Just as the NHS emerged from WWII, so must a National Care Service from Covid

Sarah James

On the 72nd birthday of the NHS, its chief executive Sir Simon Stevens called for a properly funded adult social care system. It was a salutary reminder of the desperate state of social care in England. 40% of Covid deaths were in care homes, and yet the sector still struggles for personal protective equipment, for testing and for proper pay and conditions for its staff. Over 30 years of privatisation has resulted in a profusion of fragmented and competing providers. The social care market is fragile and many providers are at risk of financial collapse, resulting in instability and inconsistent care.

Government funding for adult social care has plummeted – current expenditure is below the 2010/11 level – without acknowledging the increase in population and levels of demand. This burden has not been evenly distributed; between 2010/11 and 2017/18, the 30 councils with the highest levels of deprivation cut services by 17% per person, compared to cuts of 3% per person in the 30 least-deprived areas.

A recent health and social care select committee heard how undervalued and demoralised care staff feel – some 685,000 home care workers are paid by the minute, with travel and training unpaid for, while others report being monitored by electronic tags. It is a national disgrace that those we call upon to look after our most vulnerable citizens are treated with such contempt.

Successive governments have failed to confront this issue, but the coronavirus pandemic has shone a light on it like never before. Until we stop thinking of social care as a burden and think of it as a genuine investment in our society, then real change will not happen. If we are bold enough to embrace change and invest in our future, there is a clear way forward. Here are four proposals to reform the sector:

    1. Poverty wages must end. Years of market competition have driven down both wages and quality. Care staff are public servants and deserve to be paid in line with their counterparts in the NHS. Besides the moral imperative to pay properly, decent wages would make a career in care a more attractive proposition – drawing in new recruits and addressing the horrendous current rates of staff turnover. A happier, more permanent staff will drive up the quality of care across the sector.
    2. Introduce universal free personal care. The current system encourages those who cannot afford to pay for social care themselves to either avoid seeking help at all or accessing, free at the point of use (but to the state far more expensive) NHS support instead. A universal service would relieve pressure on the NHS by enabling people to stay in their own homes for longer, and to access preventive services sooner. It would provide support to the army of unpaid carers who dedicate their lives to looking after loved ones at home.
    3. We must reverse the privatisation in the sector. The coronavirus pandemic has shown outsourced provision to be expensive, fragile and badly suited to meeting public need. A publicly owned system would not only be cheaper to the tax payer but would also ensure care homes were backed up by state institutions, guaranteeing the stability and agility necessary to negotiate the public health challenges we will face in the coming years.
    4. The increasing reliance on council tax to fund social care must end. This risks further exacerbating regional inequality. We must fund social care the same way as we fund our NHS – through general taxation, distributed on the basis of need.

The state of the social care sector in this country is a national scandal. The coronavirus pandemic has brought the nation’s focus to bear on it. As a movement we must seize this opportunity to address the problems the sector faces, problems that have been so scandalously ignored by successive governments. The NHS, perhaps our country’s finest achievement of the 20th century, was born out of the crisis of the second world war. Let’s work together to ensure that a National Care Service emerges from the wreckage of this major crisis of the 21st.

Sign my petition here for fully funded adult social care.

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