We are at a critical time for social care. This pandemic has shone a harsh light on a system which now seems to let down pretty much everyone in contact with it – workers, users, planners. There are many heartening stories of workers going out of their way to help residents of care homes or people in their own homes. But sadly, there are more stories of care curtailed by austerity and by privatisation. The Tories’ empty promises to “fix social care” ring hollow. This is what they have been overseeing.
60% cuts to Local Authorities have devastated social care, despite councils doing their best to maintain services. This has resulted in other services suffering even worse cuts. The workforce, in some places, has been cut by 50%. Governments prevented local authorities using public capital to build or upgrade their care homes, leading to the mass sell-off of state-owned care facilities from the 1990s through to the late 2000s. It is currently the case that 83% of care home beds are owned by for-profit companies.
Over 90% of social care provision is privatised across both personal and residential care. Large care home chains extract cash and are then bought and sold using debt leveraged buyouts. There is an astonishingly high 12% rate of return on capital. Privatisation leads to perverse outcomes. Occupancy in residential care is kept high to maintain profitability. Larger homes are more profitable and tend to have worse care. In the community, zero-hour contracts and 15-minute appointments are still common which impact on workers and users. Personal budgets liberate some disabled people but can also be a crushing burden on others.
There are 1.3 million workers in social care now, with 2 million needed by 2035 – a larger workforce than the NHS. 82% are women and about 10% are from the EU. The fallout from Brexit is likely to hit the sector hard. There is an 8% vacancy rate and a turnover of 31%. Training is very limited and there is virtually no career path. The conditions of work are poor with little protection, and yet workers repeatedly sacrifice themselves for their clients.
1.4 million older people do not receive care services to which they should be entitled, as eligibility criteria are tightened. Nursing care beds have been reduced with 26% fewer older people receiving support since 2010. There are inequalities in funding and delivery of services and a lot of evidence that current services do not meet users’ nor carers’ needs.
There are also countless examples of inadequate care due to short appointments with private companies seeking to maximise resource at the expense of personal wellbeing. I have spoken to a disabled person who was left naked in their bath because a professional carer had to rush off to their next 15-minute appointment. The system is usually top-down with very little user involvement.
The UN recently declared that the UK government has committed “grave” and “systematic” violations of disabled people’s human rights under its welfare reforms. And yet social care actually generates wealth, it generates a £38.5 billion contribution to the economy in England, through wages and taxes being spent locally and not in tax havens. The calculation for London alone is £5.2 billion.
The Socialist Health Association in partnership with Keep Our NHS Public are launching a joint campaign to transform social care and are calling for the introduction of a National Care Support and Independent Living Service. The government would have responsibility for, and duty to provide, a service providing care, independent and supported living whilst adopting into English law articles from the UN Convention on rights of disabled people that establish choice and control, dignity and respect, at the heart of person-centred planning.
This Saturday will see an online launch of this vision with speakers which will include Labour MP John McDonnell, as well as representatives from unions, local government and pensioners groups. There is a surprising consensus on what is needed. Much of it is summarised in our demands for a new settlement, built with disabled people and carers. Social care should be fully funded through government investment and progressive taxation, free at the point of need and fully available to everyone living in this country.
Social care should be publicly provided and publicly accountable. A long-term strategy would place an emphasis on de-institutionalisation and community-based independent and supported living. There should be no place for profiteering, and the market in social care would be brought to an end.
Such a service should be mandated nationally, but delivered locally. The government would be responsible for developing within the principles of co-production, a nationally mandated set of services that will be democratically run, designed, and delivered locally in partnership with local authorities and the NHS. They must identify and address the needs of informal carers, family and friends providing personal support and the new employee strategy must be fit for purpose.
Support should also be given to the formation of a taskforce on independent and supported living with a meaningful influence, led by those who require independent living support, from all demographic backgrounds and regions. This would also make recommendations to address wider changes in public policy.
We need to think of social care as an investment for the future. If we manage it well, it can prevent problems, increase wellbeing and support independence for all who want it.