Dan Smart, Social worker and UNISON South Gloucestershire, branch secretary (personal capacity)
Social care provision is in the midst of a perfect storm and faces massive challenges ahead. At the end of last year, 2.4 million people in the UK over the age of 50 were in need of care services but were getting none. This is an indictment of a system that was fought for, as part of the welfare state, to ensure that those who most need support in society receive it.
During the Covid pandemic, people stood on their doorsteps to clap social care workers who had up until then felt ignored. On the back of this wave of support, many promises were made to resolve the crisis and to not go back to the way things were. Today however, little to nothing has changed and problems are getting worse.
As people are living longer and are therefore likely to experience more age-related health issues, demand for social care is rising. Dementia is now the leading cause of death in the UK. While demand is rising, austerity has meant that funding has been slashed. The Health Foundation reported that to tackle the levels of unmet need and meet future pressures, “adult social care in England would require additional funding of £7.6 billion in 2022-23 rising to £9.0 billion in 2024-25”. In fact, funding has fallen far short of this, with an increase of just £2.9 billion being made in 2022.
Privatisation
Adult social care is the responsibility of local councils to deliver, and a major proportion of their budgets go into organising and funding care. It is absolutely urgent that councils are funded adequately, to be able to provide the care needed. However, huge sums of money are being paid out to private, for-profit care providers. Investment firms now own one in eight care home beds in England, according to the Care Quality Commission (CQC). The social care model has moved dramatically towards reliance on the private sector, with local authorities now running a mere 7% of care services in-house.
The fundamental goal of these organisations is to extract profit from the provision of care, which inevitably involves extensive cost-cutting and exploitation of the workforce. Carers face some of the worst conditions in society, with the vast majority on minimum wage or, in reality, less. A large proportion are on zero-hours contracts and are not paid for time between visits. The times for care calls are often the bare minimum to provide for people’s most basic needs. Carers work in the sector because they have compassion and want to help, but this is being taken advantage of. The race to the bottom in care ties in conveniently with the Tories’ ideology, with top-down pressure on council budgets, enforcing privatisation and ruthless cost-cutting.
The crisis in care is nevertheless acknowledged across the political spectrum as a problem. In 2019, Boris Johnson said he would “fix the crisis in social care once and for all”. Following that announcement, various policies were put forward to reduce the amount people would have to pay for care costs, provide greater integration with the NHS, and increase the amount local authorities pay to care providers. However, without addressing the underlying crises of privatisation and underfunding, these promises have proven impossible to implement.
Many people are currently forced to pay eye-watering costs for care, frequently having to sell their houses. The government’s proposal to reduce the number of people paying privately however, would require a major increase in social worker capacity to complete Care Act 2014 assessments and implement care packages. With the majority of social workers, according to a survey by the Social Workers Union, saying their mental health has got worse due to workload and stress, and one in ten saying it has ‘collapsed’, this is obviously unfeasible. The only major change that has resulted from Johnson’s reforms has been CQC inspections which have put more scrutiny and pressure on staff trying their best to cope with insufficient resources.
Councils can fight back
Adult social care is in a vicious cycle, where needs escalate into more severe problems. But councillors do have a route to fight back.
They must fight for the funding needed to meet rising demand, and pay and treat staff fairly, which would improve the quality of care. By setting budgets based on objective, social need, then using reserves and borrowing powers to implement this, huge support could be harnessed to build a campaign for the funding required from central government. They must also make the argument for care to be brought back in-house, which is more efficient, removing the profit siphoned off, and provides better standards.
These are the urgent priorities to start to address the crisis in social care, but the problem has much deeper roots. Under the guise of buzzwords and social care theories such as ‘care in the community’, ‘personalisation’, and ‘strengths-based approaches’, emphasis has been shifted onto individuals, rather than wider society, to take responsibility for care.
On the surface, this is about greater community involvement (as opposed to the big, impersonal institutions of the pre-1980s) and supporting each other as part of the ‘big society’. In reality, a dangerous precedent is being set of reliance on families and volunteers for meeting care needs, undermining the post-war gains of the welfare state. People with support needs are falling through the cracks of uneven and inadequate services which tend to be better in more middle-class areas. These policies cynically manipulate people’s instincts to care for one another, while placing huge strains on families and communities (disproportionately women), to fill the gaps created by lack of funding and privatisation.
In a socialist system, based on the nationalisation of the key industries, the vast wealth that exists in society could be harnessed to fund quality services, reduce the working week and fund decent living conditions. In such circumstances, workers may choose to spend more time caring for friends, relatives and those in the community. This would reduce the epidemic of loneliness faced by those with disabilities, mental health issues, and older people in particular.
As part of such a programme, there would need to be an extensive democratisation of care, with committees of social care workers, service users, families and communities. This would enable a sharing of professional expertise and personal experience, key to effective care.
People living longer should be cause for celebration, however under the profit-driven capitalist system it becomes an unending crisis. It is more than possible to deal with the issue of demographic changes, ensuring people thrive and have dignity throughout their whole lives, but only on the basis of a fairer, socialist society.
Dan is standing for TUSC in Hillfields Ward in Bristol’s council elections
