In the week up to 10 April, according to the Office of National Statistics, 1,043 care home residents died as a result of Covid-19 – leaping from 217 the week before. Then over the Easter weekend (11-15 April), according to the Care Quality Commission, that may have doubled again to about 2,000.
Before those figures, Care England, which represents care homes across the country, estimated that around 7,500 residents had died from the virus - five times the government's 1,400 figure and adding to the total (official) number of deaths by almost half. National Records of Scotland has suggested that a third of deaths there have been in care homes.
There are many care homes where dozens of people have died, some where the dead constitute a significant minority of residents and, in a few cases, a majority.
Problems with availability of and access to Personal Protective Equipment and testing for workers are well-known. And there is increasing concern and anger about the perhaps equally important issue of sick pay and the right to self-isolate. Something like half a million care workers get only Statutory Sick Pay of £95.85 a week – or not even that, if they earn less than £120 a week or are nominally self-employed.
At the government's daily briefing on 16 April, Business Secretary Alok Sharma repeatedly refused to even answer a question about this, attempting to fob it off by uttering the word “Heroes” over and over (see the video put up by Safe and Equal, which campaigns for the right of workers to self-isolate on full pay, at bit.ly/aloksharmvideotw).
In these circumstances, many workers are under enormous financial pressure to continue working even when they or someone in their household has symptoms. Some care workers have turned to food banks in their determination to self-isolate.
This factor alone makes it little wonder that Covid-19 is spreading like wildfire in care homes. This horrible situation and the Tories’ determination to avoid any significant action to change it are severely exacerbating the threats to very large numbers of care workers, even larger numbers of those they care for, and the general public.
Capitalists and care
The wider background is the systematic privatisation of the care system, both care homes and home care provision (ie care work in people’s homes), over forty years, and what this has meant for the working conditions of most care workers.
In the early 1990s most care homes were still owned by councils; now only 3% of beds are directly provided by councils, 5% by the NHS and 84% by private companies. The process was well under way long before the financial crisis. Since then, in the staggering context of councils losing a majority of their central government funding and slashing, £8bn cuts to public social care funding, 2009 local authority jobs have decreased 37%, or 65,000, and private jobs increased 30%, or 290,000.
Two thirds of care workers say the quality of services has declined as a result of the sector's increasing domination by private providers.
The companies we are talking about are making serious money. In care homes, out of a total £15bn operating income, last year firms running homes paid £1.5bn in dividends, directors’ fees and other forms of profit, as well as rents which are many times higher than those paid by non-profit providers (ie another form of directing funds to capitalists).
Many of these companies are owned by financial institutions, including hedge funds. Six of the 26 largest providers have owners registered offshore in tax havens!
Many homes rated by the Care Quality Commission as “inadequate” – in some cases with gross failings – have nonetheless produced large profits for their owners.
In 2016 Corporate Watch revealed similar scandals in the home care sector, with large payouts to owners combined with inadequate and in many cases declining services.
These profiteers receive extensive funding from the public sector – the result of a mainly public care system being gradually dismantled and reorganised on a new, private basis through privatisation, outsourcing and various forms of contracting and subsidies. This was followed up by a reduction in public funding through deep cuts, making the situation even worse.
In general, private provision has grown even faster than public provision has declined. This has happened in a typically capitalist way, with crises, retrenchments and irrational imbalances, rather than rationally planned national and local provision for needs. This in addition to spectacular collapses like those of major care home chains Southern Cross (2011) and Four Seasons (2019).
Surreally and disturbingly, there are reports of care home providers threatening to cut jobs as a response to the Covid-19 crisis reducing resident numbers.
There are very urgent, immediate changes that need fighting for. But the more fundamental answer from the labour movement, and anyone concerned about care for the vulnerable and workers’ rights, should be comprehensive state takeover of both care homes and organisations providing home care, with large-scale public ownership, provision and investment. All aspects of care should become a free public service, with majorly improved standards for service-users and terms and conditions for workers. At the moment there is relatively little advocacy or campaigning for this: there needs to be.
Social care is a vast sector, employing perhaps 1.5 million workers – comparable to the NHS. This includes about 900,000 frontline care workers, ie those actually looking after people. It provides services in one way or another for many millions of people. 12m UK citizens are over 65; 1m are in care homes or sheltered accommodation; 4m have a life-limiting illness and 3.5m need help with some aspect of daily living. Important parts of the social care system looks after children and working age disabled people.
In addition to care homes and organisations providing home care, large numbers of care workers are employed directly by service-users, some of whom receive "direct payments" to enable this. This developed in the context of privatisation and fragmentation of services and casualisation of labour. At the same time, it reflects long-running struggles by service-users for greater independence, and is not in itself the same issue as privatisation of collective public sector provision. Workers employed and services provided this way are not the focus of this article; more discussion of this aspect of care is needed. Of course, as part of wider cuts, direct payment budgets have been cut too.
83% of frontline care workers are women. 18% are BME. 13% are single parents, compared to 4% of all workers.
Care workers generally suffer from low pay, casualisation and weak rights, undermining their ability to insist on working safely or not working. Very large numbers work part time and very large numbers have other jobs in care or elsewhere, with obvious consequences for the direct spread of Covid-19 into care institutions.
Half or more are not paid even the so-called “real living wage” of £10.75ph in London and £9.30 outside.
Over a third of home care workers are not paid for travel time at all, a major issue when huge numbers of workers have to travel between multiple homes. Many more will not receive full pay for travel. Around a quarter of care workers and over half of home care workers are on zero hours contracts; two thirds of care workers are employed through agencies that use zero hours contracts. Frontline care workers are three times more likely than other workers to be employed through agencies.
In the private sector, which accounts for the large majority of social care jobs, things are at their worst. According to one widely-cited set of figures, there are 795,000 care workers working for private employers as against only 33,600 employed by local authorities. 38.5% of private employees are on zero hours contracts (compared to 10.1% employed by councils); average annual pay is £15,700 (£18,900 for council workers); 51.5% have no relevant qualification (19.3% for council workers); 36.1% have been employed in the sector less than two years (12.9% for council workers).
Three quarters of all private sector care workers do not receive the “real living wage”; in February 2019 median private-sector pay was £8.10 an hour, up only 62p since 2012.
Most private care workers get only Statutory Sick Pay or none at all.
Significant numbers of care workers are employed by the NHS. They also generally have better terms and conditions than in the private sector. Things in the public sector are usually substantially better than in the private sector, but still not brilliant.
Given that they receive large amounts of public funding through various mechanisms, from councils, the NHS and other sources, when private providers drive down workers’ conditions and standards for service-users they are channelling more of this funding into their profits. It is class struggle against their workers, obviously, against those who require care but also against the working people who contribute to tax revenues.
Union membership in social care is low but not insignificant, with 19.8% of care workers a member of a union or staff association – compared to, for instance, 82.6% of nurses. Membership is concentrated among workers employed by local authorities or recently outsourced; there have been some important struggles (and victorious ones, relatively recently, eg in Birmingham and Glasgow).
Many care workers’ precarious situations and weak union organisation create difficulties for enforcing even limited rights that exist on paper, with consequences now for issues like safe working, infection control and the right to self-isolate. Even if you are denied adequate PPE or similar, you may not feel confident to refuse work if there is no collective organisation to back you up, just as you may not feel able to self-isolate if you have minimal or no sick pay.
A potentially very important development during the pandemic is a new network of care worker activists, the Care Worker Coronavirus Action Group [later relaunched as Care and Support Workers Organise - see here]. We will report more on this soon.
In addition to the situation for workers, the extreme fragmentation of the sector makes formulating and enforcing high and consistent standards for anything very difficult - let alone a desperate attempt to deal with a devastating emergency like Covid-19. There are 18,500, mostly private and profit-driven, organisations involved in providing social care, with 9,000 home care agencies. There are huge variations in standards, fees and many other things between institutions, companies and regions. Regulations are not strong or strictly enforced enough, and in any case relying on regulating the private sector is inherently limited.
Fragmentation and inconsistent standards must greatly increase the severe practical challenges posed by the virus, with large numbers of vulnerable and often anxious or frightened service-users and the difficulty or impossibility of performing many tasks safely.
Consider that 27% of workers in home care report carrying out visits of just 15 minutes, and over two thirds of councils commission such short visits. Many more visits will be not much longer than that. This is a very serious issue that many home care workers raised routinely, even before this crisis.
The £8bn of public funding cuts, resulting in large increases in fees for individuals, surely make many aspects of the whole care sector more vulnerable to the disruptive logic of profit-seeking and cost-cutting.
Brexit is a big problem. Leaving the EU and ending UK-EU free movement will probably result in 120,000 fewer care workers. The hard Brexit the Tories want to impose in January 2021, along with their vicious migrant-bashing, will be a disaster for care as well as more generally.
This relates to another big problem. Widely-accepted estimates are that around 600,000 more care workers will be needed by 2035 to cope with a rapidly growing older population. In particular, "high dependency" care needs for over-85s are predicted to double between 2015 and 2035. There are already over 120,000 vacancies in the sector.
The wider crisis in care – the fact that it is organised so irrationally, has suffered from severe cuts and is now receiving further blows of various kinds – must be additional background to and reason for its vulnerability and disarray in the pandemic.
People not profit: socialise and transform social care
The problems described here indicate the kind of changes needed so care workers can have better working lives – and in so far as they are won quickly, safer ones – while providing a better standard of care. These include: many more workers employed, much higher pay, permanent contracts with guaranteed hours, an end to bogus self-employment, much more time available for home visits, full payment during travel between service-users, more training, opportunities and funding for qualifications, decent sick pay. In addition to, urgently: adequate PPE, access to testing and the right to self-isolate on full pay.
In other words, similar things to what many workers in large and growing sections of the economy need but do not have. All this implies a drive for union organisation, to help care workers stand up for their own rights, forcefully assert those that already exist on paper and win new ones.
To repeat: much better conditions and rights for care workers are essential to improving the service they provide.
What framework of organisation would facilitate these demands? Comprehensive public ownership.
For years after 2010 and even after Jeremy Corbyn became leader in 2015, the Labour Party talked about a “national care service” and “integrating health and social care”, but left what this meant ambiguous. NHS campaigners were concerned by the failure to guarantee that social care would be a publicly-owned, funded and provided system, not a Trojan horse bringing further privatisation and fragmentation into the health service.
The party clarified a bit in 2019, but as with many issues, too little too late. Labour did commit to free personal care – but only for the over-65s. There was continued ambiguity around various aspects of the policy. In particular, was it just for basic personal care, as opposed to all-round social care facilitating as many people as wish to live to independently in their own homes? And was it proposing actual public provision, or channelling more public money to private providers, as the debate is typically framed at the moment?
Now, in the midst of the raging crisis in social care, unions have rightly stepped up recruitment and made demands around issues like PPE, but mostly not very aggressively, actively or with attempts to actually mobilise care workers. And both unions and the Labour Party have remarkably little to say in the way of “big picture” proposals to transform the sector.
The labour movement does sometimes call for more funding, which particularly in the context of massive cuts is certainly necessary; but more funding by itself means propping up and further enriching the companies who administer the existing disastrous system.
Before the crisis and since, our movement has failed in its duty. By its timidity and conservatism it has sadly let down a million-plus workers doing a vital job and the many millions in some way supported by the service they provide. But if now is not the time to wake up and start fighting, when is?
We should respond to the care bosses' and the Tories' struggle for their class' interests with a class approach of our own, forcefully insisting that the rights of vulnerable people and those who care for them must come above profit. Beyond immediate changes, the whole "business" of care should be taken out of the profit-makers' hands through public ownership. Services should be run on the basis of proper professional, clinical and academic assessment and advice, with democratic oversight and input by the workforce, service-users and public authorities.
Activists linked to the Health Campaigns Together coalition have launched a Reclaim Social Care initiative for public provision of social care. RSC campaigns for social care “based on supporting independent living for all; free at the point of use; paid for, like the NHS, through central taxation; brought into the public sector; staffed by people well-supported and with a positive career structure; [and] with financial support for voluntary carers.”
Labour Party conference 2019 passed left-wing motions attempting to commit the party to a stronger position on these issues, as well as on a fully public NHS. As with other left policies, the challenge is to get the party to to fight for the demands.
The motions passed included demands that “Social Care systems... should all be universal, comprehensive, publicly owned, provided, funded and accountable”; to make “provision of all social care free to the recipient as is the case for health care under the NHS”. And to “transfer responsibility for funding social care from the [local authority] to the national exchequer through progressive taxation [and] distribute funding to the LAs for social care on the basis of the population served (age, sex and deprivation) and the cost of the care.”
There is no doubt a lot to work out. That includes the right relationship between local and national elements. It also includes how to combine a comprehensively public system with maintaining and strengthening the greater independence some service-users have won over decades, including elements of control and choice over their own care. Working these kind of issues out is surely possible, on the basis of input from service-users and workers.
What is clear is that a national framework and national funding for public provision are needed. Councils seem likely to be central to how a public social care system is organised and provided. Even now, they absolutely can and should do more to curb and mitigate the chaos and misery in social care in their areas, and this is something local Labour Parties and union branches in particular should take up. In the first instance, we should demand all councils follow Salford and ensure the right to isolate on full pay for all care workers in their area. But radical transformation requires a much wider approach.
Demands should include restoring all the national funding councils have lost since 2010, and providing an adequate system of additional funding for a well-functioning public social care system. Creating this public care system is connected to and must go alongside reconstructing the NHS as a fully public service, but it is a distinct demand.
Socialists should consider the possibilities to bring together trade unionists and workers’ campaigns, service-users and their organisations, social care, NHS and local government campaigners, Labour Party activists and others into a united campaigning force - to argue for and win public ownership of the sector, as a free, comprehensive and well funded service, with dramatically improved standards, conditions, pay and workers’ rights. It seems likely that, given what we are going through, a campaign like this could quickly win wide support.
This is not a small policy, obviously, but the problem is not a small one. As when we won the NHS in the 1940s, the labour movement must be ambitious.
• Please feel free to get in touch with ideas, comments and corrections, or proposals for follow up articles: firstname.lastname@example.org. Thanks to all who have fed into this so far.
The stats in this article come from the sources below, mainly the background reading. Figures on many things vary widely, so I “softened” several of the numbers to an approximation. Hopefully the overall picture is accurate and informative.
• Reclaim Social Care
• Safe and Equal, campaign for right to self-isolate on full pay
• Care Worker Coronavirus Action Group [later relaunched as Care and Support Workers Organise]
• Home Care Worker blog
• Salford Unison update on right to self-isolate
• Care Workers vs Covid-19, Unison North West campaign
• Unison Ethical Care Charter
• Policy passed at Labour conference 2019, published on The Clarion (see p19-20)
• We Own It, campaign for public ownership including in social care
• Reclaiming Our Futures Alliance, alliance of disabled people and their organisations
• Inclusion London, campaigning for equality for deaf and disabled people
• Health Campaigns Together
• Motion for labour movement organisations, published on The Clarion
Background and information
• 'What happens after the clapping stops?' (Resolution Foundation, 2020)
• 'Homecare.co.uk Workforce Survey' (2019)
• 'Private sector care workers three times more likely to be on zero hours contracts' (GMB, 2019)
• 'The state of the adult social care sector and workforce in England' (Skills for Care, 2019)
• '84% of care home beds in England owned by private firms' (Guardian, 2019)
• 'Plugging the leaks in the UK care home industry' (Centre for Health and the Public Interest, 2019)
• 'Care home operators making up to £1.5bn a year in profits' (i, 2019)
• 'The striking regional differences in care home cost and quality across Britain revealed' (i, 2018)
• 'Social care needs for over-85s predicted to double in next 20 years' (Guardian, 2018)
• 'Companies running 'inadequate' UK care homes make £113m profit' (Guardian, 2018)
• 'House of Commons report on Long-Term Funding of Adult Social Care' (2018)
• 'The home care business' (Corporate Watch, 2016)
• 'Understanding care workers' pay and travel time' (Corporate Watch 2016)