When the tide goes out…

There are tribes of people in our world who go largely unnoticed, yet can have a profound impact on our society. Here we look at two that, in light of the current pandemic, can no longer be ignored.

A rising tide lifts all boats, they say, but what happens when the tide goes out? Well, the tide is going out fast and we are having to take a long hard look in the mirror. Only now, it seems, are we being forced to look at two large groups of individuals that have traditionally been ignored by society at large but are increasingly finding themselves in the spotlight. One group – the providers of care – play a vital part in the health of the nation but are undervalued at the best of times. The other group – the homeless – often make us feel so awkward that we find it easier to look the other way than proffer assistance. Out of sight out of mind. Both groups overlap in more ways than one, and both of them are finding themselves in crisis territory as a result of Covid-19.

Caregivers

It’s often said that a society can be judged by how it looks after its weakest and most vulnerable members: the elderly, people with special needs and the homeless, to mention but a few. And goodness there are many. However, while people line up to clap for the NHS, little is ever mentioned of another vital part of our health system: the two million strong tribe of dedicated (generally female) people employed in care outside the NHS (not to mention the circa seven million unpaid carers across the UK). These people wash us, feed us, clothe us, hold our hands when we are ill and do their best to make sure that we are not alone when we die. They work under extreme pressure and risk their own health to comfort the dying. In fact, according to Office for National Statistics figures,  people working in social care in England and Wales have been twice as likely to die with coronavirus as the general working-age population.

Despite their fundamental role in society, carers are technically classified as “unskilled workers”, many are poorly paid and on zero-hour contracts. Today, the number of carers the UK relies upon from abroad is so large that they now comprise up to a fifth of all care workers in the country. The fact that they have not been afforded automatic visa extensions – unlike doctors and nurses from abroad – nor the opportunity to obtain a fast track visa puts us all in a precarious situation. Although clearly being every bit as important to our welfare as those who work in the NHS, carers have not traditionally been recognised as key workers. The stark reality is that carers are significantly undervalued today.

What’s more, the care system upon which they depend for employment is creaking under the strain of budget cuts. While NHS funding was ring-fenced during the austerity years, funding for social care was not. Not easy when an ageing population is creating unprecedented demand for social care.

The Homeless

The tide is also going out on the plight of the homeless. Despite Britain being one of the richest countries in the world, we have over 300,000 homeless. Of these some 30-40,000 are either sleeping rough or are in some kind of temporary accommodation such as hostels or night shelters. Many of them sleep on people’s sofas and floors.

People become homeless for different reasons. Many simply can no longer afford their rent or have fallen into debt. Others may have lost their jobs, had a relationship break down, have mental problems or have been the victims of violence. Some may have left prison or care homes and had nowhere to go. We don’t know all the reasons. What we do know is that the longer a person lives on the streets, the greater the pressure builds on both the NHS and on care providers. This applies to their physical as well as their mental health. Tragically, homeless people die on average at just 44 years old (compared to 77 years for the general population). Before they die they are the group most dependent on emergency and hospital A&E services.

Homelessness can be a terrible mental strain for children as well as adults and can lead, amongst other things to behavioural issues, unemployment, depression, self-harm, alcoholism, and criminal activity, all of which have knock-on effects that play out over the long term at a significant cost to the communities in which they live. With the economy under pressure we will likely see an uptick in homelessness just as funding for local authorities is at an all time low. It’s the perfect storm.

Local authorities have the huge and growing statutory responsibility of looking after the most vulnerable in society.  An acute and difficult problem they face is the vulnerable people who end up in hospital but when fit to leave have no place to go.  They end up blocking beds for people who need urgent care. The term is “delayed transfer of care” or “DTOC”. Everyone loses in a DTOC: For patients, longer stays in hospital are associated with increased risk of infection and physical deterioration as a result of long periods of immobility – a vicious circle that can increase their chances of readmission to hospital; for hospitals longer stays reduce the number of beds available for new admissions, increase waiting times and, according to Age UK, cost the NHS over £500 per minute.

The Impact of Covid-19

With Covid-19, all these problems have been exacerbated on several accounts. The extra effort that has been given to free up beds by discharging medically fit patients from hospitals into community or social care has created a need for social care for which there is insufficient capacity. As a result, social services are being overwhelmed. Furthermore, people who go into care often need places for life, not just a few weeks. Providing the care required is becoming increasingly difficult task.

Carers are facing the brunt of the virus in more than one way. Not only do the people they care for generally have underlying health conditions which makes them more vulnerable to the virus­ – as is indeed the case with the homeless – but they have also not been given the weapons to fight the war. They have been behind NHS and other key workers in the queue for testing and PPE, increasing their personal risk and making it harder for them to do their jobs.

The care workers have now become the second ‘hidden’ frontline against the pandemic and they require similar infrastructure and equipment as the NHS has been able to mobilised in record time.  

As for the homeless, they are uniquely vulnerable to disease due to the preponderance of pre-existing physical and mental medical conditions. To make matters more complex, it’s extremely difficult for the homeless to follow government advice; after all, it’s difficult to self-quarantine or practice social distancing in a crowded night shelter or in a shared room. And it’s simply not possible to regularly wash your hands when you live on the street. They can’t exactly check the medical history of passers by who give them food or money. That is, of course, if there are people on the streets to give them food or money. With people staying at home, one valuable source of aid for the homeless is now no longer there. Greater numbers of homeless mean greater pressure on hospital beds and greater pressure on the providers of care. It’s that simple.

Today the homeless are a hidden tribe and social care is an over-looked, poor relation of the NHS.

These issues are not easy to overcome though.  Over the past 20 years, the question of how to improve and fund social care for instance has been explored in 12 “white” or “green” papers, 4 independent reviews or commissions and a plethora of parliamentary inquiries and think tank reviews. 

The whole issue is politically toxic too.  In 2010, Labour was punished for planning a “death tax”.  In 2017, Theresa May’s election campaign was dogged by accusations that she planned a “dementia tax”. 

Improving outcomes is a complex, multi-generational issue which gets “weaponised for partisan gain”.

There are grounds for optimism though.  The sheer scale of the Covid tragedy may now crystallise the political will to improve the care of our most vulnerable.  As Bill Gates said recently “when historians write the book on Covid-19, what we’ve lived through so far will probably take up only the first third or so.  The bulk of the story will be what happens next”.

Private sector capital will remain crucial, but profit expectations need to be balanced against social responsibilities.  Social care mustn’t simply become ‘financialised’ and overly leveraged to meet buyout groups expectations.

At Triple Point we strive to find the balance between people, purpose and profit.  We will only put our investors capital to work in situations where we are satisfied that there are sustainable, positive outcomes for all the parties concerned. Through the Triple Point Impact Housing Fund, our aim is to provide 10,000 new homes for vulnerable adults and children of all ages, including the homeless and those with care and support needs.