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Steve Fouch

Social care and COVID-19: crisis or opportunity?

Steve Fouch is CMF Head of Communications. He has worked in community nursing, HIV & AIDS and palliative care. He serves on the International Board of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

If a week is a long time in politics in normal times, then at the moment two years can feel like a geological epoch!

In January 2018, we welcomed the explicit inclusion of social care into the name of the former Department of Health, making it the Department of Health and Social Care. Social care, the long-neglected junior partner to health looked to be on the road to proper recognition as an essential and properly resourced part of a fully integrated national health and social care sector.

Such happy memories. Move to April 2020, and we see how that hope seemed so Pollyannaish. While reports of cases and deaths from COVID-19 in hospitals had been steadily rising and the media had focused (quite rightly) on the massive and costly effort of health professionals in acute settings, the care sector had been largely ignored for much of March and April this year.

Then the numbers of deaths in care homes began to get reported, and it suddenly became apparent that there was another, almost hidden epidemic underway. Figures released at the end of April showed that there had been some 4,000 previously unreported deaths related to COVID-19-19 in care homes in the previous two weeks.

It is worth noting that over the same period, deaths in care homes not related to COVID-19 also went up by 21.5%  – suggesting that either more untested residents of care homes are dying of COVID-19, or that the pressures on health and social services are leading to more deaths from all causes. Probably both.

While hospitals had struggled to get adequate supplies of personal protective equipment (PPE), at one stage care homes and domiciliary care staff could barely access it at all. That situation may now be improving, but somewhat late in the day. My own daughter, who works with the frail elderly in their homes, was unable to access PPE until 1 May (and until that point was advised by her employer that she should only use it if a ‘client’ had symptoms of COVID-19 – arguably far too late to stop infection spreading).

Current figures suggest between 16 and 40 per cent of all recorded deaths from COVID-19 are in care homes. And it’s not just the residents that are dying – a growing number of carers have themselves died in the last few weeks.

The Department for Health and Social Care has been working hard on guidance and getting testing and PPE into the care sector. And to be fair, they are getting there, albeit behind the curve. But they were starting from an already dangerously low base.

In 2001, Lord Dilnot delivered a report calling for a radical reform of the care sector, its funding, pay structures, resourcing and prioritisation. In 2016, the Institute for Public Policy Research (IPPR) warned that the sector was in danger of critical meltdown as those in need of care increased whilst funding and staffing dropped. Successive governments had promised to address the crisis in care, but all failed. Social care was a problem that everyone agreed needed addressing, but no-one was able to bite the bullet and do something about it.

Then, when Theresa May sought to deliver a Dilnot-style funding solution for care in the 2017 General Election, it became an albatross that arguably lost the Tories their parliamentary majority.

It seems as if everyone is now clamouring for more resources and support for the care sector. But are we, as a nation, truly willing to grasp that nettle? Maybe the 2017 election manifesto pledge was badly communicated. Still, the way we voted suggested that we were reluctant to pay the cost of a properly funded social care system. Is it because we want to put out of mind the reality of ageing and frailty? Do we see funding for health and education for the young and fit as more important than the care of the elderly and disabled? And, faced with our declining years, do we cry out for assisted suicide and euthanasia to release us from the burden of simply growing old?

Actually, I think most of us are not that callous or self-absorbed. Maybe the ironic twist of the pandemic is that it is making us re-evaluate what matters to us as a society. That we should be caring for our weakest members. That people matter more than political or economic ideology (of the left, right or centre).

There are some promising approaches to state funding and coordination of social care that might be working. One notable example is the integrated health and social care model being piloted in Greater Manchester. That, in time, may become the way that we can improve how care is delivered nationally, integrating it more fully with the NHS.

But I also think, and have long argued, that there is a wider and deeper social change that is needed. One that COVID-19 may be making us wake up to.

When William Wilberforce was campaigning against slavery, child labour and cruelty to animals in the early nineteenth century, he understood the need for political, social and spiritual activism. As he campaigned on the many social issues of his day in Parliament, influencing governments and political parties and cross-party movements, he also worked on societies and associations that promoted the transformation of ‘public manners’, built up families, translated and distributed Bibles and proclaimed the gospel of Jesus Christ.

This social and spiritual movement changed society, paving the way for the Victorian social reformers who in their turn influenced the creation of the NHS and the welfare state.

But Wilberforce saw more than this. He saw the gospel of Jesus as central to transforming the way society thought and acted. The transformation of society started with individuals being themselves transformed by God’s saving grace. That was the secret of his campaigning and the social movements that sprang up from his work: meeting the deep spiritual needs and hunger of his day.

With one in four of the population now accessing some kind of online service or prayer meeting at least once a week, that spiritual hunger is evidently here today. We have a message of hope and healing for shattered lives to proclaim to a broken world – let’s not squander the opportunity.

Social care needs to be transformed, and that will certainly take concerted government action and the commitment of considerable public funding. But government action needs to go hand in hand with deep social change, and that starts with us. COVID-19 is a wake-up call to the church to tell the Good News in word and deed to a world that needs to hear it more than ever.

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