More people may be dying from coronavirus in care homes and the community than in hospitals, according to a leaked letter from care bosses that accuses ministers of a bias towards the NHS and treating social care as “an afterthought”.

In a three-page attack on government strategy, seen by the Guardian, the Association of Directors of Adult Social Services (Adass) said national delivery of protective equipment to care homes had been “shambolic”, the government had fallen short on testing of care staff and residents, and it had provided “contradictory messages” about how to shield vulnerable people.

The letter lays bare tensions between the highly devolved care sector and the Department of Health and Social Care, led by the health secretary, Matt Hancock, which has focused on extending the capacity of the NHS to cope with a peak in cases.

Covid-19 now appears to be sweeping through council- and privately run care homes, with some operators estimating that up to two-thirds of their residents are infected.

The care chiefs said they were “extremely unhappy” with communications from the ministry before Easter and issued an 11-point list of complaints, concluding: “We and our staff are working flat out.”

The letter was sent on Saturday, since when Hancock has announced a new social care strategy including making testing available for all care staff and residents, although no deadline has been set. He said that in three weeks a new online delivery system for PPE would become available linked to the NHS supply system.

But the council bosses responsible for commissioning care for hundreds of thousands of people put on record what many in the care sector are beginning to fear, which is that “there is a risk that there are greater levels of deaths in social care and in the community than in hospitals”.

So far there have been 12,868 deaths from Covid-19 in the NHS in England and Wales. Figures from care homes are not being collected in the same way. The latest industry estimates suggest the death toll in England from confirmed or suspected cases of the virus is at least 1,400 and is likely to be significantly higher.

The Guardian revealed on Wednesday that the sector’s regulator, the Care Quality Commission, only started asking care homes specifically whether people were dying from confirmed or suspected Covid-19 last Thursday.

While new Nightingale field hospitals have been built with military help for the NHS to cope with an anticipated peak in intensive care admissions, many care homes have complained they cannot access enough personal protective equipment to keep their staff and residents safe. They have also reported staffing and materials costs rising by around 20% while funding has stayed broadly static.

The letter, addressed to Jonathan Marron, the director general of community and social care at the DHSC, said: “We are very concerned that there is a significant imbalance between listening, hearing and understanding NHS England as opposed to social care.”

It said social care bosses were unhappy at “social care appearing as an afterthought in recognition, monitoring mortality and morbidity and a whole host of other areas.”

On Wednesday Hancock sought to respond to growing criticism that social care was being left behind in government thinking. “From the moment of the emergence of coronavirus we have known that some of the most vulnerable to the disease are in social care,” he said at a Downing Street briefing.

“We have been taking action right from the start. Our goal throughout has been to protect residents and support our 1.5 million colleagues who work in social care. We have injected an extra £1.6bn and, as the chancellor said, we will do whatever it takes.”

Adass criticised the delivery of PPE through a national system that it said was not working. It said early deliveries were “paltry” and more recent drops had been “haphazard”.

Many care homes have said they have received only 300 face masks from the national stocks, which in a reasonably sized facility can be used up in a day. There had been reports “that orders from abroad have been confiscated by Borders and Immigration for the NHS”, Adass complained.

With many care operators working with 10% to 20% of their staff self-isolating and therefore stretched, Adass said it was “shameful” that the creation of the National NHS volunteer scheme had not been done in collaboration with councils and it had “diverted 750,000 volunteers away from supporting local communities and left them with nothing to do for the first three weeks of the epidemic”.

Sam Monaghan, the chief executive of charitable care home operator MHA, said the memo was a “fair and accurate analysis of the situation over the past few weeks”. By 9am on Thursday it had lost 251 residents to suspected or confirmed Covid-19 across 222 facilities.



Monaghan said: “We have said from the outset that we were being treated like the poor relation to the NHS when in reality we are the second frontline. Each and every one of these deaths is devastating for families of residents and also for our colleagues who have been working tirelessly to both care for residents and also keep themselves safe. We can only speculate what a difference adequate levels of testing including contact tracing and ample, readily available supplies of PPE could have made.”



A Department of Health and Social Care spokesperson said: “The government has set out a comprehensive action plan to support the adult social care sector in England throughout the coronavirus outbreak, including ramping up testing, overhauling the way PPE is being delivered to care homes and helping to minimise the spread of the virus to keep people safe. We will continue to work closely with the social care sector to ensure they have everything they need to respond to this outbreak and receive the recognition they deserve.”