Commentators such as Simon Duffy have written about the drastic impact of cuts in social care funding. Hundreds of thousands of older people are being denied the right to a level of independent living they could achieve. But this is not only about the elderly. Cared-for children fare badly in later life; support for children with special educational needs is vanishing; the treatment of people with disabilities of all ages is a scandal; many of those entitled to benefit support are treated abominably; and who cares for the carers? We should be ashamed of what is happening in one of the richest countries in the world.
Whilst marches, demonstrations and twitter storms defend against even the most minor alleged interference with our cherished NHS we have sat back over decades as social support withers almost to the point of extinction. This has to change.
The first change is to stop the NHS leadership from constantly portraying social care as some sort of prop for the NHS. Why are most of the local attempts being made to improve and join up local care service being led by NHS Chiefs usually from the hospital sector? How does it make sense to protect NHS funding but not social care or benefits?
There must be worries about what will be in the much vaunted and hugely costly NHS Plan? It looks to be going the same way as the local versions – the Sustainability and Transformation Plans (which have changed titles about ten times since). These were plans in name only; unrealistic wish lists drawn up without any engagement with patients, public or staff – mostly developed in secret. Plans based on assumptions that were laughably unrealistic in a way reminiscent of the underpinning assumptions that made PFI “value for money”.
An NHS Plan is not enough. There must be a plan for national welling in which the NHS has a role. Social care is important in its own right and far more important than the NHS if the objective is to enhance welling and reduce the inequality brought to us by neo-liberalism.
The current NHS led obsession for integration is often badged as cost saving with the NHS hoovering up social care (for old people anyway) in some ill defined and probably disastrous fashion. Better care is not cheaper care.
But far worse is that social care on the NHS model means we lose any say – local authorities have at least some semblance of democratic accountability and community engagement but the NHS has none – nobody ever knows who makes the decisions in the NHS. A far better model sees the “local” services – public health, children’s services, social care, housing, primary and community health care and some of the less complex aspects of secondary care joined up through local authorities – the NHS obviously cannot do this!
If Labour sets as its highest priority the reduction in inequality then investment in social care, public health, community care should be in the forefront. In fact, the record shows that the services that do most to counter inequality are cut first.
The NHS does many wonderful things but makes little contribution to reducing health or any other inequality and actually has some negative impacts. The vested interests which control the NHS ensure its funding is allocated disproportionately to the tertiary and acute sectors (hospitals) and thus starve other services of funding – learning disability, mental health, social care, community care all get cuts to prop up the deficit ridden flagship hospitals.
In terms of policy, Labour’s 2017 manifesto had some high cost universal promises around the pensioners triple lock, tuition fees and funding for the NHS; although these were not in themselves aimed at redistribution. It signalled some important commitments around social care, disabilities and reducing exclusion but so far there is no clarity about any radical changes to benefits or to the alignment of cash benefits to publicly provided services. Again, this policy gap needs filling soon, not least as the painful experiment with Universal Credit is a live and hugely contentious issue for many.
Improving the care of children and increasing the value of vocational social work also needs an urgent policy development. And more besides.
Solutions will need to be local. A return to the days of better funded, more respected and powerful local authorities is necessary; with these local authorities having proper management teams and their own research and development functions – backed by adequate funding. They can and would work closely with the many voluntary and third sector groups that support wellbeing. And as local responsive care improves and investment flows funding for social care will become nationally based as with healthcare; and entitlement to care will be set nationally not locally as now – a truly national care service.
For better social care for older people, major investment in the professionalisation and regulation of a more highly skilled workforce is key to raising standards. Improving the wage incomes of 1.5m mostly low paid care workers will be an economic boost. Improving quality of care in residential homes requires embracing ethical commissioning and paying more to get far better care. As care becomes more joined up and care in the home far better supported then demand for residential care should reduce and there is likely over the longer term to be a private/ public split with more publicly funded residential care provided by public bodies. Better domiciliary and residential care will cost money, quite a lot of money, but still far less than the sums mentioned to reinstate the NHS.
And should social care be free as NHS care has always been? The moral case for free personal social care (without the “housing/hotel” element) looks to be similar – the state steps in to support those in need due to circumstances beyond their control; the national level pooling of risks for the betterment of all. The state might then also stop making things worse for those who need support! If all care is free then joining up systems, workforce and information looks to be a lot easier, although the biggest beneficiaries will be the better off! Let’s see the analysis and have the debate.
So, whilst we never stop the fight for our NHS its time to up the fight for decent social care and to move policy along. Time to move ahead on one of the greatest scandals our society is facing – the way we fail to care for the most vulnerable.