England’s social care workforce has shrunk for first the time in ten years. “People’s lives and dignity are at risk,” said Helen Wildbore, director of the Relatives & Residents Association told The Guardian in October 2022.
The South Asian comm-unity has its cultural and pragmatic reservations against the regular norms of caregiving.Care giving is an intimate task. From an emotional perspective, a family or a person that is seeking care from a professional caregiver does not necessarily have an extended family or children to take care of them. Hence the need to hire outside help. Those who have children and family, may not always be able to seek their support since everyone has their own battle to fight, not to forget that the cost of living crisis is a curse for the younger generation and the middle class. More often than not, youngsters and children who hire caregivers or put their elderly in care homes remain guilt-ridden and emotionally helpless. The pressures of the modern-day work culture and economic crisis are not alien, but definitely not easy for the elderly to completely understand. So families who opt for care workers, already make an emotional compromise. It is common knowledge in the community, especially within those families who are actively looking for carers that youngsters or even adults who would previously take up caregiving jobs are not interested in doing it anymore. They would rather wait tables and work as bartenders at pubs, than give their time and energy to the elderly - which to them is clearly a more demanding task, sometimes beneath them. It is unfair to critique them for their choices, but with the given shortage of labour, NHS backlog and pressure on the healthcare system, the future of caregiving looks grim.
According to new figures from Skills for Care, England is projected to need close to 500,000 more care staff by the middle of the next decade, but last year there was a net fall in the workforce of 50,000 people, leaving about 165,000 jobs vacant. The largest ever review of their standards of care, seen by the Guardian, has found ethnic minorities are less likely to get an early or “timely” diagnosis, less likely to access treatment, and less likely to receive support when diagnosed, because of a “totally inadequate” system set up decades ago for a predominantly white population.
Care experts said this shortage of care workers has exposed the “absolute crisis” facing a system still reeling from the impact of Covid and Brexit. According to Carers UK, at least 1 in 8 adults (around 6.5 million people) are carers. An estimated 6,000 people take on a caring responsibility each day, equalling over 2 million people each year.
Earlier this year, the BMA (British Medical Association) warned of a ‘an unprecedented crisis in social care’ and released a report outlining the challenges the sector is facing, which will impact on Britain’s most vulnerable. The findings call for urgent reform in the social care sector, explaining that ‘years of chronic underfunding, severe workforce issues, and a fragmented system mean we cannot adequately meet the growing needs of the population.’
Dr Anil Jain, chair of the BMA’s committee on community care added: ‘It is alarming that we could see up to 500,000 vacancies in social care by the end of 2030. This, alongside an ageing population, means that we are effectively facing a ticking time bomb.’ The report urges the Government ‘to effectively remunerate and value care workers to ensure that there are enough staff to look after all those in need of social care in the future.’
A Glasgow based care worker told the press that she felt burned out. Her hourly rate of £10.02 barely covers her bus fare, let alone her bills. There have been times when she has walked everywhere because her energy bills were higher due to cold weather. “There was one shift where I checked my Fitbit, and it turned out I had walked 11 miles that day. I always call it my 11-mile shift. But then sometimes service users live far out, so I can’t walk to them and have to get a bus, which can cost around £10 for the journey,” she told a publication. Additionally, sometimes, Katie not just with the long hours, she also endures the occasional instance of dealing with verbally abusive service users.
Nirmala Bhojani, Founder of Women of the World Awards, Journalist, Community Activist and Campaigner told Asian Voice, “I think your feature is quite topical as the situation with care workers has certainly got worse after the pandemic. Many of our elderly do not want to pay Agency rates for trained staff, so they are actually relying on women who clean or cook for them, for a bit of cash. Care work is not paid well or valued and many people cannot afford to work the hours required to survive if they are students, as they are only allowed to work limited hours. This means that the elderly who are vulnerable may be at risk as they are looked after by the untrained staff, who don't have a proper understanding of their needs. Some who live on their own are feeling isolated and neglected and I find that they have no one to talk to. I run a Chai n Chat group in Leicester where many of the elderly women share their stories with me, it's so sad to hear how lonely they are. I have just spoken to a friend who is struggling to find a carer for her mother! Looks like there is a Carer Crisis in the Asian Community.”
Shakuntlaben Inamdar from Cambridge told the newsweekly, “Although care workers play a vital role, they are entitled to feel under-prepared, under-supported, under-protected and under-rewarded. Those on the front line of this crisis have rightly been lauded as heroes, but for our care workers, these have too often been merely warm words. I personally believe the change can occur immediately. Indian community arrived in the UK in the 1970s from Africa has proved to fulfil the gaps and hence they played a vital role in the history of making Britain prosper. This should be a good example to set a programme in place to enhance further future development in community care today.”
Major contributing factors of this crisis
Chronically meagre wages are a key problem, with one in five care home workers – most of whom are women and disproportionately black – estimated to be in poverty, according to a separate study by the Health Foundation thinktank of earnings data even before the cost of living crisis hit. Reportedly, the average hourly pay of care workers, £9.50, is currently £1 less than novice healthcare assistants in the NHS receive.
According to the Guardian, even jobs available at Amazon warehouses for people with zero previous experience are paying £11.45 per hour for a day shift, rising to £22.90 per hour overtime. Almost a quarter of care jobs are on precarious zero-hours contracts compared with 3% in the wider population. Hospitals are having to keep patients on wards longer than necessary because there aren’t enough care beds and homecare packages available, which is slowing down the delivery of other medical treatments.
From January to April 2021, just 1.8% of new starters in adult social care were from overseas, compared with 5.2% in the same period in 2019, according to Skills for Care figures. The government’s post-Brexit immigration system initially all but locked out people from moving to the UK to work as care workers through a skilled worker visa.
Recruitment barriers
However, around half of care workers and a third of senior care workers earn less than this, said a report earlier this year by the Migration Advisory Committee, which advises the government on immigration. Also, care workers were only added to the shortage list for 12 months, pending a government review, while employers must pay for a sponsorship licence, and then face ongoing charges, to bring staff in on a health and social care visa. PM Sunak has promised to cut overall immigration while assuring the CBI that he would “unapologetically create one of the world’s most attractive visa regimes for entrepreneurs and highly skilled people”. Opposition leader, Sir Keir Starmer, believes that it would be “pragmatic on the basic lack of people”, but that any loosening of visa rules would come with new conditions for business to “help the British economy off its immigration dependency”. There are more speculations than solutions at hand.
UK health services failing south Asian people with dementia
Alzeimher’s Soceity from London School of Economics and Political Science projected that more than 25,000 people from Black, Asian and minority ethnic groups in the UK are affected by dementia. More importantly, as life expectancy rises, the population with dementia – currently 900,000 – is expected to hit 1.6m by 2040. It has been perpetually reported in the press that people of south Asian heritage in the UK are more likely to develop the disease than the general population due to their higher risk of other illnesses, such as heart disease, stroke and diabetes, that increase the risk of dementia. The number of them living with dementia is set to increase by 600% within the next three decades. Barriers to dementia diagnosis, care and support faced by south Asians are harming “all areas of their lives: mentally, physically, socially and financially”, with many suffering from isolation, anxiety, loneliness and depression as a result. Many elderly people in the South Asian community, fortunately, have the means and monetary resources to afford better care. Quality care at home and finding skilled carers are worrying subjects for many old aged people in the community. With Brexit driving thousands of skilled carers away from the UK, the state of social care is pitiable. Withstanding more harsh truths like Dementia, Loss of hearing, Parkinson's, Cancer, Long Covid, Arthritis, Liver and Kidney dysfunction, cardiovascular diseases and also the loss of key members of the family to the pandemic, care given at home by care workers has never been more instrumental in shaping the society than it is at the moment.
The language barrier challenge
Karan Jutlla, the author of the report and dementia lead at the University of Wolverhampton said, “We are losing people in the system.”
“There’s also a language barrier challenge,” said Jutlla. “English is not the first language for many older people within the south Asian community. Materials and support are largely provided only in English, leaving families to piecemeal translate leaflets and conversations with healthcare professionals. We also heard of care agencies muddling up south Asian languages and thinking they are interchangeable.”
Getting a dementia diagnosis in the first place is often more difficult for south Asians, her review says, because of a “lack of culturally appropriate diagnostic tools”. Because questions in some cognitive tests are about significant events in UK history, many first-generation south Asian immigrants have insufficient knowledge to complete the assessments.
A report titled ‘Satisfaction with social care services among South Asian and White British older people: the need to understand the system’ published online by Cambridge University Press back in 2015 which was co-authored by two South Asians among four writers, explained the crisis years ago.
It stated that the then national surveys showed that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicated that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care.
Kate Lee, the chief executive officer of Alzheimer’s Society, said south Asian people were expected to see a 600% increase in dementia diagnosed by 2050 compared with 100% in the general UK population.
Jabeer Butt, the chief executive of the Race Equality Foundation, told The Guardian, “It’s unacceptable that in 2022, south Asian communities are having worse experiences with dementia simply because of prehistoric systems and support. Not only are south Asian people more likely to receive their dementia diagnosis at a later stage, limiting their access to treatment, but most cognitive tests used to diagnose dementia have been validated and tested in English, with a strong bias for western culture, language and education.”
