The authors conclude that quality principles for a long Covid service should include ensuring access to care, reducing burden of illness, taking clinical responsibility and providing continuity of care, multi-disciplinary rehabilitation, evidence-based investigation and management, and further development of the knowledge base and clinical services.

• The NHS and local authorities must set out how they will involve social care providers and care homes in winter pressure planning to ensure that social care is placed on an equal footing with the NHS, and that their situation is understood, accounted for and supported. This must include the provision of regular and timely testing and PPE.
• National UK governments must guarantee that where care was stopped due to coronavirus precautions (particularly domiciliary care), it will be reinstated when deemed safe, without the need for unnecessary further formal assessment.
• The UK Government must ensure that the Infection Control Fund remains in place until at least April 2021 and care providers should be able to use that fund flexibly, including for infection control, technology and supporting visits.
• National UK governments should commit to ensuring that any communications to, or requirements of, people affected by dementia (both in the community and in care homes) are clear, consistent and straightforward to understand. Any guidelines should reflect the daily lived experience and particular needs of people affected by dementia.
• Recognising the key role that informal carers play in the lives of people living with dementia, national UK governments must take action to support people in this role by: a. Allowing for at least one informal carer per care home resident to be designated a key worker, with access to training, COVID-19 testing/ vaccinations and PPE. b. Ensuring the delivery of carers’ assessments and provision of short breaks for carers. c. Collecting local authority and health authority data on carer assessments and respite care.
• Where care homes are unable to facilitate visits from loved ones, they must be required to notify national care inspectorates (CQC/CSSIW/RQIA) and seek to put in place suitable alternative arrangements to maintain appropriate contact between loved ones and care home residents who have dementia.
• National UK governments needs to set out a clear strategy to enable people affected by dementia to recover from the effects of the pandemic, including rehabilitation to counteract effects on cognitive or physical functioning, support for mental and physical health, and speech and language therapy.
• National UK health and social care departments must develop and implement a clear recovery plan to ensure that all elements of memory assessment services can re-open and urgently catch up on waiting lists so the freefall in dementia diagnosis rates does not continue.

The report found:

• 6 in 10 (61%) parents shared significant concerns about their mental health.
• A quarter (24%) of pregnant respondents who cited mental health as a main concern said they would like help with this, rising to almost a third (32%) of those with a baby.
• Only around 3 in 10 (32%) were confident that they could find help for their mental health if they needed it.
• Almost 9 in 10 (87%) parents were more anxious as a result of COVID-19 and the lockdown. There was a notable variation among respondents who reported feeling ‘a lot’ more anxious: White 42%, Black/ Black British 46%, Asian/Asian British 50%, parents 25 years old or under 54%, and parents with a household income of less than £16k 55%.

This report sets out the action that will need be taken to reduce the risk of transmission of COVID-19 in the sector, both for those who rely on care and support, and the social care workforce. This report sets out how we can enable people to live as safely as possible while maintaining contacts and activity that enhance the health and wellbeing of service users and family carers.

Throughout this report, a number of recommendations are made based on learning from the first phase of the pandemic. They range from 'quick wins' to consideration of topics that will require a degree of more substantial change and/or additional resource. In addition, there are a number of supporting recommendations in the annexed reports of the subject-specific advisory groups, which should be considered in tandem with the main report recommendations.

It was by no means all bad: some patients reported good ongoing care, and were impressed by the way their local communities came together to support them.

This report uses what patients said to look to the future, both near and long-term. It contains recommendations for the next phase of the emergency response, and also a call for the health and care system to be built back better after the pandemic: the current emergency footing cannot be the basis for the ongoing relationship between patients and the NHS.

The paper conceptualises harm to health using the following four categories:

• A. Health impacts from contracting COVID-19 (A)
• B. Health outcomes for COVID-19 worsened because of lack of NHS critical care capacity (B)
• C. Health impacts from changes to health and social care made in order to respond to COVID19, such as changes to emergency care (C1), changes to adult social care (C2), changes to elective care (C3) and changes to primary and community care (C4).
• D. Health impacts from factors affecting the wider population, both from social distancing measures (D1) and the economic impacts increasing deprivation (D2).

The results are briefly discussed in the section below; summary tables of the mortality and morbidity impacts can also be found below.

• Based on existing data, healthcare professionals should be aware that pregnant and recently pregnant women with COVID-19 might manifest fewer symptoms than the general population, with the overall pattern similar to that of the general population.
• Emerging comparative data indicate the potential for an increase in the rates of admission to intensive care units and invasive ventilation in pregnant women compared with non-pregnant women.
• Mothers with pre-existing comorbidities will need to be considered as a high risk group for COVID-19, along with those who are obese and of greater maternal age.
• Clinicians will need to balance the need for regular multidisciplinary antenatal care to manage women with pre-existing comorbidities against unnecessary exposure to the virus, through virtual clinic appointments when possible.
• Pregnant women with COVID-19 before term gestation might need to be managed in a unit with facilities to care for preterm neonates.

The survey responses confirm that for the majority of respondents, the pandemic has been a very challenging experience. They indicated that their work and wellbeing has been worse or much worse than at normal times, during the survey period.

Having to accept patients from hospitals with unknown COVID-19 status, being told about plans not to resuscitate residents without consulting families, residents or care home staff, lack of guidance on issues like personal protection and issues of poor access to pay if they became ill were some of the major issues the care home workforce faced during March and April 2020.

While two thirds of respondents said they ‘always’ had access to appropriate personal protective equipment (PPE) and most others said that it was usually available, a small minority were not provided with PPE and had to improvise, by obtaining it themselves or by making it. The need for appropriate PPE in care homes is of critical importance in staff and resident safety: 21% of respondents said that their home accepted people discharged from hospital who had tested positive for COVID-19.

The majority of survey respondents found it easy to access hospital care for their residents when this was required; however, a substantial minority found this difficult or very difficult. Additionally, a substantial number found it difficult to access District Nursing and GP services, which are universal parts of the National Health Service. In addition, many indicated that they were not able to access essential training from other health professionals at this time.

Some respondents refocused work to consider how they could improve on their approach to end of life care. Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.