When Sara Hussein, 42, first started working in social healthcare, it was, she says, because she loves caring for elderly people. Doing so reminds her of her close relationship with her father who lives near to her home in West London.
Her journey to the United Kingdom was not an easy one. She arrived in 1993, when she was just 14, after fleeing the civil war in Somalia.
Hussein faced all of the normal trials and tribulations of growing up as a black, working-class teenager in the UK but with the added pressure of being the oldest daughter and having to care for her younger siblings.
Hussein’s parents both worked full-time and so she was tasked with stepping in as the maternal figure at home. She would help her siblings with their homework, prepare their meals and support them emotionally.
Today, she lives with her own six children and, as a single parent, now faces even greater responsibility. Hussein split from her husband a few years ago. “He just stopped speaking to me and started expecting me to do everything,” she explains. Working as a carer and raising her children, the youngest of who is now 13, meant that, in Hussein’s mind, something had to give and it ended up being her marriage.
Hussein works for a private social care company looking after elderly clients in their homes. Her work takes her all over West London and she sees a minimum of four clients a day. Her tasks range from tending to bedsores to preparing breakfast.
She stresses that while she is passionate about her job, it is challenging and these challenges have only been amplified by the COVID-19 outbreak.
The UK is now nearly four weeks into its lockdown. All residents have been advised to practise social distancing. Prime Minister Boris Johnson’s advice has been to avoid all travel unless it is “essential to do otherwise”. Exempt from these rules are front line and key workers as well as workers in the private industry whose jobs require them to keep going. For example, delivery drivers.
And what is more essential than providing care? As Hussein says: “The work we do is vital. We are providing much-needed care to many vulnerable people.” But this does mean that carers like Hussein are exposed to many risks.
Hussein speaks candidly about how her manager has yet to provide personal protective equipment (PPE) to help protect them during the outbreak, despite the government’s warnings. “Look at my mask,” she says. “It’s the same one I’ve had for a week that I got from my cousin’s son because we haven’t been issued any new ones.”
With the threat of coronavirus, and the NHS under a severe amount of pressure, more elderly patients are being released from hospital when they are not necessarily ready. This puts even more strain on the limited amount of time carers have to spend with them.
The time limitations were a problem long before coronavirus and have only grown worse.
Hussein recounts a story about one of her clients, an elderly man in his 80s, who suffers from epilepsy and often has seizures. One blustery winter’s afternoon last December, she arrived at his home in Harrow, West London, to find him unconscious on the floor of his kitchen. She called the emergency services, rang his family and reported the incident to her office. She says the office did not even call her back. She had to decide whether to wait with him until the emergency services arrived and be late for her next client, or to leave him. She chose to wait.
Hussein thinks resources are stretched at her company because they take on too many clients and cannot keep up with demand.
Since 2009, the adult social care workforce in the UK has continued to shift away from local authority jobs in the public sector and towards independent sector jobs.
One of the reasons for this is the reduced public health spending by the British government. According to research by the Health Foundation, over the past decade, the growth in health spending has slowed to 1.6 percent of the gross domestic product (GDP), compared with an average of 3.6 percent a year over the history of the NHS.
Hussein used to work for a state-funded care-home and explains that with private care companies, “some people are in the business for the money rather than the general wellbeing of their staff and their client”.
This means resources are stretched because less money is being spent on the provision of care.
Poor regulation and little support
Over the past 10 years, there has been a 30 percent increase in the number of private companies in operation in the social care sector and 290,000 more private-sector jobs.
Meanwhile, a report by the Association of Directors of Adult Social Services has stated that the public sector simply “cannot go on” without a significant increase in government funding.
The report puts continuing budget cuts at the heart of the problem for public social care and warns that without timely intervention, the UK risks leaving thousands of people without the provision of care they desperately need.
With private social healthcare companies, there are not the same checks and balances in place as there are in the public sector. As Hussein explains, if you are in the public sector, then you can at least take complaints to the council, underfunded as it may be. Your voice will be heard.
Hussein says that during her 10 years in the care industry, she has also seen an influx of smaller companies entering the market. In her experience, this has meant social care work is riskier because they are not regulated as stringently as larger companies and there is a shortage of registered care nurses to oversee the practices of these smaller organisations.
As there is limited safeguarding with no background checks carried out on the addresses of clients she is sent to look after, there is a fear of the unknown when she is approaching a new house for the first time. From more serious risks, like the time her co-worker stumbled into the middle of a drunken domestic violence incident, all the way down to the fact that Hussein has a severe pet allergy, every new client may pose a risk.
The social care industry is already understaffed, and this is only set to worsen after the UK leaves the European Union (EU). About 115,000 out of the total 1.62 million social and care-related workers in the UK hold EU citizenship and there are now fears the country is heading towards a social healthcare crisis.
Low pay, huge responsibility
Zoe Palmer, 42, who lives in Portsmouth on England’s south coast, is a registered care manager with 14 years experience in the industry. She says recruitment is definitely one of the daily struggles her organisation faces.
“There is always more work than there is staff for it,” she says. Recruitment is difficult for her private-sector employer because care work is not seen as particularly glamorous and it is hard to attract new workers.
The reality is low pay for a lot of responsibility. Even without the current threat of COVID-19, carers are responsible for very vulnerable people but are paid not far off minimum wage. In the UK the minimum wage is 8.72 pounds ($10.69) an hour if you are 25 or over; Hussein earns just nine pounds (about $11) an hour for her work.
“Care workers are frontline key workers in every sense of the word,” says Palmer. “There is a strong argument that the work they do is just as important as the work that nurses undertake. They are frontline workers who go out to hospitals, go out to vulnerable people’s homes.”
Palmer says she is struggling to get PPE for the carers she manages. They were sent 300 masks by the government last week but that did not even last them three days. Sourcing masks in the current climate has been proving difficult, as Palmer says they are sold out nearly everywhere.
Private care companies derive income from fees paid by private clients themselves or from the state or NHS where care work has been contracted out to them. But they are struggling to keep up with the challenges that coronavirus has thrown at them.
Palmer says she believes the government should be stepping in at this point. As well as money for protective equipment, Palmer says she wishes that the government would take a longer-term approach to the sector generally and offer organisations like hers money for training new and existing care workers both on the job and online.
If they had more money to spend on training, she says, then they would be able to reallocate more money to higher hourly rates for care workers and hopefully entice more people into the profession which would help with meeting demand.
In Hussein’s company, there is no formal training for carers as they are expected to “learn on the job”. As a result, she is often asked to deliver unpaid, ad hoc training to the other carers. “What do I know about training?” she asks. “I’ve only done the job myself.”
With a lack of sufficient training, squeezed timetables and low pay, the UK is headed towards a social healthcare crisis. According to a report by the Care Quality Commission, only 1.4 million older people (nearly one in seven) are receiving the care and support they need.
There has been a large amount of research into changes in the social healthcare industry and how the effects of these have played out in terms of care provision.
For instance, the boundaries between private and public care have become blurred with local councils as well as the NHS relying heavily on outsourcing to private companies due to a lack of resources and recruitment.
There is also evidence from the Care Quality Commission that there is a clear lack of coordination between different agencies, for example between the home carers in the private sector and other health professionals such as public sector nurses. This means that fundamental things like the details of a client’s medication are missed.
Palmer says that frequently a care package is agreed between the council and her private care company for a client, but the details of what is needed for the care involved in terms of equipment and allergies is not finalised because of time pressures and demand on services. This leads to confusion and severely affects the carers on the ground as well as the clients who are dependent on this care.
The carers have to then spend the time they have with their clients double-checking these details which affect their other tasks. Clients may be at risk of not receiving the right medication and their time with carers is cut short.
Who cares for the carers?
The demands of the job can also place a strain on the mental wellbeing of the carers.
Jasmine Pace is 19 and studying social care at a college in southwest London as well as working for a private healthcare company providing at-home care for elderly clients.
Although she says she derives a lot of satisfaction from helping people, the long hours mean she rarely has any time to relax.
“It’s about the timing and how limited you are,” she says, explaining that there is a set amount of time she is supposed to spend with each client. But the amount of time needed varies from one person to another, she says, and sometimes she will not even have the time to get her clients dressed and prepared for the day.
Pace says that for days on end, she will be the only human interaction some of her clients have. This has been made even worse by the coronavirus outbreak as many relatives cannot visit any more. Pace is worried that many of her clients are becoming increasingly frightened about the virus in their isolation.
“It would be nice to have more time to talk to each client as they can sometimes miss the emotional connection,” she says.
She explains that if she or another carer is tending to a client’s physical ailments then often their mental health needs fall down the very long list of priorities. She laments the lack of time and resources to tend to both: “I just wish there were more of us.”
Pace adds that she has some clients who are very sick with health conditions such as Parkinson’s Disease, and she would like to take the extra time to read them a favourite book or play a favourite song.
This all contributes to her own mental health problems and, because of the sheer pressure, she is forced to sacrifice spending time with her own family.
Even before the coronavirus, carers say they were working under a phenomenal amount of pressure. They are providing a public service, but say their hard work frequently seems to go unnoticed.
As Palmer explains: “We would like some recognition from the government as well as normal people, it’s a hard job but we’re keeping things running.”
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