When it’s all over they will build memorials to the doctors and nurses who died, overloaded with Covid-19 infection and often without sufficient protection. Will there be memorials to care workers, too, struggling in care homes and peoples’ own homes in far worse conditions, some wearing bin bags? Low-paid, largely untrained, often on zero-hours contracts, employed by agencies, their vital work is lowest status. It’s no surprise there are 122,000 care vacancies.
Public clapping and belated political tributes at last recognise that the hidden, underfunded and fragmented world of care is a life-sustaining artery of the NHS. When it fails, NHS beds fill. But will this revelation outlast the crisis?
Since 2010 Tory governments have promised “a plan” for social care, but wasted the decade as a rapidly ageing population left local councils crushed under the costs of care: the extra 10% of funding to care providers to cope with Covid-19 allocated via local councils barely touches the cash crisis as homes fold weekly. Rude awakenings greet the powerful baby-boomer generation as they find care absent, scarce or often bad and 84% of it profit-led. If you have more than £23,000 in savings, it’s cripplingly expensive to live too long, with inheritances subject to the roulette wheel of health: live for years with dementia and leave nothing, but drop dead and your children cash in. Those without money find they need to be at death’s door before they qualify for any help – some 1.5 million people aged over 65 have an unmet need for care, according to Age UK. The random mix of 35,000 care providers includes large companies owned by avaricious hedge funders, small struggling family-run homes, a hotch-potch of domiciliary agencies, and a few charitable and fewer council services. There are nearly half a million care home beds, ramshackle like the pre-1948 health system.
We don’t know how many are dying of coronavirus in care homes, and may never know how many died at home alone. Hawthorn Green home in London’s East End last week had seven people dead and 21 infected. In theory the CQC counts care home deaths, but couldn’t tell me how many there have been yet.
Judy Downey, chair of the Residents and Relatives Association, which represents older people in care, fears some 30% of deaths will be in care homes, if the UK mirrors other European countries. She says some homes are good, some not. “Out of sight, with no relatives visiting, there is no oversight,” she warns. Data from the EU suggests the figure could be even higher.
Andy Burnham in the last Labour government devised a National Care Service to mirror the NHS. Now, as Manchester’s mayor, he is trailblazing city-wide commissioning for NHS and care together. It’s a struggle. What’s needed, he says, is a single integrated national service, with care staff part of NHS structures, trained, paid and status recognised on the NHS Agenda for Change scale. People needing care deserve free treatment, as in the NHS, either in their own homes or in care homes, with a set year’s worth of care funded for the frail from the centre, with no NHS/care division. Care payments cause a great barrier: dementia is not an NHS illness so those families pay for care but, say, a long-term lung disease is free on the NHS. These days care-home residents are so frail that there is little difference between care “residents” and NHS “patients”.
To pay for this, Burnham tells me we should tap the wealth of the older generation, so everyone contributes 15% of their assets on retirement, usually through equity release on their property: the state pays for those without assets. Every family keeps 85%, so no family risks losing everything after paying for years of care: with risk fairly shared, inheritances are secured, with better free care for all. Who owns care homes is secondary once all staff are NHS/care employees. Gordon Brown so liked the plan he sent Burnham a framed front page of the 1948 NHS act on his 40th birthday, writing that he would be “the new Bevan”. It didn’t work out that way – or not yet.
Boris Johnson wants cross-party agreement, to spread any blame for unpopular new care payments: Theresa May’s bold attempt was damned as a “death tax” and it blew up in her 2017 campaign. The history of cross-party working is not auspicious. As Burnham’s plan was forming in 2009, the Tory shadow health secretary Andrew Lansley asked to join his meetings, as did the Lib Dem Norman Lamb. Agreement was close, though Lansley hankered after a voluntary insurance scheme that would break the whole point of risk-sharing universalism. Lansley quit the talks and within days a Tory ad claimed “Now Gordon wants £20,000 when you die”, with a gravestone. Nick Clegg withdrew: Norman Lamb, too. The “death tax” helped sink Labour in 2010.
When this is over, will there be an upsurge of support for social carers – and a willingness to pay that 15% retirement asset tax to fund a decent service with well-paid staff? Labour should certainly join Johnson’s discussions. But expect a heavy Tory lobby for some insurance-based, voluntary scheme. If this happens, Labour should walk away to promote a universal, compulsory, joint NHS and care service. If the Tories try branding it a “death tax” this time, they may find it backfires after too many staff and residents died for lack of a tax to pay for good enough care.
• Polly Toynbee is a Guardian columnist