“Everyone knows you can’t fix the NHS without fixing social care, and you can’t fix social care unless you drop the government’s current plans on Indefinite Leave to Remain (ILR) and settled status.”
By Neil Duncan-Jordan MP
Just days after taking office, Andy Burnham announced he would make fixing the broken social care system a political priority. He spoke movingly about his personal experience of seeing his father in a care home, called for more recognition of the care workforce and instructed Baroness Louise Casey to bring forward her review of the sector by 12 months.
So far so good. But sadly, we’ve been here before. There have been at least 25 social care commissions, select committee inquiries and white papers since 1997. All of these have highlighted the problems with a social care system that has no cap on lifetime care costs, little support for unpaid carers and rising demand for support. Eligibility thresholds have been tightened to restrict access to services, while the upper capital limit of £23,250 hasn’t changed since 2010/11 – meaning more and more people are paying large amounts of money towards their care. This either comes from their savings or the sale of their home. For a start, any National Care Service worth its name is going to have to address these challenges.
Everyone knows you can’t fix the NHS without fixing social care, and you can’t fix social care unless you drop the government’s current plans on Indefinite Leave to Remain (ILR) and settled status. Not only is it grossly unjust to change the immigration rules for those already here and making a contribution to our society, it’s also completely counterproductive. The latest figures for the social care workforce show around 110,000 vacancies in the sector. There is no way this figure will be reduced by making it harder for existing workers to stay. The government’s ILR plans therefore need to be scrapped for Burnham’s social care vision to work.
Alongside this, the root of the social care problem is quite simple: some illnesses we pay for collectively as a society and some we leave to the individual to fund alone. NHS care is public, universal and free at the point of delivery, whilst social care is means-tested and almost exclusively in the hands of the private sector. Unlike the NHS, those in residential and nursing homes have two costs: one for the care they receive and one for their accommodation. Funding the care of those with dementia therefore has to be done in the same way as how we fund the treatment of those with cancer. Anything less and talk of social care reform will be meaningless.
The third challenge is the need to tackle the dominance of large private companies in the sector. Without more state-run care, any additional public money that is raised through the Burnham reforms will go straight to businesses in the form of higher profits, in the same way that housing benefits go directly to private landlords. The government could start to address this by bringing back all domiciliary care in-house as and when the contracts with local authorities expire – similar to what it has done with the railway companies.
Any reform must also tackle the issues faced by the workforce. Low wages, exploitation of the visa system by employers and much-needed workforce development as a way of raising standards and quality across the sector have to be faced. As a first step, the distinction between residential and nursing care homes should be removed so that the full range of staff can be employed to reflect the needs of the residents. The introduction of sectoral collective bargaining will also help, but the government should also be prepared to challenge the age-old issue of profit before people.
Over recent years, the private sector’s market share in care homes has increased, with many large operators owned by private equity firms. This has led to a shift in the social care landscape, where private companies now own and run 84% of beds in care homes in England. There is frankly no way a National Care Service can be structured on this model going forward.
That’s why the issue of funding is crucial. Back in 2009, Burnham put forward a Green Paper with a number of options as to how a National Care Service could be funded. Some of the options he considered included a private insurance scheme, a compulsory payment for the over 65s and a proposal whereby some costs are covered by the state whilst the rest was means-tested on the individual. This time we need to come up with something better.
For years there has been widespread agreement that there needs to be a long-term solution to how social care is funded. The public instinctively know the current system is unfair and they want it fixed. Labour’s job is to advocate for a new system funded through a range of general taxation measures that pool the risk and share the costs.
Like The Smiths’ song, Burnham has started something – let’s hope he knows how to finish it.
- Neil Duncan-Jordan is the Labour MP for Poole. You can follow him on Twitter/X, Facebook and Instagram.
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Very good, exactly what is needed; we need to stop this system of making money from sick people, it is not ethical.