As soon as Philip Hammond, Britain’s chancellor of the exchequer, announced an extra £2 billion for social care in his first budget in March, jostling began on how the money would be spent.
Care providers suggested that the money could be held back by local authorities and might fail to make its way to frontline services. But care services on the frontline are increasingly run by large, for-profit providers, commissioned by local authorities. For the New Economics Foundation think-tank this raised concerns that the £2 billion would go “straight into the pockets” of big companies that have benefited from the increased incursion of the private sector into public service delivery.
The money is both necessary and welcome. Although details of how the money will be allocated are yet to be finalised, the Local Government Association has urged for councils to be given flexibility in how it is used. But the extra £2 billion clearly isn’t enough – it will just about cover wage increases associated with the introduction of the living wage, and has been introduced at a time of looming post-Brexit labour shortages.
A recent Panorama investigation revealed that the tightening of spending has already led to a proliferation of zero-hour contracts in the squeezed care sector and, alarmingly, an increasing number of care contracts being handed back to local authorities because of the financial challenges.
Some have suggested the money could be used to provide a “breathing space” that enables the government to actually undertake significant reform of social care financing. But this could run the risk of focusing purely on finding a sustainable financial solution and so shore up a broken social care system in which the profits of private providers are prioritised over the delivery of personalised long-term care to those in need.
It is time to take stock and consider what we want social care to look like in the UK. A report we wrote for the Political Studies Association Commission on Care in 2016 made some specific recommendations about what a more socially inclusive, justice-centred care system would look like. This isn’t a system administered via a one-size approach aimed at maximising profits, but one that seeks to enable older people to live well into old age and to properly support those that care for them.
The Commission on Care sought to collect evidence from across the sector and in particular sought to examine how social inequalities – notably those relating to gender and race – were being exacerbated by the care crisis. Women are “naturally” seen as the group most likely to have to step in and care for family members, neighbours and friends in need of care. This matters, because it appears that the ability of successive governments to cut social care spending reflects assumptions that a person’s family – and women in particular – will always step in to fill the social care gap.
A National Care Service
Our key recommendation was that the government should seek to establish a National Care Service that is free at the point of delivery, funded through general taxation, to give social care equal status with the NHS. This builds upon proposals put forward by the Labour party during the 2010 election campaign. While life expectancy has risen, the amount of time people spend in ill-health towards the end of their lives has gone up, an issue that is invariably compounded by the significant declines in public and mental health spending.
The UK needs a preventative approach – one in which real commitments to ageing can better support people to live independently. Appropriate use of assistive technologies, such as devices that help monitor older people in difficulty, or web link-ups with medical professionals, can play a role. As can preventative initiatives, including improving diet and exercise that reduce demands on social care in the future. But new technologies will not easily replace the important role of face-to-face care for older people.
All care recipients and their carers must be listened to if a National Care Service is developed, in order to help shape the delivery of the service. Minority ethnic communities must also have a voice here, as our research revealed that they are often overlooked in the design and delivery of adult social care.
There is an urgent need to professionalise and support the care workforce. We proposed the establishment of “Care First”, an initiative aimed at raising standards and pay across the sector. This could create better and more well-defined career pathways for care workers, and encourage them to stay in the workforce.
We also argued for the roll-out of specific measures to support unpaid carers – measures that would, for example, help with the provision of information about their care, enabling them to better navigate a complex care system and also providing better workplace protections for unpaid carers. Such initiatives are costly, but they also generate potential long-term savings and wider economic benefits.
Society needs to provide for older people – not only for economic reasons but in order to secure a fair and caring society where everyone gets the support they need, irrespective of their colour, class or creed. Even with Hammond’s latest budget promises, there is a considerable way to go in attaining this goal.