By Angela Craig
Emerging figures showing the high incidence of COVID-19 deaths in care homes should come as no surprise. They reflect not only Boris Johnson’s government’s failure to prepare for a pandemic or to respond efficiently when faced with the coronavirus early this year, but a particular underlying narrative to official policy. This has consistently conveyed the idea that the coronavirus was mainly a serious problem for older people and those with ‘underlying health conditions’: ‘9 in 10 dying have existing illnesses’ as the BBC put it, reporting on ONS data. We are to infer that these were people nearer death anyway, so COVID-19 was simply taking them a bit earlier. As Johnson stated in March ‘many more families are going to lose their loved ones before their time’: get used to it.
What explains this callous attitude is the same as that which explains much of the Tory government’s response to the pandemic: supposed economic interests are put before human lives. In this case (in the particular logic of capitalism) those viewed as economically less productive could be sacrificed.
In the very first report of a coronavirus death in England, the brief official announcement stated that this was ‘an older patient who had underlying health conditions’. Official pronouncements and media reporting repeatedly stressed the status of deaths by age and ‘underlying condition’. An estimated 43 per cent of adults in England have at least one long-term health condition so the message on a literal level is nonsensical: the government didn’t expect deaths on that scale. Rather the language sought to divide, and to inure the public to certain deaths: younger and non-disabled people were safest it implied. This could only sow social division among communities, the exact opposite of what an effective response to a pandemic needs. It is the logic of a strategy of ‘herd immunity’: a living with rather than eliminating the virus strategy that has never, so far, been abandoned by this government.
Government policy set about delivering to this expectation. Care homes – home for hundreds of thousands of people – are today in Britain largely run by private sector companies, with notoriously underpaid workforces. Care homes found themselves at the back of a long queue for personal protective equipment with appeals for testing and equipment ignored. Care homes have reported residents being refused hospital admission for treatments for fractures and other non-coronavirus related issues, and of being forced to re-admit COVID-19 positive residents to care homes from hospital knowing that there were not protective measures in place within the institution.
Even by late April the BBC reported that of 210 care providers spoken to, 159 said none of their staff had been tested. Although from 28 April deaths in care homes began to be counted in England and Wales – with 4,343 deaths in the two weeks up to 24 April – the true scale of deaths is likely to be much higher than current estimates: the Financial Times suggests the daily death toll is twice the official number, many as a result of death in care homes. In the week up to 26April more than half of COVID-19 deaths in Scotland were in care homes.
Added to these will be deaths ‘in the community’, until later in April, also uncounted. The Coronavirus Act removed from local authorities the duty to provide social care under the Care Act 2014 unless there was a breach of human rights (a very high threshold test). Care workers in the community – who provide domiciliary care – also complained of a lack of protective equipment. Unsurprisingly rates of self-isolation and illness rocketed among home care staff rocketed, leading to huge pressures on local authorities to reduce care provision.
Those receiving care services – whether living in a care home or in their own home – are not only older people: many are younger disabled people and disabled people of all ages. Since 2010 funding cuts and wholesale closures of programmes like the Independent Living Fund have seen disabled people’s ability to live independently hugely undermined. Over this time many younger disabled people have been forced into residential care or live more avoidably limited lives, dependent on reduced home care support.
In the coronavirus context disabled people needing to self-isolate have been told it is safe to allow care workers to come into their homes, despite a lack of protective equipment. Some disabled people receive direct payments and contract their own personal assistants. They have been denied any advice or support to allow such services to proceed safely and many feel ‘abandoned’. A government drafted list of ‘vulnerable’ people to be given priority for food deliveries appears random as to who is in and who is out: disabled people with significant impairments omitted from the list have found great difficulty accessing food. There has been massive concern about discrimination in medical treatment, including reports of pressure to sign do not resuscitate orders (DNRs) and concerns that prejudicial attitudes about ‘quality of life’ would influence access to medical treatment and facilities.
A very large number of disabled people and disabled people’s organisations issued an open letter to NHS England in April expressing concern about pressure to sign DNRs and value judgements that would affect their access to treatment. NHS England have said that treatment should be decided on an individual basis, yet discrimination appears ongoing: one learning disability care provider said it had received ‘unprecedented’ numbers of DNR orders which it believes to be unlawful. Only the efforts of disabled people themselves has brought this catalogue of deadly discrimination to some degree of public attention.
This spread, in care homes and in the community, of COVID-19 and the resulting deaths, can only be halted by a proper, more stringent, lockdown where care workers and those using the services of care workers have adequate protection. But the Johnson government is shifting policy in the opposite direction and trying to soften up public opinion for a lifting of the lockdown. This threatens many many more lives.
Labour, the main opposition party, ought to be attacking the government’s policy and demanding protection equipment and medical resources for care homes and also supporting disabled people in their campaigns. It should stop pressing the government to publish plans for lifting the lockdown and instead demand that the lockdown is tightened till the incidence of all new cases, including in residential homes and the community, is reduced to the very low numbers that allow for thorough testing, tracking and tracing to succeed. The priority should be to save people’s lives.