Joanna Lumley has revived her turn from Absolutely Fabulous to front a trade union call for a pay rise for care staff. Describing the 1.5 million workers as “the invisible part of our nation’s health system … the forgotten ones”, she slipped into Patsy’s drawl to show a nation’s gratitude: “Cheers, sweeties.”
Many observers agree this group is hard done by. Last year half of care staff were paid less than £8.72 an hour. Now they are exhausted by Covid, which has played a part in the deaths of more than 36,000 UK care home residents.
But a pay rise is only part of the solution. In the second wave of Covid, care home deaths have returned to levels last seen in May, and failings that might have been attributed to operators being caught off guard appear systemic.
Care Quality Commission visits behind the closed doors of homes with recent Covid outbreaks show how, months into the pandemic, some operators have left staff untrained in basics of infection control. They have not given the right personal protective equipment (PPE) and have failed to provide enough staff to safely care for residents. Where managers have gone off sick, homes have been left rudderless, with agency workers coming and going, risking infection spread. Several do not have enough cleaners. At one home with an outbreak in December, live flies were found in an old urine bottle, and toilet brushes were clogged with faeces. These are the worst cases and thousands of other homes have done far better, but they are instructive.
Consider one home in the east Midlands. On two days when inspectors showed up, people who were known to have Covid were mixing in communal areas with people who were known not to have Covid. It was a recipe for infection. And this was in November, seven months after the crisis began.
Staff are not comfortable working like this. “We work on different wings each day, it’s not right,” said a care worker at another home that inspectors concluded was breaching the Care Act. “Yesterday I was on a Covid-19 wing, today I’m on another unit.”
At another home, a worker told inspectors that residents’ incontinence pads were so full they were leaking because there were not enough staff to change them. The same home became a carousel of agency staff – 26 people, mostly working just a single shift, over less than a month. No one is happy with this – not the staff, the residents or their loved ones.
In July 2019, in his first speech as prime minister, Boris Johnson promised: “We will fix the crisis in social care once and for all.” In January 2021 he told MPs reform was coming “later this year”.
Some in the sector think a good place to start is with the staff. A national workforce plan that identifies the roles that need to be filled, the level of training required and the right pay levels to create stability hasn’t been drawn up for years. Once that is in place, it could be easier to work out how much more the taxpayer will need to pay to improve standards. The former Conservative health secretary Jeremy Hunt has said at least £7bn a year more is needed.
How to better regulate the companies that operate the homes is another issue. Some chains use different companies for each home, with the result that the parent company is not held responsible when things go wrong. Councils could also be given a stronger role in steering care standards in their areas. And some observers suggest all care should be delivered by not-for-profit entities, although that would be a huge shift from the 82% of places in care homes of all kinds currently provided by private firms.
Whatever solutions emerge, the widening cracks in UK social care emerging under the persistent pressure of Covid have made doing nothing politically impossible.