• Problems with three-way communication between care home, prescriber and dispensing pharmacy
• Training of care home staff
• Leadership and the need to create a safety culture
• Problematic care processes, including record keeping and ordering medication

The aim of the report was to review and make recommendations for social care reform and integration with health in the wake of the COVID-19 pandemic, to inform the government’s plans for reform.

The report proposes a wide range of recommendations for adult social care system reform. The government have since taken forward a number of the recommendations in the white paper, People at the Heart of Care, which was published in December 2021.

They have also published an integration white paper which sets out measures to make integrated health and social care a universal reality for everyone across England.

The government published its response to the Lords report on social care.

• 66% of homecare providers who responded are now having to refuse new requests for home care.
• 43% of care home providers are closing to new admissions.
• 21% of providers of homecare are handing back existing care packages.
• an 18% vacancy rate and 14% absence rate amongst providers who responded, as a result of the Omicron variant (overall a shortage of around a third of all staff, on average, across the survey).

1. People have choice, control and support to live independent lives
2. People can access outstanding quality and tailored care and support
3. People find adult social care fair and accessible

It sets out a range of policies that the Government will implement over the next three years, working with the care sector and its users. These policies include:

• at least £300 million to integrate housing into local health and care strategies, with a focus on increasing the range of new supported housing options available. This will provide choice of alternative housing and support options.
• at least £150 million of additional funding to drive greater adoption of technology and achieve widespread digitisation across social care. Digital tools and technology can support independent living and improve the quality of care.
• at least £500 million so the social care workforce have the right training and qualifications, and feel recognised and valued for their skills and commitment. We want the workforce to also have their wellbeing prioritised.
• a new practical support service to make minor repairs and changes in people’s homes to help people remain independent and safe in their home, alongside increasing the upper limit of the Disabilities Facilities Grant for home adaptations such as stairlifts, wet rooms and home technologies.
• up to £25 million to work with the sector to kick-start a change in the services provided to support unpaid carers.
• £30 million to help local areas innovate around the support and care they provide in new and different ways, providing more options that suit people’s needs and individual circumstances.
• a new national website to explain the upcoming changes, and at least £5 million to pilot new ways to help people understand and access the care and support available.
• more than £70 million to increase the support offer across adult social care to improve the delivery of care and support services, including assisting local authorities to better plan and develop the support and care options available.

The report makes a number of recommendations to the Government relating to:

• carers and their finances, including increasing the carers allowance and changing eligibility for other benefits.
• support and services, including increasing baseline funding for social care and providing support for carers at key points in their caring journey.
• health and wellbeing, highlighting that this is a top priority for carers, and that caring has been identified as a social determinant of health.
• carers and physical activity.
• carers' assessments, stating that they should be more carer-centred.
• digital, data and technology.
• juggling work and care, including fulfilling its pledge to introduce Carer's Leave as soon as possible.
• equality, recognition and combatting loneliness and isolation, through systematic awareness-raising and by making caring the 10th protected characteristic.

• Care planning
• Monitoring blood glucose levels
• Flash glucose monitoring
• Administering insulin
• Insulin passports
• Hypoglycaemia (low blood glucose)
• Hyperglycaemia (high blood glucose)
• Storing insulin
• Labelling
• Accurate recording

The Review includes reports of abuse against residents; residents being left to lie in wet urine-soaked bedsheets; concerns from relatives about their loved ones being neglected; reports of there being insufficient food for residents, no hot water and no heating; claims that dozens of residents were sharing one bathroom.

Here's a summary of the report's findings:

• More than 100 residents had concerns raised more than once.
• More than 200 safeguarding alerts were made for individuals but only 16 went through to an individual adult safeguarding conference.
• More than 80 whistleblower or similar reports were made concerning issues that put residents at risk.
• 44 inspections were undertaken at Morleigh Group homes in the three-year period, the vast majority identifying breaches.
• There was a period of at least 12 months when four of the homes had no registered manager in place.
• During the three-year period reviewed the police received 130 reports relating to the care homes.

A spokesperson for Cornwall Council said:

“We have different procedures and policies in place and have invested time, money and staffing into making sure that we can respond better when concerns are raised.''

“One of the problems was that all the partners had their own policies and procedures but they weren’t integrated. That is probably one of the key issues that we have now addressed.”

“The assessment is so different now and the organisations are working much more closely that it reduces the risk dramatically.''

This is an important and long-awaited review. This situation echoes other care home scandals across the UK. I urge everyone to read the full report and reflect on the real root causes of the problem, which I believe go well beyond failings in inter-agency policies and communication.

• What would your action plan be?
• How would you monitor it?