Coronavirus has caused a crisis in our social care system, or so read many of the headlines. With the EU suggesting up to half of all virus deaths may be vulnerable or elderly adults living in residential care homes, the Chancellor has been forced to inject funding into the system to cope with the cash crisis as homes are folding weekly. It’s easy to forget, however, that the social care crisis has been going on far longer than the UK has been in Corona crisis. It is only now that the nature of pandemic is revealing the incompatibility of a privatised, under-staffed, and decentralised care system with a national health service. It not only raises questions of whether we are condemning the frailest in society to be ‘inevitable’ victims during this virus but also, in the long-term, about what care we are entitled to at all.
The government has been forced to react to reports of equipment shortages and a lack of staff in care homes leading to over-reliance on agency workers who travel between homes, potentially spreading the virus further. Those off work due to sickness or isolation are, however, only adding to the existing 122,000 estimated vacancies in the sector . The lack of resources reflects the £7bn reduction in funding they’ve seen over the last decade of Conservative government. Both training and recruitment levels are low. This is unsurprising as it is most likely not a sector that you’d want to be involved in, with around half of domiciliary workers on zero-hours contracts and another half of all careworkers thought to be on less than the real living wage. Staffing and resources, it seems, are not issues specific to the current crisis for social care.
The reason social care has fallen so much by the wayside and so far behind the provision of NHS services? Privatisation. Unlike in many European countries, social care is broadly not considered part of the public-funded healthcare system in the UK. If an elderly relative needs to enter a care home following hospital treatment or illness it is usually down to their family to cover the costs of their remaining care. Dementia is not categorised as an ‘NHS illness’ at all so families bear the financial burden in a way that someone with, for example, a long-term lung condition would not. This is not just the cost of the services themselves either as the sector is now 84% profit-led , leading to a market where standards and provisions vary hugely according to postcode and decent care can therefore quickly use up entire life-savings. During the current crisis, the decentralised and fragmented nature of the system has become even more obvious. Why can’t we see accurate figures of testing in care homes? Why don’t we know the true numbers of deaths? It is because there are over 35,000 care providers, ranging from large corporations to family-run homes, meaning that the UK’s half a million care home beds are scattered across a ramshackle system of private businesses. Care homes are full of the most vulnerable people in the country but they’re also outside of the government’s remit.
The flip side of a fragmented and costly system is that even more elderly people are isolated at home today. Age UK estimates that around 1.5 million over 65s have an unmet need of care, either because they do not meet the stringent qualifications for government help or because they cannot afford the care services that would most benefit them. The mortality figures we see reported not only struggle to cover care home deaths but almost totally neglect the vulnerable who are now dying alone at home because they couldn’t even access the care system.
The inconsistency with social care also has negative repercussions for mainstream healthcare services. With our ageing population much of the original crisis in NHS services came from the lack of hospital beds, with elderly people spending longer in hospital than they should. This was largely down to the lack of affordable social care options to move them onto. Now that it has become a matter of urgency to free up hospital beds and move on non-Covid patients, the difficulty (and dangers) of discharge into community care is becoming more obvious.
So, is there any hope of a rescue plan? The Tories have been saying they will put forward a social care plan for the last 10 years, but have ultimately failed to address the situation. It is perhaps a hopeful, if somewhat posthumous, sign that this pandemic has revealed the extent of the crisis and motivated them to give a 10% funding increase via local councils. However, the issues highlighted here suggest that, beyond a simple lack of financial resources, the problem lies in the illogic of a system of care for the most vulnerable that is completely detached from the centralised system of national healthcare.
It is easy to think that, if we pay taxes our whole lives to access care when we need it, this shouldn’t fall down in old age when we are in our greatest need of it. Many political problem-solvers have thought the same way over the last decade. Whilst the TUC continue to argue for a universal service funded by progressive taxation similar to the NHS, Andy Burnham was praised as ‘the next Bevin’ by PM Gordon Brown when he suggested a system of risk-sharing. He suggested people give 15% of their assets upon retirement (usually from equity release), to guarantee 85% of assets staying within the family, so that anyone who needs to access care in their later years can do so. As Mayor of Manchester, he has even started implementing some of his ideas by joint-commissioning NHS and social care staff and services. This means that care staff get the same status, pay and training as their NHS counterparts.
Whatever social care solution is opted for when the dust settles on these ‘unprecedented’ times, it has gone beyond doubt that we are in need of one. There is something profoundly sad about the image of society’s most vulnerable being crammed into an abandoned system of care. Coronavirus did not do all the damage in this case, it is merely revealing over a decade of scars.