Jam tomorrow for some and gruel today for everyone – Burnham’s social care plans

It is good to see social care out of the closet and on the political agenda and a prime minister talking   about making social care free at the point of use.  However the icing started sliding off the cake when he spelt out that there would be no grand plan until the next parliament, it would only go ahead if he gets a mandate from the public, and he would be looking to make pensioners pay for much of the cost. Within a matter of hours concerns grew that the cake itself was half baked as Downing Street confirmed that Burnham was talking exclusively about older people. This leaves the 50% of disabled adults who are of working age out in the cold and has generated division, anger and mistrust. 

Burnham said little about the quality of care/support. What we definitely don’t want is free provision of the current institutionalised “care” people receive in their own homes as well as in residential establishments, which focuses almost entirely on basic physical needs. What matters most to all of us – relationships, activities, interests and skills rarely make it on to the job card of overburdened care workers on a median wage of £12 per hour. Their job satisfaction suffers as a result and staff turnover tops 30%. What also must end is the abuse of vulnerable, often learning disabled people. From routine individual cases of death due to neglect, lack of staff and training to major scandals from Winterbourne (2011) to Whorlton Hall (2019), multiple “Never Again” reports gather dust on backroom shelves.   

Choice and control, often referred to as ‘independent living’ (not to be confused with living independently), must be the axle on which a new “Care” service turns and genuine co-production the motor that drives it. The fact that neither Labour nor the Trade Unions seem able to get beyond the label “Care” is telling. Although snappy, it is shot through with deep seams of “done to” rather than “done with” and “get what you are given not what you want and need”.  The End Social Care Disgrace Campaign pitches for a “Care, Support and Independent Living Service” (NaCSILS) which isn’t perfect but feels closer to the mark.  

What does need to be on the agenda is a commitment to reversing the 84% privatisation of social care. Not only do private firms leach money out of the public purse, they shape provision, building large institutions to maximise economies of scale, cutting corners, depressing wages and lowering the quality of care. Of the 800 establishments closed down by the CQC between 2011 and 2023, all but twelve were in private hands. Privatisation also creates instability and insecurity as any of the 18,000 providers can collapse or pull out at short notice.

In addition, there needs to be recognition that a NaCSILS is not a stand-alone solution. National and local government need to work across all Departments to build human shaped, inclusive communities. 

Meanwhile around half the people requesting support are being turned down by cash strapped Local Authorities. Disabled people of all ages, as well as many of the estimated 10 million unpaid, largely unsupported carers are being impoverished, excluded, diminished and demeaned in what is a highly rationed, labyrinthine, top down system and millions are failing to get the NHS treatment they need because of around 13,000 delayed discharges. Waiting another three years for just a hint of jam tomorrow only adds to their misery.

Burnham has an opportunity to start making a serious difference now while laying down some tracks for the way forward. He could: 

• fund Local Authorities (LAs) to enable them to make domiciliary support free at the point of use, as in Hammersmith and Fulham Council together with Tower Hamlets, and drop the pursuit of care charge debts
• encourage and support LAs to work with disabled and older people, carers, care workers and local communities to develop imaginative, bottom up ‘not for profit’ provision, by cooperatives, micro enterprises, peer support projects etc. and set up a flexible menu of support for unpaid carers

• pursue an immediate rise in the pay of care/support workers to a minimum of £15 per hour,  proper training and career structures

• ensure that all sponsorship of care workers from overseas is transferred from individual providers to Government stewardship and rescind proposed extensions to the “leave to remain” qualification period 

• take bold steps to get the carers’ overpayments scandal sorted and justice restored now (not over a lifetime) while starting to look at providing a decent income for unpaid carers 

• robustly challenge the narratives that exclude and divide us one from another, blocking any radical transformation of social care. 

• reframe Social Care as a universal service that any one of us might need at any time, challenging the ‘othering’ and abuse of disabled people and recognising that valorising “working people” discounts  all the unpaid carers and community volunteers whose labour underpins failing public services   

• reject the fiscal rules straightjacket; nail  the harmfulness and failure of neo-liberalism, the unacceptable human costs of the current system in terms of insecurity, anxiety and misery as well as the money wasted on provision that is part of the problem rather than part of the solution

If Burnham is looking to walk in the footsteps of Bevan he will need a bolder, broader, more radical vision and the will to plough his own furrow, stand up to vested interests and refuse to be dragged down by a hopeless search for consensus. For the sake of justice and the safety, wellbeing and security of us all, we demand no less.  

Gilda Peterson is a campaigner with the End Social Care Disgrace campaign

Image credit: Lauren Hurley / Number 10 – Creative Commons