On the Corona Frontline - European perspectives on social care

A new report based on in-depth case studies of social care workers in nine European countries offers a unique perspective on the situation of elderly care workers during the pandemic. I wrote the Scotland case study, and it was fascinating to see how the different care systems across Europe responded to the pressures caused by COVID-19.

Even though the coronavirus pandemic has had different impacts on European countries, one common denominator is that the virus has hit the elderly hard, particularly those caring for older persons. This placed Europe’s care workers on the coronavirus frontline. The overview report, written by Lisa Pelling, head of the Swedish think tank Arena Idé identifies some common themes across Europe, including:

• Shortages of personal protective equipment and lack of clear guidelines for when and how it should be used.
• Pre-existing staff shortages worsened further during the crisis, increasing the already unbearable workload of care workers. 
• Care workers suffered from increased physical and mental pressure, and there are reports of a dramatic increase in the incidence of burnouts, depressions and substance abuse.
• Although they were forced to work harder and more overtime than ever before, elderly care workers were left with precarious working conditions, many on zero-hour contracts and paid by the hour. When they too fell ill, many countries left them without adequate sick pay.
• Trade unions representing elderly care workers have made a decisive difference, both for the workers and older people. 

The report makes several recommendations covering the pandemic and the broader reform of social care. These include basic safety provisions, raising employment standards, and an end to social care underfunding. 

In my case study, I explain how health and social care are organised in Scotland and how they responded to the pandemic. It is interesting to look at how other countries deliver these services, with varying degrees of integration and the balance between public and private sector involvement.

In Scotland, social care was in crisis before the pandemic hit due to an ageing population, staffing shortages, and chronic underfunding. The pandemic has cruelly exposed these problems with excess death rates significantly higher than similar countries in Europe. Half of all deaths from COVID-19 have been in the largely privatised residential care sector, exacerbated by the transfer of patients with the virus or untested from hospitals to care homes early in the pandemic to release NHS capacity. The lack of Personal Protective Equipment, inadequate testing, minimal sick pay, and the use of agency staff have all contributed to this outcome. Care at home services have also been reduced, placing additional pressure on unpaid, informal carers.

Employment standards in social care vary considerably between sectors and employers. Care work is undervalued, not least because of discrimination against the mostly female workforce. Attempts have been made to improve pay in the sector with the requirement to pay the Scottish Living Wage, along with new registration and training standards. However, implementation has been challenging, which leaves a range of poor employment practices that have not been addressed.

The trade union response focussed on providing immediate support to members, negotiating with employers and government, and campaigning for service reform. The pandemic has exacerbated the challenges in organising a disparate workforce, and unions have relied heavily on social media. Recruitment has improved, helped by victories over wages, the provision of Personal Protective Equipment (PPE), sick pay and death benefits. Unions have also campaigned for a reformed social care system, structured around a new National Care Service, which is properly funded, ends the marketisation of care, and values the workers who care for society's most vulnerable members.

I wrote the paper before the Feeley report was published, but I was able to add in a short commentary. The establishment of a National Care Service and workforce reforms have been welcomed by the trade union movement. However, the proposed structures are highly centralised, largely removing local democratic accountability, and does not do enough to rein in the marketisation of services. While the need for a significant increase in funding is recognised, the report makes no recommendations on how this should be financed.

The overview report concludes:

"The pandemic has proven that deficiencies in social care— which trade unions and their members have warned and protested about for many years—such as precarious working conditions, understaffing and underfunding, have been devastating for the ability to protect the most vulnerable during the coronavirus pandemic: the elderly. It is high time that we listened to them."

UK Budget 2021 - Schizophrenic or maybe not

 Depending on who you read in today's UK budget analysis, the Chancellor has either gone full-blown John McDonnell or is returning to austerity. You would think both cannot be right, and in my view, they are not. This is a Tory Chancellor reverting to form.

Let's start with Scotland. There is £1.2bn in Barnett consequentials, which gives some flexibility in the Scottish Government budget for this year, even if it adds to long-term financial planning challenges. An important issue, particularly for those organisations that need greater funding certainty, and will make the traditional arguments over manifesto costing pretty irrelevant. 

The Budget also confirms a trend we have seen in recent years of the UK government funding projects in the devolved administrations directly, to the tune this year of £1.4bn. Union Jacks are to replace the Saltire on a wide range of projects. His speech was replete with UK rhetoric, which implies the Union Directorate in No.10 has been working overtime despite its regular leadership changes! Martin Kettle explores some of the politics behind this in the Guardian this morning. Brian Wilson did an interesting piece concerning the incompetent management of EU funds by the Scottish Government and makes the valid point that; "We need more of a power grab – so that powers reside with the level of government best placed to implement them efficiently and for the purposes intended. Scotland is not all one localism and our politics need to reflect that."

The more serious medium-term concern is the consequences for public services. The short-term spending looks huge, but it hides a plan to return to austerity pretty quickly. For example, nothing was said about the NHS and social care, which will have consequences for restarting the NHS and the pandemic backlog. It also means that the Scottish Government can no longer duck the issue of how they will fund the Feeley Review recommendations. 

Ending the Universal Credit uplift in six months will throw half a million people across the UK into poverty, including 200,000 children. It was also silent on helping 700,000 households who have fallen behind on rent and are now at risk of eviction. Freezing personal allowances will add to this concern. Having said that, personal allowances generally help the better off, so they are not the best way to help the lowest paid. The SNP's Council Tax freeze is regressive for similar reasons. We should instead be looking at other aspects of personal taxation to make it more progressive.

For the economy, the short term boost of pent up spending may get us through to next year, but as the OBR report makes clear, growth is likely to be pretty anaemic after that. The Chancellor seems to think that private investment will provide a boost, supported by his 'super deduction' to Corporation Tax. There is a good reason while this has not been tried before. This type of allowance generally rewards investment decisions that would have happened anyway. The big increase in Corporation Tax looks very Corbynesk, but it is still lower than when the Tories came into power. Corporation Tax is aimed at company profits, so should recoup a share of the profits from firms who have had a 'good' pandemic. However, these are often the very firms that are most adept at dodging tax.

One big health warning over the Budget plans. The real budget lines only apply to the coming financial year. Anything after that is just planned. Experience shows that these are likely to change, even more so in the uncertain times we live in. 

Overall, it seems clear that John McDonnell has not managed to sneak into No.11 and shift shape himself into the Chancellor. This is an austerity budget that will hit the poor hardest. Sunak has returned to form.