It’s time to make the case that a Guaranteed Living Wage (GLW) should be paid to all carers whether they are family members, domiciled or private sector workers. This idea can also form the basis of a new national model of social care which shifts provision away from care homes in the private sector back toward families and communities.
Social care faces a great crisis in social and economic terms. A joint report produced by Local Government and Health and Social Committees recently called for a 3% ‘Social Care Premium’: a levy to be placed on the over 40s to pay for the spiraling costs of a growing proportion of elderly and those with mental and physical disabilities now estimated at 400,000. After they originally pledged to introduce this plan back in June the government are now back-sliding on the introduction of its Green Paper which was due this autumn.
The present model which relies on private and charity based care home providers and has 11,000 care homes is now clearly unsustainable. Annual costs to councils were estimated at £17.5 billion for the last financial year and 40% of total NHS spending is now allocated to elderly care. Of course, this SCP simply repackages the Tories’ plan for a ‘Dementia Tax’ to pay for social care that backfired so disastrously in last year’s GE campaign.
So how did we reach this crisis point?
Social care has been badly hit by severe government cuts to council budgets. Overstretched services are also heaping pressure on the NHS while there isn’t enough capacity to provide home-support and nursing care when patients are well enough to leave hospital. The present model whereby the state funds private care homes to look after us has hit a brick wall as last year’s Conservative General Election campaign and their plans for a ‘Dementia Tax’ suffered a considerable backlash from a wary general public.
In the run-up to the 2008 financial crash large chains of private care-home providers borrowed heavily from banks to build up huge property portfolios that became over-valued and unprofitable after the slump in property prices. When Southern Cross imploded six years ago cash-strapped local councils were left with the responsibility for 750 care homes after its owner the private equity firm Blackstone walked away with profits of over £500 million. It’s clear that the present monetarised system of private healthcare provision based around a now deflated property bubble is unsustainable as it presently stands
Private care providers like Four Seasons Health Care, Valley View and BUPA have all experienced similar financial difficulties and have also cut the number of care places available, while accountancy firm Moore Stephens estimate that one in six UK care homes is at risk of failure. Within the last few months cracks have started to show at some of the country’s biggest providers which are now laden with debt from over-borrowing in the property market.
How would it be run?
The solution lies in placing less reliance on this private based model and wherever possible the setting up of community based groups around existing families that may be able to provide social care for their relatives. This could be regulated by existing GP Trusts. At present, there is also the burden of care responsibilities placed on family members. For many relatives or friends the financial strain and lack of support within this role makes care an impossible task.
Families and communities have always provided a bed-rock of support during periods of economic hardship – this communitarian ethos is the basis of social solidarity after all. Why not harness these resources for the greater good. Where possible, family members, relatives or friends of those who require social care should be given state support to care for their loved ones along with payment to their carers of a Guaranteed Living Wage. This rate should also be paid to all carers presently working in private care homes as a matter of right to provide a benchmark salary that cannot be undercut by private care providers.
Social and Economic Advantages
The social and economic benefits of this alternative model are potentially great. This scheme shifts social care back into the home where possible by providing greater incentives and security to relatives or friends who would wish to provide social care to members of their families and communities. It could be regulated under the present system of GP Trusts which could provide local hubs for its implementation in communities where strain on the private social care system is most acute as a series of pilot schemes.
After all who is better suited to assess the care needs of patients and the suitability for the role of those who care for them than GPs and support staff in the existing Trusts and Clinics that we have at present? Social callers could be on stand-by for any care arrangements that run into difficulty. Carers could also receive training and support through secondment to colleges which could potentially be supplemented with formal qualifications in social care.
The provision of skills training and qualifications required for this scheme could also run in conjunction with Labour’s policy for a National Education Service. It offers a potential solution embedded in local communities that can be run from the ground upwards. This would allow potential variations in care packages to take place according to different carer-patient needs on a more specific case by case basis.
One of the social benefits of this scheme is that it could improve the lives of hard pressed family members who could overcome the financial hardship of leaving employment to look after their patients. The lives of the patients themselves would also improve knowing they are in the care of their loved ones. The New Economics Foundation (2009) produced a study of the social impacts of particular employment roles in relation to the value and well-being they create in society. It found for every £1 invested in social carers £7 in value in the form of positive knock-on effects is created in their community. Surely, the benefits provided by carers justify the implementation of this scheme?
In hard economic terms the average cost of one place in a residential care home is £32,000 rising to £44,000 per person, per year when nursing and dementia care is included in the package (Paying For Care, 2018). There are also regional variations which mean in the North East it costs anything from £568-697 while in the South East it costs from £732-£1052 to keep one person in private residential care depending upon their needs.
This can surely be achieved more cheaply using existing NHS resources, families, and communities. It’ll also give extra disposable income to be spent in their own communities. This will circulate to generate even greater income and be distributed on a more equal and local basis compared to the tax-avoidance and exemptions enjoyed by the private care sector. This policy is in line with the objectives of the Labour Party and People’s Assembly who both called for the closure of a £44 billion ‘tax-gap’ (HMCR, 2018) that is exploited by the owners of private residential care homes.
Although still embryonic, if implemented correctly the overall social benefits of this idea are potentially immense and could represent considerable cost savings to the state. This scheme embodies our shared objectives of helping to reverse the privatisation of the NHS and social care services. It also places these services under the democratic of communities in a more sustainable social care model which places people rather than competition at its centre.