It was always unavoidable that mistakes would be made during the handling of this pandemic. No public health threat on this scale has existed in any developed economy for many decades – and given that modern economies are integrated and interdependent (networked) on a scale previously unimaginable – the economic and social impact of a global pandemic were always going to pose severe difficulties. These unavoidable problems were always going to be exacerbated by the fact that governments globally are almost universally driven by the need to facilitate the interests and the continued profits of the parasitic capitalist class, leaving working-class interests and safety a very low priority. But these considerations notwithstanding, it is also undeniable that there has been a range of governmental responses globally, leading to varying severity of outcomes for workers in different countries and regions.
The covid-19 pandemic came on the back of a decade of biting austerity cuts to public health and social care services in Northern Ireland. It also occurred against a backdrop where social care for vulnerable and the elderly was highly fragmented with the majority of residents in care homes being run by private companies from ‘the independent sector’. Parties on all sides at Stormont, the seat of locally devolved government, had normalised the profit motive in the provision of care and indeed pump-primed the growth of the sector through public funding tied to the growing numbers of residents in private care homes. Nonetheless care homes operators often felt the need to ‘top-up’ their public sector revenues through the imposition of hefty additional charges levelled on residents or their families. The situation in care homes was always going to a major difficulty should a pandemic strike.
Care homes workers and residents exposed to risk
The focus of the Stormont Executive to the crisis was initially split between the challenges of instituting a lockdown in lockstep with the rest of the UK and the mounting political furore in the heart of government. The divisions between Northern Executive parties widened very sharply in the run-up to the imposition of a lockdown by the UK government, especially after the government in the South instituted their own lockdown. This meant a different approach either side of the border, which was reflected on the ground by an informal but powerful movement of parents and workers to close schools, workplaces and public facilities. While Stormont Ministers were briefing against their cabinet colleagues on scandals, including the misleading claim by Sinn Fein Finance Minister Conor Murphy to have secured procurement of Personal Protective Equipment (PPE) through the Irish government, to the endorsement by the Ulster Unionist Party Health Minister Robin Swann for the British Army to be deployed in the roll-out of covid-responses, the on-the-ground crisis in the distribution of face masks, gloves and visors to front line health sector workers proceeded apace.
The situation in care homes was even worse and because many of the worse facilities tended not to have a recognised union, it went unreported.
The longstanding crisis in Care Homes
Care homes have been facing an underfunding crisis for many years. The transfer of much responsibility to private sector operators has allowed declining standards of care, the widespread exploitation and pervasive abuse of staff – e.g. in Dunmurry Manor and Muckamore Abbey – as well as the imposition of “top up” charges by care home operators. Throughout recent years the Executive parties and senior management within the health sector have attempted to ignore the situation and indeed the response when allegations have come forward has been to paper over difficulties.
The last year has been a particularly chequered one for Northern Ireland’s care home sector. Authorities were forced to shut down a number of the worst operators when widespread neglect and abuse was exposed.
So again, the crisis from covid 19 did not occur in a vacuum when it hit the care homes. At the end of March, health and social care workers in a number of settings were reporting that elderly patients suspected to have contracted covid-19 were discharged from hospitals to care homes before their results came back. CWI Ireland supporters also heard, first hand, of the difficulties facing workers in care homes who had to try to isolate suspected covid infected individuals from other residents.
At the same time, workers in care homes were reporting a total absence of PPE. In one instance, workers received a covid-suspect patient from an ambulance where the paramedics were wearing full protective equipment but care home workers receiving them had nothing. In other care homes, management refused to confirm whether workers’ colleagues had been forced to self-isolate due to suspected covid infection and indeed proceeded to victimise those who raised concerns.
CWI activists, including myself, Donal O’Cofaigh, in my role as a councillor on Fermanagh and Omagh District Council, were publicly raising concerns, and reports we received from workers, in the local press by the end of March. In the Sunday World newspaper, 5 April, my concerns were raised on a regional platform. I was able to highlight reports of suspect covid patients being discharged into care homes in the county and the prospect of a broader wave of infection.
The UK media had raised concerns about the absence of PPE in care homes by 3 April, with a report exposing the absence of provision being carried by the BBC correspondent Laura Kuennsberg. This also highlighted the growing prevalence of ‘Do Not Resuscitate’ orders being discussed with elderly residents of care homes ahead of the possibility that they would become infected with the disease. The widespread reported pressure on elderly residents and those with long-term illness or comorbidities, to sign ‘DNR’s, which effectively meant that they would not receive any needed treatment should they contract the virus, was a particularly disgusting reflection of the state of healthcare services. It showed the impact of a failure to invest in sufficient intensive care unit beds, ventilators, and other specialised equipment.
The first confirmed cluster of covid infection in a UK care home was formally reported on 4 April in East Sussex. By 8 April the scale of the potential crisis exploded into the Northern Ireland regional media. The leadership of the trade union Unison was prodded into talking about the threat posed to the 16,000 residents of nursing homes, which were akin to ‘Coronavirus petri-dishes’. It was only from that point that mainstream politicians in Northern Ireland began reacting to the crisis but again only very slowly as the focus was very much elsewhere.
The fragmentation of the care home sector – primarily a consequence of the extensive privatisation of the sector – exacerbated the logistical shortcomings around the supply and provision of PPE to frontline workers. Many employers in the sector, long used to exploiting their employees, were certainly not overly concerned to ensure PPE supply.
Starting with donations solicited and provided from the workplaces which had closed under the lockdown, consignments of gloves, face masks, and visors started to arrive at care homes sporadically but the requirement that they are single-use only meant that there was a failure to ensure continuity of supply. There was no general approach – the situation varied widely. It was to take until the end of April for a comprehensive system of supply and the provision of care home PPE helplines by the NI Executive. Only then was it clear that all care home staff including those in private sector homes would be adequately supplied with protective equipment.
Rising death toll and the continued cover-up
In line with wider UK practice only those who were diagnosed with Covid-19 and found to have died as a result of the disease in a hospital setting were initially excluded in the statistics of deaths. This was almost certainly an attempt at a sleight-of-hand by a government which recognised the likely backlash from a huge death-toll in the care home sector.
As pressure built up from growing awareness of the magnitude of the clusters of deaths in care homes across the UK, the rules in England and Wales and Scotland were eventually changed to include all deaths of covid-19 suspects in a hospital setting and then statistics which combined deaths of suspects in hospitals and other settings.
By comparison, the Department of Health has refused to produce ongoing statistics revealing the full extent of the spread of the virus in care homes. Despite the promise from the Health Minister that the numbers of victims in care homes would be released on 17 April, families are still seeking the truth. The Northern Ireland Statistics Research Agency (NISRA) has provided statistics combining deaths in care homes with those in hospices and hospitals where the virus has appeared on the death certificate. But, as yet, no indication has been given for the number of deaths at hospitals originated from a care home setting. In addition, Northern Ireland remains the only part of the UK where the anomalous situation exists that while covid-19 is a notifiable disease, suspect deaths from the virus are not notifiable to the coroner. This means many families may never know whether their relatives have died from the condition or not.
The scale of human destruction
In the absence of comprehensive statistics, the scale of the rampage of covid-19 through the care home sector is hard to ascertain. The latest figures which have been released indicate at least 75 confirmed and a further 35 suspected outbreaks in care homes – approximately one-quarter of all care homes. These include twelve care homes run by Runwood Homes, the dominant private company operating in the sector in the North. Sixteen care homes have had to be closed because of the scale of the outbreak at them. The latest estimates from NISRA suggest that just below half of all the more than 600 deaths associated with the virus have occurred in a care home setting.
Lack of a real political alternative
The partial statistics on covid-19 deaths in care homes that have been released, the requirement for more rigorous testing of covid-suspects by hospitals prior to release, as well as moves to ensure the provision of adequate PPE to care home workers, have only been secured through high profile campaigns. It has been a feature of this crisis that only under mounting pressure from trade unions, public challenge by individuals, such as the Commissioner for Older People, and extended investigations by journalists that the pro-capitalist politicians in power in Stormont have moved on a range of mounting scandals – not least, in regards to the crisis in the care homes.
Throughout the crisis, the ‘Nolan Show’ on BBC radio has spearheaded the public challenge to Stormont’s criminal inaction on a variety of covid-19 crises. Day after day, the radio show has exposed and highlighted the growing number of infection clusters throughout the care homes and also the human impact of these infections – e.g. revealing live on air a home where 36 of 38 residents had been confirmed to have contracted the virus.
This situation reflects the absence of a mass party of the working class in Northern Ireland which, with few exceptions, leaves workers reliant on non-political vehicles for effective representation. Workers’ interests and those of the most vulnerable are nowhere near a priority for the institutions of the Northern Ireland state or the capitalist parties in the Stormont Executive. The turning of workers back towards the trade unions reflects the growing awareness of the need to best protect themselves through collective organisation and the continued rise of trade union consciousness in the class, a process that preceded the current Covid-19 pandemic. Despite this, working-class political representation – not just union power – is needed to move beyond a desperate defensive fight to one where the possibility of a fundamental reconstitution of the economy along socialist lines is a possibility.