Lost Worlds
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In the days following the Queen’s death, many were caught off guard by their own feelings of grief for a distant and unknown public figure. Also removed from our daily lives, the monarch’s passing ended an era that for the vast majority began before we were born and was ingrained in the memory of parents and grandparents.
Many of us have recently lost loved ones. Since Covid emerged in early 2020, nearly 180,000 deaths have been recorded in the UK within 28 days of testing positive. Due to the restrictions in place, many died alone, their funerals were poorly attended and socially distanced. Indeed, the image of the Queen at Prince Philip’s funeral, sitting alone and wearing a black face covering, has become one of the defining images of the pandemic.
But while few lives have remained unscathed by the pandemic, those living in care homes have suffered more than most. At the onset of the pandemic and with increased demand for hospital beds, the decision was made both in Scotland and elsewhere in the UK to send elderly patients back to care facilities often without testing them d first for Covid.
Between March 1 and May 31, 2020, more than 3,000 untested hospital patients were discharged to care homes in Scotland. It was a decision now considered one of the biggest mistakes of the pandemic.
Donald Macaskill, chief executive of Scottish Care, a charity that represents private care homes, says many of the measures subsequently put in place to protect vulnerable older people ended up having negative consequences.
“The damage caused by certain measures, ostensibly to protect, has become a continuing violation of human rights,” he says. “We haven’t heard the voices and experiences of individual care home residents. There’s always a tension between the need for collective security and an individual’s desires and I think as a whole system we got it wrong.
Macaskill says staff working in the sector have been physically and emotionally drained by the pandemic. And yet, Covid has not gone away. Macaskill says around 80 care homes are still under some form of restriction, although many believe the worst of the pandemic is behind us.
“Even when people were pulling up the sunbeds in the summer and acting like Covid was over, the care industry faced the challenge of people still getting the disease despite vaccinations, boosters etc, and some people getting extremely sick “, he says.
“Anyone who thinks it’s like a cold or the flu is fooling themselves, and matters are not helped by a political and media system so eager to return to normality that it ignores the reality that Covid remains a challenge for the sector care…”
And yet, despite the rigors of Covid and the impact it continues to have on residents, Macaskill says the biggest challenge is yet to come. He says soaring energy prices have left care homes wondering how they will survive the winter, with many reporting a 1,000% rise in the cost of gas and electricity.
“Personally, I’m more worried about the impact this winter than I was in the winter of 2020,” Macaskill says. “Fortunately, fortunately, unless Covid really changes, we won’t see people dying to the same extent. But I am really concerned about the sustainability of the social care sector in Scotland, on which the NHS fundamentally depends.
“There is a myth that, particularly in the independent care sector, it is full of multinational organizations – this is not the case in Scotland. The majority of private providers in Scotland are small family farmers, often sole proprietors, who simply do not have the resources or income – even in good times – to cope with these kinds of exponential increases.
“You add to that the cost of living crisis on food and non-energy utilities, the impact on the workforce, and I’m really deeply concerned about the financial stability and ability of a cohort of really exhausted workers getting us through the winter.”
Donald Macaskill says this winter will likely be tough for care homes | 1 credit
Macaskill says a typical 50-bed care home would normally expect an energy bill of between £26,000 and £36,000 a year, but is now quoted eight to ten times that figure.
“With Covid, certainly in the winter of 2020 when vaccination started, we had a sense of hope and optimism that there was light at the end of the tunnel,” he says. “At the moment we think the lights will go out and we will literally have a hard time getting through the winter.”
It is in this difficult context that the current politics of social care is played out. When he became Prime Minister in 2019, Boris Johnson promised to ‘fix social care once and for all’, eventually introducing the Health and Social Care Tax, which aimed to address chronic NHS backlogs as well as the long-standing problems in the provision of social care by forcing workers to pay an extra 1.25 pence in the pound in National Insurance contributions.
But amid the cost of living crisis and with a tough winter looming, Liz Truss has pledged to scrap the tax less than a year after it was introduced. Macaskill says it would leave a “tax hole” as well as unanswered questions about the implications for Scotland.
North of the border, the Scottish government plans to introduce a new National Care Service. Described as the biggest political intervention since devolution, the local council called it a “power grab”.
Macaskill says the National Care Service is currently a “massive distraction” from the day-to-day realities facing the sector.
“At the moment, there is such a lack of detail in the bill and associated documents that it is not clear what the future will look like. The National Care Service is seen as a massive distraction from reality day of trying to carry on and survive this winter.
“People don’t have the energy…to contribute to the conversation around the National Care Service. We’re standing on a burning platform and it’s burning on both sides. The promise of a National Care Service is , for the moment, a mirage that will not save us from drowning.
So should discussion of the initiative be postponed until the sector is on a level playing field?
“I know the unions and others have called for a postponement,” Macaskill said. “We have fundamental issues that we need to address. I do not see why we cannot deal with them at the same time as having a debate which is less about legislative change and the establishment of a new structure than about the essence of what this national service should be of care.
“Having been skeptical at first, I am someone who thinks we need a substantial change to the system. We have a broken system in its current format, so status quo is not an option.
As if things hadn’t been tough enough over the past two years, the sector has been further undermined by Brexit, that singular act of self-harm that not only failed to deliver any of the promised ‘opportunities’, but instead left a series of difficulties in its wake. For Scottish care homes, especially those in rural areas, the biggest issue is the difficulty of recruiting staff.
“The National Care Service debate is fine,” Macaskill says, “we can come up with the best ideas, the most innovative proposals, but they need people on the ground. That’s what we lost with the men and women of phenomenal talent who had made Scotland their home and felt the need to leave the country.We are unable to recruit at the level required.
“Yes, the Home Office has made things better and visa processes are easier, but for a social economy like Scotland’s, with so many SMEs, the simple practicality of recruiting internationally is almost impossible.”
I ask Macaskill if Covid, Brexit and now the energy crisis have come together to create a perfect storm for the sector.
“I sometimes wake up wondering what major doomsday disaster is going to hit the care sector this week. Many of the issues we were facing were there in January 2020, but no one listened to them. They have been aggravated and deepened by the pandemic and yet the sector has not sunk thanks to the amazing professionalism of the women and men working on the front lines.
“Then we faced a huge workforce crisis partly because of the Covid trauma and the negativity around the social care sector which meant we lost a lot of people to the retail, hospitality and other sectors that had nowhere to recruit in terms of international recruitment. So Brexit has not only affected direct recruitment, it has also affected our ability to retain staff who have left for sectors unable to recruit from Europe.
When the Queen died earlier this month, Macaskill was preparing for the launch of a report by the UK Commission on Bereavement, on which he sits. Launched in June 2021, the Commission gathered information on the main challenges faced by bereaved people and emerging issues caused by the pandemic. It is presided over by the Bishop of London, Sarah Mullally, who gave a reading at the state funeral. After the announcement of Elizabeth’s death by Buckingham Palace, it was decided to postpone the publication of the report, which will now be published at a later date.
“There’s a generation that has a special resonance with the Queen,” Macaskill says. “For many people in care, but also for those who are supported at home, this is a subject they want to talk about and think about. For many people, it surprised them that it put them in touch with their own feelings about their parents, partners, or someone important who is no longer in their life. Collective mourning has impacted and highlighted individual mourning.
“For staff [in care homes] it’s been a tough time because they’re exhausted from an extremely stretched summer. On top of all that, this great emotional and psychological moment was very tiring.
In a blog posted after the Queen’s death, Macaskill wrote that he was “saddened” by the idea that we should mourn less for someone who has reached the age of 96 compared to someone younger.
“There is immense hypocrisy around mourning and grief,” he says. “We believe that our personal response to the death of a loved one should be reflected in the response of others. It is inappropriate to place a hierarchy of emotion upon an individual…grief is deeply individual and unique .
“People often make the comment about someone ‘having a good run’…it suggests that an older person has less to contribute than a younger person,” he says. “If there has been someone who has held the role of matriarch or patriarch in a family, their loss is disproportionately more intense the older they are because we don’t know life without them.”
