Outsourcing is Killing Social Care

The care crisis is worsening, with workers overworked and underpaid and users charged a fortune. It's time to bring services back in-house, and run them to serve people – not to make a profit.

The only real solution to the care crisis is a publicly owned service. Credit: Getty Images

It can’t be doubted that the care sector is in crisis. The pandemic has acted like an X-ray in revealing the deep inequalities of an environment where those in need aren’t given the quality care they need, while care workers themselves are subjected to terrible pay and conditions by private care home providers interested in nothing but aggressive tax evasion and profit extraction.

Over the years, successive governments had vowed to remedy this crisis, but the current social care funding gap is expected to rise to between £6.1 and £14.4 billion by 2030-31. Cuts in funding mean that the number of older people receiving publicly funded care fell by 400,000 between 2009-10 and 2015-16. One in 10 people aged 65 face future care costs of over £100,000. Add to this the countless care providers at risk, and it’s clear what is needed—a publicly owned, universal care system, fully funded and free from corporate interference.

Where national government has failed, others have stepped in. That alternative is now being considered by local authorities who have begun stepping in to fill the vacuum, delivering radical change within the sector, organising care workers, and bringing services back in-house. One of those places where this is happening, offering hope to so many, is in the North West of England, where Unison have been instrumental in organising the sector.

Organising Care Workers

Dan Smith, Unison’s lead for social care in the North West, says the union has always had a proactive approach to organising the care sector. ‘It’s the most underpaid, most insecure, most exploited, and a predominantly female work force as well, so we’ve got a long-term commitment to putting resources into organising the sector.’ He tells Tribune it’s very difficult, though, due to it being such a ‘fragmented, isolated, hostile sector’, meaning that ‘you need to have a lot of resources or be very strategic in how you deploy those resources.’

Alongside highlighting campaigns of political lobbying and getting councils to sign up to Unison’s Ethical Care Charter, which establishes a minimum baseline for the safety, quality, and dignity of care and the sector’s employment conditions, the union ran a survey. Completed by 3,000 care workers, it found that eight out of 10 wouldn’t receive normal wages if they were absent due to coronavirus, receiving statutory sick pay at best, but more likely on zero pay. This meant many faced having to work while infected—risking spreading the virus to some of the most vulnerable—or staying at home with no income.

Yet leveraging councils around certain campaigns can only go so far—and Dan is under no illusion that the only real solution to the crisis is publicly owned services. ‘Whatever we do in the current social care sector and market is just tinkering around the edges if you retain that private ownership,’ he explains. ‘The only way you can deal with the problem is to move services back in-house, so they are publicly delivered with proper terms and conditions, proper contracts, guaranteed hours and sick pay—and you’re doing it for people rather than profit.’

Proactive Insourcing

Dan says insourcing must be not only reactive—and in places like Liverpool and Salford, Unison has been working proactively with councils to help bring this about. ‘We need to build a case of proactive insourcing, to not do it reactively to a provider collapse, but do it because it’s right for the workforce, for residents and for local government.

‘Cheshire West and Chester have committed to bringing back in-house Vivo, which is an arm’s length subsidiary of the council from next year,’ he continues. ‘600 workers are going to come back into the council on council pay and council terms and conditions. That is a proactive step because they don’t believe they can have the ability to respond to a market while things are outsourced: they need that scrutiny, they need that ability to react to changing circumstances, and they want to pay a living wage.’ A number of local authorities, including Halton and Trafford, have also stepped in to take over care homes, while Plymouth Council recently announced it is creating its own in-house care company.

What lessons does Dan think can be learned from what’s happening in the North West? He reminds Tribune of the difficulties organising the sector: ‘It’s so fragmented, people are on zero-hour contracts, it’s very difficult to get access to workers. Then you’ve got hostile employers.’ But he’s keen to emphasise that it’s about putting boots on the ground and pouring resources into campaigning. ‘We identify particular councils we need to move that will act as a vanguard for the rest of the local authorities, or where we think we can make inroads, and then we mobilise workers around specific actions, aimed at the councils, aimed at surgeries with councillors.’

Where government has failed, local authorities can step in to offer radical change. ‘We can’t hang around for the government to have a progressive social care policy,’ he says, ‘because it’s not going to happen. And we can’t rely on Labour being re-elected at the next election, because it’s not going to happen.’

The Salford Offer

One of those councils that isn’t hanging around for a change in Westminster to deliver quality social care is Salford City Council under City Mayor Paul Dennett. The council has had its budgets dramatically slashed as a result of austerity, losing £220 million since 2010-11. For Dennett, the city has been at the forefront of the fight to secure better pay and conditions for care workers. ‘We talk about work being the best antidote to poverty and inequality,’ he says, ‘and what we mean by that is decent paid work, sustainable work and work with good terms and conditions of employment.’

Dennett believes that talk of a care crisis is disingenuous, since the Tories have manufactured the problem. ‘If that money was there today, we would not have a crisis in social care,’ he says, reminding Tribune that ‘compulsory competitive tendering was introduced under Norman Lamont in 1982, and what’s happened since then is that councils up and down the country, even under New Labour, have been hollowed out. We’ve fully embraced this whole nonsense of new public management and of outsourcing services to deliver public services, and arguably we’ve paid a price for all of that.’

One of the first actions Dennett undertook as Mayor was establishing an insourcing commission to examine ways of returning a number of services to the council. The commission, which is comprised of union representatives, academics, politicians and senior council officers, has already made some progress, such as Urban Vision, the public-private partnership that helped planning enforcement and highways issues, being brought back in.

But Dennett is crystal clear that the council’s number one priority on health and social care is insourcing, and giving workers green book terms and conditions. ‘The reason is obvious: years of outsourcing, precarious employment, people operating on zero-hour contracts has plagued that sector for some time. These people have been on the frontline during Covid-19,’ he says, ‘so I think there is a moral and ethical imperative here that we try and do this as quick as we possibly can.’

This would mean starting with domiciliary care, Dennett believes. ‘There are possibilities around domiciliary care, where we’ve got care workers going to people’s homes to provide care, we think that’s easier to consider insourcing than residential care where you’re in a contract with a provider where they own the building.’

Dennett’s administration has made pay increases to care workers, getting them closer to the Real Living Wage. In December 2020, Salford initiated what has been called ‘the Salford Offer’, where the council and Salford NHS Clinical Commissioning Group (CCG) offered to raise the pay of care workers, but also to ensure care workers were on full pay if they could not go into work if they had Covid symptoms.

Not all care homes took up the offer, highlighting once more the rooted difficulties in improving conditions in a privatised sector. Among the excuses for not taking up the offer was how raising pay would upend internal pay scales and how—according to providers—it would mean pay disparity for care workers in other parts of the country that were employed by the private providers.

On this, Dennett is scathing of those who have opened up social care to global capital, making serious money for many who aren’t even living in this country at the expense of a diminution in care quality for those who do.

But that won’t deter him. What advice does he have for other councils? ‘Have positive relations with trade unions and work closely with them. Look at procurement activities in terms of recognising unions when the council is contracting services, and jointly work with them when things aren’t right.’

When one considers the general political character of councils of all stripes in this country, having that sort of political relationship may be easier said than done. But other councils certainly should be paying attention; what’s happening in the North West has the potential to provide a blueprint in how we positively deliver social care—a model that centres people before profit, and ensures a secure future for both care workers and the recipients of it.