by Mike Saks
10th August 2020

The recent outbreak of COVID-19 has raised challenges for governments and people across the world. Given its high global mortality and morbidity rate, attention in addressing the pandemic in modern societies has focused on a range of issues.

These have spanned from seeking suitable tests, treatments and vaccines for combatting the virus to ensuring that safe social distancing measures are maintained in private and public places. There is also a fear that the health of populations could further deteriorate because of the economic impact of COVID-19, which may be larger than that of the Great Depression almost a century ago. Over and above this, there has been a fear that health services may be overwhelmed by sharp spikes in cases. Health concerns are therefore absolutely paramount at present and these are amplified by the fact that other major illnesses such as cancer and heart disease may have slipped down the priority list for governments.

In all this, one central focus in more modern countries has been on the frontline health professional workers dealing with cases of COVID-19, especially in hospitals where those with the worst symptoms have been put on ventilators in intensive care. In the United Kingdom, as in a number of other countries, there has generally been an upsurge of public support for key workers such as doctors and nurses at the frontline in dealing with those more severely affected by the virus. Even here, though, there has often been a shortage of personal protective equipment and testing procedures. However, the sheer invisibility of support workers has made their situation far worse and not nearly so well publicised, despite the fact that they have also been operating at the forefront of care, and form by far the largest proportion of the health workforce.

As such, support workers, alongside health professionals, are at the heart of the response to the threat to wellbeing posed by COVID-19 in all its manifestations. This has been accentuated by the growing pressure on unpaid informal carers in the context of an ageing population and the associated mushrooming of long-term conditions which are known to increase vulnerability to the virus. Concisely expressed, health support workers are those who provide face-to-face care or support of a personal or confidential kind to users in clinical or therapeutic settings – with the caveat that, while many hold qualifications, they are not members of recognised professional bodies. They fill a multitude of positions ranging from health care assistants and home carers to nursing and physiotherapy aides. In this sense, the many hundreds of different types of paid support workers are employed across the whole spectrum of provision relating to mental and physical illness, from hospitals to residential care and people’s own homes.

In the myriad roles that they occupy, support workers are clearly centrally involved in the fight against COVID-19 – whether through testing or providing emotional support and facilitating treatment. Yet, despite their centrality in these roles, many are amongst the lowest paid in society, suffer from great job insecurity and are disproportionately drawn from minority groups in terms of ethnicity and gender. Moreover, in terms of user safety, support workers are often poorly regulated – particularly those who work outside organisational contexts and conduct their activities in domiciliary settings. This has to some degree been offset by measures taken through larger-scale employers, supervision by health professionals and more proactive recruitment agencies that supply such workers. But real issues continue to exist in the health challenges posed by COVID-19.

Governments have been heavily criticised for the lack of speed and robustness of their response to the COVID-19 crisis (see, for instance, the recent article by Michael Calnan), but this is a time when – if they are to be successful – they need to co-terminously improve the position of health support workers. In this respect, stronger management and regulation is required if the growing number of clients affected by COVID-19 are to be more adequately protected – among other things, through the oversight of support workers by selected health professional groups. Further progress is also needed in mitigating risk to protect the health of support workers themselves. This includes enhancing their precarious working conditions and acknowledging more fully their critical part in the mainstream health and social care division of labour.

In sum, governments and other players in modern societies now need to take on board advice from bodies beyond the nation state like the World Health Organization and the United Nations in the struggle against COVID-19. This will require the exercise of responsible leadership, which should be embedded at all levels of health and social care. This should not only be used to guide direct action in relation to COVID-19, but also to shore up the situation of the support worker labour force which contains so many of the valued personnel operating at the frontline and beyond. A good starting point would be to develop, where appropriate, a more solid career structure based on a climbing frame of opportunities leading into the health professions themselves. Action in this and other respects should be a priority in the interests of humankind in facing the COVID-19 pandemic.

Mike Saks is Emeritus Professor at the University of Suffolk and Visiting Professor at the University of Lincoln, Royal Veterinary College, University of London, University of Westminster, UK, and the University of Toronto, Canada.

Support Workers and the Health Professions in International Perspective edited by Mike Saks is available on the Policy Press website. Order the hardback here for £60.00, or the EPUB for £21.59.

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