All eyes are on the NHS this election, with all the main parties promising big funding increases to support it.
But what about the social care system, which is also in crisis?
After the last election, government promises to reform and transform social care were significantly watered down.
But this is a problem we have to fix, as Britain’s ageing population puts more pressure on a creaking system.
So what solutions would we like to see parties adopt?
It’s always going to be about money - how much is needed, and who is going to pay.
The population is ageing, with demand for social care set to rise by as much as 60 per cent in the next two years.
There are more people to care for, and those with multiple and complex care needs are living longer.
This should be celebrated, but if we’re to cope with rising demand we need to radically overhaul the current system to make it fair and sustainable.
Social care, unlike the NHS, is the responsibility of local authorities. That means those above the threshold are left to meet costs themselves, which can be very high if this involves a prolonged stay in residential.
But between 2009/10 and 2017/18, there was a 38 per cent fall in central government funding for social care to local authorities.
Although the government recently provided an extra £1.5bn for adult social care, this is another case of a short-term funding injection to patch up the problem.
The King’s Fund estimates that £2.5bn is needed just to maintain current service levels. And the Health Foundation estimates another £10bn would be needed by 2023/24 to restore services to pre-austerity levels, including pay rises for the workforce.
That’s why we need a free universal service for domiciliary and residential care, paid for through progressive taxation.
This would require a commitment of two per cent of GDP (current spend is 0.7 per cent), bringing us in line with countries such as Japan, the Netherlands and Sweden.
It would support economic growth in every part of the country through good jobs, as well as create savings for the NHS.
The adult social care market is hugely fragmented: cash-strapped local authorities currently commission care services from 20,000 different providers. This drives down costs below sustainable levels and encourages spot contracting rather than a holistic view of what care a person may need.
This short-term thinking, within a profit-driven market, means that local authority commissioners are unable to establish long-term relationships with good-quality providers. Instead, they are being pushed towards outsourcing models to make short-term savings.
Ultimately, this impacts people receiving care as well as those delivering it, who are forced onto low-paid and insecure contracts.
Social care services should be provided in-house by default. However, given that over 85 per cent is currently outsourced, there are questions over local authorities’ ability to achieve this.
Care should be commissioned to promote social value and employment standards, enabling longer-term partnerships between local authorities and quality providers, with a voice for service users and the care workforce. Innovative approaches to care should also be promoted.
Adult social care employs 1.49 million people in England. Pay is low - the median hourly rate increased by just over £1 an hour in real terms over a five-year period. 28 per cent of care workers are on the minimum wage – almost double what it was two years ago.
In fact, many don’t even receive minimum wage as they are not paid for their travel time between home visits. Insecurity is rife. One quarter of adult social care workers are on zero-hours contracts, rising to 50 per cent among domiciliary care workers.
Providers are struggling to recruit and retain workers, levels of training are low and there’s a significant dependence on EU nationals.
Surveys show that service users want continuity of staff and carers - but the current system can’t provide that.
We need to overhaul the sector by having a proper workforce strategy, including collective bargaining that supports standards, productivity and workforce development. This would ensure workers are valued and paid at the level of other comparable public services.
We need investment in training, formal skills accreditation to enable proper career progression, and a proper pay and grading structure.
With 82 per cent of social care workers being women, collective bargaining can tackle the gender pay gap, ensure professional skills are recognised and help families make ends meet. This is the best way to prevent social care becoming an isolated, low-paying sector.
Essentially, we need to treat social care as the key public service it is - used by and employing millions of people across the country - and not just as an afterthought.
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