Covid-19 exposes our failing care system

Coronavirus is shining a light on the work that goes on, day in, day out, in homes and hospitals to care for people who are sick or need ongoing support to live independently. In the case of social care in particular, this work is often unseen and unrecognised. Only a few weeks ago the government announced a new immigration policy that would shut the door to supposedly ​‘unskilled’ care workers, despite there being 122,000 vacancies in the sector.

With the urgent need to free up hospital beds for the expected influx of coronavirus patients, the government is now turning its attention to social care. A £2.9bn pot of emergency funding was announced yesterday to support hospital discharge and care in the community. More than half will go to local authorities to boost the social care workforce, given the high numbers of care workers likely to be off sick. Meanwhile, the coronavirus bill will make changes to the Care Act in England to allow local authorities to meet only the most urgent and serious care needs, in case the pressure on services builds to a point where they find it impossible to meet their usual statutory duties.

The problem is that the government is trying to patch up a service on its knees. Starved of funding since 2010, councils are already limiting care to those with severe needs only. Age UK estimate that 1.5 million older people are struggling without help to carry out everyday tasks such as getting out of bed, going to the toilet, washing and getting dressed. This financial strain means that the sector, which is made up of more than 20,000 providers, has become worryingly fragile. A small but growing number of private-equity backed chain companies have made things worse, being deeply in debt and therefore prone to recurrent crisis, while extracting money — much of it public funds — to benefit their owners. Home care agencies are now reporting fears of bankruptcy due to the extra demands placed on them by the outbreak.

This pressure gets pushed down onto care workers, half of whom are paid below the real Living Wage. Those able to work will find their jobs more demanding — the people they support will have been forced into social isolation and are likely to be more anxious than most of us about the spread of the virus, but crammed work schedules will leave scarce time to respond to their needs, wishes and concerns. Care workers who are ill or self-isolating will be worried about trying to get by on statutory sick pay — just £94.25 a week. A third of care workers are on zero hours contracts and may not be able to prove that they earn above the threshold of £118 a week, so risk falling into even deeper financial hardship because they will not qualify for the payment.

“This pressure gets pushed down onto care workers, half of whom are paid below the real Living Wage.”

In this immediate crisis phase, the imperative is to provide urgent assistance, both to people needing care and to the care workers themselves. This is likely to require more than the £1.6bn earmarked for social care, given the scale of unmet need that was already present before the pandemic. It means that the government must go much further and faster to protect the incomes of care workers — and all low-paid workers — by guaranteeing wages as well as extending the availability and trebling the amount of statutory sick pay.

They should also ensure that public funds are directed towards strengthening social care in the longer term, rather than simply propping up a flawed system. In order to ​“look after the people first”, as Johnson promised to do yesterday, the government should bail out the shaky private-equity backed chain companies through nationalisation, instead of permitting them to continue to suck hundreds of millions of pounds out of the system, like Four Seasons has infamously done. By insourcing services and workers, they can do a better job of protecting them.

As we enter the recovery phase, hard as it may be to imagine right now, keeping the fiscal taps turned on will be critical. We cannot repeat the mistakes of the austerity decade. The government should follow Scotland’s example, and set an ambition for social care to be a universal service, shifting risk away from individuals to the state through providing free personal care. Social care delivery should expand, with the public sector leading the way and collaborating with socially-minded, not-for-profit organisations. This will help both to promote health and wellbeing in a post-coronavirus economy and to create jobs at a time when unemployment will be high. Social care is an effective job creator — the Women’s Budget Group have found that investing 2% of GDP in the sector would generate twice as many jobs as the same investment in construction. The mission should be to improve the quality of care and care jobs in tandem, while seeking not just to meet needs but also to intervene early to prevent their development and escalation.

After 20 years of dithering and decline, the government is not in a position to shy away from reform. The spotlight is on social care, as well as the NHS. The right action in the upcoming days, weeks and months can protect people now, while laying the foundations for a much stronger public service long into the future. 

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