Minding the gaps: Recognising ancillary staff contributions in care homes during the COVID-19 pandemic

The ongoing UK enquiry into the country’s response to the COVID-19 pandemic has shed light on the severe toll taken on care homes, where 45% of excess deaths occurred among residents who succumbed to the virus. ¹ Staff working in the care home sectors were exposed to the virus with many experiencing severe infection and an increased risk of death. ² Regrettably, ancillary staff, comprising mostly laundry, catering, and cleaning workers, have been largely overlooked in the discussions, exposing a critical gap in understanding the full impact of the pandemic on the care system. Luijnenburg et al’s contribution to this edition addresses this oversight, providing a robust and poignant analysis of ancillary staff experiences during the pandemic.

Care homes operated amidst a paucity of official guidance and resources during the first wave of the pandemic in the United Kingdom. Despite facing challenges, ancillary staff demonstrated unwavering dedication, often taking on extended roles and responsibilities beyond their pay grade.^3,4 Working in uncertain disruptive times led to valid fears about their own health and wellbeing. Support and team working with sound leadership by the care home managers mitigated some of those fears. ⁵ The emotional toll on these essential workers, coupled with a lack of mental health support, reveals a significant gap in the overall care home framework. ⁶

While acute care services have dominated pandemic discourse, it is crucial to recognise the interdependence between acute care, care homes and domiciliary care in ensuring timely transitions from hospital care to community-based care, ensuring that people could leave the high risk, artificial hospital setting in a timely manner, and helping to maintain availability of acute care resource at a time-of-service demand resource constraint. The historical systemic lack of understanding about care homes, by successive governments compared to the National Health Service (NHS), became evident during the crisis. Regulatory bodies sought to contain the exponential challenges by mandating regular detailed information from individual homes, often with minimal practical guidance, leading to tensions. Issues such as the absence of real-time data on bed capacity and resident needs, coupled with a lack of organizational compassion, contributed to ambiguous decision-making. ⁷ Early perceptions of neglect towards the care home sector positioned the United Kingdom unfavourably compared to other European countries in managing the pandemic’s impact. ⁸

The crucial role of care home managers in mobilizing responses, implementing early lockdowns, and sharing knowledge highlights the need for timely and evidence-based support.^4,5 However, the lack of sustained PPE supplies, inevitable reliance on agency staff and the pressured acceptance of untested hospital discharged residents brought significant challenges, emphasising the need for robust policies and practices in pandemic preparedness. The DACHA (Developing research resources And minimum data set for Care Homes’ Adoption) study, initiated in 2020, offers promise with its system-wide prototype to maintain a minimum data set for care homes. ⁹ International studies provide valuable real-time research evidence, contributing to a better understanding of managerial and systemic responses. ¹⁰

The ongoing UK enquiry’s systemic approach, while commendable, risks overshadowing the voices of those directly affected by the pandemic, including ancillary care home staff. Ancillary staff have few voices to represent them, with fewer ways to publically voice their opinions and experiences. The work of researchers such as Luijnenburg et al ³ raises their voices in the fight for more equitable representation in health and social care. This work emphasises the importance of funding and enabling care home research to continue.

Moving forward, it is imperative to include the entire care home workforce, especially ancillary staff, in future planning for public health and the NHS. The stigma associated with working in older people care must be addressed, along with improving working conditions for all, including migrants and those on precarious contracts. ¹¹ By devising comprehensive policies and practices, including pandemic preparedness, the sacrifices made during the pandemic can pave the way for a more resilient and equitable health and social care system. We urge a collective reflection on the lessons learned and a commitment to fostering a culture that values every individual within the care home workforce.