Community care services could be rationed in England

Care services in the community could be rationed amid the spread of Omicron, which is causing staff absences in England’s public services to rocket.

Nicola Slawson 

Choices will need to be made about what services can and cannot be covered, according to Patricia Marquis, the England director of the Royal College of Nursing.

“Services are already really stretched and it won’t take a lot – either further staff absences or increasing numbers of patients needing to be seen because the hospitals are full – to really push the services over the edge,” she said.

Marquis predicts that as services begin to reopen after Christmas, it will become clearer how much more pressure they are facing.

Community nursing is a particular area of concern and those services could end up being rationed, Marquis said. “Everyone automatically thinks about hospitals, but staff shortages aren’t just affecting hospitals. Limiting the number of community services that are available will possibly need to be considered.”

Stephen T Chandler, president of the Association of Directors of Adult Social Services, also warned that social care provided in people’s homes could be badly hit by the Omicron wave.

“In some places, people are having to wait longer to be discharged from hospital or may be waiting longer for people to come out and assess them. In some instances, it will result in some services being unavailable in the short term and that’s what we mean by rationing,” he said.

A day care facility in Oxfordshire has already had to temporarily close due to staff shortages, he said. Homecare is likely to be badly affected, as it is harder to redeploy staff.

“The best-case scenario would be a stranger would come into your home who is not familiar with your care and the worst case is the number of visits having to be reduced,” he said.

Chandler said care provided in the community plays a crucial role in protecting the NHS as it can reduce the number of people visiting hospital. “This is why it is so critical that you don’t have anything happening that would risk that,” he said.

Meanwhile, Dr Chaand Nagpaul, chair of the council of the British Medical Association, warned that GPs are being hit by staff shortages and said the government’s focus solely on hospitalisation data when making decisions about further Covid restrictions was shortsighted.

Nagpaul said: “To me the elephant in the room is the alarming levels of NHS staff shortages, and hospital data do not include general practice, which is being impacted significantly.”

The BMA has been told that large numbers of appointments are being cancelled as a result. “We’re also seeing cancellation of clinics for blood tests, for example where nurses are off sick. Reception staff are also going off sick, which means phones are going unanswered.”

When people can’t get GP appointments, A&E visits usually increase, so there is a knock-on effect on hospitals. “The government’s focus purely on hospital absence and Omicron hospitalisation is missing the larger picture of the impact on general practice, which is for patients that first point of contact.”

Public transport also continues to experience pressure due to Covid-related staff shortages. The Rail Delivery Group, the British rail industry membership body, said that on Monday 6.8% of trains were cancelled, up from an average of 5.4% in the seven days to Friday 24 December. The annual average of cancellations is 2.9%.

A spokesperson said: “Our staff are working in difficult circumstances and, like everyone else, they are susceptible to the virus.”

Waste collection services also continue to be disrupted in some areas of the country, with Basingstoke and Deane borough council having had to announce on Christmas Eve that some collections may not take place owing to Covid-related staffing issues.

Bin collections for Cambridge and South Cambridgeshire between Christmas and the new year also had to be revised, with some collection dates delayed by five days.

Green bin collections in the area were suspended from 13 December due to the number of absent drivers and loaders, particularly due to Covid-19 or self-isolation, the Greater Cambridge Shared Waste Service said, with rounds not due to return to normal before 24 January.