The crisis in social care: who’d be a care worker?
Social care was overlooked in the early weeks of the COVID-19 crisis, forcing itself into the public domain as the mounting death toll in care homes made attention to it unavoidable. Six months on, has care’s second-class status in any way changed? Although the Prime Minister’s speech to his party conference promised to ‘fix the injustice of care home funding’, it made no mention of any more care home workers to match its boast of 14,000 extra nurses for the health service. Yet, as this blog argues, there is no solution to the problems of social care that does not start with social care workers, what they need from society being understood within the context of society’s much greater need for them.
Contributors to a short series of three blogs, of which this is the first, include Achilleas Georgiou, Ahmet Oykener, Alan Sitkin and Doug Taylor, all of whom have served, and some of whom still serve, as Councillors in the London Borough of Enfield. Achilleas Georgiou was Deputy Leader of the Council (2010-2018), Ahmet Oykener was Cabinet member for Housing (2010-2018), Alan Sitkin was Cabinet member for Economic Regeneration (2014-2018) and Doug Taylor was Leader of the Council (2010-2018). Achilleas Georgiou, Ahmet Oykener and Doug Taylor continue to serve as Councillors. Outside of their council roles, Achilleas Georgiou is a communications professional who has worked for and advised major companies and non-governmental organisations in the UK and internationally, Ahmet Oykener was a Director of an adult social care company, Alan Sitkin is a lecturer in international economics and Doug Taylor worked for Which? on personal finance issues for a decade and was a member of the FCA panel for six years.
The second blog will look at how other countries arrange social care while the third will consider what the UK can do. The authors write in a personal capacity.
A Cinderella service?
At the start of the pandemic, as the government ran a strong messaging campaign to ‘protect the NHS’, adult care providers, care homes and care staff once again felt they were the Cinderella service.
When the government first reported on the number of people who tested positive for COVID-19 or who died as a result of this deadly virus, figures were given for those who died in hospitals but not for those in care homes for the elderly.
Adult care services have long lagged behind, not been prioritised, and received less government funding in comparison to the NHS. This comes as no surprise given the number of government-sponsored papers that have been produced on this subject.
How the government stepped in on this and numerous other occasions to “bail-out” NHS Trusts but not local authorities or the adult social care services they provide, is a bone of contention for local government officials.
It was only ever going to be a matter of time before recognition was given of COVID-19’s impact on adult care. Given that the virus is more deadly for older people, it was inevitable that care homes would soon be affected. The National Audit Office has since reported that at the height of the pandemic 25,000 hospital patients were discharged to care homes, sometimes without being tested for COVID-19.
Elderly residents and their carers became the subject of a campaign for them to be included in daily figures on the number testing positive and the number dying. And with that, as the government announced new pots of money to fund Britain’s COVID-19-hit economy and the NHS, some extra funding was also announced for adult care.
A notable change in public awareness and attitude also came about in the critical role of care workers. Just as doctors, nurses and other essential workers are recognised as working on the ‘frontline’ and ‘key workers’ in the fight against COVID-19, so care workers were also identified.
However, the level of pay and training between care workers and other essential key workers remains a big difference. The Social Care Secretary Matt Hancock, wearing a ‘care’ badge at a Number 10 press conference, calling for care workers to get the same priority as other key workers to access supermarkets, does not bridge the gulf of that difference.
While the problems in the adult care system have been well documented, and Prime Minister Boris Johnson announced on the steps of Number 10 in July 2019 that “We will fix the crisis in social care once and for all”, it took the COVID-19 pandemic to make the demand a nationwide reality. The difficulties in recruitment, lack of funding, and a care market in crisis, are just some of the features of a system that’s not working and needs fixing.
Care workers are trained to a required level by their employers, some gain nationally recognised qualifications. Their responsibilities - to look after elderly and vulnerable people, to administer their medication, to ensure they are eating and are clean - are high. The wellbeing of any elderly person is reliant upon a conscientious carer.
But, compared to their responsibilities, salaries for care workers, whether they work in a care home or provide domiciliary care, are low. The government’s announcement at the end of July 2020 for above-inflation pay rises for many public sector workers did not include nurses and social care providers, many of whom work in the private sector.
It is as if there is a reluctance to fund adult social care any further. One route would have been to give the money to local authorities and ring-fence it for them to finance care provision – something that the government has done previously when allowing local authorities to increase council tax for adult care. This would have increased money in the system, which should also result in a rise in income for care workers.
Instead, as one care homeowner put it “Why would anyone be a carer? You can work in a supermarket, get more pay and have less responsibility. You do something wrong as a carer, administer the wrong medication, and you could kill someone. You don’t have responsibility working in a supermarket.”
Being a carer, as one local authority Director for Adult Social Care put it, “is high responsibility, high stress, low paid work.” And even though he stated that he would “happily” change the status of care staff, including increasing their salaries, he added “funding simply does not exist to be able to afford it.” For this reason, salaries, and therefore recruiting carer workers remains difficult.
It is not surprising to find domiciliary care workers, who rush from one home to the next, with limited time to look after their elderly clients and also write up notes, work on low wages for only a limited number of hours so that they are not penalised from getting government benefits. They balance how many hours they work in order to still to be entitled to benefits; if they work more hours, and earn more money, they lose their benefits.
Attracting and retaining care workers in Britain is difficult according to several domiciliary and home care providers. Most are women, many are 50 to 60 years of age. As one care provider said, “it’s not a career. We don’t get young people applying.”
In multi-ethnic Britain, care providers, some as private enterprises, others as charitable bodies, have set up care services targeted at specific ethnic minority groups. They have attracted ethnic minority workers and migrants from across the Europe Union to provide services.
Migrant workers have found a work opportunity in Britain’s care services – and care businesses are grateful for their labour. The Greek debt crisis, for example, acted as a push for many Greek workers to seek employment in Britain to care for elderly people in north London, according to one home care provider. However, the new points-based immigration system announced by the government will disqualify them from coming to the UK. Although care workers are now seen as ‘key workers’, at least since the outbreak of COVID-19, as far as the immigration system is concerned, they will be classed as ‘unskilled’ and not entitled to a visa.
Moreover, care providers and carers now fear that, with the post-Brexit immigration plan announced by Home Secretary Priti Patel, from January 2021 many care workers would be excluded because they do not meet the minimum salary requirements that have been set.
Care home providers
Just as funding for salaries is an obstacle to recruiting and retaining staff, so it is too in domiciliary care and in the placement of elderly people in homes. Many businesses were attracted to work in the care sector. They could see that the elderly population was growing, there was a free and competitive market place with opportunities to offer private care services and to win contracts from local authorities.
However, 10 years of financial austerity and cuts in local government budgets have lessened those opportunities, and in some local authority areas the competition is fierce. Adult social care services have come under financial stress, and reducing costs becomes a key success target for local authorities. Councils, with limited funds, have pushed costs on to providers; and in turn they have looked to reduce their costs which has often meant low salaries for carers.
In this period care homes have seen an increase in costs. In part this is due to a rise in the minimum wage, and their largest cost is salaries, up to 80 percent, while there has not been a corresponding increase in payment from local authorities to pay for the clients they place.
For one care home provider, recognising that “care is expensive”, also points out that 30 percent of residents are underfunded. This is predominantly for those placed by local authorities, who also advise the care owner to charge more for private clients to make up the financial loss. In essence, private, wealthier clients subsidise those placed by the public sector.
The situation for care home providers has been exacerbated because of COVID-19. Occupancy rates have declined as families are deciding not to place their loved ones in homes where there is insufficient PPE, limited testing, and death rates are unacceptable.
As a result, care homes have closed, companies have resigned from the sector and ended their contracts with local authorities. As happened with one local authority, which having decided to award contracts to four national domiciliary care companies to serve the borough’s elderly, found that they withdraw their services for various reasons within a few years. The local authority, as others in similar situations, acted under EU procurement rules – in post-EU Brexit Britain the conditions and challenges will change.
In some parts of England, where “sufficient social care services are unavailable, no matter the individual or local authority’s ability to pay”, there are ‘care deserts’, as described in a report by Kieran Lucia in partnership with Age UK.
Conclusion: seizing the opportunity created by the pandemic
There has been a growing desire to put adult care services right. The standing and visibility of care workers has increased during the pandemic. This creates an opportunity to take radical action with a degree of public understanding and support. Will that opportunity be taken?
Funding is clearly a problem but there needs to be a change in perception. Whether adult social care is merged with the NHS or kept apart, as is being considered by government, the status of care providers must be put on par with the NHS while the status of care workers must be put on a par with NHS staff. That requires training, to provide a more professional status for care workers, with higher salaries to match.
 Keynote speech by Prime Minister Boris Johnson at Conservative Party Conference, October 2020
 National Audit Office, Readying the NHS and adult social care in England for COVID-19, June 2020
 HM Treasury, Pay rises for doctors, policy and more in the public sector, July 2020
 BBC News, Dominic Casciani, ‘Priti Patel sets out post-Brexit immigration plan- including health and care visa’, July 2020
 AGE UK and Incisive Health, Care deserts: the impact of a dysfunctional market in adult social provision, May 2019