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They Don’t Really Care About Our Carers

Hollow words from the government can't disguise the reality facing the UK's care workers – underpaid, overworked, insecure and now facing a pandemic without essential protective equipment.

Politicians spend a lot of time giving thanks for our NHS workers – every now and then, they even remember to thank the social care workforce. In the midst of a national health crisis, fresh deference to the tremendous, heroic, essential work of health and social care workers is being shown by those with decision-making power at the heart of government. Do politicians assert the worthiness of these national heroes in the hope that some of that worthiness will reflect back on them, or do they now realise the real worth of effective social care? 

The coronavirus crisis brings clearly into view that the economic value of care workers’ efforts and expertise has many dimensions. In the pre-virus era, government ministers trotted out a line that strong public services were only possible as a consequence of a strong economy. Yet, the politics of the virus era is hammering home a message that the strength of society determines the strength of our economy. Without the ability to support one another, our economy falls apart. Without strong health and social care provision the economy gets sick. It is a harsh reality that the UK depends on a social care sector that has been on its knees for years.

Complaints of the Italian Nurses Association and International Council of Nurses highlight that infection rates in Spain and Italy have been fuelled by the lack of PPE for nurses and care workers. News is beginning to filter through of elderly care home residents in Spain, abandoned by terrified and overwhelmed care workers, found dead in their beds. Dr Michael Ryan of the World Health Organisation has warned that the UK may expect a more severe epidemic than elsewhere in Europe. An alarming proportion of chief executives have reported their NHS Trusts have insufficient sanitiser, are short of cleaning supplies and are extremely concerned about PPE shortages. In social care, these problems are not only rife but are harder to remedy because of the state’s longstanding disregard for social care and the social care workforce.

Dan Dobson reported in Tribune on the economic hardship awaiting a million workers in the construction industry who fell outside the government support scheme for employees because they were (falsely) classed as self-employed. The insecurity of work and voicelessness of occupational communities across the UK did not seem to matter much to government in pre-virus times, but now these inequalities are moving centre-stage. 

Despite the existence of public duties and the availability of public funding to finance the care of those most in need, the social care market is built on private arrangements; private contracts, private contractors and private agreements. In the social care sector, there are unknown thousands of purportedly self-employed, live-in and directly employed care workers providing essential services to older people and those with disabilities. The state has constructed the care system to be this way: amorphous, hidden, fragmented, exploitative and cheap.

Unlike in construction, the social care workforce is not currently endangered by a lack of work, but by the work itself. PPE – such as masks, gloves and aprons – is unavailable in many residential homes and anti-bacterial gel is in very short supply. Homecare workers provide care to highly vulnerable people by moving door-to-door from one home to another. Without protection, this is a super-spreader system par excellence. We have heard promises of new logistics operations to get PPE to NHS workers, yet government ministers do not have the levers of control necessary to get gloves, masks and aprons to workers employed by private sector contractors in social care, let alone to the unknown masses of personal assistants, live-in and self-employed care workers who are toiling behind closed doors. 

Up and down the UK, it is our minimum wage workers who are now our maximum value workers: delivery drivers, cleaners, care workers. But the praise of those with decision-making power rings hollow. My research has documented and explored the social and legal status of workers in social care. I have analysed care workers as a class of workers subject to ‘institutionalised humiliation’ by their treatment in law and their virtual invisibility in policy and political discourse. In the pre-virus era, they have been constantly and consistently judged to be inferior labour market participants on grounds of their class, their femaleness or their ethnicity – variously by judges, employers, the media, policy-makers, government and legislators. This pre-virus disrespect rings discordantly with society’s needs in this time of virus. 

The depths to which the pre-virus problems in social care have sunk are such that workers are currently required to care for clients with 24-hour care needs without a full right to minimum wage protection during night-shifts in which they may sleep. As a consequence, care workers are coerced into working night-shifts without minimum wage, in order to qualify for minimum wage work on day-shifts. 

The advance of marketisation and privatisation over more than two decades has refashioned social care such that insecurity is its foundation. Since 2010, the routine use of zero-hour contracts, particularly in homecare services, has been systemically designed to claw wages from workers. The only legal attempt to disrupt the routinisation of insecurity came from the Welsh government. New regulations require employers to offer homecare workers a choice of a guaranteed hours contract after 12-weeks on a zero-hour contract, backed up with other requirements for written schedules that include designated time for travelling between clients. 

But now we are in the virus era, the Coronavirus Act 2020 and accompanying announcements by regulatory bodies means that care standards are being set aside and compliance will no longer be inspected. Furthermore, the Coronavirus Act introduces a swathe of newcomers into the sector under the government’s new ‘emergency volunteers’ scheme, by which employees in other parts of the economy can be stood down to volunteer in social care. Undoubtedly, people are in need of support at home and there are not enough care workers. Yet an emergency volunteer scheme cannot hide the fact that is no UK-wide government plan to improve wages in social care, no plan for greater job security, no plan to introduce occupational sick pay, no plan for getting PPE to every social care worker and no plan for infection testing of social care workers. 

Understanding social care during the virus era requires an awareness of the pre-virus problems in our systems of social care and social security. Repeatedly, medical researchers have reported hundreds of thousands of premature deaths amongst the older and disabled population in the UK and correlated this rising death toll with cuts in benefit payments, poor quality or unavailable housing, the introduction of benefit sanctions to punish the poor and to the inadequate provision of social care. Human geographers and public health specialists have repeatedly documented declining life expectancy in the UK population, linked to the effects of austerity, not least the inadequacy of social care provision. Labour law research has documented how and why inadequate legal protection for UK workers exposes the population to fear, anxiety, insecurity, poverty and exploitation. Social policy research has warned that that our political and community institutions at local level have been undermined to the point of impotence. Now, the spectre of the virus-era is that our systemic cruelty, disregard of equality and tin-ear to expert opinion, is the context for the deaths of thousands and the crippling of our economy.

Minimum wage workers need more than hollow thanks. The quick-march towards treating care workers with respect must begin by keeping them safe, urgently setting up PPE banks in local communities as a hub from which supplies can be delivered to them and to which they can drop-in for replenishments. They are also in urgent need of security of income, not least full pay should they have to self-isolate because of coronavirus. Our post-virus society needs to provide everyone with security, and respond to the science about equality in order to build a robust and healthy economy. The state of social care, and the safety and well-being of the social care workforce, can provide a hugely significant bellwether of progress.