Social care: the case for making it a priority

Many trade unions not engaged in organising staff in the NHS frequently debate the need to defend the health service, yet very few of those unions discuss the need for better social services. Do we all think that we will never need to make use of these services ourselves?

Chancellor Philip Hammond promised £410 million for adult and children's social care in 2019/20. This was promptly condemned by the President of the Association of Directors of Children’s Services (ADCS) as nowhere near enough. He went on to say that children’s directors felt their services alone needed an extra £840 million a year until 2020 just to “stabilise the ship”, and expressed deep concern at the government’s piecemeal approach to funding children’s services.

A recent report from the association said that 2.4 million people contacted children’s services in 2017 about concerns involving a child, up 78 per cent on ten years ago. The number of children on child protection plans has risen by 87 per cent over the same period, while funding has been slashed.

Means tested

Social services are severely underfunded and difficult to access. Quality is very variable. Unlike the NHS, which is “free at point of delivery”, social care is means tested. And the two services are in general very poorly integrated.

The difference is exemplified by the fact that almost all costs are covered by the NHS for older adults suffering from cancer, while almost none are covered if they suffer from dementia.

Adults and the elderly people of Britain who rely on social care provision are finding that the safety net on which they rely is not catching them, and is in danger of total disintegration.

In England, publicly funded adult social care is primarily funded through local government, constituting the biggest area of discretionary spend for councils. Those local authorities rely on central government funding, but government is pursuing a relentless agenda of public sector cutbacks, starving those local authorities of funding. This has severely impacted on social care. 

The Local Government Association (LGA) which represents local authorities says that services are at “breaking point” and goes on to say that “the current situation is unsustainable and is failing people on a daily basis". Age UK has identified 1.4 million older people with unmet social needs.

According to the BBC, spending on care for the over-65s has fallen by around 25 per cent in England since 2010, once inflation is taken into account. English councils have made, or look set to make, social care cuts of £700 million in the current financial year, equivalent to nearly 5 per cent of the total £14.5 billion budget.

The LGA estimates that adult social care services face a £1.5 billion funding gap by 2019-20, rising to £3.5 billion in 2024-25. The cuts in funding are exacerbated by a growing and ageing population, increasingly complex care needs, and increases in care costs. 

Average life expectancy in Britain is now 79.4 years for men and 83.1 years for women, and 18 per cent of the population is 65 and older. Yet after many decades of improving life expectancy, that improvement has now stalled. This may well be related to the reduction in the quality of social care.

Councils are spending an increasing proportion of their total budget on adult social care. This financial year, it is 38 per cent as against 34 per cent in 2010. Directors of social services freely admit that they will have to continue to reduce the number of people in receipt of care packages. 

Already, half of local authorities overspent on adult social care budgets last year, with 50 per cent of these drawing on reserves to meet the shortfall. The National Audit Office has warned that on current trends about 10 per cent of councils will exhaust their reserves in three years.

In Tory-controlled Northamptonshire, the county council did indeed go bankrupt earlier this year, and government-appointed commissioners were sent in to take over. Ofsted had already warned that children’s services there were putting children at potential risk. Northamptonshire social workers were overwhelmed and “drowning” in casework, with hundreds of children unallocated to a social worker.

‘Sticking plaster’

David Jones, a member of the British Association of Social Workers and chair of Health Watch Northamptonshire, condemned the “sticking plaster responses” from the government and described its inadequate response to “a major and growing social crisis the likes of which I haven’t seen in my lifetime”. He went on, “We are stacking up problems for the future".

The Parliamentary Committee for Housing, Communities and Local Government has produced a recent joint report with the Health and Social Care Committee. It concludes that “in its present state, the system is not fit to respond to current needs, let alone predicted future needs as a result of demographic trends”.

‘Pressure has become extreme, with companies going bust or just pulling out…’

The government has been embarrassed into increasing its financial support to local authorities, specifically ring-fencing it for adult social care. But it is mere window dressing. The support goes nowhere near to meeting needs. Ministers were supposed to be addressing the issue more fully this year, but that has been kicked into the long grass.

Adult care packages are being cut to the bone. Too often, the families, friends and neighbours of service users are being expected by social services to act as unpaid voluntary care assistants, frequently forcing working women in particular to give up their paid employment to do so.

Many local authorities have tried to protect social services by severely reducing other areas of expenditure. Even so many now say they are being forced to reduce or end social care expenditure that is not required by law. Faced with having to find savings of £45 million by 2021-22, East Sussex council now plans to offer only the legal minimum. Some local authorities are arguably not even fulfilling those statutory duties and legal minimums.

The effective privatisation and fragmentation of social care provision means that local authorities now procure these services from a huge number of private care providers, with the system designed to ensure that they can be put under pressure to continually reduce their prices. 

That pressure has become extreme, with companies going bust or just pulling out because they can’t make sufficient profits. Almost a third of councils have reported that some residential and nursing home care providers have closed down or handed back contracts.

The effects of the squeeze on funding are illustrated by a recent report by the Care Quality Commission (CQC), the care watchdog: out of 642 inspections of care homes, 247 (38 per cent) were deemed inadequate or requiring improvement.

Shocking data obtained by the Guardian from the government’s Office of National Statistics shows that 1,463 patients in NHS, local authority and privately run care homes have died suffering from malnutrition, dehydration or bedsores over the past five years. An estimated 1.3 million older people suffer from malnutrition.

Inevitably, these pressures mean that in order to maintain any sort of profitability, the private care providers must reduce costs – and that means that the wages of care staff are squeezed (see We need to talk about pay). 

And despite its cheapness, a recent report on the state of social care by the Commons Public Accounts Committee considered the long-term outcomes and found little evidence that the current lightly regulated private care “market” has in any way delivered social care in a cost effective way.

Costly

The PAC found that care is being prioritised to people needing the most support. Those with moderate needs such as an older person who is at risk of becoming malnourished, or at risk of falls, wait much longer for care packages to be put in place. This often becomes more costly in the long run if patients are hospitalised and need a hip operation from a bad fall, or develop more serious infections or disease because they’re not looking after their health.   

Reacting to the PAC report, Unison Assistant General Secretary Christina McAnea said that “low-paid staff are propping up a care system that has no funding, no strategy and no long-term solutions. The crisis in adult social care is not a warning for the future, it’s happening across the country right now.” She went on, “…ministers are ignoring the care disaster that’s right under their noses.”

At this year’s Unison Annual Conference, Tracy Holmes described to delegates the bad homecare practice she had witnessed, from visits scheduled to last just five minutes to workers being denied ID cards by their employers and having to persuade vulnerable people to let them in to their homes. The conference discussed how interdependent the NHS and social services are, and how problems in one affect the other.

In fact, the Institute for Public Policy Research has warned that the social care sector’s low pay and unattractive work conditions could lead to a shortage of 400,000 workers by 2028. It makes the point that radically improving pay and conditions would attract sufficient British workers as an alternative to the current reliance on low-wage migrant workers.

But that won’t happen unless those in the sector organise for pay themselves. Brexit will provide the opportunity, but workers must grasp it.

Growing burdens

Unison delegates were clearly aware of the growing burden that cuts in social services are placing on the National Health Service, itself under extreme financial pressure, to plug the gap in social care provision. More and more frequently, elderly and vulnerable patients cannot be discharged from hospitals because care packages are not in place or cannot be provided. 

The British Medical Association says that the underfunding of social care is feeding the NHS’s annual winter crisis – that seems to get worse every year.

“Underfunding of social care is feeding the NHS’s annual winter crisis…”

Social care depends on the goodwill and dedication of staff. Many social workers work on average around ten hours for no extra pay every week, and care assistants on low wages continue to take it as read that they will not be paid for anywhere near all of their time spent working.

It is not unusual for social workers and other care workers to pay for essentials that their service users lack. And most have seen the buying power of their salaries eroded as pay rates have failed to keep pace with inflation. 

Standards of health and safety that so many workers take for granted simply do not exist for much of social care. There’s an epidemic of stress and ill health, sickness absence rates continue to climb, and many leave the profession when they burn out or cannot take any more. The loss of those skilled and experienced staff further reduces the effectiveness of social care services.

Trade union organisation in the sector is patchy, with too many not members of a union. That needs to change if the issues faced by workers delivering social care are to be effectively tackled.

The TUC and trade unions in other sectors need to raise awareness of the importance of a well funded and comprehensive social care sector which is interdependent upon and complements the NHS.

We should not only value social care, but given the wealth that exists in our country, the fifth largest economy in the world, we must demand that wealth is used to ensure that the aged are able to enjoy a fulfilling and dignified life, and that children, those with severe disabilities, and all those that need care are properly looked after. That is the hallmark of a civilised society.

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