The COVID pandemic has provided us with a unique opportunity to correct the problems we have created with the division of the NHS and Social care, dating back to the creation of health authorities in 1974.
In 2005, the Sixth Health Report estimated the cost of joining up social care and the NHS to provide seamless free care at £1.5 billion a year, projecting forward that the cost of providing this care by 2050 would have risen to four times that cost (£6 billion a year).
When we review the cost of the pandemic as having been because we were protecting our most vulnerable, the projected cost of an entirely free of charge care system, as with the NHS, seems reasonable.
We have repeatedly been told how important the protection of the ‘most vulnerable’ is, to the extent that the cost of doing so was not even considered. It was deemed so important that we were prepared to shut down society, put people into enforced isolation, close schools and greatly damage the education of children and young adults, ignore long term health issues, and destroy businesses and jobs. Ironically the forseeable loss of life expectancy because of the cost of COVID policies may make free social care more affordable.
The largest cost of providing this service will be staffing, and a stumbling block seems to be that we have an inability to perceive that carers should be paid a living wage, many work for sub living wage and Councils’ subcontracting to the cheapest providers will predetermine poor working conditions and derisory pay for this work force. The Office of National Statistics identified early on in the pandemic that there was no disproportional representation of NHS workers within COVID death numbers, but carers and other frontline key-workers were disproportionally represented in mortality figures. This again leads to disproportionate mortality figures in BAME communities who are overly represented in the care workforce.
A key problem seems to be perception: why is it that people are so invested in the NHS, people protest for our doctors and nurses, throughout the pandemic they have been provided with care packages, respite, vouchers for discounts, yet for people working in care there is nothing – In my own example my local cafe offers free drinks for NHS workers, yet nothing to other ‘key’ workers. Particularly with care workers, they seem to be viewed as an underclass – we do not like to think about care, possibly because how we treat our most vulnerable reflects on us as people, and particularly with the level of care which we give to the most vulnerable in this country – we should be ashamed.
As a care worker, I have worked throughout the pandemic, when other services, NHS – GPs, physiotherapists, occupational health, etc etc; were ‘unable’ to attend to patients we carried on. Our – usually decent – PPE was taken away and given to the NHS, we used food preparation gloves, plastic aprons, and eventually paper facemasks – we were given one per 7-10 hour shift. On one shift I was administering CPR to a client who had suffered a seizure, my fellow carer and I were wearing plastic aprons, gloves and paper masks, then two ambulances with four paramedics arrived to take over, they were dressed in hazmat suits and wearing breathing equipment. One of the paramedics said it was amazing how we had carried on working through the pandemic and gave us the spare face masks he had on his ambulance. We carried on working throughout the pandemic, you can’t stop washing people, changing their nappies, feeding them, but the other services could. So what is essential – what is most important?
Care is holistic, why do we perceive the care someone is given in hospital as more important than that given to them either at home or in care home? Both are equally important.
The opportunity: On a patient needing to return home from hospital they are assessed by a care team and carers are put in place, because it is all under one umbrella and there are no questions about funding, carers are employed by the NHS and an appropriate care package can be put in place. Carers do not have to be paid by hours of care performed, and are paid working wages with all benefits of other NHS employees; meaning they and the work they do is properly respected.
With no issues about the funding or sourcing of care packages the system of people going home or into care facilities becomes seamless, meaning that if a pandemic should occur again, the bed blocking issue will not exist.
Repeatedly government commissions have recommended that the two services are made seamless again, and government ministers have rejected the recommendations. If we insist that the reason for the Lockdowns and handling the pandemic in the way we have is because we are so insistent on protecting the vulnerable – at any cost- we need to make this an absolute imperative.
If it is so important to take care of our most vulnerable and not let them die from COVID 19, then we should not be prepared to allow them die from neglect.