It is encouraging in many ways to see that there are so many organisations that have been set up to defend the NHS locally and nationally, support the NHS, save the NHS, reinstate the NHS and to keep the NHS public. Many have done great campaigning work and kept at the forefront the guiding principles and values that we all support. Support for the NHS comes from trade unions, and political parties. It is essential that we continue to campaign for the NHS.

But what of social care?

The NHS has been through a difficult period coping with funding at its lowest level for decades. But it was protected from even deeper cuts elsewhere in the public sector and had roughly flat funding over the last parliament. Social care funding has been CUT by one third.

The NHS is seeing some increases in waiting times and some restrictions on access to ‘marginal’ services, but for the most part people can see their GP, they do get referred to hospital, they are seen far more quickly than they would have been even ten years ago, the ambulance turns up for emergencies, over 90% wait less than 4 hours in A&E; there has been no increase in scope for any charges, no general restrictions or rationing. The NHS is no longer improving and quality of care is beginning to be compromised by the current financial position. But more money is promised and additional early additional funding is being lined up through wheezes like raiding capital budgets.

Compare this with the fact that 400,000 people are being denied social care services they would have received just a couple of years ago. This also fails to count many more who no longer see any point in even applying for help. The threshold for providing care being applied by local authorities is getting ever more onerous and in many places only the most critical needs will even be considered for support. Cuts affect all age groups, not just the elderly; they affect those millions giving care as well as those who need the care.

Cuts in social security and restrictions around housing and all the other consequences of austerity just make these problems worse. And we know it is getting even worse still. In every part of the country the frail, elderly and vulnerable are suffering directly as a result of cuts to funding of social care – now. Support promised for those that carry out care and so contribute countless £bns has not been forthcoming.

As cuts in funding bite into the already privatised social care system we see poor terms and conditions for staff getting worse and we see private providers signalling their intention to pull out, often leaving huge problems for the local authorities to clear up.

Making things worse in the longer term are cuts to Public Health budgets which are about to be reduced yet again.

If the government kept its pledge to maintain NHS spending (which is highly questionable) they totally failed to meet their commitment to improve social care; changes promised in the Care Act will not now be implemented until 2020 if ever. The £6bn of funding promised to implement the Care Act changes has disappeared. We have heard no promises from the government about additional money for social care – if there is any it will only come from raiding NHS money.

The only time social care appears to get mentioned is when it is claimed that poor social care is making things more difficult for the NHS. This is important but not as important as the fact the millions are suffering unnecessarily.

Nobody voted for the destruction of our social care system. As one of the richest economies in the world we should be extending the scope and scale of publicly provided care not reducing it.

So it is time for the labour movement and the campaigners to have a wider view.

We have to campaign for a just and fair care system as a whole not just defend the NHS bit. There are no solutions to the current problems the NHS has to confront unless issues in all other parts of the care system are addressed.

So we need campaigns to save our social care with the same vigour and enthusiasm as we have seen for the NHS – and we need them soon.

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  1. bhfisher says:

    How can wee get people on the streets about this wanton destruction. This is how austerity kills people.

  2. Steve Iliffe says:

    It is difficult to see why the masses would rise in defence of a service that most do not use. Social services work in difficult and uncomfortable territory – like safeguarding vulnerable children and adults, containment of severe mental illness, and support of the frail. Social care is predicated on the primary role of families in care of the very old, in particular, with a secondary role for the State. And its delivery is in the hands of commercial organisations. Care homes have three times as many beds as the NHS, and 90% are in the commercial sector. The unprecedented improvement in the incomes and resources (especially home ownership) of the older population means that the market has been able to meet the needs of many. Whilst “pensioner poverty” is a fraction of what it was a generation ago, the public social care resources available to those older people with low incomes are smaller still.

    The current pressure from the NHS Confederation for more resources to solve the bed occupancy problem has high level backers, like Stephen Dorrell. Trusts with wards full of people who are medically fit for discharge but with nowhere to go are losing money, but they do seem likely to get short-term funding to resolve this crisis from the coming spending review, because the publicity is bad for a government with a small majority that is dependent on the grey vote. Labour will presumably support the crisis funding, but no doubt point out how longer term solutions are needed.

    Long term solutions are to hand. The Barker Report on social care, published in 2014, argues that the market in social care has failed and is explicit in its rejection.

    The Barker Report describes relationships between health and social care as opaque, inefficient, inequitable and weighted towards individual rather than collective responsibility. It argues that social care needs more generous funding, and that it should be based on the principle of solidarity. The option of developing insurance ‘products’ that allow individuals to prepare for their future care needs is dismissed as unrealistic, given the insurance industry’s lack of interest and the public’s reluctance to buy them.

    The Barker Report proposes making personal care for people with substantial and critical needs free, requiring an additional £3 billion initially, rising to £14 billion by 2025. It proposes a decade-long, staged, taxation-funded reform of social care. The first steps would be to restrict Winter Fuel Allowance and free TV licences to those on pension credit. National Insurance contributions for those aged 40 and over and for the higher paid would be increased, and re-introduced for those working beyond state pension age. Additional funding could come from new wealth and property taxes, and more attentive collection of inheritance tax.

    The alternative approach of charging for NHS services is rejected except for the prescription charge, which the Report thinks should be reduced to £2.50p per item – “less than the price of a posh coffee” – but with many fewer exceptions. Currently only 9.4% of prescriptions are paid for. Finally, the Barker Report wants a single, ring-fenced, combined budget built from NHS money, local authority social care funding and the Attendance Allowance, to be disbursed by a single local commissioner, most probably based in local government.

    There may be things in the Barker report that some SHA or Labour activists dislike, but it seeks to restore a sense of decency and justice to society by reducing inequity in the care of older people with complex needs. This will require rolling back the (failed) market and replacing it with just taxation of wealth, in a stepwise way over a decade. There’s a lot to like there.

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