Labour must not shy away from radical social care reform

Fourteen years of neglect has left social care in a disgraceful state. There are 152,000 job vacancies (1). Exponential privatisation has lead to around 10% of its funding being lost to private profits – an estimated £1.5 billion annually (2).

Labour’s “ming vase” approach to the next election has lead to them dropping a commitment to a national care service in their first King’s speech (3). A more radical overhaul of social care will be introduced incrementally, over at least 10 years.  

Social care cannot wait another decade. Local councils have been starved of government money. Services have been cut. Thresholds for eligibility have risen so high that over a quarter of requests for social care are rejected (4). 14,000 people are stuck in hospital, largely for want of support in the community (5). Including carers and family members, half of the 14 million people living in poverty are affected by disability (6).  

Labour is choosing to focus on positive, but limited, change. In the face of huge challenge and substantial need, there must be a bigger, braver commitment.

The roadmap Labour could choose to follow has already been set out groups like of End Social Care Disgrace (7). This union supported organisation, with strong representation of disabled people, argues that Labour must not eschew comprehensive reform.

They believe a national care service must also be a “National Care, Support, and Independent Living Service”. Based on the United Nations Convention on the Rights of Disabled People, this would establish choice, dignity and respect at the heart of person-centred planning. But how could such a service work?

Fund it like the NHS – free at the point of need.  

The NHS remains one of the most cost efficient health services per proportion of GDP, cheaper than most G7 countries including France, Germany, and the USA (8). Investment and progressive taxation could make social care free when it’s required to everyone in the UK.  

Make it publicly provided, and publicly accountable.  

It is hard for Local Authorities to juggle the many contracts they hold with private businesses who provide at home and residential care. A publicly provided, insourced care sector would be more flexible, more accountable to local people, and far more stable. 

Develop a nationalised service, locally delivered.  

It is important to recognise that different regions will have different local demands, requiring a different mix of co-ops, voluntary sector and Local Authority provision. The needs of city dwellers in London and rural communities of the Lake District are distinct, and an efficient care service must reflect this.  

Ensure informal carers receive far greater recognition.  

The hand of a friend or family member often takes the place of that of a paid carer. Informal carers’ contributions should be acknowledged with comprehensive support, and their time properly remunerated.  

Make social care an aspirational profession.

  An efficient care service is underpinned by thorough training and a structured career path. The skills required to do this complex, vital job well should be reflected in a decent wage and fair working conditions.  

Champion independent and supported living.

Choice, control, and flexible, personalised support is integral to independent living. End Social Care Disgrace suggests setting up a task force with teeth, comprised of organisations led by disabled people, carers and sector workers to shape this crucial aspect of care and make wider social policy recommendations.

Make it affordable.

Around £40 billion would be needed to end the dependence on private care, return funding to 2009 levels, increase carer salaries by 25%, and provide at home and residential care for those who require it free at the point of use (9).  The taxation of higher earning care workers offsets this spending, and private sector profit reinvestment would be a further boost. If you account for the NHS waiting list delays that would be reduced by social care ‘bed blocking’ and the social determinants of health that are improved by more robust social care, the benefits quickly outweigh the initial investment.

  Compare this with the cost of the status quo. Disabled people of all ages who require support could make meaningful paid and unpaid contributions. But they are held back by a dysfunctional care system, as well as barriers to access in housing, transport and town planning. The same goes for their informal carers. There are also spiralling costs of temporary workers used currently, where recruitment and retention seems impossible.  

A National Care, Support, and Independent Living Service would be good for our health, and good for the economy. It could revitalise our productivity and prosperity akin to the postwar welfare state and the coming of the NHS, brought about by a government unafraid of the change the country desperately needed. Labour did it then – they should do it again.

Written by Dr Brian Fisher & Dr Tom Riddington. Brian has worked as a GP in southeast London for over 40 years, and is a director of The Health Creation Alliance. He was awarded an MBE for his work in community development in 2007. Tom is a communications officer for Doctors in Unite.