How decision-making in the UK during the Covid-19 pandemic undermined the delivery of integrated care – a social work perspective

Abstract

Background: Many policy decisions taken in the United Kingdom (UK) during the Covid-19 pandemic undermined the capacity to deliver integrated care. Existing social and economic equalities were aggravated by the circumstances of the pandemic, but appear to have been ignored or overlooked in decision-making. Our work sought to examine flaws in decision-making from a social work perspective.   Approach: The British Association of Social Workers (BASW) applied for Core Participant status in two modules of the UK Covid-19 Inquiry. These were Module 6 on Adult Social Care and Module 8 on Children and Young People. A public inquiry in the UK is established to investigate the most serious incidents, examining what went wrong, who was responsible and then make recommendations based on lessons learned. In preparing BASW’s witness statements and recommendations, we analysed over 500 documents from the relevant period (1 March 2020 – 30 June 2022), including two surveys of social workers conducted during 2020. Conclusions were tested with two further questionnaires for social workers, one for each module. Further engagement with stakeholders was restricted due to the legally binding confidentiality undertakings required by a public inquiry.   Results: The analysis identified key findings relevant to delivering integrated care during a widespread health emergency. From BASW’s perspective, it is clear neither the role of social work, nor the structure and functioning of social care were well understood at government level The pandemic both highlighted and aggravated existing inequalities. The least advantaged suffered the most. One of the first moves made in emergency legislation was to reduce or remove entitlements to care and support and weaken basic rights. Lockdown restrictions also often saw the loss or reduction of key support services.   Restrictions made it difficult, even impossible, to conduct appropriate assessments. This was compounded by a lack of Personal Protective Equipment (PPE) in the early months of the pandemic for those working in social and community care provision. A pivot to online service provision and education was problematic for those experiencing digital poverty, leading to digital exclusion for many. Moving to virtual work also complicated the conduct of assessments. Whilst the shift to greater use of digital communication technology brought some clear benefits in the delivery of care and support, this must be balanced against the needs of those unable to engage effectively in this way.   Implications: The findings of our review of the social work experience during the pandemic raise important questions about how integrated care can be delivered safely and appropriately in the event of a future widespread health emergency. Whilst experiences differ from country to country, depending on a wide range of factors, similar tensions need to be addressed.    These include: shifting the political focus to prevention; managing risk appropriately on an individual level; preventing the erosion of rights and entitlements - which has the greatest impact on those most marginalised; better preparation to minimise the impact of loss of support services; and the need to act promptly when evidence emerges to indicate a disproportionate impact on specific groups.