National Care Service - people who access adult social care and unpaid carers: evidence

4. Impact of the Covid-19 pandemic

The World Health Organisation declared Covid-19 to be a pandemic on 11 March 2020, ten days after the first positive Covid-19 case was confirmed in Scotland^[23]. Clinical guidance for people accessing care at home and housing support and updated guidance for residential care residents was issued on 26 March 2020. Advice for unpaid carers was issued the following day.

4.1 People who access social care

The Covid-19 pandemic led to widespread changes within the social care sector and the implementation of urgent guidance to curb the spread of the virus in care homes and within care at home and housing support services. This meant that social distancing was required as much as possible and visits to care home residents were limited. For care at home services, some people had their packages of care reduced or stopped as partnerships focussed on providing support to those with critical needs. Many people who receive care and their families also chose to reduce the support they received.

According to the Care Inspectorate’s Report Delivering Care at Home and Housing Support Services during the Covid-19 pandemic^[24], 19 out of the 23 Health and Social Care Partnerships that provided information reported that they had made changes to people’s care packages that involved a reduction in support provided during the first phase of the pandemic. However, it was noted that the proportion of people receiving support that were impacted by these changes varied greatly across the country. Some areas also reported increasing the support provided through a small number of packages and service providers looked for alternative ways to meet lower-level needs, including relying on more support from families, making fewer visits, and introducing new services to provide meals and shopping, in conjunction with third sector organisations ^[25].

The report also highlighted that people receiving social care support at home during the pandemic experienced increased social isolation as well as limitations to their physical activity and daily activities. People also experienced greater impacts if they were not able to understand the reasons for measures such as social distancing and the use of Personal Protective Equipment (PPE).

However, it is important to note that not all of the reported impacts of the pandemic were negative. The report suggested that the reduction in activity helped some achieve a better life balance and others benefitted from technology enabled care to allow them to see family and access support. In the Arc Scotland report We’re all in this together: The impact of Covid-19 on the future of social care^[26], social care workers said that many people receiving social care support had coped better than might have been expected and that their relationships with the people they were supporting had slightly improved.

For care homes, the first clinical guidance was issued on 13 March 2020. This recommended limiting visits to essential visits only and social isolation in residents’ rooms in order to limit the risk of infection. Between 1 March and 31 May 2020, almost a third of care homes (348) experienced a Covid-19 outbreak while 3,278 residents had at least one positive Covid-19 test ^[27].

Between the start of the pandemic and February 2022, over a quarter of deaths where Covid-19 was mentioned on the death certificate occurred among care home residents^[28].

4.2 Unpaid carers

The ‘Delivering Care at Home and Housing Support Services during the Covid-19 pandemic’ report highlighted that the reduction of social care support meant that, in some cases, families and neighbours had to step in to provide support instead. In almost all areas that responded, some people who access social care and their families also declined their usual support in order to reduce the number of people in the home and thereby reduce the risk of infection.

A YouGov poll commissioned for Carers Week 2020^[29] suggested that the number of people providing unpaid care in Scotland could have risen to over 1 million at that stage of the Covid-19 pandemic. However, it should be noted that this is based on a small Scottish sample.

Data from the 2020 Scottish Health Survey^[30] suggests that there were 839,000 unpaid carers in 2020. However, this figure is not comparable to previous years as it is based on a telephone survey that ran between August and September 2020 rather than the usual face to face interviews over a longer period of time.

The closure of many day centres and respite services during the pandemic meant that there was greater pressure on unpaid carers, who were not always able to sustain the level of additional support they were providing^[31]. These pressures were reported to have led to greater anxiety and mental exhaustion among carers during lockdown^[32].

While the number of carers is thought to have increased during the pandemic and carers were facing greater pressures, there was no increase in the number of carers receiving formal support as recorded through the Carers Census^[33]. This may be because local authorities prioritised support during the pandemic to those with the most critical needs and services were unable to provide many of their usual forms of face to face support due to restrictions. However, it should also be noted that the Carers Census is a relatively new collection and many areas are still implementing systems to accurately collect and record the requested information. Therefore, figures should be treated with caution.