Care workers with coronavirus face an awful choice: live in poverty or risk killing your patient

A few days ago, I spent a sunny afternoon with a woman who believed the government had left her little option but to kill.

Sitting in a park, Grace and I watched her two little boys scampering among the trees. “I was trained to promote life, to preserve life, to save life,” the graduate in public health told me. Yet now she felt, “I and my colleagues may have no other choice except to kill people.”

Grace is a care worker, one of those frontline heroes at the heart of this week’s news, from Sunday’s public clapping to Boris Johnson’s attack on her colleagues. And to hear her story is to understand that the system to which we entrust loved ones ­­is now in a lethal mess.

Grace works in home care, a sector almost ignored in this pandemic even though it employs as many people as care homes. She looks after one young woman who is bedbound and has a range of health problems. Last weekend she and a colleague did 48 hours back to back cleaning up their “client”, and using a suction machine to keep her lungs clear. “If we don’t do it often enough she could choke,” Grace says. “Without carers, she would not be alive.” For this essential work, Grace is on a zero-hours contract: “If I don’t work, I don’t earn.”

Why is a lifesaver worrying that she and her workmates could cost lives? It comes down to three words that are central to the course of our pandemic: statutory sick pay (SSP). That phrase may mean nothing if when you are laid low with the flu your employer carries on paying full wages. But if Grace ever fell ill, her income would stop and she would have to keep her family going on SSP of only £95.85 a week. “I can’t pay my rent with that,” she says. Whatever Covid-19 might do to her body, it would certainly ruin her financially. With no savings to fall back on, “I’d have to choose between heating my flat or feeding my kids. The worry would make me sick all over again.”

The UK’s sick pay scheme is the meanest in the industrialised world. When ill, one might usually splutter through a working day and keep earning, but to do so now is to risk spreading death. “I’m being forced to make a choice,” says Grace. “Either I live in poverty or I kill my client.”

The same choice faces hundreds of thousands of care workers now looking after our dads or our grandmas or our children, in residential homes and in the community. Although she would make the right choice, Grace remembers meeting another care worker at the height of the pandemic in April. “She was in such a bad state, coughing and gasping for air. Forget 2 metres’ distance, I stayed 6 metres away.” Yet the other woman had kept working until, she admitted, her client died.

Grace’s agency frowns on requests for hand gel, while the gloves it provides are often too small, or so big they slip off. As for Covid-19 tests, she says, “I haven’t even seen one.”

I spoke at length to five carer workers across England. Two had got coronavirus, gone on to poverty sick pay, and landed in debt. Another had resorted to Facebook for donations of protective equipment. One, working at a care home in chancellor Rishi Sunak’s constituency, emailed her boss pointing out that there was one mask between three workers, and barely any sanitiser. She promptly lost her shifts, and is now unemployed.

What this reflects is a massive power imbalance between the care providers and their staff. Before the pandemic, bosses could make a fat profit from the needs of frail people; their workers got zero-hours contracts and low pay. Today, we are routinely expected to applaud care workers, yet those who treat them so badly are not held to account.

The need to pay ill people so that they need not endanger others is even accepted within Whitehall. At the start of March, NHS England ordered senior managers to give “any member of staff” – including those employed by outside agencies - “full pay for any period in which they are required to self-isolate”. The government did not extend that principle to social care. For those workers it was either poverty sick pay or a five-week wait for universal credit.

Even while the health secretary, Matt Hancock, threw his “protective ring” around care homes and handed carer workers a green badge of honour, he saw no problem with his “brilliant colleagues” on the frontline depending on sick pay so risibly low that, he admitted on Question Time, he couldn’t live on it. Grace and other carer workers are more than twice as likely to die of Covid-19 as the general population, but at least they’d die cheap.

After two months of chaos and tens of thousands of deaths in care homes, Hancock finally created an infection control fund, partly to “ensure” that care workers with coronavirus “are not penalised” for self-isolating. Almost all the taxpayer cash is going where the TV cameras are ­– care homes – while home care receives a mere fraction.

The cash goes to those businesses with detailed spending plans, which smaller or independent homes often don’t have the capacity to make. I saw an email from Brighton and Hove city council last week pleading with care providers to apply because, with only a few hours until deadline, only 28 homes out of the 91 in the area had done so. It said: “We are putting the likelihood of receiving the second tranche of the fund in jeopardy.” The task of checking that taxpayer money is spent properly falls to the same local councils that are already at breaking point.

Whatever Hancock’s rhetoric, he has still not forced care providers to pay their workers in full should they fall ill with Covid-19, even though in Scotland Nicola Sturgeon has done just that.

An official survey of 9,000 English care homes published last week showed that, with most of the Hancock fund already spent, over 90% of them gave workers sick pay. Yet when I asked the Office for National Statistics for a detailed breakdown, I was told the number paying any more than statutory, or poverty, sick pay was “low”. Which means the public health dangers remain high.

Care workers have spent the past three months risking their lives to protect other people’s loved ones, yet their sector has spent decades stripping them of their employment rights, status and professional dignity. Just as in food-processing plants, distribution centres and textile factories, this all happened right in front of the rest of us ­– government ministers, journalists and the public.

Poverty sick pay and universal credit have never been good enough, but, as long as the issue affected just those workers, nothing was done. Now those precarious working conditions pose a lethal threat to the rest of us: the question is, what are we going to do about it?

• Aditya Chakrabortty is a Guardian columnist