A social guarantee for adult social care

Maeve Cohen says market-driven care services must go, while highlighting a local alternative model

It looks like big changes are coming to the world of adult social care but what will they be? After decades of declining funding and failure to address the growing crisis in the caring sector, the government is now being forced to act. Last month, a regressive 1.2% increase in National Insurance Contributions was announced to raise more money for health and social care. On the 10th October it was revealed that the government is considering the creation of a national care service and a joining up of health and care services in the UK. Only time will tell what form this will take. A national care service means different things to different people. But surely we can all agree that the system urgently needs a shake-up.

In one of the richest countries in the world, insisting that the most vulnerable in society are protected and cared for should be beyond dispute. And yet our social care system – in England in particular – is failing to do just that. Big ideas for how we can fix the growing crisis in social care are welcome, but they will fail to deliver their desired outcomes unless they are designed with the core purpose of meeting people’s fundamental needs.

The Social Guarantee is a framework for policy and practice that does just that. It enshrines every person’s right to life’s essentials through collectively provided public services and a living income for all.

A Social Guarantee in adult social care would mean everyone having access to collectively provided care services, free at the point of use or at prices that are genuinely affordable for all. This stands in stark contrast to our current system of services delivered by private, for-profit companies at prices that none but the very rich can afford. Our caring industries are a classic case of market failure, and this must be recognised and overcome by removing profit extraction from the delivery of this essential service.

Private companies, by their nature, must make everything as efficient as possible to ensure they maximise profits. But this does not work for care. If you’re ever in the position where you need to put a loved one into a care home, you don’t look for the most efficient care home, you look for the one where residents are happy and well looked after. The only way to maximise profit in care is to increase the amount of people cared for in a set amount of time. Obviously, you can’t deliver high quality care to infinite numbers of people in an hour, for example. Fairly early on in that process, the quality of care begins to suffer. Running a care system on a model of increasing efficiency leads to falling standards of care and harms the people who are supposed to benefit.

Another way to increase profits is to lower wages. This has led to massive labour shortages in adult social care, exacerbated by Brexit. The disproportionately female and ethnically minoritised workforce is subject to poverty wages and insecure work, contributing to the gender and racial pay and employment gaps. But we can do things differently.

Cooperative Care Colne Valley provides an excellent example of what a more inclusive model of care could look like in the UK. They are registered with the Care Quality Commission and provide a host of different caring services. As the aim of the cooperative is to provide good quality care and fair employment conditions rather than to make profit, all the money it earns can be reinvested and spent on decent wages and training for staff and on making life better for service users. This has led to a higher quality of care, more tailored services, empowered users and qualified, well-paid staff.

Ownership models that enable service providers to pursue social and environmental benefits over purely financial gains are an essential part of addressing the social care crisis in a time of climate emergency. These can take many forms, from co-ops like Cooperative Care Colne Valley, to community-led initiatives, to local authorities delivering care directly.

This is not the only issue the caring industries face. Progressive taxation is crucial to adequately funding the system without increasing the burden on those who can least afford it. Preventative measures such as diet, access to green space and physical exercise are also a vital part of the puzzle, and these can be facilitated by a range of collective measures through local and national public authorities. Increased support and recognition of predominantly female, informal carers is also vital. We must recognise that carers and those they care for are assets – not burdens – to society, and treat them accordingly. We can learn from examples of good practice in other countries to build a system we can be proud of. We all need to be cared for at various points in our lives. A Social Guarantee in adult social care would ensure that everyone has access to the high quality, compassionate care that they deserve.

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