What should the future of social care look like?
Lib Dem leader Ed Davey has managed to generate a fair bit of interest after appearing on Sunday with Laura Kuenssberg and promoting the idea of an increased minimum wage for care staff.
During the interview, Mr Davey explained that "when I go and talk to people the biggest thing is the NHS crisis. Non-one thinks there is a silver bullet, a quick fix, but our policy to increase the minimum wage for carers - an extra £2 per hour - would deal with one of the big problems: namely, we don't have enough carers. If we get these care workers, by paying them decently, then we can ensure that people can be discharged from hospital and we can deal with the waiting lists."
In an e-mail to party members and supporters, Mr Davey added: "One in seven UK adults has had to stay at home to look after a relative over the last 12 months due to a lack of care workers. One in seven. That is startling.
"I have spoken before about my experience of being a family carer. When I look at the problems facing our country, I do so through a carer’s eyes. Being a carer of any sort is hard work. The tireless work of family carers helps ease the pressures on our health and social care systems, and our economy. That is the wrong way round."
He added: "The Liberal Democrats are calling for a new Carers’ Minimum Wage. Under our plan, social care workers would be paid at least £2 an hour more than the current minimum wage.
"The Conservatives have caused workers to flee the social care sector. Our plan would help attract workers to it. Our policy would reduce the staggering 165,000 vacancies in social care. This would ease pressure on family carers and other services in crisis such as GPs, A&E departments and ambulance services."
As Laura Kuenssberg herself pointed out, "everyone would think 'I like the sound of that'". But there are real questions to be asked about the future of social care services that really aren't be answered here, and not only Laura's question "but how will you pay for it?".
Ed Davey, in his e-mail, asked "Why are we in this position?" Unsurprisingly, he went on to blame the Conservative government. Admittedly, the government has little idea about where to go with social care, but it is hardly alone in this. The opposition's plans are poorly developed. Successive governments since the early 1990s have done very little as far as investment in social care is concerned. If you want to understand why private sector social care staff are paid so poorly, you only have to look at how social care is funded.
My issue with what Ed Davey is saying isn't that I disagree that care staff need a decent wage. It's that his solution is just a sticking plaster and that he talks as if the system was fine until these awful Tories came along...
Our social care model has been "collapsing" for years. Admittedly things are getting worse, and it's impossible to disagree with Mr Davey that "care homes were treated appallingly during the pandemic". But he is completely wrong to refer to the struggles of the care sector as "a Conservative-made mess".because it is the product of three decades of neglect. Mr Davey talks about the Conservatives "destroying our social care system" but the system hasn't fit for purpose for at least 25 years, if it ever really was. A radical Liberal party should be proposing an overhaul of the entire system, not keeping it as it is while paying carers a little more.
The Lib Dem leader told Laura Kuenssberg that he would fund the Carers' Minimum Wage by "asking the gambling industry to pay more tax. The gambling industry is causing mental and physical health problems, posing a charge to our NHS, and therefore it's a good idea to ask them to pay more so we can pay carers more. The £2 per hour extra for carers would make a big difference... we can then recruit and retain more carers. You can't sort out the crisis in the NHS unless you sort out the social care crisis."
Indeed. But, similarly, you can't "sort out the social care crisis" without a complete rethinking of how the social care system works.
My wife works in social care. I have, in the past, worked minimum wage jobs in care homes. Of course we'd welcome an increase in carers' wages. But increasing taxation on one specific industry (there are many others that also are responsible for causing mental or physical health problems) not only seems illiberal but insufficiently imaginative. And the "solution" is unlikely to have the effect Mr Davey thinks - a mere £2 per hour, while a positive gesture, is unlikely to be sufficient to deal with the problem social care has always had in recruiting and retaining staff.
15 years ago, when I was a student, I worked night shifts in a care home. Every week there was a new member of staff. If they lasted a month, we were doing well. The company who owned the home was dependent on recruiting care staff from Poland and the Philippines, sometimes on medium-term contracts, who were happy to work for the UK minimum wage and put in far more hours than the regular 48 per week. It was not what I'd call a sustainable model. Workers who were attracted to the idea of caring often didn't stick around because of the realities of what care work is actually like and the way care staff weren't valued (not even by their employer in this case). Why work in such a demanding environment when you can work elsewhere for the same (or better) money?
Sadly, in the same home, several members of staff were later found guilty of serious abuses of residents in their care. This abuse took place over a period of a couple of years. Why did it happen? Because of a complete lack of scrutiny and regulation, and because staff who were willing to work ridiculous hours beyond the recommendations of the European Working Time Directive were too valuable to the company. Earlier complaints against such people were dismissed because they were indispensable, and often complainants (generally excellent carers) left instead. The problem of recruitment and retention is not new.
Put simply, I'd need to be paid a lot more than £2 above the minimum wage to go back and work in such a place.
It's not difficult to understand that uncompetitive pay is a problem. Even care providers see that. But fixing the problem is not so simple - if only an offer of £2 per hour would lead to the recruitment of 165,000 new care staff and - KERBANG!!! - the NHS crisis is also instantly resolved. If only political solutions were so straightforward. Ed Davey talked about there being "no silver bullet" but then produced one. What increasing the minimum wage for carers won't do is deal with other fundamental problems. It's won't address how staff are treated: for example, the issue that private sector social care staff are three times more likely to work on zero hour contracts. It won't address the problem that care providers themselves are often starved of funds. And without systemic change some of our poorest workers will still be pretty poor workers under this proposal, with little scope for career development or progression. Mr Davey doesn't seem to grasp why care work is so unattractive - it's not just a question of pay rates.
My wife currently works in an independent living project. Every two years the council-run project is put out to tender in what is effectively a reverse-auction. The provider offering to run the project most cheaply is successful. In real terms, the wages of care staff at their project have fallen as the minimum wage has caught up with their once generous pay. The permanent revolution of the last few years as providers come and go (with two actually going bust and unable to complete their contracted terms) has meant that the scheme has had more managers in the last four years than Watford Football Club. The problem that Mr Davey needs to address is not the gambling industry, but the way social care is financed, the way care and carers are valued more widely, and the way in which providers themselves are funded. It's difficult to invest in your staff when the budget you receive from the local authority is not only woefully insufficient but hasn't even given thought to potential wage increases.
I was pleased to hear Ed Davey speaking up for carers. But I'd prefer to hear him explain how social care services can be developed to provide improved training and opportunities for career development/progression for staff, how workforce pressures can be relieved, how stability can be provided for the social care sector, and how providers' budgets can be increased so that they can provide incentives and invest in people. As long as social care is woefully underfunded, care will never be an inviting or rewarding career route, and that's an absolute tragedy.
What do I propose?
Ed Davey (and, indeed, Keir Starmer) need to keep an eye on what is happening in Scotland. The proposals for a National Care Service provide some reasons for positivity. They may not be perfect but, after three decades of social care being ignored, at least the Scottish parliament is attempting to get to grips with it. Elsewhere, social care has become a hot potato that no-one wants to handle (there was a reason Jeremy Hunt so so keen to kick some reasonably well-developed proposals into touch in November last year).
What Scotland's National Care Service would seek to do is improve "the effectiveness of local authorities’ commissioning practices and their ability to shape a market that is responsive to people’s wants and needs", rather than continuing to depend on a system developed in the aftermath of the NHS and Community Care Act 1990. It hopes to "drive consistency and quality by setting a vision, standards and direction for the social care system at a national level". Significantly, it will aim to "support the delivery of the Fair Work convention that aims to improve the terms, conditions, and pay for the workforce in Scotland." Care boards will be established at local levels to aid integration of social care services. Unpaid carers will be given a right to breaks under the proposals. What the National Care Service fundamentally is being designed to do is "make a commitment to placing human rights at the heart of services" and "frame social care as an investment, rather than a burden". In that respect it represents a massive step forward.
The legislation is still under discussion, and I have some concerns about the make-up of care boards, moving some accountability from local to national levels, the current lack of detail about workforce reforms and what exactly the proposed integration between social and health care will look like. There is no proposal (as yet) to introduce changes to eligibility and charging. There are many unanswered questions, and work will have to be done and some compromises inevitably made to keep everyone on board. The passage of the bill is unlikely to be smooth, with significant detail still to emerge. However, this represents at the very least a determination to take a new direction. Westminster politicians should acknowledge what is happening and seek to facilitate similar discussions on how to reshape the way social care is delivered. Let's be realistic, what is currently being discussed at Holyrood - however fraught the conversations is - is much further-reaching that Mr Davey's headline grabbing quick fix. MSPs are engaging with difficult questions, but they are questions that deserve answers.
I don't think we have to support the SNP's frustrating approach to service design, or their centralising instincts, to accept that a National Care Service is a good idea in principle. A more liberal model is possible.
I would hope that every constituent nation within the UK could introduce a National Care Service, or at least a national "umbrella" system of some kind that brings stability, investment and innovation to the social care sector. These could all be slightly different in some respects, and I would hope they could be designed to allow scope for an element of local or regional flexibility. I believe there must be some localised control within a national framework and that a National Care Service need not look like the centralised bureaucratic project the SNP is proposing. The system needs to be made more generous, with changes made to how - and how much - care users pay. But it also needs to be more responsive to the needs of those who working within the social care system, who have been neglected for far too long.
Ed Davey is absolutely right - social care has been criminally underfunded - but we need solutions rather than sticking plasters. We also need politicians who can deliver more than empty promises. In 1997 Labour promised social care reform; Blair's government established a royal commission and then did nothing. In 2010, the Conservative-Lib Dem coalition appointed an independent commission; the Dilnot Report it produced made the not entirely radical recommendations to introduce a cap on care costs (at £35,000), introduce a more generous means-tested threshold and "end the postcode lottery" through the introduction of a national threshold for care eligibility. The recommendations were sensible and uncontroversial, yet nothing happened. Legislation was initially due to be implemented in April 2017 and was later brought forward by a year. But still nothing happened. Conversations stalled. Plans for green papers came to nothing. Then, when Boris Johnson came to power, he announced he had a plan, which was not too dissimilar to the Dilnot Report. A date was even set for implementation: October 2023. But then Jeremy Hunt had a rethink, and apparently there are other priorities at the moment. The can has - once again - been kicked further down the road. Meanwhile, social care is unravelling.
We are where we are because of a succession of political failures. Unfortunately, this is not merely a political tragedy but a human one.
Ed Davey is correct in that the way we treat people who work in - and depend on - social care has to change. But that change has to be meaningful - not simply retaining the status quo while giving those on the minimum wage a moderate increase. Wage increases without the necessary structural and cultural changes will change very little. What's needed is ambitious thinking - the kind of thing the Scottish parliament is doing right now.