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As care homes are a new epicentre of the pandemic, we celebrate the historically overlooked, undervalued care sector and ask what needs to change after the pandemic.

Illustration: Rosie Carmichael

Dave* is a home care worker for a private company in Bristol. On a typical day, he’ll receive around eight calls, “showering, strip washing, sorting medication, meal prepping, shopping calls…” he lists. His service users are the elderly, disabled, people with dementia and physical ailments. He’s paid £9 an hour – “more like £7.50 if you take into account petrol money.”

He tells me of his anxiety when the pandemic broke out: “I didn’t know how big the problem was going to be or how many of my service users were going to get the virus.” Senior management, he tells me, did little to alleviate his worries. “We were just told to wear gloves, plastic aprons and wash our hands –  which is what we were doing anyways. I’ve had very little change to my work routine and regime.” 

“I felt pretty unsupported. But the whole care industry is like, ‘You’re on your own and disposable’. If you don’t want to do the job then we’ll just find someone else to replace you. ‘Shape up or ship out’- that’s the ethos.”  

Other care workers we spoke to reported similar experiences; 70 hour weeks, long commutes, worried about PPE, and low pay, all while providing essential care for the most vulnerable in our society. A great testament to their resilience and dedication. 

As Vic Rayner, the director of the National Care Forum, announced this week, “The frontline of this virus has moved into care homes and the clinical focus now needs to shift.” Arguably, our focus should have been on the care sector from the off. The fact it wasn’t represents a long standing attitude towards a vital sector too often thought of as a footnote to the NHS. As the numbers of deaths in care homes emerge, so too will the realisation that they were the other epicentre of the pandemic –  the forgotten frontline manned by unsung heroes. 

“People are proud to do their jobs, I’ve seen that. They’ve got their heads up now, day in day out, going into situations where they don’t know what they’ll find”

While Prime Minister Boris Johnson celebrates “turning the tide” on the pandemic, we speak to care workers, trade union members and care home providers in Bristol who are in the eye of the storm, without a liferaft. We look at what went wrong and what change could look like. 

“Tell you what they did give me,” Dave remembers with a jaded chuckle, “a 50ml bottle of hand sanitiser. You gotta laugh!”  

‘The poor cousin of the NHS’ 

Underpaid and overlooked – it’s the experience not only for individuals but the sector as a whole. The NHS received £6.6bn in funding, had its debts written off, and is pride of place in the government slogan “Stay home, Protect the NHS.” Meanwhile, the care sector – which employs more staff overall – has to make do with a share of £2.8bn in emergency coronavirus funding allocated to local authorities. This disparity shines a spotlight on the shadow in which the care sector has always lived. As Steve Mills, Bristol Unison representative and former care worker aptly puts it, “care work is the poor cousin of the NHS”. 

Oona Goldsworthy – CEO Brunelcare

The British Medical Journal revealed that 24% of people working in adult social care are on zero hour contracts, and 25% were being paid £7.83 an hour or less. While NHS staff are granted up to six months of sick leave on full pay, statutory sick pay (SSP) for care workers is a measly £92.24 per week. “I’ve had issues with a couple of care homes that won’t pay sick pay,” says Mills. “People who can’t afford to live off SSP are coming in with the flu. It’s a disaster waiting to happen.”

Mills wonders what’s to stop carers from buckling: “Carers are going to be traumatised by losing service users who they have come to know. But between the trauma, poverty pay and low SSP,  carers could just say ‘I’ve had enough.’” 

It’s an already dire situation without throwing the crippling costs of staying open into the mix. We catch up with Oona Goldsworthy, the CEO of Brunelcare, one of Bristol’s residential care providers. 

The council has earmarked £9.3 million to adult social care from the £13.5 million allocated to it by the government to tackle the coronavirus emergency. But the figure doesn’t stretch far enough, says Goldsworthy, it covers only “ a fraction” of her extra costs. “We’re having to pay people time and a half for covering others shifts, we’re having to use a lot of agency staff, which costs a lot, and we are paying workers who are self isolating in full, not just the SSP.” 

“I wish I wasn’t worrying about that,” she adds, “but I am.” Faced with an “unsustainable” financial situation, and no end to the pressures in sight, Goldsworthy worries how they’ll continue to care for their residents.  

She says her employees, the forgotten foot soldiers, remain determined, “People are proud to do their jobs, I’ve seen that. They’ve got their heads up now, day in day out, going into situations where they don’t know what they’ll find.” The workers may be extraordinarily resilient, but the care system is anything but. The pandemic might be the straw that breaks the camel’s back. 

Goldsworthy knows her staff are invaluable, and worth far more than she is able to give, but she feels her hands are tied. “Their rates of pay are embarrassing. I’d love to pay the real living wage, instead of the minimum, but I can’t. Commissioned rates from local authorities don’t allow me to do that. It’s not their fault, it’s the central government. It’s about what we value as a society.” 

The decline of the care sector 

How did a sector ironically premised on caregiving, get so little care in return? Understanding its demise requires understanding how it operates. This is no mean feat. While the NHS is state provided, taxpayer funded and free at the point of access, social care is means tested and provided by local authorities and the private sector. “Means tested” results in only those with the highest need and the lowest income being eligible for local authority funding, everyone else pays their own way. 

Here’s why this led to a crisis. Over the years, the Government’s austerity measures slashed local authority funding –  that meant fewer people eligible for council funded care and less generous provisions given to those who were. And we have an ageing population, which means high demand on a decreasing supply. Age UK calculates £160 million cut in total public spending on older people’s social care over the last five years. This has meant around 1.5 million people aged 65+ end up just going without the care and support they need. 

Local authorities resorted to contracting out social care to private equity-owned companies. Social services in the UK are among the most privatised and fragmented in the western world. The British Medical Journal reported the UK has 5,500 providers operating 11,300 care homes for older people and there are roughly 50 different providers in Bristol.

Towards a better future: What needs to change? 

Crisis breeds opportunity, or so Goldsworthy and others in the sector hope. “Social care has been ignored for so long,” she says. “If we don’t make a fuss now, it will be relegated back to the bottom of the pile again. We’ve been shouting about this for a long time.” Reforms to social care have been kicked like a can down the road by successive governments. Boris Johnson’s announcement to fix the “crisis in care” within his first 100 days. But that was before the UK was facing the biggest economic challenge since the 2008 financial crash.

Mike Campbell, a social scientist and member of campaign group People not Profit, says now is the time for a total reconfiguration of the system. “Why not have Bristol lead the way and take home care back into public ownership?” Many in the sector support the services and staff being back under government control. It would be a publicly accountable system, delivering higher standards of care by a properly trained and equipped workforce. 

Others call for a universal integrated health and social care service, understanding that both sectors complement the other. For example, if community care fails, you are more likely to end up in hospital and stay in there longer. 

The practicalities of such proposals are contentious; but there is one undisputed point –  at the heart of any social care reforms must be the workers –  the lifeblood of the sector. Bristol Unison are calling for an Ethical Care Charter for all workers, with hopes to bring a motion to a full council meeting in the coming months.

As Unison reminds us, “it was not politicians, bankers, celebrities, or football players who strove to defeat this virus and look after vulnerable service users: it was us, key workers in care.  We deserve to be respected, treated fairly, paid well, and kept safe whilst undertaking our duties.” 

You can also read our investigation into outbreaks of Covid-19 in Bristol’s care homes and their struggles with PPE, and also hear from a Cable member what it’s like having a relative in a care home during lockdown.

*Name changed to protect anonymity

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