We don’t have a social care system – we have a social care crisis. This is an uncontroversial statement. Even Boris Johnson acknowledges “the crisis in social care”.
You would be forgiven for thinking, however, that this crisis is just about elderly people in care homes. According to this view, the main problem with our social care system is that some older people might need to sell their homes in order to pay for their care. The issue, therefore, is a largely about the needs of elderly, wealthy homeowners. This couldn’t be further from the truth.
Let’s start with the basics of the crisis. There are an estimated 400,000 people in care homes in England, with more than double that number receiving care in their own homes. But this is not the full picture, as Age UK estimates 1.5 million elderly people have unmet care needs, as do several hundred thousand disabled adults.
In fact, around 40% of those receiving social care are working-age adults with disabilities. For all the talk of intergenerational unfairness when it comes to funding social care, this doesn’t reflect the reality of the situation.
Additionally, many people are reliant on family members and friends for their care. We know that 1.3 million people claim carer’s allowance benefit, which pays a pitiful £67 per week to those unpaid carers providing at least 35 hours of care per week to a close friend or family member.
Professional carers don’t fare much better. There are around 1.5 million people working in the care sector (200,000 more people than work in the NHS), but because of the fragmented and privatised system these workers are treated abysmally. According to the TUC, 70% of professional care workers are paid less than the real living wage, and a quarter are on zero hours contracts. Many receive no contractual sick pay, dragging themselves to work when ill just to make ends meet.
As such, last year the Care Quality Commission found that 1 in 6 providers were not meeting acceptable standards. Moreover, a study by the London School of Economics earlier this year found that risk of death from Covid-19 in UK care homes was 13 times higher than in German care homes.
Shortly after becoming prime minister in 2019, Boris Johnson declared: “I am announcing now […] that we will fix the crisis in social care once and for all, with a clear plan we have prepared to give every older person the dignity and security they deserve.”
In January 2020, he then promised that social care legislation would be in front of MPs within a year. Dawn Butler can add that to her list of the prime minister’s lies.
But last week it seemed there might be a breakthrough. Briefings to the press suggested an agreement on funding had been reached, and the imminent publication of the long-awaited plan. The rumour was that the government was going to increase national insurance contributions by 1% in order to fund social care.
The debate that followed, however, mentioned nothing about unmet care needs, poor standards of care, or low pay for care workers. The few billion pounds that hiking national insurance would raise is far too insignificant to solve the care crisis – and yet all the talk was about intergenerational unfairness.
When Keir Starmer ran for Labour leader, he put forward a very Corbyn-esque ‘ten pledges’. He also backed calls for free social care, telling Disability News Service: “It is only through radical action that we can deliver the change that is needed.”
Starmer’s leadership pledges are now residing in the same secret location as Shergar, Lord Lucan and the Forde Report. His former position on social care seems to have met a similar fate, with a member of his shadow cabinet recently telling delegates at Labour Women’s Conference that calling for free social care would “just give Tories a stick to beat us with”.
So what would necessary action when it comes to the social care crisis actually look like?
One idea is the creation of a ‘National Care Service’ or a ‘National Independent Living Service’, along the lines of the NHS: funded from progressive taxation, free at point of use, with universal coverage, and with care staff on terms aligned to NHS pay and contracts. Yes, this would be expensive, difficult, and require vision and leadership to drive through. But these are the sort of challenges great leaders rise to – as Welsh Labour politician Aneurin Bevan did when he founded the NHS.
It’s worth reminding ourselves that in 1945, the UK had a national debt two and a half times greater than we face today. What’s more, we could raise the funds for a National Care Service in any number of ways – as groups like Tax Justice UK have highlighted – including levelling-up capital gains tax with income tax rates and taxing inheritances and wealth more.
We often talk about physical infrastructure creating jobs and growth, but investing in our social infrastructure can do the same. The social and economic investment in a National Care Service wouldn’t just tackle the social care crisis – it would grow the economy and benefit us all.
Andrew Fisher is a freelance writer and policy consultant. From 2016 to 2019 he was the Labour party’s executive director of policy.