Coronavirus and the past, present and future of social care

The Covid-19 pandemic has laid bare the chaos in the social care sector. Many people in the UK are now seeing the consequences of decades of neglect and lack of regulation in a sector focusing on profits and cost minimisation – rather than need and ethical standards for both service users and workers. Although the crisis in care has been heightened and revealed by Covid-19, its origins are deeper.

This crisis also exacerbates gender inequality since women are more likely to take on responsibility for unpaid care for children, elderly, disabled and/or vulnerable people. Women are also the majority of those in need of care and the majority (83%) of frontline paid care workers, with BAME and migrant women overrepresented. Both zero-hour contracts and low pay are common.

Coronavirus and care: what went so horribly wrong?

The failures of the government, limited infrastructure available to orchestrate a collective strategy as well as the precarity and low pay in the care sector have undoubtedly caused almost 30,000 Covid-19 deaths.

Care homes have been worst affected because elderly patients were discharged from hospital to care homes without first being tested. Failure to provide staff with PPE and testing soon enough, meant the virus was spread to other homes and to workers and their families.  The easements to the Care Act 2004, introduced by the Government in the face of the pandemic have also further deregulated services putting vulnerable people at further risk.

There is little information on the impact on home care services where over 97% of  care is  provided by independent agencies. Zero-hour contracts are used widely in the home care sector and workers are still not paid adequately for overnight care and not at all for travel time. The obligation to visit numerous clients a day, often making multiple visits, has contributed to spreading the virus in the community and amongst the work force. There  have been reports of care workers choosing to self-isolate being accused of breach of contract and risking dismissal. Many do not qualify for sick pay and many migrant workers, have no access to public funds. ONS data now shows the fatal consequences of this precarity: care workers are twice are likely to die from Covid-19 than non-key workers and BAME workers are particularly at risk

Many care providers, not least  in the residential sector, have made incredible efforts to protect both residents and staff, both have suffered disproportionately due to lack of government intervention. Now, there are concerns that the combined lack of new residents due to Coronavirus and the cost of PPE might send many care homes and domiciliary agencies to the wall. Government intervention is needed to protect both care workers and those receiving care. The long-promised reform of social care funding is urgently needed.

How did we get here? A legacy of neglect

The crisis of the UK care system is not the result of Covid-19 alone: the pandemic has revealed the systematic undervaluing of care work both paid and unpaid, as well as 30 years of deregulation and privatisation.

The anatomy of the care sector is something that is largely hidden from the view of the general population and even from service users and their families. The sector comprises a hybrid mix of local authority not for profit providers and privately owned care facilities and home care agencies. These range from small family-owned individual homes or local chains, to large-scale multi-home chains owned by private equity finance. Since competitive tendering for council services was introduced in the 1990s under the Thatcher government, local government has been forced to become a ‘purchaser’ of services, while the private and non-profit sectors became ‘providers.’

Since 2010 English local authorities have had grants from central government cut in half and been forced to fund themselves via local tax revenue. At the same time, there has been huge cuts to central government social care funding and staffing costs have increased. Cumulatively, these political decisions have had huge consequences for regional inequality, especially when it comes to care: there is now a seven-year difference between healthy life expectancies in the richest and poorest local authorities. The quality and quantity of care is also a postcode lottery : private providers are concentrated in wealthier areas where low fees paid by local authorities can be subsidised by the higher fees paid by self-funders. Those with greatest need for social care have faced the greatest cuts. The more deprived areas have become ‘care deserts’  with few options for those reliant on local authority funding.

Poor financial regulation has allowed care to be treated as a commodity to profit from, not a public good: large chains maximise their profits whilst squeezing local authorities and exploiting their poorly paid workforce. Estimates suggest that last year £1.5 billion, about 10% of care home income, was spent on loan fees, rents, shareholder dividends, directors fees and profits.

There’s no doubt about it in our minds: this combination of funding cuts and deregulation has led to excess deaths during – and before – the Covid-19 pandemic.

Greener futures, what next for social care? 

Despite the obvious devastation, the crisis has shed light on the problems for all to see and offers an important moment to demand change. There’s no time to waste: the sector needs short term funding injection via local authorities to keep it afloat and the process of implementing a new settlement for the sector must begin now. There have been many discussions about what the recovery from Covid-19 might look like with some prioritising the economy, the environment or both. What these conversations often have in common is a focus on physical infrastructure whether it be roads and rails, or solar panels and insulated homes.

But what we urgently need is investment in social infrastructure: care jobs are the ultimate green jobs and needed in every locality These workers need to be fully trained for well-paid and secure jobs in a regulated, centrally-funded National Care Service. They can also deliver bigger wins to the economy: WBG research from 2018 finds that a 2% GDP investment in care creates double the number of jobs than the same investment in construction – and many of these jobs are for women. Investment in care is ecologically, economically and equitably sound. Now is the time for drastic action to ensure this disaster never reoccurs and all people are cared for in old age and/or disability.