In the third part of a series examining how life has changed following the pandemic, Ben Wray turns to our social care system...

WHEN Scotland locked down on March 25, 2020, only “essential” workers kept going into their workplaces. The lockdown was thus a unique social experiment – who is actually required in our economy to stop everything from coming crashing down?

As it turned out, essential workers were not the best paid, far from it. Bankers and CEOs stopped going into their offices and little changed. In fact, many of those who made it on to the government “key worker” list were among the lowest earners. And most of those turned out to be women. One study found that an incredible 98% of key workers who were at high risk from Covid-19 and earned a wage at or below the poverty line were women. The vast majority of these workers were carers, either caring for people at home or in care homes.

Covid-19 brought a spotlight on to this workforce, perhaps for the first time. Too often ignored, Scotland acknowledged their huge sacrifices made when we collectively “clapped for carers” on our doorsteps.

But what happened after the applause? Has the pandemic really lead to a sea-change in the value Scotland places on care?

Social care’s staffing crisis

CARMEN Simon, who works in the voluntary sector in Edinburgh supporting adults with complex care needs, told The National that it was not until the second week of April 2020 that they were provided with PPE, so she took matters into her own hands.

READ MORE: How Covid changed Scotland: The politics of independence

“I have a friend who is good at sewing and she made me a mask and I managed to buy carbon filters to put inside it,” Simon says.

As the Covid-19 death toll mounted, Simon was in constant fear of either bringing Covid into someone’s home, or taking it back home to her family. “It was really hard for care workers to keep going and it had a terrible impact on our mental health, from which I don’t think we have recovered yet.”

The numbers bear this out. Some 40% of voluntary and private-sector care providers say sickness levels among staff have increased significantly since the pandemic, with reasons given including anxiety, depression, stress and exhaustion.

For Simon, who is a member of Unite the Union’s not-for-profit branch, the pandemic “shed light” on pre-existing problems. “Social care was in crisis before the pandemic,” she says. “The sector has been struggling to keep and retain staff for years because the terms and conditions have kept deteriorating.”

Simon moved to Scotland from the Basque city of Bilbao in 2011.

“I came here as a migrant worker and I didn’t need a qualification to get into social care, so it was an easy way to get a job,” she said. “I’ve been working in the sector for 11 years and I earned more 11 years ago than I earn now.

“I had contractual sick pay that I don’t have now; I had contractual maternity pay that I don’t have now. I was paid for travel time and administration time and now I am not. I’ve experienced first hand the conditions being undermined.”

Social care has an abnormally high staff turnover, with almost one in five leaving the sector every year, the main reason being low pay. The living wage was introduced in 2019, and the latest increase in the minimum wage for care staff takes the hourly rate up to £10.02 but for households grappling with the cost of living crisis, that might feel like a pay cut.

“You can still earn less than in a supermarket, so I’m not surprised that people are leaving the sector,” Simon said. “I don’t encourage anybody to join it, to be honest with you.”

The exact figures are unknown but it’s thought that thousands of people in need of care are missing out in Scotland because of staff shortages, Health and social care partnerships describe the staffing crisis as “unprecedented”.

Nick Kempe, former head of services for elderly people at Glasgow City Council, says Brexit turned off the “cheap labour tap” in social care, and now the only solution to attract staff is to properly value care work. He said: “Care is quite a demanding job, it’s not for everybody, but if people were properly rewarded, if there was a career structure, a national training programme, then actually if you look at all the other jobs out there and if you look at where capitalism is going in terms of constantly destroying jobs, care could potentially offer a really secure career for people.”

IS it therefore simply a question of throwing more money at the problem, more staff and higher salaries? Kempe, who has worked on commissioning in the care sector, argues that as long as the majority of social carers continue to be working in the private sector, additional government funding will mainly go towards greater profits rather than higher pay.

A report by the UK Competition Authority found the largest 26 private care providers achieved average profit margins of 21% between 2015-17. And the private providers are increasingly dominant: three in four Scottish care home places are now in the private sector, with the number of residents in local authority care homes falling by 29% over the past decade.

“I don’t think the public sector pays enough to have the wages you would want, it’s very tight, but the problem is you can’t pay these companies any more, because they will just snaffle it,” Kempe, says. “We all need caring relationships”

Lady Poole’s public inquiry into Covid-19 in Scotland will quite rightly look at why, by the start of June 2020, more people had died from the virus in care homes

than in hospitals. One study of 26 countries found only Spain had a higher Covid mortality rate in its care homes than Scotland following the first wave.

However, this is by no means the end of the story. If the first part of the care homes crisis was mainly about infection, the second is mainly about isolation.

In reaction to the shock of the outbreak in Scotland’s care homes, tough restrictions were placed on the ability of loved ones to visit residents. For some relatives, those restrictions were far too tough and lasted far too long.

“My mum was in a care home at when the pandemic broke and I think like a lot of relatives we just thought that we’d be out for six weeks and then we’ll get back in again,” Cathie Russell told

The National. “We knew there was not a lot of PPE and there was a lot of panic in the hospitals, so everyone accepted what was happening.”

BUT by July 2020, with Covid cases down to very small numbers, relatives had gone months without meaningful contact with family members and still were not getting access. It was then that Russell began to get organised, helping to set up the Care Home Relatives Group, which now has about 2200 members.

Despite organising demonstrations at the Scottish Parliament and meeting ministers, it wasn’t until 12 months after the first lockdown when Russell could get to see her mum properly. The effect this isolation had on her mum and thousands of other care home residents was not just bad for their mental health, but also for their physical and cognitive functions, Russell says. “People’s mobility has been badly affected and their memories decline if you remove all that familiarity.”

The situation had been improving but with the emergence of Omicron, “a lot of homes have been closing down again”.“Care home residents still don’t have the same human rights and freedoms as the rest of the country, that’s for sure,” Russell says.

Kempe believes the isolation of care home residents has been a “disaster”and is proof that there is a fundamental misunderstanding in government about care. “Care is integral to human existence.

No child grows up without care and we all need caring relationships to sustain us through all parts of life,” he says.

“The balance between the need to protect people and the need for people to have support from each other is really crucial and the Scottish Government doesn’t seem to have a clue about that. I’m afraid that also informs their proposals for a National Care Service.”

First Minister Nicola Sturgeon has said the National Care Service (NCS) will be a “fitting legacy from the trauma of Covid”, but initial hopes that it would be an NHS for social care – publicly owned and free at the point of access – now seem unlikely to materialise. The Scottish Government has faced criticism for handing out contracts for the design and development of the NCS to three big accountancy firms which have an interest in profiteering from public services.

Kempe says the main thrust of the independent Feeley Review, which has informed government plans for the NCS, was to move towards more “central control”, an approach which he believes will not address most of the key problems, including staffing, training and private ownership.

AN alternative plan for the NCS was published by the Common Weal think tank last month, proposing a not-for-profit model to stop money leaking out of the care system. It would be paid for through the Scottish Government’s £1 billion in Barnett consequentials from the UK Government’s National Insurance increase, which is supposed to be spent on social care.

“That wouldn’t fix everything but it would do a heck of a lot,” Kempe, a co-author of the Common Weal report, says. “It’s taking the social out of care”

Scotland’s rapidly ageing population is a long established fact, and is far from peaking. In 2017 the National Records of Scotland predicted that the number of people of pensionable age will be 25% higher by 2042, while the number of people of working age will increase by just 1% in that time. If we are struggling to provide care for the elderly now, how bad will the situation be in a couple of decades, unless something changes?

Russell’s mother, Rose Hamilton, who sadly passed away last July, had as good an insight as any into how Scotland has struggled to adapt to the last few decades of population ageing. Having worked as a home help for 25 years, she then experienced home care herself in the years before entering a care home.

“My mum would do two hours with one person and two hours with another every day. They’d have their tea and pancake together and a bit of social time with them. She made a huge difference to old people’s lives,” Russell says.

READ MORE: Covid-19: What our Scottish NHS needs post-pandemic

“But by the time she was getting home care I had to buy it in because what I was getting from the council was 15 minute visits, which were utterly no use to her. They just left her feeling harassed. She’d never get the same person twice.”

Simon, who sits on the Social Care Covenant Steering Group for the NCS with Russell, has experienced the growth of 15-minute visits in recent years from the point of view of a social carer, and shares Russell’s concerns.

“Fifteen minutes to do personal care, food preparation, medication – that’s not social care,” she says. “By reducing these interactions to 15 minutes, it’s taking the social out of care.”

If the pandemic has taught us anything, it’s surely that care is at the foundation of all of our lives. But until we massively increase the financial and social value we place on care, we may be in danger of regressing into a very uncaring society, with the most vulnerable paying the highest price. Who wants to live in a Scotland like that?

Tomorrow, Ben Wray tackles the impact of Covid on Scotland's economy