Another year draws to a close and Britain’s social care system stumbles on, unloved and ignored by the new Government.
The social care system, of residential homes and home visitors, is everywhere and yet invisible. It employs about 1.7m people, even more than the NHS, and despite importing almost 200,000 carers from abroad over the past three years – mainly from much poorer countries – the vacancy rate for home visitors is over 10 per cent and annual turnover around 30 per cent.
And as the supply falls, demand rises, both from younger people with serious disabilities, often kept alive by new medical technologies, and from the growing army of the elderly.
There are 5.4m people over 75 in the UK, of whom only about 500,000 are in the elder care system (either in a home or receiving paid care at home). Many of the rest are looked after informally by friends and relatives, valuable and productive work not captured by the dominant GDP growth metric.
Yet the sector reckons it will need an extra 500,000 paid workers, on top of that 1.7m, over the next decade, thanks to the ageing population but also to smaller, more dispersed families and the higher number of childless old people without informal care.
Where are the carers going to come from, given that more immigration is unpopular and women – who make up 80 per cent of social carers (and 89 per cent of nurses, 85 per cent of primary school teachers, 98 per cent of nursery carers) – are now better educated and have greater opportunities than in previous generations?
Society as a whole has benefited from fuller access to women’s brains and energy, much of it directed into higher-status care professions such as medicine. But the low-status, low-pay, face-to-face care sectors, handling people’s emotions and often their bodily fluids, have lost a captive female workforce.
This tension is the subject of my new book – The Care Dilemma: Caring Enough in the Age of Sex Equality. Nobody is suggesting we limit women’s freedoms, which means that men have to step up, as they are doing to some extent in the family but less so in the public care economy. It also means that to provide the decent care for the dependent young and old that we still say we want as a society, we simply have to make care jobs, both in the home and the economy, more attractive for everyone.
Better pay for carers is one obvious answer. Frontline care staff earn slightly more than nursery carers and cleaners but less than NHS nursing assistants. Despite the emotional stress, social care, like most care jobs, registers well on job satisfaction surveys, but for many staff, the minimum wage just isn’t enough to pay the bills. A special social care minimum wage, £1 an hour above the standard rate, would cost about £1bn a year, according to the Institute for Fiscal Studies – surely a bargain to solve the recruitment crisis.
Yet higher pay is not enough. Social care also needs greater visibility, higher status and more efficiency. On visibility: schools should have more links with care homes, gap-year type temporary jobs should be encouraged, and it should be easier to volunteer (I tried and failed in a local care home when writing my book).
It would also benefit from being rebranded as the “national care-prevention service”. If the job of the NHS is to fix people and dispatch them out of the back door of the hospital as soon as possible, the job of social care should be to stop them entering the front door in the first place.
One way to do this is for home care packages and residential homes to focus much more on exercise, which in turn could reduce the falls that make it harder for people to look after themselves and cost the NHS £3bn a year.
Higher status and efficiency are linked. Social care currently has rigid demarcation lines between professional and non-professional staff, and little progression for the latter. My cousin’s carers are not allowed to cut her toenails because that is the job of a chiropodist. A carer can wash and cream legs but not do even basic wound care. One answer is to create a special type of carer – an Enhanced Care Practitioner (ECP) – trained to undertake minor medical interventions such as injecting insulin, checking vital signs, and dressing wounds.
ECPs could connect social care to the wider world of nursing and medicine and with properly designed contracts it would make the thousands of mainly small private care companies more solvent and save the NHS billions. Local authorities, who commission social care, could also make big savings if they contracted fewer home care companies within smaller geographical zones. This would cut wasteful journey duplication by carers and allow them to walk or cycle between appointments. Wigan has introduced such a system and is saving tens of millions.
The social care sector is destined to become one of the biggest and most important sectors of our service-based economy, and in return for the extra taxpayer support it needs, it must come out from the shadows, shrug off inertia and enable carers to provide a better, more efficient service.
David Goodhart is the author of The Care Dilemma: Caring Enough in the Age of Sex Equality (Forum, £25)
