Caring for the carers

In response to the increasing outrage at the predicament that care workers find themselves in, battling against a virus that is cutting a swathe though our care homes, the English health secretary, Matt Hancock, rewarded them with a badge.

A green enamel badge that says ‘CARE’. A badge of ‘honour’ with its message writ large in capital letters. A badge that is meant to give some parity with the ‘NHS’ lapel pin that Hancock and others so prominently wear. A badge meant to symbolise the importance that these low-paid, undervalued and ill-equipped workers should have in the delivery of care for some of our most vulnerable citizens.

And a badge that was actually issued 12 months previously by the care home industry in response to the “lopsided” message that Hancock himself sent out by only wearing an ‘NHS’ badge.

This pandemic has shone a spotlight on a care system that has lived in the shadows of the NHS for too long

Care homes have, in the last week, become a real focus of COVID-19 as reports of mass deaths have circulated. With 40 per cent of the 1,000-plus care homes in Scotland reporting cases of infection and amid the heartbreaking headlines about old people dying in large numbers in individual homes, Scots have rightly been appalled.

And behind the daily tally of cold statistics lies the agony of grieving families unable to say a last ‘goodbye’ and the toil of carers who balance the risk to their own lives simply by going to work.

At her daily COVID-19 briefing last week, Nicola Sturgeon was grilled repeatedly by journalists on the number of deaths. She has clearly been moved by the unfolding tragedy. Who wouldn’t be?  But at one point she said that “care homes can be more susceptible to infection outbreaks”. It stopped me in my tracks. A care home should be no more susceptible to an infection outbreak than any other institutional setting. Indeed, given the experience every year of tackling the winter vomiting bug, it should arguably be even more ready. But then maybe this was an accident waiting to happen.

My mum is not in a care home. She lives, as we would all wish for, at home, supported by social care staff employed to keep her as independent as she possibly can be. That’s the way she wants to live, and this is what Scotland’s world leading free personal care was designed for.

But while I worry every day about her and whether she is safe, it is, ironically, the risk of contamination from the very people that are employed to care for her that concerns me most.

These are good people: kind, caring, patient, and well-meaning care workers who do a job that I don’t, and get paid at a rate that I wouldn’t consider. They do it for my mum. I thank God for them every day, and right now, I also thank my lucky stars that she is not resident in a care home, where people appear as sitting ducks, waiting for the virus to strike them down.

My mum balances her risks every day. She has stopped seeing us, sees neighbours through the window, gets her shopping left on the step and insists that if any of her care workers come to the door unmasked, they will not be let in.

Her tenacity to stay alive is awe inspiring. But she knows people like her in care homes are living on a knife edge, unable to exert even the small control she has over her care, over their own. Telephone calls are a daily update on which homes have now got COVID-19 and she fears for people she knows.

But the roots of this crisis well predate this pandemic. Care homes have been left behind for decades. Under resourced, their purpose not talked about, their privatisation an embarrassment, their staff undervalued and their residents too often viewed as an inconvenience, dumped and waiting to die.

And in this public health emergency, the vital care that these homes provide has been forgotten in the weekly celebration of the NHS. They have been at the back of the queue in the scramble for more PPE, their beds have filled up as those in hospital have been emptied, they have not had access to routine testing and while vulnerable residents have been rushed into signing DNR forms or to agree not to be admitted to hospital should illness prevail, they have also been cut off wholesale from friends and family and their deaths not even included in the official statistics.

by Stewart Stevenson

Society & Welfare

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And in a measure of just how catastrophically bad the situation is, no one in a position of power seems to actually know how bad it really is. Up until a matter of days ago, official government guidance insisted that “it remains very unlikely that people receiving care in a care home or the community will become infected”.

But we were given clear prior warning from European nations hit before us as horror stories emerged from care homes of mass deaths, abandoned corpses and fleeing staff in countries such as Italy, France and Spain.

Yet here, the social care sector fell down the list of priorities, with inadequate advice offered to care teams, minimal testing for residents or staff and a failure to deliver adequate protective gear to the frontline workforce.

Staff have been frightened to go into work, fearful to go home at night for what they might carry back with them and worried for their own health and how they carry on. But they do. Because they care.

There are everyday stories of heroism, kindnesses and small humanities. Staff who sit for hours with dying residents so they won’t slip away alone, care workers making protective clothing from bin bag and in Angus, the greatest sacrifice of all by staff at two care homes who have left their own families to go into lockdown with residents in a bid to put up a barrier between them and this virus.

This pandemic is brutal, but it has shone a spotlight on a care system that has lived in the shadows of the NHS for too long. The care sector has suffered from an unnecessarily negative perception. And at its heart is a question of cost.

There is much talk right now about the kind of society we want to shape when all this is over. We should not flinch from the hard questions. But I know of wide-ranging reports, prepared by influential actors in the care sector, which provided blueprints for a radical new shape of care sector over a decade ago but long kicked into the long grass on considerations of money and of shifts of power.

This tragedy will hopefully see care for the elderly elevated to the same level that we laud our NHS and we will look to create a National Care Service that offers consistent and appropriate end of life living that isn’t just about waiting to die.