Had there been a government which had a modicum of competence, the disaster that befell care home residents and which led to thousands them dying from Covid-19 would have been completely avoidable. But the record of the Tories betrayed a complete indifference in preparing for the impending crisis and their incapability to organise the basic steps in managing the pandemic when it hit Britain. There was no attempt to obtain and use information about the spread of the virus; warnings issued to the care sector were belated and imprecise, and later on, there was criminal complacency in accounting for the appalling mortality in Britain’s care homes. ROBERT CLOUGH and JAMES PIKE report.
Precise figures for the number of Covid-19 deaths among care home residents are impossible to get because no count was maintained until mid-April, and was then dependent on first, whether care homes submitted data to the Care Quality Commission (CQC), the government agency designated as responsible for collecting the information, and second, whether Covid-19 was recorded as a cause of death on death certificates. However, between 11 April and 22 May alone, the CQC shows that 15,414 residents died from Covid-19; thousands must have died in the weeks beforehand, meaning that estimates by the International Long Term Care Policy Network of 22,000 deaths are completely realistic.
Why have there been so many deaths? There are about 15,500 care and nursing homes in England, with 465,000 residents, 60% of whom are aged over 85. Older people are particularly susceptible to Covid-19, in part because they anyway have weaker immune systems, but also because they suffer more from conditions which affect their immune systems. Type 2 diabetes is a known factor in developing Covid-19 complications. In hospital settings, for instance, 53% of all deaths as at 29 May were of patients aged 80 years or more (14,000 out of 26,384 deaths) of whom some 40% had been transferred from care homes. People aged 80 or more number some 2.6 million or 4.6% of the population of England; of these half are aged over 85. Once a coronavirus infection starts in a care home, it spreads rapidly because social distancing is difficult to maintain, and because it can be introduced and spread unintentionally by asymptomatic staff.
Anatomy of the disaster
Despite the evident warnings from China which in January already showed the devastating impact of coronavirus on the elderly, the Tory government took no action, despite evidence that the spread of the virus was already thought to be doubling every five days. Instead, it waited until 25 February before issuing its first guidance on the virus and care homes. This claimed there was no need for isolation since it was ‘very unlikely that anyone receiving care in a care home or the community will become infected.’ In the event of a suspected case among staff or residents, ‘no restrictions or special control measures are required in these settings while a member of staff or resident is waiting for laboratory test results for Covid-19. In particular, there is no need to close or send staff home at this point.’ The guidance did not mention outside visits, and stated that staff did not need to wear face masks.
Updated guidance on 13 March continued this complacent attitude; Chief Scientific Officer Sir Patrick Vallance was still musing about the need to ‘build up some kind of herd immunity’, while ‘at the same time we protect those who are most vulnerable to it.’ At this point, care home operators were ‘advised’ for the first time to ‘review their visiting policy, by asking no one to visit who has suspected Covid-19 or is generally unwell.’ As it was, unable to wait any longer, the larger private care home groups had unilaterally stopped non-essential visits. Later, on 13 May, Boris Johnson was to claim that the 13 March guidance meant the government had locked down care homes before the general lockdown – a lie. Two days later, the Health Secretary Matt Hancock was to allege that the guidance showed that ministers had ‘tried to throw a protective ring around’ care homes ‘right from the start’ of the outbreak – another lie, and then implied it was a government success that 62% of care homes had escaped infection.
The 13 March guidance unleashed a storm of criticism which the government ignored, waiting nearly three weeks until 2 April, 10 days after the national lockdown, before saying ‘family and friends should be advised not to visit care homes, except next of kin in exceptional conditions such as end of life.’ By this time the damage had been done; tracking data made available by Public Health England at the end of April showed that by the end of March there had been 793 outbreaks in care homes. Some 15,000 elderly patients were being discharged from hospitals into care homes to free up beds; they were not being tested for coronavirus unless they were symptomatic or were being transferred from somewhere with a known outbreak. They became a further source for infection spread. The 2 April guidance stipulated that testing would be strictly limited to those care home residents who were symptomatic, and only if five or more residents in the same home showed such symptoms. On 25 March, Johnson had told parliament that every care home worker would receive all necessary PPE ‘by the end of the week’, but as late as 4 May one care provider told The Guardian that they had received a total of 400 masks when they need 35,000 a week.
It was not until 15 April that Hancock announced ‘plans’ to test all symptomatic care home residents and staff; not until 28 April a ‘plan’ to test all residents and staff, symptomatic or otherwise. At the time of writing, the government claims that every care home for the over-65s will have been ‘offered’ testing for residents and staff by 6 June. Like so many ‘plans’ the government has put forward over the past three months, this is likely to be yet another empty promise.
A pre-existing crisis
Before the pandemic, the care system was already in a deep crisis, with a staffing shortfall of 122,000 workers across the whole sector, endemic low pay, and cuts to local authority spending of over £8bn since 2010. 1.4 million older people were estimated to be living without the care and support they needed, while the care that many received was often wholly inadequate.
1.2 million people work in the care sector: 465,000 in care and nursing homes, 610,000 providing domiciliary care and 150,000 day and community care. With few prospects for increasing productivity, private providers have pursued higher profit margins by slashing workers’ wages and conditions:
- 28% of all care workers are paid the minimum wage; it is estimated that 10-13% of care workers are in practice paid below this legal minimum.
- Around 10% of all care home workers are on zero hours contracts.
- 58% of frontline domiciliary care workers and 54% of domiciliary nurses are on zero hours contracts.
There is widespread use of agency staff – precarious workers drafted in to meet an existing staffing shortfall of 122,000 (8% of all roles) across the sector exacerbated by up to 25% of staff absent due to the virus. They have been faced with the impossible choice of working with no protections, or a total loss of income; this has undoubtedly contributed to the spread of the virus. As it is, death rates among care workers from Covid-19 are double those for the population in general.
Making a killing
Private care services have long existed for the wealthy, but it was not until the 1980s that public money began to be routinely funnelled to private care companies. The 1990 NHS and Community Care Act, which passed full responsibility for care to cash-strapped local authorities, accelerated a process of privatisation. The large providers which had emerged in the 1980s began to be floated on the stock market. Attracted by guaranteed streams of public and private fees and property assets which can be speculated with, finance capital has asset stripped the sector, and saddled care home operators with massive debts, before selling them on for a profit.
The first care home to be threatened with having its licence taken away by the CQC during the pandemic, Home Farm Tree in Skye, is run by such a company – Britain’s largest private care provider, HC-One. Two thirds of HC-One’s 340 homes, which house 22,000 people, have experienced outbreaks, and over 800 residents have died. HC-One’s history can be traced back to March 1993 when Nursing Home Properties plc (NHP) was established to buy up the property of nursing homes, in order to then lease the properties back to the operators. This split between property company and operating company is central to the ownership model in corporate care – it is a key part of how vast profits are hidden by being reclassified as debts within the same corporate group. HC-One was set up by NHP to operate 249 homes which ended up in the hands of NHP following the debt-fuelled collapse of the UK’s then-largest care home operator Southern Cross in 2011.
HC-One is ultimately owned by the financial corporation Formation Capital LLP, Safanad Inc, and Court Cavendish – original partners to NHP, founded by Labour Party donor Chai Patel. The corporate structure of HC-One involves 62 companies with names like FC Skyfall Intermediate Holdco 3 Ltd. Nineteen of these, including the ultimate parent company (FC Skyfall LP), are registered offshore in Jersey or the Cayman Islands. HC-One has declared a loss in every year except two since its formation – but has paid out nearly £50m in dividends over the last three years. It has paid almost no corporation tax in that time, while receiving £6.5m in tax credits. The company’s highest paid senior director has received £2.5m since 2011, and Court Cavendish, which is 90% owned by Patel and 10% by his family trust, has received £25m of management fees. The CEO is paid £800,000 a year. The company is currently on sale for £1bn.
HC-One (whose non-executive chairman, David Behan, was until 2018 head of the CQC) is, alongside Care England, the trade body representing the large private providers, leading the charge in demanding yet more state money be funnelled to care operators who, it argues are being paid ‘below the cost’ of providing care. One study for the Centre for Research and Socio-Cultural Change, however, has shown that what corporate care providers consider operating ‘at cost’ is in fact turning a profit of 12%. The Competition and Markets Authority (CMA) says that between 2015 and 2017, the 26 largest providers turned an average 21% ‘economic profit’ on top of the 6.5% the CMA considers necessary to break even before interest, tax, depreciation, amortisation and rent.
The 30 largest care home providers supply around 30% of beds, and include many companies backed by private equity or other financial investors. These include HC-One, Four Seasons (up for sale by private equity owners H/2 Capital Partners; split into a corporate group of 187 companies, many based in tax havens – see FRFI 270) and Care UK (controlling stake held by Bridgepoint Capital, a private equity investor holding £16bn in assets). At the other end of the scale, 29% of beds are supplied by the fragmented mass of companies only operate one home. Concentration in the sector is growing and will increase as the smaller operators (which tend to have much higher operating costs) fold under the financial pressures of the pandemic. One individual home, Friary Lodge in Barnet, is already the first to close down operations due to the pandemic, telling its residents to get out by the end of May – demonstrating the utter inhumanity of a system in which care is provided for profit.
FIGHT RACISM! FIGHT IMPERIALISM! 276 June/July 2020
