From tragedy to preparedness: Adult social care’s voice in the Covid-19 Public Inquiry

By Cathie Williams, former ADASS CEO

Five years ago we were in the thick of the pandemic. Now, the Hearings for the Social Care Module of the Public Inquiry have finished, the Inquiry is taking closing statements and we will await the report.  

I want to mark both the dreadfulness of that period, the magnificence of what you as ADASS members and staff did during that period and to highlight some recommendations we made from ADASS to the Inquiry  as to how we might better manage in the next pandemic. 

We started considering what we hoped the learning would be for the next pandemic from early on – a long time before the Inquiry was set up.  We submitted Witness Statements to Modules 1,2,3 and 4 as well as to this Module and I attended to give evidence last month.   

Key themes outlined in the Witness Statement, most of which were replicated by others, include preparedness and resilience, the understanding of social care in government, the levels of understanding of scientists of the impact of the virus on people needing and working in care and support, the need for greater focus on our social and psychological needs, social care as an afterthought to acute hospitals, the paucity of national infrastructures and awkward emergency planning structures (to rapidly step up PPE, testing, vaccination, workforce measures and infection prevention and control and to more rapidly identify carers and people needing and working in care), the balance of protection and connection,  quality, safety, effectiveness and safeguarding, national/local tensions, consultation and engagement and funding.  

We welcomed the opportunity to contribute as a Core Participant, anxious to acknowledge the sorrow of the bereaved, those needing and working in social care who were traumatised by their experiences or who still endure long covid, to pay tribute to unpaid carers, to the committed care staff and to mark the very significant efforts of everyone who worked excessively long days for months and months without a break.  

The module heard with remarkable consistency from participants that what happened to people needing and working in social care was both tragic in terms of the lives lost or compromised, but also much evidence of remarkable demonstrations of commitment, courage and the best of human nature. 

We said that in relation to planning for a future pandemic that we realise that it is not the brief of the Inquiry to address the underlying lack of resilience and long term funding in social care, though that is fundamental and potentially leaves us in a no better position to face a future pandemic or other national crises. 

Having heard or read the statements from most of the hearing, we were invited to make a very short closing statement.  In it we said that given the level of the tragedy we would make five recommendations practical national action that may have impact.  These were: 

• a thorough review of the infrastructure needed at every level – national, regional and local – such that social care and our social and psychological needs are addressed in a pandemic alongside the clinical and hospital focus. That means ensuring that there is social care advice to scientists from people with operational as well as policy experience and regular such advice to government at the highest level alongside the NHS. It means a review of Local Resilience Forums and NHS arrangements and accountabilities and what the best mechanisms for planning and response  are in the case of a national care and health emergency.  

• The creation of a national mechanism that could take the form of a ‘reservist Task Force’ to be stood up annually so as to continually review and assess readiness and ‘fit-test’ plans. It should cover the work of the same Advisory Groups as that of the Task Force that Sir David Pearson chaired in 2020. It should review the recommendations made by each of those advisory groups. It should be informed by and draw on regional perspectives (for example ADASS regional chairs). It should be ready to stand up at the earliest indication of a future pandemic.  

• It should be a requirement of government to act on such a Task Force’s recommendations with relevant partners to ensure that social care leadership and workforce is trained and equipped to deal with a pandemic. This would include the identification of those needing and working in care and effective mechanisms for shielding, vaccination, testing, PPE provision, data, professionalisation, pay and sick pay, access to healthcare, mental health support, access to care, support and safeguards such that we are all better protected, connected and valued.  

• Serious consideration being given to increasing awareness, recognition and the valuing of social care through embedding very operationally experienced and senior social care personnel in government, cross government recognition and mandatory induction delivered by leaders in the social care field for DHSC civil servants and politicians, both those with briefs in social care and the NHS, and also for people working in senior roles in the NHS. 

• A thorough revision of Discharge to Assess practice to include a greater focus on integrated ‘intermediate care’ – the care, treatment and support offered to people so as to avoid the need for hospital admission and to enable people discharged from hospital support to recover, rehabilitate and, if long term care is needed, to weigh up the benefits, risks and costs of their options.  

• That quality, safety and safeguarding are integral to planning for and responding to a pandemic, given that people needing and working in care and support may once again be behind closed doors at home or in closed institutions. 

Having spoken with many about what they hoped for from the Inquiry I said that there is a collective hope that it will make a mark in recognising just how essential social care is for all of our lives and start to build a new social contract about how we live, work and care for each other. 

I am humbled that ADASS retained me to lead our input to that Inquiry and was privileged to work with all of you during that period.  

All of ADASS statements and supporting evidence (100 items for our statement) are on the Public Inquiry Website. The Witness Statement for this module is a longish read and at: https://covid19.public-inquiry.uk/documents/inq000571608-witness-statement-of-cathryn-williams-on-behalf-of-association-of-directors-of-adult-social-services-dated-18-12-2024/