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."