Tomorrow, the National Records of Scotland will publish its latest study on the demographic impact of Covid-19. It will look at how the virus has affected people based on age, sex and deprivation levels. Evidence from England suggests it should also analyse the impact by ethnicity.
The deprivation link is important, because while wealth and power are no barrier to the transmission of this coronavirus, it is becoming clearer by the day that those required to go out to work are at a higher risk than those who can work from home, and that those with pre-existing health conditions are more vulnerable than those with none. And what we also know is that there is a direct correlation between deprivation and poor health.
In fact, just as Covid-19 was beginning to take hold, an updated report into health equity in England led by Professor Sir Michael Marmot was published. It concluded that over the last decade the health inequality gap has not narrowed but grown wider. “People in more deprived areas spend more of their shorter lives in ill-health than those in less deprived areas,” wrote Professor Marmot in February. We can expect the figures released in this week’s NRS study to reflect that health equity in Scotland is no different and that vulnerability and susceptibility rise with poverty here too.
Perhaps the most shocking dimension of this pandemic has been the impact on our residential care homes for the elderly. They now account for over half of Covid-19 deaths in Scotland. 886 care home residents had died of Covid-19 by April 26, and as of May 2, as many as 569 care homes in Scotland (53 per cent of the total) have reported at least one case of suspected coronavirus.
Yet, in spite of the scale and virulence of this, the Scottish Government has been, at best, woefully slow in acting. At worst, it has been negligent in the discharge of that basic duty of care which the state has to its citizens.
Confusion and anger
A cursory review of the unfolding evidence over the last critical four weeks illustrates my point. On April 7, a letter from the Scottish Government’s Chief Nursing Officer was issued which created confusion and anger in equal measure by downgrading the personal protective equipment (PPE) usage guidance for care staff. Care worker Catherine Sweeney had died three days before. A week later, following intense political and trade union pressure, the Government was forced to relent and reverse the downgrade.
The following week, the SNP Government had still failed to honour its commitment to publish the number of care workers who had been tested. I asked Nicola Sturgeon for the figure at a virtual session of First Minister’s Questions. Rather cryptically, she replied that around 20 per cent of the health and care workers tested had been from the care sector. Do the maths, and it turns out that meant just 1.72 per cent of the social care workforce had been tested, over 98 per cent had not.
It was only on April 17, by which time care homes had recorded 1,621 cases of coronavirus and a series of deadly outbreaks had been reported, that SNP ministers announced direct deliveries of PPE to care homes. It has since emerged that in the meantime, there were reports of homes resorting to buying PPE supplies on eBay.
The Scottish Government only issued updated guidance on testing residents and new admissions to care homes on April 22, ten days after international evidence revealed that care homes deaths could account for around half of coronavirus deaths in Europe. And it was not until April 26 that ministers officially revised clinical guidance on hospital admission for care home residents. This was despite over 500 coronavirus deaths being recorded in Scotland’s care homes by this point, and despite repeated concerns from human rights bodies and care sector organisations that discriminatory, blanket policies were being implemented.
Many care workers feel abandoned
Ministers set a testing target of 10,000 a day by April 30, which has now been and gone with tests sitting at an average of around 2,000 a day over the last week. The SNP Government’s 2016 Silver Swan pandemic preparation report, which was leaked at the weekend, made no mention of testing at all, so perhaps it is no wonder that progress has been so slow.
Many care workers have said to me that they feel they have been abandoned, that their sector is treated like the poor relation of Scotland’s NHS, which has itself been starved of resources for over a decade. I’ve long been concerned by the under-resourcing of social care, which was under strain well before this pandemic.
When I raised the issue of elderly residents facing eviction from specialist care homes in January 2018, Nicola Sturgeon responded by insisting that she “understands the challenges that the care home sector faces”. When I raised it again in June the same year, she said her Government would “continue to discharge our responsibilities with the dignity and respect that we owe our older residents very much at the top of our minds”.
But if the events of the past few weeks have taught us anything, it should be that no amount of understanding can make up for a lack of action. No amount of talk about respect will assuage the worries and anger of families who feel their loved ones have been discriminated against, simply because of where they live.
Ministers must act now to ensure care homes have the resources, personal protective equipment and testing capacity they need to stop the further spread of the virus, without the built-in delays of days stretching to weeks that have become so familiar, and so costly. Of course, for many it is already too late. But the least we can do is rebuild our care sector so it is better equipped to withstand a crisis like this one.
That means an end to outsourcing and profiteering. It means giving our heroic care workers pay and conditions to match the vital public service they deliver. For those receiving care at home, it means an end to 15-minute visits. In short, it means building a compassionate, accountable and integrated Scottish Care Service worthy of the name.
Richard Leonard is leader of the Scottish Labour Party
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