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| Adult social care is not a problem – it is a human necessity | Adult social care is not a problem – it is a human necessity |
| (3 days later) | |
| At the tail end of the last Labour government, the relevant limbs of the NHS were just starting to reach out to their counterparts in adult social care about bringing the services together. One of those negotiating on the NHS’s part reminisced: “It was going OK, but it was a bit like going on a first date, thinking, ‘we’ve certainly got a lot in common’, and then adult social care ending the evening with, ‘right, now we have to get married, because I haven’t got any money’.” | At the tail end of the last Labour government, the relevant limbs of the NHS were just starting to reach out to their counterparts in adult social care about bringing the services together. One of those negotiating on the NHS’s part reminisced: “It was going OK, but it was a bit like going on a first date, thinking, ‘we’ve certainly got a lot in common’, and then adult social care ending the evening with, ‘right, now we have to get married, because I haven’t got any money’.” |
| I have social policy nostalgia: not just for a time when public servants could say the word “reorganisation” without implicitly meaning “give it over to the private sector” (though I miss that too); nor for a time when public servants could have entire conversations without any thought for commercial confidentiality, and without using the words “low morale” (though, of course, ditto). No, I miss the time when it was taken as given that there were problems that would have to be solved. Yes, we had an ageing population, which would only continue to age. Yes, outsourcing the care of the elderly in the first place had been a huge mistake. Yes, the care sector was beset with injustices, and the NHS was often having to fill cracks at vast and unnecessary expense, and services would have to be joined up if they were ever to work. But there was, it seemed then, an underlying assumption that, even if this were not all soluble, it was at least the intention of every reasonable person to work together and try to solve it. | I have social policy nostalgia: not just for a time when public servants could say the word “reorganisation” without implicitly meaning “give it over to the private sector” (though I miss that too); nor for a time when public servants could have entire conversations without any thought for commercial confidentiality, and without using the words “low morale” (though, of course, ditto). No, I miss the time when it was taken as given that there were problems that would have to be solved. Yes, we had an ageing population, which would only continue to age. Yes, outsourcing the care of the elderly in the first place had been a huge mistake. Yes, the care sector was beset with injustices, and the NHS was often having to fill cracks at vast and unnecessary expense, and services would have to be joined up if they were ever to work. But there was, it seemed then, an underlying assumption that, even if this were not all soluble, it was at least the intention of every reasonable person to work together and try to solve it. |
| Related: Social care chief savages failing system for elderly | Related: Social care chief savages failing system for elderly |
| The tone is different now. At the weekend, Andrea Sutcliffe, the chief inspector of adult social care, described a sector that was “under stress and strain”, in which an ageing population with increasingly complex needs was only half the story. Serious problems also stemmed from the feedback loop of inadequate funding, delusional commissioning and undervalued care workers. Regulators receive more than 150 allegations of abuse of the elderly every day. “Treating somebody with dignity and compassion,” a department of health spokesperson responded, “doesn’t cost anything.” Except it does, or rather, hollowing out the funding of care, while speaking the language of compassion and decent conditions and fair wages, creates a situation in which not only are the services impossible, but those very concepts are undermined, exposed as lies, emptied of meaning. | The tone is different now. At the weekend, Andrea Sutcliffe, the chief inspector of adult social care, described a sector that was “under stress and strain”, in which an ageing population with increasingly complex needs was only half the story. Serious problems also stemmed from the feedback loop of inadequate funding, delusional commissioning and undervalued care workers. Regulators receive more than 150 allegations of abuse of the elderly every day. “Treating somebody with dignity and compassion,” a department of health spokesperson responded, “doesn’t cost anything.” Except it does, or rather, hollowing out the funding of care, while speaking the language of compassion and decent conditions and fair wages, creates a situation in which not only are the services impossible, but those very concepts are undermined, exposed as lies, emptied of meaning. |
| As much as £4.6bn has been cut from social care budgets over the past five years. Even before then, the funding was unrealistic – local councils were running scared of adult social care cost increases. They used to talk of the “graph of doom”, in which they plotted their funding against their social care spending. At some point over the next three decades – it varied according to geography – all the money would be swallowed up by care. But the fact is, different local authorities were responding with different degrees of creativity and ambition. There were councils who commissioned social care packages which simple arithmetic would have told them were insufficient to pay minimum wage salaries to the care workers. Charged with this, they would have pleaded impotence. What do you do, if the money simply isn’t there? You have to go with the lowest cost provider. | As much as £4.6bn has been cut from social care budgets over the past five years. Even before then, the funding was unrealistic – local councils were running scared of adult social care cost increases. They used to talk of the “graph of doom”, in which they plotted their funding against their social care spending. At some point over the next three decades – it varied according to geography – all the money would be swallowed up by care. But the fact is, different local authorities were responding with different degrees of creativity and ambition. There were councils who commissioned social care packages which simple arithmetic would have told them were insufficient to pay minimum wage salaries to the care workers. Charged with this, they would have pleaded impotence. What do you do, if the money simply isn’t there? You have to go with the lowest cost provider. |
| Any conversation that starts with 'ageing population' will end in the long grass, and that is deliberate | Any conversation that starts with 'ageing population' will end in the long grass, and that is deliberate |
| But there were other local authorities beginning to insource, others still commissioning from social enterprises (like the Sandwell Community Caring Trust); councils committing openly to paying a living wage. That trajectory, had it been nurtured, would have led inexorably to a conversation about how we raise the money collectively, in order to be able to care collectively. Instead, we have had a series of reports and debates and “hard truths” in which someone floats the necessity of each of us paying for our own care individually, which immediately becomes unsayable because the elderly are so rigorously pandered to by political rhetoric, while simultaneously sold out by political decisions. | |
| One thing is guaranteed: any conversation that starts with “ageing population” will end in the long grass, and that is deliberate. The best way to strip out public services without being challenged is to paint a picture that is as inexorable and predictable as the coming of winter. Then, erect a series of incompatible half-truths: we love pensioners, but we are happy to segment their care into units of 15 minutes; we care desperately about a living wage but unfortunately haven’t any money to pay it. Pretty soon, that debate is impossible to have. | One thing is guaranteed: any conversation that starts with “ageing population” will end in the long grass, and that is deliberate. The best way to strip out public services without being challenged is to paint a picture that is as inexorable and predictable as the coming of winter. Then, erect a series of incompatible half-truths: we love pensioners, but we are happy to segment their care into units of 15 minutes; we care desperately about a living wage but unfortunately haven’t any money to pay it. Pretty soon, that debate is impossible to have. |
| Related: Britain must invest properly in adult social care | Letters | |
| We need to start somewhere else: remind ourselves that caring for the elderly has always been part of the social journey, and any pride and security we take from the concept of society is within that wholeness, the fact that no one gets cut adrift. We have never been averse to paying for this collectively, and aren’t now. The creativity of social enterprises and local authorities is both excitingly modern and reassuringly timeless – this, after all, was how the welfare state was built, from the formalisation of autonomous initiatives in which communities cared for each other. | We need to start somewhere else: remind ourselves that caring for the elderly has always been part of the social journey, and any pride and security we take from the concept of society is within that wholeness, the fact that no one gets cut adrift. We have never been averse to paying for this collectively, and aren’t now. The creativity of social enterprises and local authorities is both excitingly modern and reassuringly timeless – this, after all, was how the welfare state was built, from the formalisation of autonomous initiatives in which communities cared for each other. |
| Care workers are routinely portrayed as very low-skilled, almost sub-skilled; this is just a ruse to account for their low pay. In fact, care work requires many skills, both hard and soft, and anyone wishing to dispute that statement needs to spend one morning doing it. This could be a fulfilling career for millions of people, if only we could ensure that there wasn’t a profit-seeking layer over the top of them, screwing down their wages. | Care workers are routinely portrayed as very low-skilled, almost sub-skilled; this is just a ruse to account for their low pay. In fact, care work requires many skills, both hard and soft, and anyone wishing to dispute that statement needs to spend one morning doing it. This could be a fulfilling career for millions of people, if only we could ensure that there wasn’t a profit-seeking layer over the top of them, screwing down their wages. |
| The precondition for all of that is optimism: conceiving a future in which social care isn’t a huge problem that is simply managed as it gets larger, but is recognised for what it is: a set of relationships, as human, as meaningful and as warm as any others. | The precondition for all of that is optimism: conceiving a future in which social care isn’t a huge problem that is simply managed as it gets larger, but is recognised for what it is: a set of relationships, as human, as meaningful and as warm as any others. |
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