Who pays?

Most people don’t realise that they have to pay for social care support. They assume that, like the NHS, social care is funded by our common taxes. Its only when they come up against the social care system, usually at times of massive anxieties about how a loved one will be cared for and kept safe, or because of the need for support to live independently with a decent quality of life, that they are shocked by the dysfunctional, fragmented nature of social care provision, and the thorny issue of costs.

Kings fund

Urgent reform is needed

The Kings Fund has identified eight areas for reform which are consistently raised by service users, carers and families, policy-makers and people working in the sector: 

These are:

  1. Means testing: it’s not like the NHS 
  2. Catastrophic costs: selling homes to pay for care 
  3. Unmet need: people going without the care and support they need 
  4. Quality of care: 15-minute care visits and neglect 
  5. Workforce pay and conditions: underpaid, overworked staff 
  6. Market fragility: care home companies going out of business 
  7. Disjointed care: delayed transfers of care and lack of integration with health 
  8. The postcode lottery: unwarranted variation in access and performance

Learn from history

The NHS was formed at a time of rebuilding after the war despite severe economic problems, and has grown to be the largest employer in the country, employing about 1.5 million people.

This last paragraph of the Beveridge report seems as relevant today as it did in 1942: 

461. Freedom from want cannot be forced on a democracy or given to a democracy. It must be won by them. Winning it needs courage and faith and a sense of national unity: courage to face facts and difficulties and overcome them; faith in our future and in the ideals of fair-play and freedom for which century after century our forefathers were prepared to die; a sense of national unity overriding the interests of any class or section. The Plan for Social Security in this Report is submitted by one who believes that in this supreme crisis the British people will not be found wanting, of courage and faith and national unity, of material and spiritual power to play their part in achieving both social security and the victory of justice among nations upon which security depends.

Too many reports

Since the Royal Commission chaired by Sir Stewart Sutherland in 1999 there have been 12 White Papers, Green Papers and other consultations about social care in England, but very little progress has been made. It is indeed a miracle that the show stays on the road at all, and that’s tribute to the many dedicated people who work in social care across all kinds of provision, who do their very best against the odds to support and care for those vulnerable people they find themselves responsible for. Research and numerous reports have featured the crisis of social care over many years, documented in recent years for example in Stories of Care: A Labour of Law by LJB Hayes, and Madeleine Bunting in Labours of Love: The Crisis of Care

Until recently, the extent of this human crisis has felt invisible to the public eye. Coronavirus has changed all this.

Action is needed

For the first time ever, social care has taken centre stage in public awareness. To be sure the concerns are focused on older people in care homes and the death toll there, and those supported in their own homes remain under the radar. However, the whole notion of shielding people who are vulnerable, of noticing those in most need or at most risk, is a powerful new phenomenon. The upsurge in community action, volunteers seeking those who need help and support, food distribution, creative measures put in place to support the homeless or those escaping from domestic abuse – all unthinkable as recently as February 2020. There is a massive opportunity to make the changes needed in the provision of social and community care. More funding is only a part of the answer. The system itself needs to change radically and fundamentally. Improving the pay and working conditions of care and support workers, restoring community infrastructure, moving away from the profit motive for care service providers, and addressing the ‘catastrophic’ costs of residential care, are imperatives which require a long-term cross party political solution.


A broader vision for adult social care

Social care is much broader in the real world than is commonly recognised. It encompasses family and community caring activities where interdependence is the significant factor. It is integral to the way in which other public and community services are delivered, including public space, housing, transport, anti-discriminatory action and measures to reduce poverty. There needs to be a wider vision of what we’re working towards – how do we as a society want to provide care and support for vulnerable people? How far do we go with dementia friendly communities, or the social model of disability, or supporting independence and choice wherever possible? How much will we listen to those who need support, and those on the front line of service delivery? Social care campaigners have long argued for more community-based services, localised support, cooperative business models, and ongoing involvement of service users and front-line staff in the development of these services. Their approach is based on valuing independence, enabling people to retain self-respect and control where possible, a rights-based approach which offers independent advocacy and real choice.

Time for change

Building a movement for change

In their 2018 report on funding for social care support, the Kings Fund found that public understanding of the means testing system and the low threshold of savings which are taken into account was very limited. When they found out how the system worked, people were opposed and even angry, and felt it should be changed. Research tells us that most people believe that social care is funded like the NHS, until they experience it directly. This creates a significant political problem. Trust is so low in politicians, the Kings Fund concluded, that a movement for social care is needed independently of political parties, with the aims of informing the wider public about social care funding. The current coronavirus crisis has brutally exposed the problems for some parts of the adult social care system, and there will be more hidden scandals emerging over the coming months. While social care is squarely in the public eye, the opportunity for such a movement is here and now.

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