We rightfully celebrate our centenarians and veterans such as Sir Tom Moore. Ironically, we forget that many of these people are cared for, in their homes or in care homes, by social care workers. Why then are social care workers so invisible, forgotten, and undervalued? Currently of the 1.5 million people employed in the care sector, approximately 840,000 general care workers are caring for approximately 420,000 vulnerable people in care homes.
Social care workers are often referred to as “low skilled and low paid”, a narrative that feeds into them being undervalued. This has been dramatically demonstrated during the covid-19 pandemic by the government’s poor responses in support of the social care sector. These responses may have contributed to the deaths of 11,186 care home residents as reported by the Office of National Statistics (ONS) 2 June and of 131 social care workers registered up to 20 April 2020, and deaths to date are likely to be higher than this. 
We also see the devastating impact of the pandemic in the loss of lives of social care users and workers internationally.  The inevitable conclusion is that undervaluing of, and poor support for, the social care sector and social care workers is an international scandal. It should be recognized that not all social care workers are “low skilled or low paid”, and that many care providers pay the living wage. [3,4] Many speciality trained social care workers are qualified nurses, social workers, physiotherapists and occupational therapists, providing 24-hour care to vulnerable people with complex needs.
For the social care sector, ONS data further demonstrate a twofold higher risk of death from covid-19 compared to the general population. Later data showed five times more positive tests for SARS-CoV-2 for health and social care workers in contact with patients and users, compared with the general population (ONS Infection survey 12 June). These workers, disproportionately exposed to the virus, clearly need effective personal protective equipment, as we have previously argued is necessary for all health and social care workers on the frontline.  The ONS data from May confirmed that care homes were the epicentre of the pandemic. For the week ending 1 May care home deaths (6409) exceeded hospital deaths (6397).
Why is this the case? Some initial insights may be gained by comparing and contrasting the funding support given to the NHS and the social care sectors. Over 15 years of successive governments and austerity have slashed local authority (providers and commissioners of SC) funding by over 50%).  That squeeze on funding is passed on to a sector that is already financially stressed, hence contributing to severe consequences for users and workers. 
It is noteworthy that during the pandemic the NHS debt was cleared and local authorities received billions of pounds, with expectations that this would flow down to those caring for the most vulnerable. However, in reality little has yet been delivered to the care sector.  Over 60% of providers say they had received nothing up to 12th May.  A budget of £600 million for infection control was announced by the prime minister on the 13 May. Although welcomed, this is at best an admission that the social care sector and its workers have been poorly supported.
Other factors contributing to deaths of social care workers related to interactions between the NHS and social care sectors have also become evident. First was the rushed and premature transfer of elderly patients from hospitals to care homes in order to free up hospital beds. Subsequently, it was realised many patients were infected with covid-19. This represented the beginning of the perfect storm for the deadly outcomes in the social care sector.  The NHS abdicated responsibility for older people, by discharging patients without testing. Returned residents unknowingly transferred infections to other users and social care workers resulting in deaths and morbidity from covid-19. In parallel, there was a national shortage of Personal Protective Equipment (PPE). The NHS was prioritised for what PPE was available, exacerbating shortages in the social care sector and inflated prices of PPE for the social care providers. [7-10]
The social care sector, however, have not been passive during the pandemic. Early on, some homes closed their doors (fearing the worse for the residents and the workers). Some social care workers left their families and moved in to live with and care for residents. This was “shielding” in action, not just words. Also notable was that senior social care leaders in March warned a parliamentary select committee of the looming dangers for social care. 
Belatedly the government published (16 April 2020) its “adult care action plan”. Hospital Trusts were told they would need to test every patient prior to discharging them, whether they had symptoms or not. Contrastingly, within care homes, comprehensive testing was not available until 6 June, further evidence of neglect of the sector. 
The covid-19 pandemic has highlighted a system that is broken, through lack of funding and resources.  In order to avoid the same tragedy in another pandemic, lessons must not only be learnt, but must also be acted on. Government needs to publicly own, support, and finance social care. The sector can no longer be seen as low skilled and deserving of low pay. Tinkering at the edges and having unending reviews of integration of health and social care is not what is required. What social care is crying out for is a system in its own right—funded and valued in its own right. The pandemic has demonstrated these needs. The Kings Fund recommended setting up a “single system” redesigned around the care required by individuals.  A system that we will all recognise, value, and be proud of, like the NHS. We need a system that champions social care and is the voice at the pillars of power.
Marcia Stewart, Social Care professional and Emeritus Principal Lecturer, De Montfort University
Denise Kendrick, Professor of Primary Care Research and General Practitioner, University of Nottingham.
Raymond M Agius, Emeritus Professor of Occupational and Environmental Medicine, University of Manchester
John FR Robertson, Professor of Surgery & Consultant Surgeon, University of Nottingham.
Herb F Sewell, Emeritus Professor & Consultant Immunologist, University of Nottingham.
Competing interests: None declared
Acknowledgements: Our thanks to colleagues in the Care Providers Association and National Care Association for their reading of the draft article and useful feedback.
1.(COVID-19) related deaths by occupation, England and Wales www.ons.gov.uk › deathsregistereduptoandincluding20april2020 (10 June 2020, date last accessed)
2. https://www.euronews.com/2020/05/08/the-deadly-impact-of-covid-19-on-europe-s-care-home (10 June 2020, date last accessed)
3. https://www.skillsforcare.org.uk/Home.aspx (10 June 2020, date last accessed)
4. https://www.indeed.co.uk/salaries/care-worker-Salaries (10 June 2020, date last accessed)
5.Robertson JFR, Stewart M, Kendrick D, Sewell HF. Covid-19: Protect health and social care workers and refer their deaths to the coroner. https://blogs.bmj.com/bmj/2020/04/21/covid-19-protect-health-and-social-care-workers-and-refer-their-deaths-to-the-coroner/ (10 June 2020, date last accessed)
6. Local government funding: Moving the conversation on https://local.gov.uk/moving-the-conversation-on/funding (10 June 2020, date last accessed)
7. https://careprovideralliance.org.uk/cpa-and-coronavirus-calling-on-the-cqc-to-support-care-providers-during-the-pandemic (10 June 2020, date last accessed)
8. https://nationalcareassociation.org.uk/news-events/news/covid-19-statement-from-the-board-of-national-care-association (10 June 2020, date last accessed)
9.https://www.caremanagementmatters.co.uk/money-for-covid-19-not-reaching-providers/(10 June 2020, date last accessed)
10.Covid-19: The support UK care homes need to survive BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1858 (Published 14 May 2020) Cite this as: BMJ 2020;369:m1858
11 Iacobucci G. Covid-19: Lack of PPE in care homes is risking spread of virus, leaders warn BMJ 2020;368:m1280 doi: 10.1136/bmj.m1280 (Published 27 March 2020
12 https://www.nationalcareforum.org.uk/ncf-press-releases/test-test-test/ (10 June 2020, date last accessed)
13. https://www.theguardian.com/world/2020/mar/25/the-guardian-view-on-social-care-and-covid-19-the-neglected-frontline (10 June 2020, date last accessed)
14. https://www.kingsfund.org.uk/publications/ne w-settlement-health-and-social-care (10 June 2020, date last accessed)