A Crisis of Care in the Context of Covid-19: Challenges facing BAME older people and their carers

shahnazThe Chancellor Rishi Sunak’s spring budget delivered in March pledged an injection of £5 billion into the NHS and social care. Whilst the budget considered the impact of Coronavirus on the care system, here our researcher Dr. Shahnaz Akhter looks at the budget within the context of the Coronavirus pandemic and the emergency legislation bill to examine its implications for the BAME older people accessing care.

 The Spring 2020 budget promised an injection of £5billion into health funding to support the NHS and social care during the then imminent Coronavirus crisis.  A detailed breakdown of how these funds will be allocated is, as yet, not available. On adult care, the budget reaffirms the Tory Manifesto pledge to build a cross-party consensus on reform, but that ‘[a]head of those discussions, the government will invest £1 billion of additional funding for social care next year’ (HM Treasury, p. 42). Although this reflects the 2019 Conservative Party Manifesto promise of increased funding into the social care system, the Kings Fund’s breakdown of the proposed spending of the £5 billion reveals that despite the apparent increase in funding, the Department of Health and Social Care budget is only up by 3.4 % to £145.bn in 20/21. Since the budget, Sunak has, as we know, unveiled further emergency packages but, as yet, none have targeted adult care.

Moreover, social care campaigners have raised significant concerns about the impacts of the emergency Coronavirus Bill on local authority provision of care.  The Bill contains within it a clause that if trigged allows a suspension in the legal duty of local councils to provide social care for all those eligible under the Care Act 2014. In the Summary of the impact report, the government states that if there is a 30% absenteeism of health workers ‘many essential health and social care services may cease with detrimental impacts on those that need them most’. Campaigners have warned against the impact of the bill, with Baroness Grey Thompson calling it a ‘health and social care obliteration bill by a different name’.

These worrying concerns raised by Grey Thompson and others will require ongoing monitoring and analysis and are not the specific focus of this blog. Rather, I want to highlight two important takeaways from the budget: 1) The budget contained no specific address for disparities within adult care provisions for the BAME community. 2) The budget contains no specific support for voluntary and familial care networks. Whilst the budget offers some support for small and medium-sized care providers who, ‘will benefit from the refunded Statuary Sick Pay and other proposals aimed at businesses employing fewer than 250 staff’,  many BAME carer organisations fall outside this framework. As we well know, BAME elders are often cared for within informal care networks (often linked to community or religious groups) in which there is little in the way of state funding to support this work.  The Spring budget may well have dangled the promise of increased social care funding, but we can expect that very little of this funding will find its way into supporting the vital work of older care going on within the UK’s BAME communities.

Such inequalities in support for adult social care take place alongside the growing discriminatory practices at work within state healthcare provision. Sunak’s Spring budget also saw an increase in the Immigration Health Surcharge to £624. Whilst the charge is ostensibly aimed at newly arrived immigrants, the recent Windrush scandal revealed the impact that this had on some BAME communities, particularly those who had arrived before 1973. This was seen in the case of the Albert Thompson who was asked to pay £54, 000 upfront for cancer treatment as he could not ‘prove’ his residency.  The charge can be seen as contributing to the ‘othering’ of BAME communities as outsiders, and may serve to prevent some older people from accessing the help that they need.  The government has since updated its advice on ‘upfront charging’ updating its policy in February 2020, to prevent those who are considered vulnerable, within the Immigration system, or who require urgent medical treatment from receiving the charge.

The Race Equality Foundation has set out the possible impacts of Coronavirus on BAME communities in the UK. Highlighting that many BAME elders have higher rates of conditions which put them on the vulnerable list, they point for the need for information packs to be multilingual. The framework provided by the government for adult social care in responding to the Coronavirus outbreak includes within a need for inclusiveness and for the need to ‘provide appropriate communications to all involved, using the range of communication methods and formats needed to reach different people and communities’. Such a strategy is certainly to be welcomed, but it needs to be recognised that this also places additional burdens on chronically underfunded local authorities already struggling with the outbreak.

The government framework also calls for support to be provided for ‘those who have extra or new responsibilities to care for others’. As was pointed out in an earlier blog by Elias and Rai, healthcare professionals often assume that BAME, particularly South Asian older people, do not require support as their families will be taking care of them. Whilst the government has produced a support page for vulnerable people, this is reliant on self-reporting. The  blog by Asna Wajid, on our website, highlights the issue of stigmatisation within the South Asian community, where both stigma from within the community and perceived outsider status ‘has led to the shunning of the social care services among ethnic minorities  for fear of being further ostracised by the system’. This could lead to a potential ‘invisible’ proportion of BAME elders falling outside the care system during the COVID-19 crisis, further exacerbating the issue of lower numbers of BAME elders getting access to Social Care.

 BAME Caregivers

Whilst Rishi Sunak has also announced financial packages for those in work, businesses and the self-employed, there is no meaningful package of support for unpaid carers. The  PSA Commission on Care report found that ‘BAME voluntary social care organisations have experienced disproportionately greater funding cuts than mainstream voluntary service providers in the last few years and that mainstream providers have reduced services specifically targeting BAME older people’. Although some steps are now being taken to support charitable organisations suffering financial losses due to lockdown, it remains to be seen what the impact of this recently announced scheme will be on the small, specialist and often ad-hoc and community based voluntary organisations delivering support to BAME older people and their carers. As the racial disparities at work within the Covid-19 crisis have become ever more stark, the need to properly value the work of voluntary organisations in supporting BAME elders matters now more than ever.

The Race, Equality Foundation states that  ‘[b]lack and minority ethnic families also tend to be larger on average, which places additional stresses on space within the home and on bills and finances as a result’.  The higher proportion of multi-generational households within the BAME community will mean that with schools now shut, carers will be faced with additional childcare in addition to their duties as carers. The burden of care within this period will fall disproportionately on women.

Adult social care has so far only been discussed in the context of Covid-19 in terms of the challenges facing care homes. These challenges are indeed many and include the lack of PPE for care staff and the significant rates of infection and deaths from the virus in care homes. But in many respects, such stories merely represent the tip of the iceberg when it comes to evaluating the impact of the Coronavirus outbreak on care for older people. As the earlier work of the PSA Commission showed, we need to be attendant to both race and gender in understanding the impacts of the crisis on adult social care, the central role that women’s unpaid labour plays in supporting social care, and the longer term impacts of the demands of caregiving, especially for BAME and economically marginalised groups of women.

 

 

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