COVID-19 management in social care in England: a systematic review of changing policies and newspaper reported staff perspectives

Abstract

Adult social care has been a major focus of public attention and infection control guidance during the COVID-19 pandemic, with a high mortality both for carers and those receiving care. To protect themselves and others from infection, staff in residential and domiciliary care settings had to quickly adapt to infection control measures that heavily impacted on their working and every-day life, whilst navigating new responsibilities, uncertainties and anxieties. We sought to explore the production and reception of guidance and look at ways these can be adapted to improve the working life of care staff in domiciliary and residential care whilst reducing the risk of SARS-CoV-2 transmission amid this pandemic and of future emerging infections.We conducted two complementary and integrated systematic reviews of published documents in the pre-vaccination era: (1) National guidance for social care (conducted between 29 July to 28 October 2020), and (2) Newspaper coverage of infection control issues in social care (conducted between 27th July to 10th September 2020).Three higher order common themes emerged in the integrated systematic review of guidance documents and newspaper articles: a) Testing, b) Personal Protective Equipment, c) Employment. The reviews revealed a sharp disjunction between the content of infection control guidance and its usability and applicability in social care settings. We suggest that infection control guidance needs to be better adapted to social care settings and informed by the sector. The practicalities of care work and care settings need to be at the core of the process for guidance to be relevant and effective. Modes and timings of communications also need to be optimised.

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

“…Longstanding challenges and shortcomings of the COVID-19 policy response entangle in producing adult social care as a marginalised sector during this pandemic. As many have argued, the adult social care sector has been facing systemic problems for decades, and these have been exacerbated by the pandemic [24,38,39]. Most of these problems afect the workforce directly and include, along with market fragility and lack of adequate funding, low wages and underpaid staf, increased casualization, high turnover and vacancy rates, and unclear career development and pathways, especially for those in direct-care jobs [18,39].…”

“…Tis qualitative work was part of a mixed-methods implementation project aimed to understand what guidance and interventions would improve the working life of care staf in domiciliary and residential care whilst reducing the risk of SARS-CoV-2 transmission. Te project also included the development of a mathematical model of infectious disease transmission in domiciliary care, using COVID-19 as a test case [23], and an integrated review of national infection control guidance for social care and newspaper coverage of infection control issues in adult social care [24].…”