We do not wish to reinvent the wheel. Keep Our NHS Public and the Socialist Health Association are launching National Care Support and Independent Living Service on 10th October, The TUC and the Labour Party, through Reclaim Social Care, have good policy on how social care should be organised which Doctors in Unite would be able to broadly align with.
Doctors in Unite believe that the current model for social care is not working and that this has been brought into sharp focus during the COVID 19 Pandemic. Care homes bore a huge burden of deaths during the first wave, for many reasons, but not least due to the fragmentation that privatisation has imposed on that sector. This has led to a lack of local capacity and national coordination of care for some of the most frail and vulnerable in society.
Social Care at home is in a similarly parlous state. Domiciliary care is also largely outsourced to the commercial sector and provided by a workforce on extremely low pay, poor conditions and zero hours contracts. Many workers are not paid for the time they spend travelling between clients. Workers have too little time to spend with clients and it is difficult for them to build trusting relationships.
We believe that:
- Care is a basic human right and is good for society as a whole. There must be a national care service which is publicly funded, publicly provided and free at point of need. It should be paid for out of general taxation and years of underfunding must be reversed. The Keynesian Multiplier for care service is substantially higher than the 2.5 figure at which spending is self-funding because for every £1 spent on the service the economy benefits by £2.50 which generates £1 in taxation. Within reason, spending on services with a multiplier above 2.5, such as health, care, environments, education and welfare actually reduces the deficit and so is money well spent.
- Private/for profit care services should be brought back into public control.
- The national care service must be subject to local democratic control. Users, their families and workers, through their trade unions, must have a strong voice and local councils must be accountable. Neighbourhood health committees should be set up as we suggest in our earlier paper “Public Health and Primary Care”. https://medicalpractitionersunion.files.wordpress.com/2020/05/public-health-and-primary-care.pdf The service should be funded centrally but organised locally.
- Users and their families must be at the centre of their care, which should be personally directed and flexible, but not through personal budgets. We acknowledge that users are usually best placed to determine the care that they need but we are concerned that personal budgets can be unnecessarily expensive and bureaucratic to administer and will give some an economic advantage over others with equal need. Everyone should be able to access the care that they require in the way which is most suitable for them as individuals without the need for personal independence payments. We would like to work with disability action groups to develop personally directed care while taking the economic inequalities out of the system. There must be proper funding and support in place to enable users to access the system and find services that meet their needs.
- There is a broad spectrum and continuum in social care needs Doctors in Unite believe that the natural home of social care is within the local authority not the health service. Nevertheless, where necessary, a National Care Service and the NHS should work collaboratively for the needs of a user. There is no need to merge the two services. It is unhelpful to classify a need as either social or medical, a need is a need. Services must be properly funded so that if someone needs a bath they get help with a bath without the historical arguments as to whether the need for that bath is social or medical.
- The National Care Service should be funded sufficiently so that people can be supported to live independently if they wish. People should not be pressured to go into a care home because services, such as night sitting, are not available in the community or deemed too expensive. Similarly, residential care home options should be available if this is what people prefer and need.
- Care must be dignified and both residential and domiciliary care should be comfortable, homelike and run by the local authority. Many small locally run services strive to provide this though often they struggle to remain viable. Bringing these providers into public ownership whilst maintaining their ethos would provide stability for staff and clients. Proper service planning would also end the geographic perversity such that residential care homes are set up not where they are needed but where the real estate is cheapest, meaning long journeys for relatives to visit their loved ones distant from where they live.
- Domiciliary care should be brought back into social ownership under Local Authority control immediately. As already stated, users and their families must have a strong voice as well as fully engaging with care providers.Existing small locally run businesses could be organised to work collectively as not for profit cooperatives. Current owner managers could be employed by the publicly owned National Care Service with a national wage structure rather than owning the businesses. We think that many might prefer this as their jobs would be less precarious. A national care service should capture the ethos of the smaller organisations, providing comfortable homely care but relinquish the current commercial economic model. Smaller providers often aren’t able to respond to crises and weren’t prepared for the pandemic, for example, they had totally inadequate supplies of PPE. A national care service should take the best of all the models, be properly funded and brought back into public ownership.
- Under a National Care Service care workers must be properly paid, we support an immediate 35% pay increase. Care workers must have a proper career structure with progression and training which must be funded and transferable, including into the NHS. These must be nationally agreed, along with terms and conditions, as is the case with Agenda for Change in the NHS. We would like to see an end to all zero hours contracts, though acknowledge that some workers do find their flexibility helpful. We therefore would support an opt in to a zero hours contract after three months of working, as is currently available in Wales.
- All social care vacancies must be filled within a year.
- Last but by no means least we must note that a large proportion of care workers are overseas migrants, many with precarious residency in the UK. Without these people a National Care Service could not function. We demand that they are all granted permanent status immediately and that care workers are regarded as essential workers for immigration purposes.
APPENDIX 1
KONP/SHA NACSIL demands:
Publicly funded, free at the point of use Publicly provided, not for profit
- Nationally mandated but designed and delivered locally
- Co-produced with service users and democratically accountable
- Underpinned by staff whose pay and conditions reflect true value & skills
- Meets needs of informal carers Sets up an independent living task force
APPENDIX 2
Reclaim Social Care policy and demands:
https://www.reclaimsocialcare.co.uk/policy/
Reclaim Social Care is clear that the country requires social care to be:
- based on supporting independent living for all
- free at the point of use
- paid for, like the NHS, through central taxation
- brought into the public sector
- staffed by people well supported and with a positive career structure
- with financial support for voluntary carers
Reclaim Social Care composited the below motion which is now Labour Party Policy:
SOCIAL CARE COMPOSITE RESOLUTION PASSED AT LABOUR PARTY CONFERENCE SEPTEMBER 2019
This was brought together from motions from across the country, many based on Reclaim Social Care’s text. It is now Labour Party policy.
Conference notes the current postcode lottery of Social Care funding and the real hardship and unfairness this causes, impacting on the most vulnerable within our society reducing life expectancy, health outcomes and wellbeing.
Labour to develop a universal care and support service working with user groups, in collaboration with a national independent living support service and available to all on basis of need, based on Article 19 of the UNCRPD.
England’s social care system is broken. Local Authorities face £700million cuts in 2018-19. With £7billion slashed since 2010. 26% fewer older people receive support, while demand grows. Most care is privatised, doesn’t reflect users’ needs and wishes, whilst charges increase.
Disabled and elderly people face barriers to inclusion and independent living, thousands feel neglected. 8 million unpaid, overworked family carers, including children and elderly relatives, provide vital support.
Make the provision of all social care free to recipients as is the case for health care under the NHS.
A service:
- That provides a new universal right to independent living
- Enshrined in law and delivered through a new National Independent Living Service co-created between government and service users.
Consequences of marrying social care to the NHS include medicalisation, isolation, indignity, maltreatment, bringing social care under a struggling NHS umbrella is not the answer.
Transfer responsibility for funding social care from the LA to the national exchequer through progressive taxation.
Distribute funding to the LAs for social care on the basis of the population served (age, sex and deprivation) and the cost of care.
Locally democratic and designed by service users and carers in partnership with LAs and the NHS, delivered as far as possible by service users.
Publicly, democratically run services, designed and delivered locally, co-productively involving local authorities, the NHS and service users, disabled people and carers.
Providing staff with nationally agreed training qualifications, career structure, pay and conditions.
Fund social care to provide a pay rise of at least 35% to all care workers.
Giving informal carers the rights and support they need.
Conference resolves that within the first term of a new Labour government to provide a universal system of social care and support based on a universal right to independent living.
https://www.reclaimsocialcare.co.uk/a/40563951-40565561
Summary
- Social care is in a deep crisis created by severe cuts enforced on local government by central government and the failure of the system to defend itself from these attacks.
- Integrated care is now proposed as a solution to the social care crisis, but not only is it not the answer, but it will harm, both social care and the NHS itself.
- Social care is a distinct public good state and it needs to be organised in ways that recognise its strengths and its role as an agent of citizenship for all.
- The problems facing social care today are the result of decades of poor policy-making and the refusal to put social care on a level footing with the NHS and other services.
- The resources necessary to transform social care into a universal public service are modest and can easily be achieved with the necessary political will.
- Universal social care should be implemented alongside a range of other reforms, including the reintegration of social care for children and adults.
- Creating the case for a decent social care system also demands the creation of a wider alliance for change and systems that can protect the system in the future.
- Better coordination of health and social care services will only occur if the NHS itself begins to work more effectively with citizens, families and communities.
APPENDIX 3
TUC Key recommendations:
https://www.tuc.org.uk/research-analysis/reports/fixing-social-care
Key recommendations
- A new funding settlement: This year’s spending review should fully offset the cuts of the previous decade and establish future rises at a level that will allow local authorities to meet rising demand and improve pay and conditions for staff.
- Immediate funding to fill all social care vacancies: In a time of rising unemployment, social care could provide a steady source of new decent jobs. The government could act now to unlock 120,000 existing vacancies, to help those losing their jobs.
- Fair pay and conditions for care workers: To provide sustainable livelihoods and an attractive career, all social care workers must get a sector minimum wage of at least £10 per hour. There must be an end to the zero-hours contracts, and poor or non-existent sick pay that put social care workers at risk during the pandemic. And all social care workers must have guaranteed opportunities for training and progression.
- A national Social Care Forum: A new body is needed to bring together government, unions, employers, commissioners and providers to coordinate the delivery and development of services, including the negotiation of a workforce strategy.
- A reduced private sector role: The government should strengthen rules to prevent financial extraction in the care sector and should phase out the for-profit model of delivery, so that all public funding is used to deliver high-quality services with fair pay and conditions for staff.
- A universal service free at the point of use: The changes above can be made quickly. Longer-term, the government should make social care a universal service, paid for through general taxation to ensure high-quality social care can be quickly accessed by everyone who needs it, in every part of England, without any variation in cost and qualifying rules.