Social care is frequently literal, as carers maintain and support their service users ability to remain a part of our society. It is incredibly common for carers to develop deep personal connections with their service users through this process as well. The coronavirus pandemic has disrupted these connections, shattering many and compounding the isolation this virus necessitates. Rebuilding these connections as we slowly reduce lockdown measures will define the future of social care, and what will become the ‘new care normal’. We spoke to Scottish Care CEO Dr Donald Macaskill about social care’s present crisis, and what it means for the future.
Dr Macaskill, like so many others in social care, has been barely stopped in the past two months. “I think for anybody involved in the care sector this has been an intense period of time,” he says. “As the head of a representative body, especially around care homes and care at home and particularly because of the fact our members support older people, the impact of COVID has been immense.”
Along with the immense pressure, there has been increased public interest in social care. The specifics of what social care providers do and the realities on its frontlines have become daily news stories. Though this long-sought publicity has not necessarily come in the form the sector would have liked. Especially considering the evidence indicating social care is yet to pass its own infection peak. However, as the ever enterprising Phineas T. Barnum would say: ‘there is no such thing as bad publicity.’ The empathy, dignity and commitment of care workers during the pandemic has writ their cause large in the British consciousness. Dr Mackaskill says: “There has been an astonishing degree of interest from the media on the care sector. Some of it informed and intelligent, others sensationalist and ignorant. The vast majority of the general public have limited experience of social care. I think what this virus has done is to help people understand that social care is intrinsically important to health, wellbeing and [has a] societal benefit.”
This is something we have heard expressed by many other industry figures such as Dr Townson of UKHCA and Karolina Gerlich of the Care Workers Charity. Social care is not something everyone will experience as frequently as they would the NHS. As a result of this virus, and social care’s response, attention and awareness have massively increased over the last two months. “The optimist hopes [the increased attention] will carry through into a continued collective awareness,” Macaskill says. “While the pessimist might suggest that people might fall back into their usual ruts of ignorance or disinterest which has been the problem in years past.”
This increased focus on social care has led to some calling for a centralised body to be created. The idea being that if social care ran more like the NHS it wouldn’t suffer from as many funding or organisational issues. However, ensuring that choice, control and social connections remain for service users would be paramount. As Dr Macaskill points out, ‘we’re not an emergency service: social care is about life, potential choice, and the exercising of that choice.’
The coronavirus has already severely restricted the choice available to social care recipients. Not to mention the life those choices provide. “[Coronavirus] has virtually removed the independence of people in care homes. The whole process of social distancing [and] self-isolation has basically removed it. The sense of independence, freedom, choice and control,” says Dr Macaskill. “That’s one of my main concerns at the moment. How do we reconnect people? Because people are being given life and being sustained in living. But there is a difference between existence and living. Living is about relationships, it’s about connections, it’s about purpose and value. I think that’s what we’ve lost significantly and that’s what we urgently need to start to rebuild.”
Technology has played a huge role in keeping society connected during this pandemic. Whether for business or personal needs technology has been almost exclusively keeping us in contact with each other for nearly two months. It has the potential, when applied correctly, to do something similar for social care.
“Technology can [rebuild that bridge],” Macaskill says. “We set up in Scottish Care a project called the Tech Devices Network. It is about people donating tablets and devices and then giving them out to care homes and individuals who are living in isolated circumstances. That’s growing in success, so technology has kept people in contact, through tablets, through Skype, through Facetime, through Zoom.”
“But we have to remember that a significant number of the care home population are individuals who have lost the cognitive ability to either independently, or indeed even with assistance, use such devices. There are limitations of technology; there are benefits as well.
We are using tech creatively and purposefully but it can never replace touch and presence.”
Touch and presence are crucial factors for providing social care. However, they are also the primary methods of spreading Coronavirus. With uncertainty around PPE supplies and changes to the PPE requirements, touch and presence can be very hazardous to provide right now.
“I am pretty convinced that we need to start moving towards that new care normal. France, have begun to make sure that people were reconnecting to families, still staying safe but with a degree of PPE being used,” says Dr Macaskill.
“I was in a conversation yesterday and they had a 103-year-old resident [who doesn’t have] weeks and weeks of life left in order not to be connected,” Macaskill says. “I think they have the right to decide whether or not being in touch, being in contact, having the presence of their families is more important than extending the clock of life. For all of us in the older care environment, whether Australia, Canada or the US, are beginning to ask these questions. How do we exit in a manner which preserves life, treats people as individuals and doesn’t discriminate simply on the basis of age or characteristics and reconnects communities?
How do we rebuild the broken connections? Can we provide choice while still preserving everyone’s safety? How do we prevent this from happening again? What will that cost in personal freedom of choice?
These are huge questions and ones that will shape the ‘new care normal’ we are heading towards. They are daunting to engage with and at times seemingly impossible to resolve. However, deciding to address them honestly, and with real purpose, is not a choice we can delay.
Recruitment and retention have been prominent and longstanding issues for social care. At the start of the year, approximately 10% of social care jobs were unfilled. That equates to over 130,000 carer vacancies around the UK. Since the outbreak of coronavirus, these issues have been considerably exacerbated. Self-isolation has further impacted social care’s beleaguered workforce. Across the country, care providers are struggling to meet the needs of their service users as staff members are required to stop working for weeks at a time. In response to this brewing workforce crisis, the government has launched a new social care recruitment and training programme.
The government’s campaign is titled: ‘Care for Others. Make a Difference’. The goal is to have more people consider a career in care. As part of this campaign, they are developing free-to-access e-learning courses and webinars for local authority and care provider staff. Key topics will include: safeguarding, person-centred care, dementia, Mental Capacity Act, infection control and supporting care at home to reduce pressure on the NHS. The goal is to raise the profile and accessibility of social care to increase interest. Secretary of State for Health and Social Care Matt Hancock says:
“I want this campaign to reignite the search for people with a zest for caring and protecting our most vulnerable to step forward to join them.”
It is a noble cause. However, the government launched a similar campaign last year. Last year’s campaign was titled: ‘Every Day is Different’. The goal of that campaign was to help fill the then 110,000 vacancies in social care. Again, it aimed to attract the ‘right people’ by highlighting the wide variety yet universal importance of social care work. Yet, as evidenced by the increase in vacancies over the past year, it was clearly not a runaway success. So why did it fail?
One explanation might be that social care recruitment campaigns only address half of the problem. They don’t address the issues surrounding staff retention.
Retention is typically a matter of money. The chronic underfunding of social care means that the average pay for carers is always around the minimum wage. In effect, approximately half of all care workers earn less than the living wage. They are also four times more likely to be on a zero-hour contract than the average worker. When this is combined with the high level of emotional and physical investment social care demands, it is understandable that so many find it unsustainable. It is an unreasonable commitment to ask of someone, and it should come as no surprise that it’s mostly heroes who agree to the terms. Heroes that the government has been letting down. CEO of Scottish Care, Dr Donald Macaskill says:
“I think the danger of a campaign is that it is window dressing. It makes politicians feel as if they are doing something to address systemic issues. Whereas the systemic issues are about the lack of value, the lack of adequate resources to remunerate staff, the lack of adequate resources to enable care homes to function.”
The lack of funding for social care manifests itself in the day-to-day realities of carer’s lives. Realities that have become markedly harsher during this crisis. When describing the need for the recruitment campaign, Skills for Care CEO Oonagh Smyth says:
“We know that significant numbers of social care staff are unable to work, so realising this ambition of recruiting thousands of people to where they are needed by providers right across the country is absolutely vital.”
This touches on the reality for frontline social care workers who have to self-isolate. Suddenly being unable to work for two weeks would be difficult for most people. But it is particularly impactful for people on minimum wage or zero-hour contracts. This particular powder keg is currently being dampened by organisations such as The Care Workers Charity. Executive Director of The Care Workers Charity Karolina Gerlich says:
“As a charity, the truth is we shouldn’t have to exist. We are having to provide financial support to key workers that are giving themselves, all of themselves to support people. And they should never have to struggle for money, but the reality is we have to exist.”
And even this is only a temporary solution. The charity is giving out more grants than ever before due to the coronavirus crisis.
In response to the need for additional social care funding, the government gave £1.6 billion to local authorities in March. An amount they doubled in April. The goal is that this money will support adult social care providers and workers. It is a desperately needed injection of funds to prop up local authority services. However, it is important to bear in mind how wide a scope those services have. UKHCA’s CEO Dr Townson says:
“The Local Authorities are as short of money as we are. They’ve got the money [the government’s £3.2 billion] but they are worried about bankruptcy. Their costs have risen dramatically as well.”
There are different opinions on how best to resolve care’s funding crisis. Some have called for a centralised structure for social care, similar to that of the NHS, although the complications involved in such a process remain of concern to veterans of the sector. Karolina Gerlich says:
“It’s always been true: people don’t understand. Social care is more complex than healthcare…in terms of delivery because you get care at home. Social care doesn’t have one brand like healthcare does in the form of the NHS. What people don’t understand is that social care and health care budgets are separate. That social care and health care cannot exist without each other, and social care is as important as healthcare. But is nowhere near funded to that extent, or supported to that extent.”
There are also concerns about how this will impact service users’ choice and control of their care. Regardless of the complications, the consensus is that the answer must involve a significant increase in funding.
On the surface, the major functional difference between the two social care recruitment campaigns is the context in which they are operating. Social care is on the frontline and at the forefront of the public’s sentiments. The government hopes to attract people to social care by raising its profile, by highlighting the inimitable grace with which social care workers have conducted themselves during this ongoing pandemic. As well as the weekly salute across the nation at 8 p.m. on Thursdays.
The government is further promoting social care by creating a unifying CARE brand, comparable to the NHS badge. In the hopes this could help raise public recognition of social care. The idea started last year as a collaboration between Care England and Everylife Technology. The result was a literal badge of support, with the proceeds going to support social care charities. Over the past year, it has grown considerably, moving from the corners of the occasional Facebook post into the House of Commons. The government recognised the applicability of the project and have taken over ownership of the CARE badge. While the initial announcement was met with scepticism by some, care workers were largely grateful for the national acknowledgement it gave them. It is something that has been conspicuously missing in the first few weeks of the crisis, not to mention the preceding decades.
There remain over 130,000 vacancies in social care. The government is trying to make the occupation more accessible for those who are interested, and yet accessibility has never been a barrier to entry into social care work. Many people take up social care after a direct experience with it, either through a friend, or family member requiring care. It is a noble calling, one that has many emotional rewards. The problem is that the delivery mechanisms simply aren’t sustainable. There isn’t enough money in social care to support the workers it already has, without adding another 10% on top of that.
Recognition is increasing, the role of social care workers on the frontline is as undeniable as it is inspirational. Introductory courses will hopefully make it easier for people to pursue an interest in social care. But without a sustained and informed injection of funds, the system cannot survive as it is.
