Health workforce and COVID-19
The north west of Tasmania is currently experiencing the strictest COVID-19 lock down of any part of the nation. Between 1,000 and 1,200 hospital staff are quarantined with their households (a total of probably 5,000 people), and only essential activities allowed across the region. Several of the people infected are health workers, a group that internationally is experiencing a heavy toll.
It remains unclear how the virus has been spread, but one avenue of investigation is the movement of health care workers between multiple sites. One such worker, doing shifts in five sites in the State’s North West, tested positive to COVID-19 almost two weeks ago. As well as working shifts in the North West Regional and the North West Private hospitals, the person worked in three aged care facilities. This may well not be the only instance where the risk of such cross-contamination exists; the circumstances that led to this pattern are likely to be repeated across the State and indeed the nation.
So what does it tell us about the systems that we rely on to support the health and care of Tasmanians?
The most obvious is that there are health workers who are shouldering a great deal of the system’s work.
But there are more, and deeper, things this news highlights.
Why would one person work in so many places? For some, it may be a desire for variety, but for many more it is the casualised nature of much of this work. It can be difficult to get enough hours from one site to make ends meet.
More and more people in the workforce are in casual roles – that is, roles with flexibility, but usually without the protections of sick and holiday pay. In Tasmania, in 2019, more than one in five (21%) workers in residential care services had no paid leave entitlements; that is, they were employed casually. The situation was more dire for those who work as a carer or an aide. Here, one in four (24.7%) were employed casually. Not only that, nearly 15% of those working as a carer or aide had more than one job. And a quarter of all carers and aides wanted to work more hours. That is, they wanted more shifts than they were being offered. People in this situation will find ways to cobble together sufficient income, and that often means multiple workplaces.
The roles most affected are in lower pay brackets – precisely those roles that involve the hands-on care and support of people with health needs. They are also the roles in which staff become familiar with the residents of aged care and can develop friendships and a sense of caring not only for, but also about those residents. For these workers, missing a shift can mean the difference between a week with enough money and being unable to pay for a necessity. It can also mean worrying that residents will miss seeing a familiar face, or having their particular needs met, especially when family and friends are unable to visit due to lockdowns. Residents need the individual attention that is so hard to provide in rushed facilities. Staff that care will be acutely aware of the now compounded pressures created by lockdown on top of already inadequate staff ratios (as reported by the Royal Commission into Aged Care Quality and Safety and numerous national studies).
But, as the pay and casualisation of the care workforce suggest, they are also the people who receive less respect. This is underlined by the prime minister’s willingness to tell the media that the health worker in the North West had lied to contact tracers (and to suggest this demonstrates the need for surveillance through our phones). Yet the incomplete information the worker gave may well be a product of a lack of clarity about what information mattered; people in all sorts of roles are struggling to make sense of COVID-19, what it is, how it manifests, and what to do. Health Consumers Tasmania’s recent survey found that Tasmanians had significant information deficits around the nature of the disease, its spread, Government testing regimes and responses, rules around lockdown and isolation, access to health and other services, and modelling and strategies. These are things many of us are unsure about, not just the health worker concerned.
The State Government has made provisions to extend the public services’ paid entitlement to include an additional 20 days of special leave where an employee is unable to work due to COVID-19. It’s not enough. It does not benefit people who are employed casually and those workers whose work is outsourced, including to the private sector or not-for-profit community organisations. This is the scenario for many residential care providers—80% of all carers and aides work in the private sector. The public–private division is of course artificial, since the federal government is largely responsible for the funding and oversight of residential aged care. And wage rates are set federally. The recently-announced $400million injection into aged care will make little long term difference without systemic change, to the wages of health workers and to staffing ratios ($400million represents about 2% of the annual commonwealth spend on aged care).
The system that is intended to keep Tasmanians (of all ages) safe, was sick before COVID-19 struck us; the need for health staff to work multiple roles in order to survive is just one piece of evidence. Now is an opportunity for both State and Commonwealth governments to make the needed systemic changes to demonstrate that they value both the people charged with keeping us well, and those of us who need health care.
Dr Susan Banks is a health sociologist and Research Fellow in the Tasmanian Policy Exchange; Dr Lisa Denny is a demographer and a Research Fellow with the Institute for Social Change at the University of Tasmania.
Photo credit: Osbourne Images