After the NHS, the care sector that is facing the greatest hazards in the coronavirus pandemic is adult social care, including residential homes and care services in the home. Workers in this sector have worse conditions and lower pay than even in the NHS and they will be lower on the list of priorities for the severely short PPE and testing kits.
As it is with the NHS, the adult care sector has been run down for decades and is prey to greedy private owners whose ‘business plans’ are based on low pay and cutting corners for elderly residents and care receivers.
Outbreaks in elderly care homes
The BBC website yesterday commented that “The vast majority of coronavirus deaths are happening in hospitals – 501 of the 539 deaths analysed here”. But in France, also according the BBC the same day, there were 607 coronavirus deaths in hospitals and 820 in nursing homes, strongly suggesting that the UK number is an underestimate the number of deaths of the elderly in homes.
Two outbreaks in Scottish care homes, one in Glasgow and the other in Dumbarton, resulted in sixteen and eight deaths respectively in the last week. At the moment, care home staff are struggling to find any PPE equipment and the same goes for those who care for the elderly in their homes, with the added risk that they are going from one home to another, potentially carrying the virus.
On April 3, the BBC reported that a document had been sent around by the Brighton and Hove Clinical Commissioning Group (CCG), the local NHS management structure that draws together GP practices. The document give guidance for the 35 GP practices in its area, whose doctors might be called to one of the local 98 residential care homes.
Check over your ‘Do not resuscitate’ orders
It spells out that many of the most vulnerable people will not be admitted to hospital if they are infected with Covid-19 and they will therefore not be treated. It suggests that all the homes in the area check they have resuscitation orders, or more specifically, ‘Do Not Resuscitate’ orders on every patient. One care manager, according to the BBC, “was deeply concerned that residents and families are being pushed to sign the forms.”
According to the BBC, the CCG advice includes the comment that “frail elderly people do not respond to the sort of intensive treatment required for the lung complications of coronavirus and indeed the risk of hospital admission may be to exacerbate pain and suffering…We may therefore recommend that in the event of coronavirus infection, hospital admission is undesirable.” One care home manager in Hove was reported to have been told by a GP that “none of your residents aged over 75 will be admitted to hospital“, leaving them “shocked and numb”.
In other words, the old are being left to die unnecessarily…the very scenario attributed to Boris Johnson’s adviser, Dominic Cummins, with this ‘herd immunity’ strategy. The advice of the Brighton and Hove CCG cannot be unique.
Drastic changes in a few decades
The Care home sector has changed drastically in the last few decades, as a result of the policies of Thatcher, followed on by New Labour and even more so by this Tory government since 2010. As an article in the Guardian pointed out four years ago, “Since 1979 there has been a remarkable shift in sectoral provision”. In the year that Thatcher came to office, 1979, 64% of residential and nursing home beds were provided by local authorities or the NHS; by 2012 it was 6%. In the case of domiciliary care, 95% was directly provided by local authorities as late as 1993; by 2012 it was just 11%” Decades of cuts to local authorities in particular have driven care of the elderly into the hands of private providers. A small number of large chains account for a high percentage of private provision and this figure is expected to rise.
Care homes are struggling to cope
Even before the epidemic, there was a shortage of 120,000 workers in the sector, hardly surprising given the abysmally low pay and poor working conditions. Now they are struggling to cope. In an article in the Financial Times on March 26, an executive director of the Care Workers Charity commented that it was “catastrophic” for care workers to take two weeks off to isolate. She described Statutory Sick Pay, at just over £94 a week, as a “joke”. One care worker, who asked to remain anonymous, said care staff were used to working 80-hour weeks and were fed up of being classed as “low-skilled” by a government now asking them to “go into harm’s way” during the crisis.
There is now a real risk that many private care providers will go bust as their costs increase during the crisis. Almost exactly a year ago, the Four Seasons care home company, with 22,000 residents in 322 homes went into receivership, the second major collapse in eight years after Southern Cross in 2011. Four Seasons must have been making someone some money because it had changed hands seven years before for over £800m.
Labour’s 2019 Election Manifesto
Labour’s 2019 manifesto pointed out, “Social care funding cuts have left 1.5 million older people without the care they need. Almost £8 billion has been lost from social care budgets since 2010. This is having a profound impact on unpaid carers in this country, with 2.6 million carers quitting their jobs to provide care to family members. The current care system is at risk of collapse. A Labour government will build a comprehensive National Care Service for England. We will provide community-based, person-centred support, underpinned by the principles of ethical care and independent living. We will provide free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”
Incorporate all adult social care into local authorities
Labour members should demand that Keir Starmer keeps this as Labour’s policy. More than that, Labour should be demanding that the care sector is fully nationalised and incorporated into local authority and NHS community planning. Labour should seek to reverse the cuts and privatisations of recent years. If care homes were run by local authorities, in conjunction with the NHS, as they were previously, they could cope with a crisis of this kind far more effectively by a planned distribution of equipment and staff. Labour should also support decent pay and working conditions for all those in the social care sector, so they are no longer a poorer version of the NHS
*No more profiteering from the elderly and infirm
*Municipalisation of all social care services and care homes
*Integration of care services and homes with community NHS provision
*Decent pay and proper working conditions for all care staff.
April 8, 2020
