The threat that the Coronavirus disease (COVID-19) poses, especially to older people and those with pre-existing medical conditions, is at the forefront of public debate.
Keeping perspective
It’s important to keep this threat in perspective – 300+ people have been infected in this country amidst a population of some 66 million. However, experts expect this number to rise substantially, with the big questions being to what level and how quickly. In the meantime there’s no doubt that the people who work for the NHS and central and local Government are working hard to ensure the right things are in place to collectively manage this sudden health emergency as well as possible.
Playing our part
And, of course, we all have a part to play and it may well be a growing one in the weeks to come, especially if lots of us, especially older people, have to self-isolate or are advised to stay at home, away from others from whom we could contract the virus. If this happens then all of us are likely to have to step up and be good neighbours and friends, subject to the advice and guidance of Public Health England – but we are not there yet.
So far there has been lots of discussion about how well the NHS is coping and will cope, our hospitals especially. This is partly as a result of reports, not always reassuring ones, about the experiences of health services in countries with higher numbers of coronavirus cases so far, most notably Italy.
What about social care?
As yet there has been far less coverage of the issues facing social care. This isn’t surprising since social care is not well known or well understood by much of the public who have no direct experience of it. On the other hand, social care is on the front line when it comes to keeping older people, younger disabled people, and those with serious health issues safe and well. It’s not that they’re more likely to contract the virus, but if they do it may be harder for them to fight it off.
Public Health England’s advice to the care sector addresses practice issues for providers but the Government has to step up to advise on how the sector can plan a more coordinated and resilient response. The absence of this type of strategic planning is bound to fuel suspicions that social care is being treated as less of a priority than is necessary and appropriate, given how many older, sick and disabled people it keeps going, both in residential settings and in their own homes.
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Care needs care, too
Social care is used to being treated as a second class citizen compared to the NHS but really, in this context, it’s important that just as much thought goes into protecting our care provision as our health services. The NHS and social care are interdependent and we know that hospitals want to free up beds for possible new coronavirus sufferers. The way for them to do this is by safely discharging patients with other health problems, who are mostly older people. However, they’ll only be able to do so if there’s enough good social care available to support these older people. The fact that social care is so understaffed and underfunded already means we are not starting from a good position – unfortunately the chronic Government neglect of social care is now coming home to roost.
It’s also true that when it comes to the kind of emergency planning that’s needed, the structure of the social care system is an impediment rather than a help. That’s because the vast majority of providers are small independent operators, with the big owners of residential care mostly based abroad, and with the market so fragmented, this makes communication difficult. ‘Herding cats’ comes to mind, meaning that a lot depends on the effectiveness of local resilience forums convened by local authorities that have lost people and strategic due to budget cuts.
The risks
The primary risks that need managing across the care system differ according to the setting but are all pretty potent. Care and nursing homes with older people living in them, invariably not in good health, would be a mecca for the virus if it can find its way in. There is a huge responsibility on managers and staff to keep the virus out and that means strictlig adhere to hygiene protocols, among other precautions. The good news is that care workers in all settings are accustomed to this, routinely wearing gloves and aprons while carrying out personal care.
Within domiciliary care many care workers visit several clients each day, so the obvious risk is that someone who contracts the virus unintentionally will spread it to a number of older people whose health is already compromised. Some people have expressed concern too that the poor terms and conditions that many care staff are on, including zero hour contracts, mean there’s a risk that a care worker who starts to feel unwell may keep working for fear of being unable to pay their bills. And what does it mean for an essential public service already running with 1 in 10 vacancy rate if staff, rightly, have to take time off unwell or for a period of self-isolation if they do come into contact with the virus? Older and disabled people fundamentally rely on the daily support they receive.
Promises being made
The Chancellor said this past weekend that the NHS will be given everything it needs to combat the threat of coronavirus, but will he extend this pledge to social care too? He really should, so that local authorities get the extra cash they need for their contingency planning, and providers are able to ensure any care worker who feels unwell can afford to stop work and still keep afloat, financially. It is, of course, disgraceful that care workers who do such an important job should find themselves in this position and whatever measures the Government has in mind to stabilise and refinance social care must address this issue too. But that’s for tomorrow. Today should be about supporting social care to help keep their clients and their staff as safe and well as possible.
Finally, many similar concerns apply to informal carers too. So far the best advice I’ve seen for informal carers is in the New York Times! They – we – need good advice here too; for example, if I get the virus how do I self-isolate and protect my 91 year old mum who’s bedbound and with whom I cohabit and care for part-time?