As the UK approached its coronavirus peak in April, it became clear that working conditions were helping to drive the infection’s spread in care homes. Both nursing home staff and home visit carers told the New Statesman at the time that they could not afford to self-isolate, because statutory sick pay was either impossible to live on or was not available to them.
Individuals have to work a certain number of hours to be eligible for statutory sick pay or the sickness benefit Employment and Support Allowance, which rules out many workers on part-time or casual contracts in the sector. More than 14,000 deaths in care homes have been attributed to Covid-19 so far, while excess deaths (the number of deaths of any cause exceeding figures in previous years) stand at 26,500.
As care homes took on agency workers and bank staff (those who cover temporary vacancies across different homes) to cover staff sicknesses and shortages in this period, they told us they were becoming increasingly vulnerable to the Covid-19.
And so it proved, as a survey of 9,081 care homes in England by the Office for National Statistics (ONS) released on 3 July showed: care homes in England that use above-average numbers of agency staff, or do not offer sick pay, were found to have higher risk of infection levels among residents.
The use of these working practices is one of the main factors thought to be behind the spread of coronavirus among care home residents. The odds of a resident testing positive for Covid-19 go up by around 50 per cent if the care home regularly employs bank or agency nursing staff. Staff testing positive is also nearly twice as likely in care homes with bank or agency staff.
More than half of care homes used agency and bank workers during the crisis. While the use of outside staffing is normal, its extent likely increased during the crisis with staff sickness rates more than double their usual level across adult social care.
Chart by Patrick Scott
These staff are often on low pay, and temporary or zero-hours contracts, which means they have little option but to continue working, and – in the case of care home agency and bank staff – moving between sites to ensure they worked the hours they needed to live on, with no cover for dropping shifts.
As one young care worker in Leeds told us in April: “I wouldn’t be able to afford to self-isolate. I’ve been picking up extra shifts to save in case I have to. I live with another person, so I would have to self-isolate for two weeks which I just can’t afford.”
It was a similar situation for cleaners in hospitals, surgeries, offices and shops, who are also often provided by agencies or large government contractors on part-time or hours-based contracts, as revealed by the New Statesman at the beginning of the crisis. Those at the front-line were inadvertently spreading it, at the mercy of their industry’s employment practices.
According to a report leaked to the Guardian, Public Health England was aware of this pattern from a study it conducted on 11-13 April, which found the virus moving between six London care homes via cover staff. The problem was allegedly slow to be reported to care home providers themselves.
Yet this is an issue that has long been growing. The number of agency workers employed in residential care activities has increased by 80 per cent in the past nine years according to a New Statesman analysis of the ONS’s Labour Force Survey. In 2020, 35,935 employees in the sector said they worked for an agency, up from 19,948 in 2011. The majority of these, at 24,000, said they were permanently employed by the agency in question, while the rest were temporary staff.
Across all sectors (excluding the self-employed), 2.3 per cent of people were employed by an agency in 2020, making the residential care sector far more reliant on agency workers than the norm, at 3.9 per cent.
In addition to this, as much as 5.6 per cent of the adult residential care workforce are bank or pool staff, according to analysis by the charity Skills for Care. This figure is likely to be even higher among those most exposed to Covid-19, with one in ten nurses across the entire adult social care industry being employed as bank staff.
The proportion of the care workforce employed on zero-hours contracts is 9 per cent, which also skews towards less senior jobs. Just 4 per cent of senior managers across the entire adult social care industry are on zero-hours contracts, compared with 17 per cent of registered nurses and 35 per cent of care workers.
It appears that, yet again, the pandemic has exposed a weakness in employment practices that emerged long before Covid-19 began to spread.