Is COVID a catalyst for systemic change within care?

By Dr Onkar Sahota | 14 September 2020

COVID-19 has had a devastating effect in care homes across the country. There have been 30,000 ‘excess’ deaths in England’s care homes, and the risk of death from coronavirus was higher in UK care homes than almost any other European country. Nowhere has this been more pronounced than in London, which has the highest care home death rate of any region in the UK.

And it isn’t just care home residents that have lost their lives. More than 540 care and social workers in England and Wales have tragically died, which is among the highest number in the world.

This has not affected everyone equally. As with the general population, black, Asian and minority ethnic care workers appear to have died at a significantly greater rate than their white counterparts.

So what did we get so wrong? And what can we do to ensure our care homes and care workers receive the protection they need, both immediately in the event of a second wave and local spikes in infection, and in the longer term to make the sector more resilient? These are the questions the London Assembly Health Committee asked in our public meeting earlier this summer, where we heard from Professor Kevin Fenton (Public Health England’s regional director for London), Dr Vin Diwakar (NHS regional medical director for London), Dr Chaand Nagpaul (chair of the Council of the British Medical Association), Lisa Elliott (London regional director, Royal College of Nursing) and Gavin Edwards (senior national officer for social care, UNISON).

Professor Fenton told us that the role of care homes in spreading infection was underestimated during the first phase of the pandemic, referring to care homes as the ‘epicentre’ of infection. Dr Nagpaul and Gavin Edwards agreed that the care sector was a long way behind the NHS in the level of planning received from the Government.

The unsafe discharge of care home residents from hospitals, the lack of personal protective equipment and insufficient access to testing have all been widely reported. But less publicised is the role played by fundamental systemic issues within the care system. Care workers were disincentivised to self-isolate due to poor pay and condition, and in many cases, they could not afford to self-isolate. This had terrible consequences for care home residents and workers.

The Government has provided a £600m Infection Control Fund, which is allocated to care providers through local authorities. It is designed to limit staff movement by providing finance to protect wages and allow care workers to self-isolate.

This fund is clearly required. However, UNISON has raised doubts over the extent to which this money is being used for intended purposes by care providers, and over the ability of local authorities to monitor this, given their own resource constraints. While the fund is explicitly designed to ensure staff receive their normal wages when isolating, recent polling by UNISON of its members across July and August found that more than half (56%) of care home workers had only received statutory sick pay of £95.85 per week. In addition, the Association of Directors of Adult Social Services (ADASS) Unhas stated that the fund is both confusing in its purpose, insufficient in amount, and overly bureaucratic in terms of required reporting.

It is vital this money reaches the frontline, that the spending of these funds is transparently reported, and the reporting process is simplified. If local authorities require assistance or further resource to report, then it should be provided.

To protect care home residents and care workers, it is absolutely crucial local authorities and care providers receive assurance that further funding will be made available for the same purposes in the event of a second wave or localised spikes in infection, like those we have seen in Leicestershire and Greater Manchester. The protection of care homes is a key piece in the puzzle of controlling future outbreaks.

More fundamentally, while this emergency money is clearly welcome, the model of social care in our country leaves care workers on such a financial knife edge, and with such poor employment conditions, that they are often moved to risk their own lives – and the lives of the people they care for – to put food on the table.

Greater oversight of and trust in private care home providers is needed, especially when assurances are required that life-saving emergency money is being used effectively and appropriately.

The coronavirus pandemic must act as a tragic catalyst for us to look, as a country, at how we treat and value our care sector, and make the deep systemic changes necessary to ensure it never gets left behind in this devastating way again.

Dr Onkar Sahota is chair of the London Assembly Health Committee

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