Andy Ford, Unite NHS rep
The recent election campaign saw a conspicuous failure, by both major parties, to mention or debate an absolutely huge problem confronting the country – adult social care. It was a part of what the Institute of Fiscal Studies (IFS) called a ‘conspiracy of silence’ where both Labour and the Conservatives ended up offering improvements to schools, health and infrastructure whilst simultaneously pledging to maintain the existing tax regime and ruling out taxes on the wealthy. Because adult social care is in such crisis, and will be so expensive to fix after decades of neglect, both parties found it easier not to mention the subject.
But the reality cannot be ignored. Alzheimer’s is now the leading cause of death in Britain and affects 1 in every 14 people over 65, with 2% of the population caring for someone with dementia. Apart from dementia, over a million old people are not getting the care they need.
Bed Blocking Crisis in the NHS
The crisis in social care has a huge consequence on the NHS, with many hospitals using a seventh of their beds for older people who have no medical needs but have nowhere to be discharged to. This in turn knocks on to the A&E departments which cannot triage the patients efficiently because there are insufficient beds to accommodate the patients who do have medical needs, leading to long waits in A&E and treatment delays. And in winter 2022 this caused a huge problem of ambulance queues here that seriously affected wait times for emergency ambulances. Adult social care is not really a problem that can be ignored. But that is exactly what is happening.
The Labour manifesto was only devoted three hundred words to the issue although it did promise a National Care Service (as first proposed by Jeremy Corbyn), “underpinned by national standards” so that providers “behave responsibly”. Which sounds like a regulated private sector system. The manifesto further promised “local partnership working between the NHS and social care on hospital discharge”, which happens now, as best as it can. The problem is the lack of places, not lack of partnership working.
Even these meagre pledges will take serious money to deliver. The Laing Buisson business intelligence consultancy calculated that home care providers lose £1.68 an hour on their local authority contracts, which is cross subsidised from private customers. The situation in care homes is similar. The care sector actually employs more people than the NHS, itself the third biggest employer in the world and so the pledge given in New Deal for Working People, for a Fair Pay Commission in the care sector, will take a huge chunk of funding to raise wages and standards, and provide a career structure to retain and attract staff. There are currently 152,000 vacancies in the sector.
If this is not a crisis then what is?
The Association of Directors of Adult Social Care 2024 survey told us that the situation is dire:
- Budgets are overspent by £586 million
- £903 million of savings are required when the need is greater than ever
- 90% of Directors do not “have confidence” that their budgets are sufficient
- 60% believe they will have difficulty meeting their statutory obligations
- Many more people are needing care, and the care they need is of greater complexity
- Investment in prevention fell by £100 million last year
- The proportion of older applicants failing to qualify for Continuing Health Care has risen from 50% to 75% this year, despite an ageing population – due to raising of eligibility bars
- Adult social care staff are doing tasks previously done by the NHS – without any extra funding
- 418,000 people were waiting for assessment
- Many private providers are struggling to keep solvent
- 65% of Directors reported private sector closures in their areas, with the handing back of contracts. That is, no-one wants to provide the service.
The frail old people, their carers and their families do not have the political pull of “forty new hospitals” or “more doctors and nurses”. It is a hidden problem. 1.6 million elderly people are not receiving the care they need. Right wing politicians often shed crocodile tears over the plight of pensioners (and military veterans) and draw a false comparison to “asylum seekers living in luxury” while “our” old people are not getting the care they need. But what have they done, and what do they propose for adult social care? Nothing – but the Labour Party should be better.
The King’s Fund said that, “The Labour manifesto largely dodges the issue of social care reform… best described as a plan to come up with a plan.” And indeed, the manifesto did say that “we will build consensus for longer-term reform” and” we will explore how we best manage and support an ageing population”. Building “a consensus” and exploring “how to support the ageing population” sounds like a review or Royal Commission. That would kick the can down the road for a good three years – just in time for the next election.
Reinventing the Wheel
But…it’s been done before! In 1999, the Sutherland Commission appointed by Tony Blair reported, after two years of sittings, on Long Term Care of the Elderly. Sutherland recommended:
- Free personal care, paid for out of taxes. Not implemented, except in Scotland.
- Means tested access to care home places. The problem, as Teresa May found out, is at what level does the means test sit? It nearly cost her the election, and so every politician since has steered clear.
- National standards of care. Talked about, but not touched for 25 years, but has now found its way into the Labour manifesto.
- Integration between the NHS and the care sector. But that takes money, and lots of it.
- Those are the minimum reforms needed. But it does not look like they will be happening any time soon. Without reform the sector will stagger on, with minimum funding, dependent on immigrant workers, fragmented into thousands of separate for-profit providers, and failing our old people, 17,000 of whom sell their house every year to pay for the care they need.
What would socialists suggest?
- Make residential care either a branch of the NHS, or a parallel service, with the same terms and conditions, as is the case on the Isle of Man, funded out of National Insurance.
- Make home care free as in Scotland.
- Establish good, not minimum, standards for care, and for staff training.
- Nationalise the sector with minimal compensation, like Nye Bevan did for healthcare in 1948.
Top graphic from UNISON website here
