The social care crisis won’t be solved by sticking plaster politics
Published by CapX (13th December 2016)
In these divided days, the existence of a crisis in social care is one of the few areas of consensus. Labour has accused the Government of failing the sick and old. And on Thursday, Sajid Javid is set to announce plans to permit higher council tax rises in order to help cope with ever rising costs.
In truth, however, this is just sticking-plaster politics for a gaping wound. Politicians from all parties are aware of the severity of the social care crisis, but persistently put off fundamental reforms. The result is a system coming apart at the seams. The Times reported this week that at least 250 care homes have closed in the last nine months alone.
Many more elderly people are stuck in hospital wards, worsening pressures on the National Health Service. And with weary inevitability, complaints are soaring over both home and residential care services.
On the most basic level, this is a problem of success: our species is living longer and defeating diseases that once would have killed us. On the day I was born, the number of centenarians was in three figures. By the time I am 75, in just two decades’ time, there are predicted to be more than 100,000. This means we need to reshape many things in society from public services through to pensions and workplaces.
But it also presents a problem of priorities. For years, experts have been warning about impact of big cuts in social care budgets made at a time when there are rising numbers of older and disabled people. But as a country, we seemed to have little sympathy for the people most affected – and few seem to show much interest until confronted by the issues within their own family.
One aspect of the medical advances is not only that people are living longer, but more people are living with complex disabilities. Between 2010 and 2015, local authority spending on social care for old people fell nine per cent in real terms, leading to a 26 per cent drop in the number of elderly people given help.
One million people who need aid with daily life now fail to get assistance. Spending per head on people aged over 85, the most likely to need care support, has fallen back to where it was in 2002 – since when their numbers have increased by more than one third.
Some blame must fall on David Cameron’s Coalition government, which overloaded local authorities with higher spending cuts for reasons of political expediency. This distanced Whitehall from any emerging problems, leaving councils to shoulder the blame.
Yes, gross inefficiencies remain in local services – as a Government spokesmen pointed out yesterday, the worst councils take 20 times longer to move patients from hospitals into care than the best. But this is only a minor part of the problem. Local authorities as a whole lost 27 per cent of spending power over this period, more than twice the cuts imposed on Whitehall (while spending on international aid soared, doubling to £16 billion over this decade).
Given that health and social care are so entwined, this makes the platitudes about protecting the sacred, stuttering NHS even more bizarre. Some 55 per cent of council spending now goes on social care for adults and children. With funding falling and demand for services rising, there can only be one outcome. This is why old people are abandoned without essential daily help, why parents of disabled children are having crucial respite care removed, and why care homes are closing.
This is not a problem for everyone. Care homes catering to wealthy pensioners are doing fine. Individuals paying their own way spend almost £1000 a month more than those funded by councils. Some homes are refusing even to take state-funded clients, saying their fees cannot cover the costs – and problems will only intensify as the minimum wage is rightly ramped up.
Even in the state sector, the problems are not universal. According to the Joseph Rowntree Foundation, social care spending actually rose in wealthier regions under the Coalition, while plummeting in poorer areas. Increasing funding through council tax will actually make this imbalance worse since richer areas can raise more with lower rises. So this is a regressive move.
In addition to demographic pressures, political inertia and public spending restrictions, two more issues pile on pressure in what is fast becoming a perfect storm.
The first is regulation. In recent years, several exposes have reflected the shameful lack of compassion towards old and disabled people that exists in Britain. We have seen sickening scandals revealing abuse, bullying and inadequate care in places supposed to be sanctuaries. These have mostly been revealed by the media rather than the bumbling and over-loaded official watchdog.
Yet the Care Quality Commission is toughening its inspection approach in response. A more rigorous regime is good news – but it also leads to extra costs. The official response often fails to address root problem: a lack of decency and humanity among inadequate people towards others that are vulnerable and entrusted to them. Instead, like any government body, it prefers a bureaucratic response with training programmes and layers of red tape that simply waste time.
One owner of a superb care home in the Midlands showed me the list of 109 protocols they must have in place. Some are important, most are intensely frustrating. There are so many they must now draw up policies on bribery, e-smoking, opening post, turning on televisions, handling food gifts and residents making snacks.
The second issue is immigration. I know from my own experiences as the parent of a child with profound disabilities how vital the influx of migrants has been in this sector. My family could not have survived without these staff, many coming from eastern Europe and providing fantastic care. They are among an estimated 84,000 care workers from European Economic Area countries, whose future status remains highly uncertain in the current climate.
The falling pound, hardening attitudes and the Brexit vote are already making it more difficult to recruit. The issue is not always about pay: even well-paid posts are often tough jobs with anti-social hours that many Britons simply won’t do. If the wrong people carry them out, there is risk of abuse and poor care.
Charities warn that failure to resolve this crucial issue post-Brexit will intensify the social care crisis – but as Westminster focuses on the nation’s existential crisis, the chances of it dominating the agenda look slim. Politicians only have so much capital to expend – and Theresa May’s time in power will be defined by resolving the country’s place in the world. Sadly, this means the social care crisis, like the state of the NHS more broadly, is unlikely to be sorted under her watch.
There may be minor tweaks – not just allowing councils to put up taxes, but perhaps chucking a bit more cash in the pooled fund for health and social care services – but none of the necessary fundamental reforms.
Social care, in short, will get sucked in by the Brexit backwash – just as it has previously been shunted aside by the short-termism of Westminster. Meanwhile, we let old people end their days in lonely isolation, leave families struggling to cope without state help and see people with disabilities failing to get essential help needed to engage with society.
It is not just those in need who will lose out in such a society – it is all of us.