‘The system is crumbling’

It’s almost two years since we started taking to our doorsteps on a Thursday evening to clap key workers during the early days of the pandemic. The public might’ve felt pleased with their efforts as they banged pots and pans in a show of solidarity but, in truth, the gesture fell wide of the mark for many staff, particularly those working in social care who’ve been undervalued and underpaid for too long.

“It meant nothing to us. You’d hear it and think, here we go. What’s clapping going to do, what’s it going to achieve? We’re not respected,” says Laura*, 38, a care home worker in South Yorkshire.

“I used to work in bars and clubs, and never thought I’d do care work in a million years. I think I was scared at the thought of people dying, and silly things like I’ve got to wipe their bum, but being a care worker just came naturally to me. I’ve done it for about six years, but wish I’d started when I left school because I absolutely love it.”

She exemplifies the many care home workers who see it as a vocation because no one is in it for the money. It’s long hours in a demanding role on minimum wage, and then there’s the continued disrespect they encounter.

“A relative of a resident once said: ‘I’m not speaking to you, you’re only a carer.’ I couldn’t believe it. I’m looking after their family member. We make sure they’re healthy, and do the day-to-day stuff, and comfort them when they’re crying. I could get paid more working in Aldi than what I’m on now, but I wouldn’t do that.”

The elderly residents she cares for are central to that, which is why it was so devastating for and her colleagues to witness the impact of Covid-19 in the spring of 2020.

Many care homes are owned by private equity groups bent on extracting profits and cost cutting

“The worst day we ever had was when we had nine ambulances queuing to get into our car park. It was horrendous. I think four residents died that day and two the day after. We lost so many residents to Covid, as well as illness and old age during the same period. We were knackered, we were short-staffed and we had to go into lockdown for two months. I could only see my daughter through the window. We had to improvise PPE with bin bags and builders’ face masks at the start too. You look back on it and go, was that real? It was crazy.”

But despite everything, she says she’s “grateful” she’s got a job.

“We’re plodding along, getting on with it and trying our best, but for what we do, we just want to be noticed and to be paid for it properly.”

Around £8 billion has been cut from social care spending since 2010, but funding isn’t the sole issue. Many care homes are owned by private equity groups bent on extracting profits and cutting costs, rather than focusing on quality of care and good conditions for staff.

This has brought a chronic staff shortage in the shape of 120,000 vacancies across the sector, which was exacerbated by the vaccine mandate that came into force for care home staff on 11 November. By deadline day, NHS England indicated at least 42,900 care home workers weren’t fully vaccinated.

NHS staff were due to follow in April, but following a successful lobbying campaign, the government announced a U-turn on the “no jab, no job” policy earlier this month (subject to consultation and parliamentary approval).

The decision affects care home staff, but the damage has been done. Not only did workers lose their jobs, but it’s prevented or deterred many people from joining the sector and is yet another kick in the teeth for those who feel unappreciated.

“It’s tragedy upon tragedy and people are voting with their feet, finding other jobs, which is putting huge pressure on care workers who are ground down. We’ve seen people in tears because they don’t do it for the money and put up with low pay but there comes a point when enough is enough,” says Robin Symonds, care lead for Unison, the UK’s largest union, covering Yorkshire and Humberside. He’s privy to the many problems facing care workers, from excessive hours and unsafe staffing ratios to pay disputes.

“What underpins all these issues is that the care service isn’t valued or rewarded in the way it should be. There needs to be respect, and they need to be viewed as a professional service, which is what they are, but they’re categorised as unskilled workers,” he observes.

“Sadly, we measure the worth of someone’s contribution by how much we pay them, so until the issue of low pay is addressed, I don’t think they’ll get the respect and status the job deserves.” The situation is more than demoralising, he adds, it’s “soul destroying”.

“Many care home workers have been affected by the removal of the Universal Credit uplift and also the increase in national insurance contributions, which is ironically supposed to go into funding to improve care and these individuals can’t see a way out of it. The message being handed down from the government to care workers is that they need to aspire to get a better paid job if they want to improve their lot. What does that say about care work?”

It’s over two years since Boris Johnson promised “to fix the crisis in social care” in his debut speech as prime minister, but Symonds asks: “Where is the plan?”

“Up to now, it’s not even a sticking plaster. I know what needs to happen. We need a National Care Service where the staff are valued and recognised for the work they do, and that’s properly funded, but whether I can see that happening is another matter.”

Mike Padgham, chair of the care provider organisation Independent Care Group, agrees there needs to be a structure similar to the NHS, or even one body ensuring health and social care works cohesively.

“There are two organisations trying to run something and they need to work together. If we’re not there to support the NHS, the NHS can’t work – it’s as simple as that. We need each other, and there should be parity but there isn’t,” he says.

“We always feel we’re second to the NHS. Regarding the vaccine mandate, we told the government we’re very short staffed, so asked to postpone the compulsory vaccination and bring it in at the same time as the health service, and they ignored us on that,” notes Padgham, who’s owned the St Cecilia’s Care Group in Scarborough for almost 33 years.

“We redeployed the one person who refused the vaccine because I was determined not to sack anybody, but we’re still about 25 members of staff short. We’ve had to employ agency staff to fill the gap left by the staff we do have who test positive with Covid and need to isolate, so our costs have gone up massively. We’ve also had outbreaks in some of the homes, which means you can’t admit new people. This leaves beds unfilled, which means our income has gone right down. So we’re in a difficult patch at the moment. It’s like a rollercoaster.”

St Cecilia’s was the focus of a two-part BBC documentary Inside the Care Crisis with Ed Balls, which aired in November.

The former politician worked as a care worker for a few weeks and admitted he hadn’t appreciated the skill and dedication required of the role, despite his own mum being in a care home with dementia. He also revealed the guilt he feels for failing to tackle the care sector crisis when he was in government.

“The tax rise and huge injection of funding transformed the NHS in the early 2000s, but we didn’t do the same for social care and we have to try and understand why,” Balls highlighted.

Padgham’s decision to take part in the “warts and all” documentary was to shine a light on the sector, and hopefully prompt change.

Although he thought the programme “gave a flavour of what it’s like” in care homes, he was disappointed there wasn’t time to explore wider issues in depth.

“Ideally, I wanted to get more into the politics of it really to show that governments, whether Labour, the coalition or Conservatives have really not paid attention to social care. It’s a shared blame. Each government seems to turn a blind eye to what’s happening.”

Why isn’t there widespread outrage with regards to how the sector is treated?

“Social care has probably been a Cinderella service for three decades or more, but to say why it’s thought of as second-rate is hard. I think the word ‘social’ is a factor because social care isn’t for poor people, like social security – it’s for everybody,” says Padgham.

“Care work is also viewed as something people do when they’ve got nothing else that they can do, when it’s a highly skilled job. Also, health services have always had the support of the public, but social care isn’t something you really think about until you need it.”

Indeed, people plan for their retirement, and even their funeral, but often don’t want to ponder what happens in between.

“When the NHS came about [in 1948], you didn’t live much beyond retirement. Now some people retire at 65 but live 30, 40 years longer but they want a good quality of life. If you suddenly find you can’t look after yourself, what do you do? Where is that help coming from? We have to face up to things because the workforce isn’t big enough to cope in the future with an ageing population.”

The Independent Care Group has created a blueprint for social care. Suggestions include NHS care and social care merged and managed locally or nationally, extra funding (ideally through income tax, not national insurance), proper pay, conditions and career prospects for carers, and dementia treated like other high priority illnesses.

“Boris Johnson is the only one who’s actually done something by injecting some limited funding and introducing a cap on care costs, but it’s just the very beginning. A root and branch overhaul of the social care system is needed,” says Padgham.

“Older people and social care don’t get the high profile they deserve in this country. I think that’s because politicians don’t think there are any votes in it. So, at the next election, you’ve got to ask the parties what their plans are regarding social care, and make your voice heard at the ballot box. Frankly, we need bold and radical change because the system is crumbling.”

*Name changed to protect identity