.”
Campaigners say there are many more cases similar to that of Mr Mitchell and there is a concern that the government is still underestimating the true death toll in the UK.
Lawyers are warning that they are taking on increasing numbers of new cases related to negligence in care homes.
Tracey Benson, personal injury lawyer at Slater and Gordon, told the Yorkshire Post there had already been a “steady increase in cases relating to neglect within care homes” before the pandemic.
She said: “This can range from injury due to poor conditions, to residents sadly losing their lives from cases of continuous neglect and dangerous behaviour.
“The pandemic, in our experience, has only made this problem more prominent.
“Family members we have spoken to are openly questioning whether substandard levels of care have led to the death of their loved one or if confusing government guidelines has pathed the way for unsafe practices, such as removing elderly residents for non-critical testing in hospitals.
“We have received a number of enquiries where relatives appear to have died shortly after going into hospital for these sorts of testing.
“Everything points to these enquiries continuing to rise and the need for a public inquiry.”
Aspen Hill Village has been contacted for a response.
“The doctor has written her off.”
Human rights organisations are “deeply concerned” about the rise in reports of care homes denying people the right to go to hospital and issuing “do not resuscitate” (DNR) orders during the pandemic.
Last week, the government agreed to issue guidance on the use of such orders after instances in the UK where conditions such as epilepsy and blindness were used as a reason not to call an ambulance.
One family with a relative in a care home, who have had to fight for her to be taken to hospital if she became ill, described it as “sinister”.
DNR notices are only supposed to be issued after conversations with the patient or their family about what is in their best interests but there have been many reports of healthy care home residents being pressured into signing the forms or having the notices placed on their file without a discussion.
Some of these people have been as young as their 60s, with conditions like blindness and epilepsy.
Robert Linley, whose 90-year old mother is in a care home run by Palms Row in Sheffield, said a doctor tried to persuade the family to agree that an ambulance should not be called if she became ill.
They have been extremely worried as they have been unable to see Ellen Clara Linley, who has dementia, due to lockdown measures.
He said the doctor described her as “rapidly deteriorating” and “frail”, though the family said she was well when they were last able to see her.
He said: “The doctor has written her off.”
Mr Linley said the family had previously agreed to a DNR notice for their mother but this did not extend to all hospital treatment and the doctor had tried to persuade the family to agree that Mrs Linley should not be taken to hospital under any circumstances.
“She said ‘would you want her to die in an ambulance or hospital corridor?’.”
He added: “It’s putting us in the position where we have to fight to retain any future hospital care for her, care that everyone in the country is supposed to receive.”
The Yorkshire Post previously reported how, at the start of the lockdown, Mrs Linley was moved to another care home, along with 21 other residents, against the family’s wishes.
The family later found out that there was a diagnosed case of coronavirus at the home.
A spokesperson from the Equality and Human Rights Commission told the Yorkshire Post: “We remain deeply concerned about potential breaches of older people’s human rights during this pandemic.
“People of all ages should be treated with dignity and must have access to good quality healthcare. Decisions about treatments must be taken in the best interest of the patient."
Bethany Brown, older people’s rights researcher at Human Rights Watch said: “The high numbers of Covid-19-related deaths in care homes show just how vulnerable residents can be.
“A national health crisis is no excuse to neglect older people’s human rights – it is more critical than ever before to respect their choices and ensure international human rights norms are upheld.”
Allan Hogarth, Head of Advocacy at Amnesty International UK said: “The right to life and the right to health are protected by human rights law and governments have a duty to ensure they are respected.
“An inquiry into the Government’s coronavirus response is necessary. Above all to learn lessons and ensure non-recurrence, and to ensure accountability if the Government has failed to comply with international law and standards to protect the health and lives of care home residents.”
A number of rules have been suspended since the start of the pandemic, in order to streamline processes for medical professionals and people in the care industry.
Among other high profile measures such as sick pay for anyone with coronavirus symptoms and bans on large gatherings, doctors were given the ability to sign death certificates without being present, in the emergency Coronavirus Bill which went through parliament in March.
The Bill relaxed some of the powers brought in after the investigation into Harold Shipman, the GP who was jailed in 2000 and murdered as many as 265 elderly people.
Nicola Richards, director of Palms Row Health Care said: “We will always act in the best interests of our residents. Everyone being cared for in our homes has medical care plans which are created with a local doctor and, where appropriate, in consultation with residents and their families. The care plans are person centred and reflect best practices and the wishes of the individuals we care for.”
"There will have been a lot of hardships"
The social care ombudsman is gearing up for a “flood” of complaints following the coronavirus pandemic.
Yorkshire already has some of the most complained about councils in the UK, with North Yorkshire topping the list for complaints about social care charging.
In just one year in 2018/19, there were 36 adult social care complaints about North Yorkshire County Council alone and 12 of those were about charging, data from The Local Government and Social Care Ombudsman, shows.
A total of 76 per cent of these complaints were upheld.
During that year, there were 225 complaints in Yorkshire solely about councils’ provision of adult social care, a figure that does not take into account private companies, which provide a large proportion of care in the region.
Speaking to the Yorkshire Post ahead of the release of the 2019/20 complaints figures next week, Donna Campbell, assistant ombudsman and adult social care lead, said: “We are starting to see a drip of covid complaints but we have set up a dedicated covid team so we’re ready for when those complaints start to become more of a flood than a trickle.
“For a lot of people there will have been a lot of hardships.”
Charging is a huge area where disputes can arise, as adult social care is means tested and councils take an increasingly rigorous approach against things like deprivation of assets - an attempt to hide wealth, for example by giving money or property to family members.
In one case in 2018, an 80-year-old woman ended up owing a care home £30,000 after North Yorkshire County Council stopped subsiding it, accusing her of deprivation of assets. The ombudsman upheld the complaint against the council.
Ms Campbell said: “What we found when we prepared our adult social care review last year, is that we had an increase in complaints about charging and finances, and we upheld nearly three quarters of the complaints we investigated in that area.”
This might suggest that complaints are not being dealt with effectively by underfunded councils.
Independent Age, which offers information and advice to elderly people, said it had seen a rise in the number of people visiting the social care pages of its site and had an increase in calls relating to inadequate care during lockdown.
Deborah Alsina MBE, chief executive of the charity, said: “We’ve heard from people in later life who have been so worried about catching coronavirus they’ve not felt safe to let professional carers into their home, while others haven’t yet received care assessments from their local council. This means many older people may not be getting the support they need with basic things like washing, dressing, and preparing meals.”
The ombudsman exists so that members of the public can complain when they have exhausted the complaints system at their council but the service also extends to private care companies too.
Ms Campbell added that many people who pay privately for their own care do not know about their right to complain to the ombudsman when things go wrong, as the numbers of complaints about private care have been static over the last few years.
“We still feel that 10 years on we do not get enough complaints from people who have private care.
“People don't know the ombudsman exists, and they certainly don't know that it exists for people who don't go through a council service.”
"I never have a day I don’t want to go to work"
Six months ago, carer Anne Murtough would never have dreamed she would end up wearing her husband’s DIY goggles to work.
But the global pandemic changed everything overnight as pubs, shops and restaurants closed, office workers switched to homeworking and most of the UK ground to a halt.
However, for elderly people who need help in their home, the world could not simply stop and many carers were forced to make enormous sacrifices and risk their own safety to ensure those in need were not left behind.
Early on, Mrs Murtough had got a sense that the pandemic was spreading to the UK.
“At the outbreak, I was scared. My husband reads a lot and he’d been following the news about the pandemic while it was still in China.”
Like many people, she made do with what she could get her hands on, which meant fetching her husband’s goggles from the garage.
“I looked ridiculous but I didn’t care,” she said.
“I felt a duty to go out to work. The majority of the people I visit are not able to go out and about.”
She works on her own for a small care company in Otley called Rest Assured Home Care, visiting elderly service users and helping them with daily tasks.
“It’s a very demanding job but I never have a day I don’t want to go to work,” Mrs Murtough said.
Mrs Murtough - whose employer supplied her with protective eyewear, along with other PPE like masks, gloves and aprons, as soon as it was available - has been a carer for two and a half years.
The 47-year-old got into care work after looking after her father who had dementia.
She said she was “quite traumatised” by seeing what occurred at the care home where her father spent his remaining days and realised not everyone has the skills to be a carer.
“It was a heartbreaking experience watching that, as many people will know,” she said. “But I found I enjoyed looking after people and I had that knowledge of dementia.”
Care work is almost always a minimum wage job and, due to the physical and emotional demands, carers are rarely in it for the money.
“Those of us doing it would never say anything - nobody’s disgruntled. We get that reward when people say thank you.
“I come home knowing for each service user that I’ve made a difference to their day. It’s the human touch, assisting them, giving them meds.
“They really do appreciate your help. It nourishes you emotionally, you feel rewarded.”
It is a similar story for 32-year-old Lucy Hall who works as a carer in the community in Ilkley and ended up staying in a holiday home at one point during lockdown to protect the elderly people she looks after.
“I moved out of home - someone gave me the keys to a holiday home that wasn’t being used. When I got home again I slept in the spare room,” she said.
Some friends will ask if she is “still overreacting” to the pandemic but Ms Hall does not see it that way.
“I’m shielding on behalf of the people I look after. I’ve been able to alter my life to reduce the risk.
“My hands have been red raw from washing them,” she said.
At the height of the pandemic, she was paying someone to go to the supermarket for the clients to reduce the risk of picking up the infection and now she does the shopping in the evenings when the supermarket is quiet.
“I’ve become a hermit!” she joked.
There’s no legal requirement for carers to wear PPE when visiting people with no symptoms and Ms Hall said she wanted to reduce the “fear factor” for service users with dementia, though she has it “ready and waiting” in the boot of her car if there is a need to use it.
She has been a carer for eight years and been self-employed for the last three years - though it is far from lonely as she spends most of her day talking to people.
Most of the people she visits have dementia and anxiety issues, which means seeing a familiar face is very important.
“Some haven’t been able to see their family,” she said, adding that families have been incredibly worried about their elderly relatives’ physical and mental health.
While she likes her work, it would not suit everyone.
“It’s seven days a week. If someone rings at 12pm because they’ve had a fall, I get out of bed and go and pick them up.
“It really affects your social life. There are loads of stuff I miss out on,” she said.
That is something also felt by Hull-based Melissa Senior, 45, who has been a carer for nearly four years.
“I don’t really wind down,” she said.
“You can turn up to anything. They might have had a fall, they might have died - that hasn’t happened to me but it’s happened to colleagues. You need good judgement and people skills.”
Ms Senior works split shifts, 7am until 10pm with a gap in the middle, and her typical day involves visiting 18 people, helping them with personal care, shopping and medication.
Mostly she works alone with elderly people but on evenings she is paired with another carer from the company, Springfield Homecare, to help people get into bed.
She said: “I love it. I love all the little different characters and it’s so rewarding seeing the smiles on their faces.”
The panic buying at the start of the pandemic made the job of carers like Ms Senior nearly impossible. Time in her day is very tight and she struggled to find the items clients needed, even going to multiple supermarkets.
She said: “It was an absolute nightmare. Finding toilet roll was shocking.”
She said that she shared jokes with service users about resorting to strips of newspaper but thankfully it did not come to that as they managed to track it down.
Supermarkets’ limits on the number of items that could be bought at any time also made it incredibly difficult to get the things elderly people needed.
Ms Senior said at one point she spent her weekend off cooking for an elderly man who was a fussy eater.
“I managed to buy some things he liked, like mince and sausages, and batch-cooked meals that I could take to him. I froze them all in my freezer.
“What was harder was that people were bulk-buying things they didn’t normally buy, which stops more vulnerable people being able to get hold of them.”
But it is important not to forget that the risk is still there, especially among elderly people, who are both more likely to pick up the infection and more likely to become seriously ill or die from it, according to the World Health Organization.
“You really worry that they’ll fall like a set of dominoes. We’d wrap them in bubble wrap if they did.”
Other elements of her job have been made more difficult too. Wearing gloves and aprons is standard for Ms Senior but employees now all wear masks, something that has been terrifying and confusing for some of the elderly people she looks after.
“One lady asked if we were there to murder her. It must have been quite frightening,” she said.
“You can’t smile at them when you come through the door and they don’t always recognise you. If they’re hard of hearing they can’t hear you and can’t see your mouth.
“For the clients, it’s been hard to adjust to as they’re not used to seeing it.
“It’s set people back. Some have been getting very anxious, they follow the news and all it was was covid, covid, covid.
“A few have had to shield and couldn’t go out at all. It messes with their mental wellbeing.
“Some of them need counselling after this. It depends on how tough they are. People in the community, you don’t always know if they’ve had other people round, like family.
“At the beginning I did panic a bit, I wondered what would happen if I got it. I had a couple of wobbles.
“Every carer has struggled a little bit. But you just try to get a grip.”
She said her colleagues have helped a lot and the carers have tried hard to bring some joy to stressed and anxious elderly people.
“Over the bank holiday weekend I managed to get hold of a beach scene backdrop and we took pictures of them in front of it with lollies. We had a good laugh, there were some who I thought might not be up for it but every single one took part,” she said.
“If we have to go above and beyond, we will.”
"The staff were like family to her - and to me"
Much of the attention given to care homes in recent months has been negative - the desperate hunt for PPE, the 14,000 lives lost involving Covid-19 in English care homes, the question mark over whether more could have been done to throw a protective ring around them.
But for Sue Beanland, whose mother Norma Sunderland died in the care home she lived in two days after her 82nd birthday in April - the headlines could not be further from her experience.
Instead, the staff at St Cecilia's showed “incredible compassion” for her mother, whose death was unrelated to Covid-19, and had created such a home for the former teacher it was evident that they “truly loved her”.
Despite her illness taking her short term memory, Mrs Sunderland, who retired to Scarborough from Keighley in the 1990s, was a “vibrant and intelligent” woman who showed an almost “muscle memory” whenever children came into the home, her daughter said.
Her decline began at Christmas, when a flu-like illness resulted in a hospital admission. When she came out, the illness continued. Further tests were deemed to be too invasive and end of life care began.
Staying away from her mother, for whom she had been a carer, was particularly tough for Mrs Beanland, but as a teaching assistant she felt she had to be stringent in following the official advice and staying away. It was a comfort, she said, knowing the staff were with her.
“I know in those final weeks, if I’d insisted, the staff would have let me in, but I didn’t want to risk the lives of the people in the care home,” she said.
It was only in her mother’s last week that she visited.
Visiting meant using a side entrance, and only stepping inside once she had dressed in full PPE. Her brother, Chris, was also able to make a final visit from his home in Bradford, and staff provided him with a letter to show police should he be stopped en route.
Mrs Beanland, 59, said: “My mum was very distressed, and it meant everything to me to be there.
“The staff were like family to her - and to me. They made a very difficult situation bearable. I’m so grateful that she was able to die there, and not alone in hospital.
“Before she came to the care home - which was the most difficult decision I’d ever made - mum never left the house. Suddenly she had friends, and people around her all the time, She cooked, baked and did crafts. The residents truly ‘lived’ there - they weren’t just ‘parked’.”
"How would we cope with a second wave"
“Generational change” is needed to tackle the recruitment crisis facing social care, which has left providers wondering how they could cope with a second wave of coronavirus, a leading voice in the sector has said.
North Yorkshire care campaigner Mike Padgham, who is chair of the Independent Care Group (ICG), said the vacancy rate in the sector is the worst he had seen “in 30 years in social care” and that urgent action was needed to ensure care providers had the skilled, committed workers they needed.
Formal recognition in the shape of a National Care Service, with parity to the NHS, with state registration for staff, and a universal grading system would go some way to dealing with the out-dated perception of social care as a job “anyone could do”.
“Recruitment is an everyday occurrence for care providers and the problem has never been as acute as it is now,” Mr Padgham said. “The recruitment crisis has meant the staff who are working face longer shifts to cope with staff shortages, and face harder work. Everyone is working to their absolute maximum. If more staff are needed now, how would we cope with a second wave?”
The latest figures from the independent think tank the King’s Fund, from May, showed more than 122,000 care vacancies in England. Wages have improved since 2015, but are higher in other sectors, such as retail, and still low at an average of £8.10 an hour for 2018/19 - less than comparable NHS jobs, the Kings Fund said.
Earlier this month, social care workers were excluded from a new visa route into the UK post-Brexit, that would allow fast-track visas for health workers.
Trade union Unison said the “huge” vacancy rates that exist in Yorkshire were a result of “poverty wages, poor working conditions and undervaluing the skills of staff”.
UNISON Yorkshire and Humberside head of health Tony Pearson said: “The pandemic has shone a spotlight on the fragility and importance of the sector.
“Fundamental change is needed across the whole of social care as a matter of urgency. Otherwise the recruitment crisis will continue for years into the future and vulnerable people will be let down.”
In April, the Government launched a major recruitment campaign for adult social care, with Health Secretary Matt Hancock saying he wished “to reignite the search for people with a zest for caring and protecting our most vulnerable”.
Mr Padgham said he had hoped Mr Hancock’s speech, where he re-launched the ‘CARE’ pin badges, would have resulted in better pay and conditions for carers, but he was “sadly mistaken”.
“I have never seen as much praise lauded on the social care sector as it was then,” he said. “I actually thought, ‘maybe this is the moment things will change’.
“But it hasn’t changed a thing. Care providers have been forgotten about. Carers don’t need a badge, they need a pay rise and that will only come if the Government is willing to pay local authorities more for care.”
North Yorkshire County Council recruited some 250 relief care and support workers to provide “additional resilience” in response to the pandemic. Many of whom were furloughed from their jobs and are now returning to work, so the Council is gearing up to recruit once again.
The council’s director of health and adult services, Richard Webb, said rural locations such as Ryedale, Harrogate, Knaresborough and Craven were some of the hardest to recruit localities, where demand outstripped the number of workers.
Lack of housing, transport availability and costs and the logistics for care providers to provide care in very rural areas “are all significant challenges”.
Mr Webb said a long-term sustainable solution for adult social care from national Government and an increase in funding was “essential” to enable it to improve workforce pay and conditions and make the work of adult social care “more attractive and competitive” in the overall jobs market.