The Deepening Crisis In Social Care
An obvious fact of COVID-19 is that it acts as a stressor on all sectors of the population and of the economy. The adult social care sector is by no means any different. A leaked letter from the Association of Directors of Adult Social Services (Adass) addressed to the government outlined the “contradictory” messages on how to protect the people they served, the lack of government testing of care workers and the shambolic nature of PPE supply to the sector.
Yet, BBC Panorama’s report on adult social care in Somerset in May/June 2019 served as a microcosm for an increasingly deteriorating and failing situation that the entirety of adult social care faced before this pandemic. The vulnerable people who are supposed to be receiving care and support are more and more being left behind, as the costs increase and their families find themselves unable to shoulder, financially, physically and mentally, such a difficult task. These are the circumstances before the COVID-19 pandemic and we should be asking ourselves, how is it that the world's 6th richest country let down one of the most vulnerable groups in their population? The answer can be reduced to two words; austerity and privatisation.
Austerity, a policy of cutting the spending of a government, has had a completely destructive effect on the British economy and the British people. Thanks to the Coalition Government’s fetishizing of ‘balancing the books’, tens of thousands of people have died. According to research conducted by Oxford academics, in 2015 alone over 30,000 people in the UK died due to “disinvestment”, where an underfunded NHS, which frequently subsides social care, failed to meet performance targets and so failed to provide the lifesaving care required by thousands of patients. Many of those were likely to be in the social care, where local councils, who pay for social care, have seen their budgets halved. The current Government has been eerily quiet on the issue, with no response or attempts made to address the dire circumstances that many elderly and vulnerable people find themselves.
Dozens of economists, Joseph E Stiglitz, Yanis Varoufakis, Paul Krugman and several at the IMF, have rejected austerity and the neoliberal ideology that birthed it as a necessity, pointing out the high inequality and stunting of growth it tends to lead to. As Varoufakis once said, “the problem with austerity is that it is being used as a narrative to conduct a class war”. Decreases in inheritance tax, while large scale defunding of many social programmes leads not into the great growth and meritocratic social climbing that was promised, but into a society in which the income of most is stagnating and the hordes of the few grow larger.
The other side of this unprecedented tragedy is the growth of the private sector. In 1979, 64% of residential and nursing home beds were provided by local authorities or the NHS. By 1990, along with the rest of her neoliberal agenda, the Thatcher government introduced the National Health Service and Community Care Act. The biggest consequence of this was to make councils “enabling” authorities and so forcing them to outsource to private providers. By 2012, the council share fell to just 6%.
This new private care market is hugely fractured (over 5500 providers) and fragile (in 2011, Southern Cross, which occupied a 9% market share, collapsed and most of its operation subsumed by Four Season, which itself was ridden in debt and yearly losses). The for-profit motive has pushed the providers to cut back significantly on staff pay and conditions. A wage for a senior care staff worker in the public sector is twice that of the private. Mears, a provider in the northwest, pulled out of its contracts as the fees being paid by local councils amounted to “encouragement to providers to breach the national living wage”. Due to this massive wage decrease, few people see adult social care as a possible stable career and so many of the workers in the sector have no qualifications at all. Staff retention in the private sector compared to the public sector is abysmal, with the average residential care workers in the private sector leaving after 29 weeks, while the average care worker in the public sector leaves after 96. Such facts have led to a worsening job crisis, with providers having to hire expensive agency staff.
Adult social care in Britain was a dysfunctional sector, in which privatisation and austerity, ushered in by neoliberal capitalism, worsened the lives of the people it was supposed to help. COVID-19 has not only plunged the sector into greater chaos but revealed the impracticality and instability of its current state.
It is in reclaiming and re-expanding local authorities' role in providing this essential care, in bringing the sector into public hands where greater accountability could be had, that we can give support and stability to a failing health service.