Commonwealth organisation for social work the social crisis in the COVID-19 pandemic
The Covid-19 pandemic is both a medical AND social crisis, with long-term human rights and economic consequences. The medical crisis is well understood and there is tremendous public recognition of the staff working in medical settings, acknowledging the risks they are taking and their public service. The impact of the pandemic on social order and relationships is less well documented but potentially more long-lasting and corrosive to social development.
The contribution of those providing social services (in private, non-governmental and public sectors), and the risks they face, has been universally under-acknowledged although this is slowly correcting. This reflects the difference in public understanding and respect between the health and social sectors.
Countries have varied significantly in the extent to which they have recognised key workers other than medical, including those working in social services, other public services and essential support groups such as shops, agriculture and delivery services. The UK media has become more focused on social care issues this week following realisation of the significant mortality in residential homes and awareness of the significant increase in domestic violence and criminal exploitation associated with the pandemic.
This paper briefly summarises why the Covid-19 pandemic must be seen as a social and human rights emergency as well as a medical emergency. The focus is on the specific role of social services and social work.
The structure of national health and social care systems varies between countries. The distinction between what is termed ‘health’ and ‘social’ services varies widely and is in many senses arbitrary. So, for example, the task of basic nursing in hospital can be more or less the same as providing social care in a residential home or a private residence, and in a pandemic both staff groups face the same threats of infection.
The severely reduced flow of donations and income to the NGO voluntary sector threatens many essential social services for the long-term.
The task of social services, including social work, is to work alongside health and other services (in public, private and charitable/non-governmental sectors) to ensure effective co-ordination and joint working in partnerships, taking account of the lived experience of individuals, families and communities with a primary focus on facilitating the release of their innate strengths and capacity to respond to shocks and crises. This is well documented in the disaster planning and response literature.
There are some specific interfaces between health and social care which are evident in the management of a pandemic – and problematic. These can be briefly summarised as:
- Social care is frequently being provided for people who are at highest risk in a pandemic due to age, vulnerability or underlying health conditions – older people, people with disabilities, people with long-term physical and/or mental health conditions and children and young people, some pregnant women – whether in a residential or community setting. There is therefore a serious risk of illness and death in these groups as well as high risk of infection of social care staff, as evidenced in practice;
- Social care can reduce pressure on health services by providing continuous care outside hospital, but the interface between health and social care facilities is a potential source of conflict and dispute. Some health services have implied that people in high risk groups in residential settings will not receive the full medical services once the system is under sustained pressure, leaving them to be ‘nursed’ towards death in residential settings which are not resourced to provide such nursing. There are also cases where residential homes have refused to accept a former resident back to ‘their’ home after a period in hospital because of risk of spreading infection, presenting an alternative placement challenge;
- People working in social care in the community are a ‘highest risk’ group. It is observed in all countries that this group is at high risk of contracting infection from close contact with people who have the infection. They are also at very high risk of spreading the infection by coming in and out of and frequently moving between residential and private homes. The recognition of their need for Personal Protective Equipment is coming far too slowly;
- Social workers are invariably expected to continue providing safeguarding services during a pandemic, including responding to allegations of child abuse or domestic violence within private homes. This requires home visits which expose them to risk of infection and also means they can be infectors. Significant changes in practice are also required making investigations more difficult;
- Global evidence of an increase in abuse and violence and in mental health problems within families requires a social response;
- Significant groups in the community face long-term social isolation. It is recognised that this can cause or worsen mental health problems which can be mitigated by social intervention if trained staff are available;
- Treatment programmes, frequently delivered by social workers alongside nurses and health workers for people with substance addictions, HIV-AIDS and similar conditions are inevitably disrupted during lockdowns, curfews and periods of social control, resulting in worsening health, deaths and infections;
- Pandemics always result in fear and social stigma, especially in crowded communities, sometimes resulting in physical attacks on individuals and/or the homes of people believed to have the virus or to be spreading it. This can be exacerbated when people seen to be affected come from a different race, class or ethnic group and can easily escalate. Active social management of communities including provision of reliable information, is essential to protect those who are vulnerable.
Other social factors which fuel the crisis include:
- Social media is useful, because of the speed of its reach with information, but is also spreading disinformation and exacerbating fear. Action to counter the spread of misleading community information is essential, best delivered through trusted community leaders and public servants.
- Food and water security is an issue in all countries but especially significant in the global south where social isolation in informal settlements is virtually impossible. Cases have been reported of police beating women who go to collect water from a communal standpipe despite there being no other source. Delivery of food aid to informal settlements presents huge challenges in relation to social order as people are desperate for supplies and some will fight to secure it, potentially over-powering delivery and security forces. These issues are exacerbated in refuge and migrant camps.
- Many people in the informal settlements have no savings or alternative means of survival and in urban areas little potential for living off the land. This includes young people, young carers, people with disabilities and older people. They survive on a ‘meal-to-meal’ basis, earning very modest incomes from rubbish recycling or ‘hustling’ (selling small items or doing small tasks for payment) sufficient to provide the next meal with a little saved for rent. A lockdown or permanent curfew is therefore life-threatening;
- Hand-washing is impossible in situations without flowing water. Hand sanitizer gels have become prohibitively expensive;
- Major economic dislocation creates catastrophic unemployment and loss of small businesses, changing power relationships within and between communities, frequently facilitating the growth in crime and extortion.
The social and economic crisis resulting from the medical emergency of the pandemic will affect the world for many years. In the meantime, it is essential that the importance of the social services and the risks being run by staff in that sector are fully recognised.
David N Jones
Board member, Commonwealth Organisation for Social Work
15 April 2020
IFSW statement on the key functions of social work during the global pandemic:
- ensuring that the most vulnerable are included in planning and response.
- organizing communities to ensure that essentials such as food and clean water are available.
- advocating within social services and in policy environments that services adapt, remain open and pro-active in supporting communities and vulnerable populations.
- Facilitating physical distancing and social solidarity.
- As a profession, advocating for the advancement and strengthening of health and social services as an essential protection against the virus, inequality and the consequent social and economic challenges
Read more about the Commonwealth Organisation for Social Work and the COVID-19 pandemic (link)