Compulsory care-home staff jabs may sound sensible but would create a catastrophe
I t’s a no-brainer, isn’t it? Of course every care and NHS worker should be vaccinated against Covid and anything else that puts them and their patients at risk. Those who remember people who had contracted polio at school with leg irons or paralysed arms know how to thank modern medicine for our salvation.
Facts, scientific facts, that’s the dose the vaccine-refusers need. Or so every good rationalist believes. But why do we never learn our lessons? Look where that facts-based approach got us remainers in the Brexit referendum. Humans don’t live by reason alone – maybe scarcely at all. And our government knows it, ruling by raw emotion and focus group, guided by what people feel regardless of truth. It leaves the very sensible Labour opposition flailing.
Why compulsory vaccination, and why only for care homes? For the NHS all that’s been announced is a “consultation” – but with strong opposition from the British Medical Association, Royal College of Nursing, unions, the NHS Confederation and NHS Providers, that’s likely to go nowhere. The care sector can be ordered around because it’s powerless and defenceless – as shown by the absence of that long-promised social care plan while the system collapses.
If all unvaccinated care workers were sacked, in some parts of the country care homes would cease to function at all. They would be closed overnight as unsafe, leaving nowhere to send the frail but into hospital beds. London and the south-east would be among the hardest hit: in the capital only 23% of homes have at least 80% of their staff vaccinated, only 40% in the south-east. Imagine if only a proportion of those workers walked away: they can earn more shelf-stacking in Aldi, and hospitality in that part of the country is crying out for staff. There are already 112,000 care-worker vacancies, so compulsion, the “rational” thing to do, risks turning a crisis into a catastrophe.
Scotland, Wales and Northern Ireland say they have no plans for compulsion: instead they have given their care workers £500 pandemic gratitude bonuses; the English government gave theirs nothing. No 10, polling every day, looks as if it’s engaging in dog-whistle politics here against people from ethnic minorities – many of whom have long had strong grounds to mistrust authorities and are more hesitant to take the vaccine.
Behind the scenes there is division: the very sensible NHS England – still quite separate from Matt Hancock’s politically driven Department of Health and Social Care – has quietly put out its own evidence that persuading staff to get vaccinated can and does work, gradually, if done in the right way.
NHS England reports “a sharp rise in people overcoming hesitancy”, and a large study by the Vaccine Confidence Project finds that, among the previously unwilling, 17% more men and 23% more women have come forward for vaccination, an increase of 21% among Muslims and 18% among Christians. This was achieved, says NHSE, through the health service’s uniquely close local connections, with GPs and local staff persuading their own communities: “Targeted engagement with faith leaders, pop-up clinics in places of worship, sports stadiums and local community centres, as well as strong, vocal backing from high-profile voices.” East London’s Dr Farzana Hussain personally rang up every one of her vaccine-hesitant patients.
Dr Bola Owolabi, director of NHSE health inequalities, says that vaccine uptake among black British staff has risen by more than 200% over the last two months.
It is vanishingly hard to find anyone close to the colossal workforce crisis in both care and the NHS who thinks compulsion is the way to go. The message it sends care workers is brutal, yet again: doorstep clapping is forgotten, and these underpaid, overworked staff feel fiercely resentful of government.
I just visited St Cecilia’s in Scarborough, North Yorkshire – one of four homes owned by Mike Padgham, who has become the go-to voice, representing 250 small independent care-home owners in the north. Simon, his senior nurse, and Alison, his team leader, worry about the 10 vacancies in St Cecilia’s. Staff are trying to recruit friends and family, and they praise the bravery of those who didn’t quit when hospitals sent them untested, infected cases: Covid killed four residents.
Padgham says six of his 100 staff are not vaccinated, but gradual persuasion has been working. “How can I sack them when they have stuck with us through the pandemic? I can’t move them away from the frontline either, as they’re needed.”
Small homes are closing at an accelerating rate, “but we have no political power”. Almost all his residents are state-funded, so why don’t his members strike and refuse to take in any more? He says many homes already near financial collapse would be tipped over and, besides, “the public have no sympathy: they think we’re raking it in”.
With growing anger, he waits for a government plan that never comes. “They must decide what to do with private homes: stay private or be nationalised? We could become like GPs, technically private businesses but paid a fixed rate. Do something!”
But there will be no plan until next year, and probably not then either, so another spending review will pass in the autumn with no solution because every answer is super-expensive. And the signs are that all Boris Johnson cares about is easing care costs for property-owning families, not new money to create a professional, respected, trained, decently rewarded workforce. Instead, it’s all stick with no carrot for those who risked their lives to care for others in the pandemic.
Polly Toynbee is a Guardian columnist