By Maureen Wade (Chair, Birmingham UNISON Retired Members Section)
The true nature of the ongoing crisis within the adult care sector has been exposed sharply by the Covid-19 outbreak. Figures have finally been released for the number of deaths in residential care and nursing homes, which appear to be running at around 2,000 per week. Given that the number of residents in such homes represents only 1 % of the population, this is an alarming, but expected, figure, especially with early research showing that nearly 80 % of Covid-19 cases are from cluster infections.
Given that adult social care after a decade of austerity is a fragmented, under-resourced service, with little proper health cover, the death toll is not surprising. The treatment of both residents and staff by this government has been appalling.
Preventing older patients getting to hospital
Firstly, there was widespread suspicion that ‘Do Not Resuscitate’ (DNRs) were being enforced onto residents. DNR decisions are made by medical professionals, not family, but a pattern was emerging across the country that DNRs were being widely issued, with the object of preventing very ill residents from being transferred to hospital for resuscitation, thus freeing up NHS beds.
Secondly, the government did not revise the admissions criteria for residential care homes until April 15. The revised ‘Covid-19 Action Plan for Adult Social Care’ on that day, finally announced that “… we will move to institute a policy of testing all residents prior to admission to care homes. This will begin with all those being discharged from hospital” (Section 1.30).
There was no testing policy for new residents of residential care homes prior to April 15, so deaths from Covid-19 were being hidden, as the GP signing the death certificate would be more likely to put the cause as an age-related condition, as the deceased not having been tested for Covid-19. As Labour MP for Hove, Peter Kyle, commented before April 15: “If the government doesn’t start testing care home workers in a matter of days, it is knowingly allowing people in care Hhomes to get infected and die.”
Local authority funding slashed by nearly 40%
Neither has there been much evidence of the much-promised PPE for the 1.5 million staff working in adult care.
The government’s indifference is reflected in the ‘emergency funding’ too. The NHS, which employs 1.2 million staff, has received £6.6 billion in emergency funding and has had its debts written off during the pandemic. The adult care sector meanwhile, is competing for a share of £2.8 billion in emergency funding for local authorities. This is on top of the impact of austerity since the Conservatives took office: between 2010 and 2018 there has been a 38% reduction in central government funding towards social care for local authorities (TUC figures).
The problem is that with a service so fragmented, there is no champion for it. As a privatised sector, there are 20,000 different providers, from small individual enterprises to huge overseas companies.
A single GP to over several homes
All of these are supposedly regulated by the Care Quality Commission, but it has little capacity to do the job properly. Neither is there adequate medical cover. While nursing homes will have trained nurses, residential homes are covered by a single GP, who covers more than one home, as well as his or her general practice.
The historic low wages in this sector has meant a continual battle to retain staff, while it has affected the quality of care for residents. As the TUC has pointed out, the nature of the privatised, fragmented service “… encourages spot contracting rather than a holistic view of what care a person may need” (TUC: Three Ways to Solve the Social Care Crisis).
The problem of staff retention will continue after the Covid-19 crisis, and will be exacerbated by Brexit because 88,000 EU citizens work in the adult care sector and are very unlikely to meet the criteria needed to retain UK residency.
In the meantime, thousands of people – most of whom have worked all their lives and paid taxes, and many of whom served the country during World War II – have been abandoned, just as they were before Covid-19 took a grip. Next week, VE Day will be commemorated: this is how that generation has been rewarded.
May 1, 2020
