The Covid-19 crisis has had devastating implications for so many people. However, as we know, this devastation has hit care homes more than most. This description highlights the context in care homes that existed prior to the pandemic, showing the politics and priorities that exacerbated the situation.
In 2016 I gave a presentation during Declaration festival (Glasgow) about inequalities I observed and experienced in care sector. Well it has been good 4 years since and little has changed especially after reading article from Nick Kempe (Common Weal) dated 20.5.2020 with the title The Predictable Crisis - Why Covid-19 has hit Scotland's Care Homes So Hard.
The number of dead and the amount of suffering over the past year has been difficult to digest. The blame game started over and over again. But the saddest thing - innocent and the most vulnerable people are still dying - alone, without dignity and sufficient care and without loved ones.
Nick Kempe (2020) painted quite a bleak picture of failed policies and their implementations over the past years and how this crisis in care slowly developed "with the help of PPP - public private partnerships.
Even back in 2016 “PPP in care” was a damaging partnership. Lack of transparency, and in general lack of interests in care - more so in profits; contributed to widening inequalities and a lack of equity in care. Over the years PPP did not enhance the care sector but exploited it.
Going through my notes from my 2016 presentation I can relate to so many similar problems highlighted in Kempe's work of today and it is sad that so little has changed.
E.g. one of his comments ..: "a culture that puts partnership working before standards" (Kempe, 2020, p.16) is quite worrying. Back in 2016 I presented 2 very different services within one company but with very different standards of work. While one was an example of excellence the other one was an example of disaster. The fact that such stark differences can exist within one company is appalling. Just to give a taster how bad it was in the underfunded service e.g. in one service every core member had their own bathroom while in the other service 3 core members shared one bathroom. This reflects lack of dignity core members experienced in the underfunded service.
But the care inspectorate will always offer another chance because "there is no provision for the public sector to assume control of failing care homes"(Kempe, 2020, p.16). The only option is to close the service down, which is not an option.
Another hard truth is that “the prevailing management culture in Scotland … makes it almost impossible to criticise the system "(Kempe, 2020, p.4, 16). Very few care providers will allow you "to speak out against being asked to do ever more with ever less"(Kempe, 2020, p.16).
Just to reflect on my experiences in 2016, I tried numerous times to raise with management issues about safety of core members and the staff but they always waited until it was too late to make sufficient changes.
As Kempe (2020, p.17) rightly points out, the real problem is system failure. This system failure has so many facets and one of them is the cost. Some care providers are driven by massive debt (Kempe, 2020, p.17) but in spite of that they are happy to extract some profit beforehand and then "identify the main cost" – (for example), qualified and highly skilled staff.
In my previous company some professionals were paid to leave the care home so the company could reduce the cost and replace them with low skilled staff. However management would expect the same standard of work as with high skilled staff for less money. No one would withstand the pressure. No one would pursue a career in this direction.
Another facet of system failure is that current legislation has created conditions for companies to grow bigger and bigger through acquisitions and mergers and actually allowing them to be registered in tax heavens (e.g. HC-One, Kempe, 2020, p.14,15,16).
Also my experience painfully taught me that the bigger the care provider the more expert they are in land use and buildings (finance) rather than in health care. In other words, the smaller the provider, the better they are as a health care provider.
Implications during the Covid-19 Crisis
All the above situations are true but more so during a pandemic.
I find it naïve to leave care providers to manage Covid-19 themselves especially given that most of them are profit driven. It makes you wonder…is it another act of neoliberalism or lack of Government confidence in NHS or both? (Kempe, 2020, p.11, 18).
In this market driven economy where are human rights? Markets do not care about human rights and the way they operate is often incompatible with the implementation of human rights. Markets always value financial system over people.
It is no surprise that there are now "calls for the public sector once again to assume responsibility for the provision of care" (Kempe, 2020, p.21). “The cost of this is not as high as often is assumed and mainly relates to staff numbers, skills and wages…” (Kempe, 2020, p.21).
Especially in a pandemic it needs to be clear that private providers are not going to pay for extra staff costs from their own pockets, no matter how good their resilience plan is. And the current state of NHS does not have the capacity to help.
The pandemic is still raging and Elections in Scotland are slowly approaching. It is time to take on board new progressive ideas and adopt different ways of doing things. Would political parties take on this challenge and get their inspiration from People's Health Manifesto 2021 to guide their political agenda this time?
People’s Health Movement organised the People's Health Assembly in Edinburgh April 2014 and through the series of consultations undertaken with 120+ PHM members and wider networks generated 20 demands and developed a People’s Health Manifesto informed by people’s lived experiences. In 2016 People’s Health Movement Scotland (PHMS) published People's Health Manifesto (Link).
We approached political parties and offered this "piece of gold" to be adopted in their policies. No leading party took on board these demands and instead gave us a frowned look. Let's hope that in 2021 People’s Health Manifesto will become a part of their campaigns and bring a desirable positive change.
Author: Eva Gallova member of PHM Scotland
You can follow the work of PHM Scotland on twitter here - @PHMScotland
PHM Scotland website - https://peopleshealthmovementscotland.wordpress.com/
Kempe, N.2020 The Predictable Crisis.[online] Available fromhttps://commonweal.scot/policy-library/predictable-crisis[Accessed3.2.2020]