Did anyone expect social care to be fit for purpose in a crisis: when social care is in a state of perpetual crisis? After years of neglect, is it any wonder care homes and home care were invisible as the Covid-19 crisis evolved? The NHS is a hero – and its workers universally hailed – rightly, but the care workers in social care were forgotten until the tragic facts of escalating deaths in care homes started to make the headlines. How did care homes become the frontline in managing the virus without anyone much outside the sector or with families in care noticing? Ironic, given the UK government’s stated objective to protect the elderly and the most vulnerable.
Protecting the NHS was the number one priority but this was done at first at the expense of social care. And that needn’t have been the case.
Who is guilty? Successive governments have to hold their hands up for cowardice and political prevarication. Every report and inquiry into reforming social care was dumped. The media has some responsibility too: any whisper of reform during a general election campaign was turned into lurid headlines of ‘death taxes’ and the ‘dementia tax’. Social care has never been the priority for politicians or Whitehall.
The story in Scotland is no better than in England and Wales – there are many shared characteristics, especially the nature of the workforce in care homes and domiciliary care.
So we had a perfect storm at the beginning of the outbreak. A sector that was seriously underfunded. Care workers low paid, undervalued and on zero hours contracts. Scarce PPE being sent to the NHS or even diverted from care homes. Elderly patients being sent home from hospitals without testing and some who had tested positively for Covid-19. Some care workers going to work feeling unwell as they couldn’t afford to take sick leave. A fragmented market with thousands of small companies, agencies and homes. Tests have only just started in earnest and even now there are problems securing them.
It is actually a miracle that the sector didn’t collapse. Home visits continued despite lack of PPE. Some care workers have chosen to live in their care homes to stem the spread of infection. Others had to buy masks from Amazon.
Was this all inevitable – no, not all. Some of it was a failure of policy – like discharging patients back into homes prematurely. But much of it was a disaster waiting to happen; the state of social care meant it was in no fit state to withstand the huge shock of a pandemic. And a UK 2017 government report, unpublished until now, had said that the UK was not prepared for a pandemic and was prescient in warning of the current crisis in care homes. The report, codenamed Exercise Cygnus, based on the findings of a government simulation of an influenza pandemic, concluded that Britain was not adequately prepared for a flu-like pandemic’s “extreme demands”. One of its recommendations included boosting the capacity of care homes and the number of staff available to work in them. It also warned of the challenges facing homes asked to take in patients from hospitals.
Will Covid-19 deliver the reform and funding social care desperately needed but was never forthcoming before the pandemic? Who knows? But surely there can be political consensus that this can never happen again? The response to Covid-19 has brutally exposed the sharp divide between the NHS and social care. A reformed system in England and Wales needs to see social care working alongside health as an equal partner and that means care workers being granted the status, pay, job security they don’t have now:
“For some workers in Enfield, the chants left them uneasy. Working 12 hours shifts for barely £9 per hour, below the non-statutory London Living Wage of £10.75, they wondered if those cheers for caregivers were also meant for them.
“ ‘I’m one of them,’ one care home employee, who asked not to be named, recalls telling her 12-year-old daughter as her neighbours clapped. The daughter teased her: ‘Oh, Mummy, they don’t talk about you. They talk about the NHS. Mum, do you work for the NHS?’
“The caregiver replied: ‘No. But it’s the same. We care for people’.”
(Reuters special report 5 May)
For a detailed analysis of the story of social care and Covid-19 read our latest briefing on social care: the neglected service.
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