The clapping might have stopped, but our need for care is not going away

“There is now damage to morale. Fighting spirit has been replaced by apathy.” This is how a union representative described workers in the care sector during a recent interview for a follow-up to my report: On the Corona Frontline: the experiences of care workers in England. The sector now loses one third of its staff every year: the highest turnover of any in the economy right now at 34%. And while the clapping has stopped and attention turned elsewhere, all the working conditions driving people out of care in droves have got worse.

Although the pandemic is far from over, care workers’ sense of coming together and getting through a crisis has waned. Their need for higher pay to survive the cost-of-living crisis is their top reason for leaving the sector. Failed policies such as the mandatory vaccination led to loss of staff who haven’t returned because, as a GMB spokesperson put it, “they are in retail, being paid better”. Now, cleaners and kitchen staff are joining the carers in leaving and providers are increasingly relying on agency staff. Agency spend is soaring as a result.

They are also leaving, of course, because of the ongoing failure to provide sick pay for those in our economy who most need it. This is, as the unions have said, an “incredibly dangerous move that will cost lives”. However, care workers are also leaving because they are no longer able to do their job properly. Home care workers can no longer afford the petrol to use their cars to get to clients, for example. Carers don’t like that they cannot care to the standard that their professional ethics demand. They are increasingly forced to rush through their visits – trade unionists report home care workers running down the street between jobs. As many have warned over the years, forced to look after more patients or clients in a given period, the quality of care has reduced.

A reduced capacity to provide high quality care and the continuing workforce crisis means that providers are also increasingly unable to provide the hours of care needed. Between May and July 2021, An Association of Directors of Adult Social Services survey found that social services departments were unable to meet 355,554 needed hours of home care due to lack of capacity. This figure is only based on those who had already received an assessment and therefore didn’t include those who might need care at home but had not yet been assessed.

Under investment means that more people need adult social care and support but fewer are getting it and many are getting less than they need. There is also an increased need for residential care due to older people’s inactivity during lockdown and delays to treatment causing often complex need.

One fifth of the sector is taken up by five providers, three of which are private equity funded. Over £1bn is extracted out of the sector in profits per year. The damaging role of monopolising private equity in the sector is clear to those working in it and is being increasingly exposed by organisations such as CICTAR who investigated HC-One, the UK’s largest care home operator, Death, Deception and Dividends, finding that the firm received an additional £18.9m in government payments for Covid costs, while its owners, in the year 2020 alone, continued to siphon £47.2m in tax free profits to the Cayman islands (a combination of dividend and related party interest payments). As a Unison spokesperson put it, “at the same time as they are sending profits to Jersey, [these providers] are pleading poverty to workers.”

Increasing government funding to the sector won’t address this. It also won’t stop care homes being seen, as one trade unionist described it, as property investments in which residents and staff are a secondary consideration and efficiencies include cutting food to those in their care. It also won’t help the lack of status, career progression or recognition in the care profession. England is the only country in the UK with staff providing intimate care in people’s homes and in care homes who are not registered and there are no plans to make registration compulsory for frontline care staff.

Prior to Covid, providers were already closing at an alarming rate, ceasing trading or being handed back to local authorities. Councils then can’t plan for the long term because there is no long-term central government funding. As Unison says: “The fact that a public service so essential as social care should be reduced to dependent on short-term handouts demonstrates just how dysfunctional the system has become.”

Expecting costs to be met through council tax and efficiencies is unsustainable. The context for local authorities charged with improving care has got much more difficult. Care homes are likely to approach local authorities to increase fee rates significantly due to the permanent feature of enhanced PPE testing, isolation, sickness and staff pay, increased fuel costs, difficulties securing loans and so on. They will need to fund ongoing legal costs and loss of income relating to Covid. This will put much more pressure on local authorities and lead to further market instability.

The clapping might have stopped, and everyone moved on with their lives since the lockdowns but our need for care is not going away. Rather, it will increase as England has an ageing population with increasing co-morbidities. We have a care system that nobody wants to work in for very long, due to appalling pay, conditions, associated low status and lack of career progression.

Unions, employee representatives and local authority commissioners are already much more closely aligned on the problem of care and have now effectively set up an informal tripartite structure ready to reform the sector. The only party missing from the table is government.

Employers recognise that working conditions are affecting both the quality of care and the ability to recruit people, that improving pay would reduce turnover. And not only social care employers. The NHS is now saying loud and clear that hospitals will only be able to improve their acute services if social care is improved too so that hospital stays can be reduced and there are more effective discharges to care homes.

The public is still also missing in action. Happy to leave the horrors of the pandemic behind us, we remain in denial that – as things stand – we will all get old, need care, and at our most vulnerable be effectively sold to companies, funded by taxpayers, in which a few individuals are pulling the strings by extracting obscene profits? As a trade unionist I spoke with put it: “Our care has to be paid for. It is not voluntary. Why continue for it to be paid for randomly in this disorganised way, rather than integrated and run neutrally as a public good. Why do we want the best from our NHS but are happy to turn the elderly over to a bunch of sharks?”