The pandemic has exposed how dependent on care we are not only as individuals, but as a society. But our care system, already struggling well before the outbreak of the coronavirus, has failed to cope. Care work is poorly-paid and insecure, whilst the entire system suffers from chronic underfunding. Government promises to fix the system have concentrated only on funding, which is important, but falls well short of a comprehensive plan for care.

This new essay from PEF Council member Susan Himmelweit puts today’s crisis in its border context. A new approach is needed, recognising the immense importance of care to our economy and society, with care work properly supported in all its forms, effective support from the public sector, and an integration of the care system into our wider social and physical infrastructure.

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The UK government claims that saving lives and the NHS have been its priorities in this pandemic, but until mid-April when it proposed badges for carers, it seemed to have forgotten about social care. It gave neither care homes nor home care any special attention, putting them low down the queue for its provision of Personal Protective Equipment (PPE), effectively leaving them to fend for themselves. And once enough tests were available for use beyond hospitals, rather than ensuring that care workers had easy access, testing was immediately opened it up to all key workers, so that many care workers still couldn’t get test results when they needed them.  

In many European countries almost half of all Covid related deaths have been in care homes, but there is good reason why those figures may end up being particularly bad in the UK. The 1990 National Health Service and Community Care Act mandated that that 85% of local authority funding for social care should be for the purchase of care services from the private sector.

More than 400,000 residents are now looked after in 15,517 homes run by more than 5,000 different providers, at least 80% of which are private for-profit companies, generally using debt laden business models.   Many of the 26 big care home providers use complex company structures to maximise leakage and hide profit extraction going to owners, investors, and related companies some of which are offshore tax avoiders. Many are effectively property speculation companies. Home care is also privatised with around 9,000 regulated providers trying to support more than 600,000 people in their own homes.

Funding to Local Authorities has been reduced by over £7bn since 2010, despite an aging population. Thresholds for assistance have shot up so the numbers receiving support fell by 26% between 2010 and 2016, leaving one and a quarter million people with unmet care needs even before the current pandemic.

Care provision is particularly unsuited to privatisation. Providers facing local authority cutbacks in payments per recipient can cut costs in care only by employing fewer people, or by employing less well-qualified staff who can be paid less – inevitably leading to lower quality care. Difficulties associated with doing either of these in the public sector was one of the main drivers for privatisation. Privatisation was supposed to harness consumer choice and competition to improve quality but, given the impossibility of achieving the intended cost reductions in any other way, has in practice both lowered care quality and workers’ working conditions and pay. This has meant care workers on zero-hours contracts, insufficiently trained and badly paid, moving from one vulnerable person to another, often working in many different care homes. Although austerity intensified it, this process of squeezing profit out of worsening working conditions was going on well before the financial crash and continues to this day.   

Competition between private providers also produces its own inefficiencies, so that in domiciliary care, for example, services may be provided by many different providers within the same street, while care workers may have long journeys between their clients. Although reducing the number of clients visited by each care worker would have helped reduce the infection rate of Covid-19, a care system built on competition rather than co-operation was not able to provide that rationalisation. Indeed, one reason why the infection rate in care homes in the UK has been so high is that care workers without appropriate PPE work across different care homes.

Private sector providers would in normal circumstances be expected to provide protection for their own workers, including their own PPE. But with profit in mind why would they prepare for a pandemic? In emergencies the state is expected to step in to rescue the private sector, but a state that has run itself down to the bare minimum cannot respond well to emergencies. With austerity ensuring that stockpiles were reduced, the easily predictable worldwide shortage in PPE seemed to catch the government unaware.

The government says that its priorities have been to save lives and protect the NHS. Sensibly there have been few claims of success in the first of these, but the government does say it has succeeded in its second priority. The NHS, it claims, has not been overwhelmed. But how has it achieved that? By encouraging the virus to spread to the most vulnerable by discharging potentially infected untested patients to care homes and, until recently, not even counting the deaths that occurred there? By discouraging patients from contacting the NHS, potentially thereby causing thousands of excess deaths – and then claiming this was the public’s fault for not realising that the NHS would still treat them? By failing to recognise that the number of hospital admissions whose decrease it claims as a success is a policy variable and that more lives might have been saved if that number had been higher?

Has the NHS been saved? Not if this  means that  its principles have been protected, nor if it means that the population as a whole has been shielded as well as it could have been, nor if it means that that  the  health and social care workforce have been protected in the ways they have a right to expect.

A different approach is that adopted in British Columbia where the provincial government effectively nationalised its care home staffing system to improve workers’ pay and hours and provide PPE. But a privatised care system, especially with many staff on contracts that deny them a living wage from a single job, cannot hope to remove poor contracts and multiple employers as a source of infection.

The social care sector in the UK has been so badly hit by Covid-19 because it was in crisis already. Emergency measures are needed now to protect care recipients, care workers and unpaid carers. But at the same time thought must be given as to how we can build a new care system that does not leave people so vulnerable another time, provides good quality care, well integrated with health services at every level, and treats workers and carers with respect and dignity. This would not be a private sector care service. Instead we need a public sector led National Care Service nationally funded, but locally delivered, operating with decent working conditions alongside the NHS providing support for all who need it free at the point of use.

Image credit: Flickr – Don Barrett

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