Boris Johnson last week announced his plan that was supposed to fix social care. But instead of solving problems, the Tories are ploughing on with the same policies that have led to disaster.
The myriad of private care providers delivering shockingly low standards remain in place. The complex web of rules that families must navigate to get loved one the right care stays.
The almost illegal levels of pay that drive many of even the most compassionate people out of their jobs won’t change.
And the millions of desperate people who don’t yet receive care, and those looked after by an army of unpaid and relatives at home, will see no improvement.
That’s because despite the hype, there is barely any new money going into social care. Between 2009 and 2019 central government funding to local authorities had fallen by 38 percent in real terms—and from £36.4 billion to £24.8 billion in cash terms.
The Tories’ offer of an additional £5.4 billion over three years doesn’t even scratch the surface of those cuts.
But forget all that.
The media’s sole concern was the simple message that from 2023 no one will pay more than £86,000 for the care they need. Yet even that was a Tory sleight of hand.
That “cap” figure includes help with washing, dressing and eating, but does not include daily living costs of food, energy bills and accommodation.
People in care homes can be charged around £12,000 a year for these services that fall outside the cap. What is more, spending on care will only count towards the £86,000 cap if your local council has assessed you as being in enough need to be eligible.
Already most people fail this test, so only the very frail qualify.
And Johnson did not even mention the growing sense of crisis in private sector care provision. But a look at coronavirus deaths in Scotland tells a story.
Out of more than 10,000 Covid deaths there, some 3,000 occurred in care homes. The top ten list of care homes with highest numbers of deaths includes nine being run by big firms.
The giant care operators, and the private equity businesses that stand behind many of them, make their money by running ever bigger care homes. But “economies of scale” means spreading staff thinly and running the risk of quickly spreading sickness among residents.
And it’s not just Scotland. The Care Quality Commission last year found that one in six care providers in England were not meeting acceptable standards.
Reading through the stories of care workers opposite, it is clear that only the most radical measures can change the situation for the better.
The real way to improve social care across Britain would be to scrap the existing system and start again with a simple principle. Care will be free for all those who need it.
The endless forms, assessments, rejections and appeals could be swept away at a stroke.
And the limits on the amount of care someone can receive must be removed too. There must also be a big improvement in care workers’ pay.
Currently, most receive just above the minimum wage. Jobs advertised offering just £9.90 an hour for skilled, physically and emotionally demanding work.
The only way to fill the more than 170,000 vacancies expected by the end of the year is to make sure the job can pay the bills and more. Of course these measures alone would cost billions of pounds. But the money is there.
According to Prem Sikka of the Tax Justice Network, around £17 billion of extra revenue could be had. It suggests abolishing the current capital gains tax system and instead taxing capital gains at the same rates as wages.
As a tax that rarely affects anyone but the rich, most working people wouldn’t have to pay it. Forcing those who take home salaries of more than £4,189 a month to pay the standard 12 percent rate of National Insurance could raise another £14 billion.
These are just the sort of figures that many would expect a Labour Party opposition to use to hammer the Tories and their National Insurance rise. But only with utmost reluctance will Keir Starmer’s Labour talk about the need to make the rich pay. Its failures to speak out has deepened the crisis.
‘We need fundamental change—just as the creation of the health service was’
Jenny, care and support worker in West Yorkshire
“One of the biggest problems we face in social care locally is that it is entirely privatised. As a result, it is completely separate from local authorities and from the NHS,” said Jenny.
“Everyone knows that services need to be interlinked.”
The second problem is that care work is held in such low esteem. Jenny says that’s because the people who receive care are thought by politicians to be of little value, and that they don’t contribute to society.
In addition, “care” is something that’s thought of for “old people”. “Those myths are damaging,” she added.
“I’ve just visited a woman who was a nurse, and was once healthy, active and independent, but who is now disabled by Parkinson’s disease.
“Her care has been provided by a string of constantly changing private companies. That meant not only different carers coming into her house every day, some of who she had never met before, but also them coming at different times—oblivious to her routines.
“She now has no say on when she gets out of bed, who helps her in and out of the shower. And, again and again, she has to explain to a new carer what her needs are.
“At nighttime, if she wants to stay up later than normal and watch a television programme, she can’t. Whatever time her nighttime carer arrives is bedtime and that’s it.
“Any sense of control over her life has been taken away by the way the system functions.”
Jenny said that pay is the other big issue in the care sector, with most wages being absurdly low.
“I’ve met some of the most caring and committed people at work, sometimes more so than the people I worked with when I was in the NHS,” Jenny explained.
“You build real relationships with the people you care for, and if something bad happens to them, you feel it. If they’ve died in the night, it’s you who is going to find them.
“But that commitment isn’t rewarded. Workers are spoken to and treated so badly, it’s shocking. And that can create resentment.”
The care system doesn’t just need mild reform. Jenny suggests it needs “fundamental change”.
“Some people say this sort of change just isn’t possible. But I think about the NHS and what a massive breakthrough that was,” she added.
“Only something that big could end the private firms and low pay that are typical of care now.”
‘This is the worse it’s ever been, and it’s the same everywhere’
Michelle, worker in community care in Swansea and Neath
Michelle helps her mostly elderly clients with their medication, personal care, cleaning and shopping.
On average she does 25 home visits a day, starting work at 6.45am and finishing work as late as 10pm.
“I love my job,” she said. “I love helping people, especially those who’ve got nobody. For them, our visits are the only company they get.
“But our house calls have been reduced to 10 or 15 minute slots. And we’re always under pressure to squeeze in more.”
The way care workers are treated makes Michelle really angry.
“It’s the unpaid driving between calls I really resent,” she said. “We’re only paid for the time we spend at someone’s house.
“After my morning shift, my afternoon one runs from about 3.30pm to 9.30pm—that’s six hours—but I’m only paid for three hours and 20 minutes work.
“I work two really long days, plus a half day—but I only get paid for 24 hours work.”
Michelle says that the job has been getting progressively harder and that staff shortages are now “horrendous”. The combination of low pay and long hours mean very few people want to work in social care.
“This is the worst it’s ever been,” she said. “And it’s not just the company I work for, it’s the same everywhere. Lots of care firms are going under at the moment, and I can’t see that changing.”
On Boris Johnson’s claim to have “fixed” the social care system Michelle says simply, “I will believe when I see it.”
‘I worry about my clients long after my shift is over’
Kirsty works in Glasgow with people who have mental health difficulties
“Everything that might enrich someone’s life has been cut,” said Kirsty, whose job involves seeing people in their houses, and helping them cope with mental distress.
Staffing has become such a problem that services run at only the bare minimum.
“I help people with things like their personal care and housework and so on,” Kirsty explained.
“But also I spend time taking them out of their houses, talking to them and trying to help deal with problems.”
Kirsty’s hours are long and sometimes she doesn’t finish until 11pm. Even when she’s finished work, the job is still on her mind.
“I worry about my clients when my shift is over, and I’m always checking my phone for messages. And that’s especially true if someone has had to go to hospital, for example,” she added. “It’s really hard to switch off.”
Kirsty says that work was particularly hard during the early phase of the pandemic.
During that first month she said she felt like a “Covid time bomb”.
“Our job is to keep people safe, out of hospital and integrated into society,” Kirsty said.
“But I was constantly worried that by taking the bus to see them, I’d spread the virus to my clients.
“And, with everything closed, many of them were stuck in high rise flats all over Glasgow. For some the only contact they had was with a carer who had to rush their job and leave.”
Kirsty said she and other staff often work beyond their hours, without pay, to make sure the people they look after have the bare minimum.
“Lots of us do things like shopping for clients in our own time,” she said. “The trouble is, if you log that time spent, the client gets charged for it and many cannot afford it.”
Kirsty is scathing about Boris Johnson’s plans for social care. “I think it’s terrible that he wants us care workers to pay for social care—that it’s coming out of our wages,” Kirsty added.
“We need a pay rise, but instead he’s given us a pay cut.”