With economic crisis and war in Ukraine, there is a danger that adult social care will not be top of the agenda of new Prime Minister Rishi Sunak. But overlooking social care would be a mistake.
Any incumbent or aspiring government seeking to address issues of inequality and growth needs to understand the potential of a reformed and properly funded adult social care system as a mechanism to enable this.
I had the privilege of helping to organise a fringe event at the Labour Party Conference this year, in conjunction with Progressive Britain, debating ‘Who cares? Why A National Care Service needs the non-for-profit sector’. The speakers included:
Conversation in the packed room covered the benefits of not-for-profit care and included much clearer articulation of Labour’s policy position than I’ve heard before from the Shadow Secretary of State for Health and Social Care, Wes Streeting – although some aspects are still fuzzy.
Labour is working with the Fabian Society on a roadmap to a national care service. As described by Wes Streeting, this looks less like a ‘nationalised’ care service and more of a care service that has national standards to try to avoid a postcode lottery on quality and access, and to ensure decent pay, terms and conditions for staff as well as a focus on co-production with providers and people using services at a local level.
This is all great but the main question I have is how Labour would actually fund its National Care Service and the increases in workforce pay, as well as what steps will be taken to move towards those two goals.
This is something the Fabian Society is working through and it is certainly something Labour will be challenged on during any General Election campaign when there are such pressures on public spending.
Social care is suffering a staffing and capacity crisis. The most recent annual report from Skills for Care on the state of the adult social care sector and workforce in England has revealed that there are now 165,000 vacancies in the sector and, more significantly, a decrease in the workforce of around 3% (50,000 people) from the previous year. Demand for services is growing. According to Carers UK there are 6.5 million unpaid carers in the UK and a recent survey carried out by ADASS found that over half a million people in England were waiting for care assessments, reviews and/or care and support to begin. This year’s CQC State of Care report describes gridlock across the health and care system for people and stated that “many of the challenges services are now facing are linked to historical underinvestment and lack of sustained recognition and reward for the social care workforce.”
Wes Streeting acknowledged these issues. He committed to having sector bargaining arrangements and fair pay deals for social care. Labour, he says, would guarantee fair pay, full rights at work, and proper training.
He would like to see a joined-up workforce with the NHS where someone could have a career in both but he also made it clear, to the relief of everyone in the room, that social care should not be run by the NHS due to the different cultures and ways of working. As an example of what joining up might look like he suggested moving towards pay scales for social care which are similar/aligned to NHS agenda for change
In a similar vein, Streeting called for the pooling of budgets between health and social care and said that the litmus test of Integrated Care Systems will be their ability to deal with workforce crises and join up health and care around a person. This will require a change commissioning practice needs to improve and a recognition that ‘cheapest doesn’t mean good quality’.
Quality is not just about funding and commission, but also regulation and Streeting was emphatic that ‘the next Labour government will also be much more stringent in the regulation of care’. He was very clear that they will force out private equity firms who provide poor services and ‘leech money’ out of care services.
Perhaps the most interesting part of the Shadow Health Secretary’s remarks was that he wants to get to a place where ‘care is in every policy’ of a Labour government and is treated as part of the nation’s essential infrastructure.
As we heard from the speakers during the event, not-for-profit social care plays a vital role in helping to unlock people’s potential across a broad range of services such as care homes, home care, housing services, befriending services, mental health services among others.
But even for a policy area which affects so many lives in so many ways, can care really change the whole of society for the better? I believe so, and below I’ll set out how governments of any stripe should take advantage.
Oliver Thomason got to the heart of the issue when he spoke about how social care has a significant role in unlocking the potential of people to engage with their communities and do the things they love.
It is a mechanism to tackle health and socio-economic inequalities, a net contributor to local economies (£51.5bn in 2021/22) and has the potential to unlock growth in all areas of the country if invested in and treated as a key piece of national infrastructure, interlinked to other policy areas such as housing, mental health and physical health, among others.
There is a clear failure by policymakers to understand the connection between the power of social care to deal with health and wellbeing inequalities on the one hand, and economic and social flourishing on the other. Good social care is preventative in nature, allowing people to retain their independence for longer, doing the things they want to do, living in and contributing to their communities and working. Poor health and wellbeing are a leading reason for economic inactivity and low productivity in our society.
In short, deal with health and wellbeing inequalities and you unlock productivity and growth. These are two sides of the same coin – it shouldn’t be viewed as a zero-sum game between public spending and growth as some policymakers are currently doing.
This is the space any aspiring government needs to fill; to reshape the narrative so it makes the case for what social care can bring if invested in properly, and put the person and their community at the centre. All too often, debates about social care centre on catastrophic costs to both individuals and the state, rather than the opportunities and benefits. Not-for-profit care and support should be at the centre of this thinking.
As alluded to above, a strong theme from the fringe was the role of not-for-profit care, support and housing organisations in building a sustainable social care system and unlocking potential. Geeta Nanda emphasised the diversity of social care and range of services by pointing to the huge role housing associations play in supporting entire communities and promoting health and wellbeing. These not-for-profit services are anchor institutions that are deeply rooted in their local communities and form ecosystems of care and support – their values, assets and resources benefit these same communities and local businesses. When we talk about better pay, terms and conditions, we really do need to be thinking about social care in its broadest sense if we are to tackle health and wellbeing inequalities head on.
My argument, and that of the National Care Forum, is that not-for-profit care will be key. As Sarah Jones said during the fringe, a profit motive is incompatible with good quality care. The not-for-profit care and support model should be central to any move towards a national care service for a number of reasons:
My final thought is on the importance of the voice of those that access care and support services, and their friends and families in designing a system that works for them. All too often debates about policies and systems – and indeed the sort of reform Wes Streeting was talking about during our fringe – have a danger of falling into the trap of not including or listening to the voice of the people who actually need the services.
It was great to have Oliver making his voice heard at the fringe event but how do we do better? How do we ensure policy makers, institutions, political, and bureaucratic systems, start with the person? How do we ensure we involve the voice of older adults, as well as younger people?
Getting the answer right, with the services people want and need, delivered by a workforce that is properly supported and trained will have a massive impact on British society. The positive impacts of care will reverberate out from service user to their families, friends, communities and ultimately wider society.
For more on the care workforce see Fair Pay Agreements: How Labour can help people get on at work—not just get even.
