There is a graph circulating in the care home industry that should send chills down the spine of the health and social care secretary, Matt Hancock. It predicts, under a worst-case scenario, a plunge in the demand for care homes by the end of 2021 that would leave 180,000 beds empty.
Robert Booth, Analysis www.theguardian.com
The forecast by consultants Knight Frank is not good news based on a healthier aged population, but rather is based on fresh waves of coronavirus killing thousands more people in the community and in care homes, creating a flight from the sector.
It is pessimistic, but for care home bosses reeling from the first wave of the pandemic – which killed more than 17,000 of their customers – it does not seem impossible.
Short-term, it could have a serious impact on an NHS left to look after the infirm. Longer-term, it could seriously erode the UK’s capacity to look after its most vulnerable.
Occupancy levels in care homes have already fallen substantially. Unlike the NHS, which can afford to have wards standing half-empty, the care industry is likely to respond with closures.
The UK is largely reliant on privately owned care homes to look after its most frail and vulnerable people. Many are owned by private equity companies. The largest provider, HC-One, is ultimately owned by a Cayman Islands entity. Four Seasons Health Care, which fell into administration before the pandemic, is owned by a US private equity firm.
Occupancy matters. One network with normal occupancy of 92% fell to 70%. Another said its normal occupancy of almost 90% dropped to 79%. Custom has slowly started coming back as lockdown restrictions are lifted and Covid deaths in care homes dwindle, but not in big numbers.
Some councils sent fewer than half the number of people into care homes in the first week of June than they did in 2019, while private admissions were down across the board at just 35% of 2019 levels, according to the Care Quality Commission (CQC), the regulator for England.
In a recent report monitoring the health of the market, it concluded bluntly: “Covid-19 is having a significant impact on the financial viability of adult social care services.” A quarter of directors of adult social care now have concerns about the financial sustainability of most of their residential and nursing providers.
This financial vulnerability is partly what lies behind the CQC’s refusal to expose care homes to greater public scrutiny of their death tolls during this year’s crisis. It fears a “significant impact upon providers who are already facing serious financial pressures … reducing the overall availability and choice of care services”.
In other words, care homes that suffered the highest death tolls could go to the wall as consumers react. Not only might that be unfair if the homes did everything they were told by government guidance and still lost residents, but it could put public health at risk.
Without enough care homes, a greater strain would fall on the NHS in any future rise in infection and the capacity for emptying hospital wards to make way for Covid cases would be reduced. This is the immediate danger faced by Hancock.
The government has already put £1.6bn into council services including care homes through the pandemic and may need to do more in the months to come. There is cross-party consensus on the need for a long-promised reform of social care.
Since March 2017, the government has promised a green paper on shaking up the system at least seven times, but it never came. When he became prime minister in July 2019, Boris Johnson said he would “fix the crisis in social care once and for all”. With an ageing population and a virus in circulation which is 70 times more likely to kill voters aged 80-plus than the under-40s, he might wish his party had started sooner.