It will take more than a dollop of cash to save shattered social care
Published by The i paper (6th September, 2021)
First the good news. There seems to be universal recognition that our shattered social care system needs urgent sorting. This is nothing new, of course, since the sector has been squeezed financially for more than two decades. A series of white papers, green papers and state reviews of funding ran into the sand while both main parties abused the issue for selfish tribal advantage. But now its failings have been brutally exposed by the pandemic. And the prime minister has backed himself into a corner by promising to fix the mess “once and for all.”
The other sliver of optimism is recognition taxes must rise to cover the costs since decent public services cost real money. Yet even the timid idea leaking from Downing Street of a small rise in national insurance sparked alarm in Tory circles. This highlights how the debate over the salvation of our crisis-riddled care sector remains frighteningly blinkered. Despite all we have seen in recent months with thousands of deaths, underpaid frontline staff and an exhausted army of family carers, this remains the second class public service.
Consider first the finances. Spending on social care is just £99m more than it was when the Tories took power in 2010. This equates to a substantial cut in spending per person since over this period the number of old people rose sharply. Yet the fastest rise in demand comes from working-age adults, often with highly-complex needs. Remember this when “experts” pontificate about social care as something that affects only the elderly; in fact, older folk are responsible for slightly more than half the expenditure, which is not much more than in the health service.
Politicians who become misty-eyed in their professed devotion to the NHS have pumped cash into hospitals and surgeries. Even if we exclude extra Covid costs, there has been an astonishing £33bn increase in health spending since 2010 – which is £10bn more than total spending on adult social care. Central government also slashed funding for local authorities. Given the importance of social care in helping people and keeping them out of hospital, let alone the mental and physical toll on unsupported family carers, this shows the hypocrisy of sanctifying the NHS while crushing its Cinderella cousin.
Yet for all the welcome talk about funding, there is no debate about the kind of care on offer – let alone about the glaring inequalities, the rapacious nature of some providers and what the pandemic exposed about our society. Why, after all, were politicians obsessed with protecting hospitals yet cavalier about care homes and domiciliary care? Why do frontline carers get minimum wages yet there is outrage if doctors on six-figure salaries fail to get a decent pay rise? Why has this sector been allowed to almostcollapse? And why do we think citizens dying of dementia should fund care but not those dying of cancer?
This is one area where I agree with Jacob Rees-Mogg: it is anomalous that social care is not funded from central taxation. Instead, we see the simplistic idea that a dollop of extra cash and a bit more integration will solve deep-rooted issues in a crumbling service – along with suggestions the key problem is middle-class people forced to sell properties to fund elderly care, when it is just one issue among many in a sector allowed to skew wildly off course.
This system is so flawed thousands of people with autism and learning disabilities end up imprisoned in secure psychiatric units due to a dearth of community support. The provision of care homes for older people has slid away from poorer areas to richer parts of the country as private firms chase self-funders who pay higher fees than those dependent on the state. This led to a fall in the total number of homes but a rise in larger residential units as big firms chased economies of scale. And it meant more fatalities when that deadly virus turned up.
So who benefits if extra cash goes into this broken system? We have seen before how boosts to NHS funding ended up in the pockets of prosperous doctors rather than frontline services. Yet there is less control over a care sector with thousands of private firms, where at peak of the pandemic last year, the average worker earned £8.50 an hour. The difficulty of boosting their earnings was shown by increases in the living wage that simply led employers to depress pay for other staff, leaving a senior carer earning only 12p an hour more than a new recruit. Such low wages, along with Brexit, help explain terrifying staff vacancy and turnover rates.
Yet despite the financial shortfalls, some fat cat firms have been milking the system while stashing hefty profits in tax havens, paying bosses millions and hiding their lucrative operations behind opaque corporate structures. Fiscal wizards borrow to build empires, extract cash and then sell on – symbolised by Four Seasons, one of the biggest providers left riddled with debt after being traded repeatedly among private equity firms. Or look at the latest accounts for Runwood Homes that show it drove up profits in the first months of the pandemic, tripled dividend payouts and handed one director £3m last year – while it recruits staff on 9p above minimum wage to look after people with dementia at night.
If we want better care, there must be reform to ensure extra cash ends up on the frontline. Sadly politicians have a dire record at controlling bursts of spending. But this splurge of cash is sticking plaster politics. Social care should revolve around the individual and be rooted in communities, not serve the needs of bureaucrats and billionaires. Behind this debate lies deep questions for a nation that ignores those in need of support or corrals them into institutions far removed from the warmth of real homes. Sadly, the secondary status of social care reflects our society’s sad lack of real concern for the elderly and disabled citizens who rely on its services.