First the good news. It seems to be widely accepted that our dysfunctional social system urgently needs to be sorted. This is nothing new, of course, as the industry has been under financial pressure for more than two decades. A number of white papers, green papers, and government reviews of funding petered out while both main parties abused the issue for selfish tribal gain. But now his flaws have been brutally exposed by the pandemic. And the prime minister has cornered himself by promising to clean up the mess “once and for all”.
The other optimism is that recognition taxes will have to go up to cover the cost, as decent public services cost real money. But even the tentative idea that had leaked from Downing Street of a small spike in national insurance raised the alarm in Tory circles. This shows how alarmingly narrow-minded the debate about saving our crisis-ridden care sector remains. Despite what we’ve seen in the past few months, with thousands of deaths, underpaid frontline staff, and an exhausted army of caregivers, this remains second class public service.
First, look at the finances. Social welfare spending is only £ 99 million more than when the Tories came to power in 2010. This is a significant cut in per capita spending as the elderly have grown in numbers over the period. However, the fastest growing demand is from adults of working age, who often have highly complex needs. Remember when “experts” talk about welfare as something that only affects the elderly; In fact, the elderly are responsible for just over half of all spending, which is little more than healthcare.
Politicians, bleary-eyed in their avowed devotion to the NHS, have pumped money into hospitals and medical practices. Even if we exclude the additional cost of Covid, health care spending has grown an astonishing £ 33 billion since 2010 – that’s £ 10 billion more than total adult welfare spending. The central government has also cut funding for local authorities. Given the importance of social welfare to help people and keep them out of the hospital, let alone the psychological and physical strain on unsupported caregivers, it shows the hypocrisy of sanctifying the NHS while destroying its cousin Cinderella.
But with all the welcome talk about funding, there is no debate about the type of care – let alone the blatant inequalities, the greed of some providers and what the pandemic has revealed for our society. After all, why were politicians obsessed with protecting hospitals while being cavalier in nursing homes and home care? Despite outrage, why do frontline nurses get minimum wages when six-figure doctors don’t get a reasonable raise? Why was this sector almost allowed Collapse? And why do we think citizens who die of dementia should fund care, but not those who die of cancer?
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This is one area where I agree with Jacob Rees-Mogg: It is unusual for welfare not to be funded from central taxation. Instead, we see the simple idea that a dollop of extra money and a little more integration will solve deeply ingrained problems in a crumbling service – along with suggestions that the main problem is the middle class, forced to sell real estate to care for the elderly finance when it’s just one topic among many in an off-course industry.
This system is so flawed that thousands of people with autism and learning disabilities are locked up in safe psychiatric wards due to a lack of community support. The provision of nursing homes for the elderly has migrated from poorer areas to richer parts of the country as private firms hunt for self-payers who pay higher fees than those who depend on the state. This led to a decrease in the total number of apartments but an increase in the larger units as large firms hunted economies of scale. And it meant more deaths than this deadly virus showed up.
So who benefits when extra money goes into this broken system? We have already seen the increase in NHS funding end up in the pockets of wealthy doctors, not frontline services. Still, there is less control over a care sector with thousands of private companies where the average worker made £ 8.50 an hour at the height of the pandemic last year. The difficulty in increasing their income was shown in living wage increases, which simply led employers to lower other employees’ wages so that a caregiver was making only 12p more an hour than a new employee. Such low wages, together with Brexit, explain the appalling staff shortage and turnover rates.
However, despite the financial constraints, some did Fat cat companies have milked the system while they are investing high profits in tax havens, paying the bosses millions and hiding their lucrative businesses behind opaque corporate structures. Tax professionals borrow money to build empires, extract cash, and then resell it – symbolized by Four Seasons, one of the largest providers that is riddled with debt after repeated trading between private equity firms. Or check out Runwood Homes’ latest accounts, which show it boosted profits in the first few months of the pandemic, tripling dividend payouts, and handing over £ 3 million to a director last year – while handing employees off 9p hiring above the minimum wage to care for people with dementia at night.
If we want better care, there must be reforms to ensure that extra money goes to the forefront. Unfortunately, politicians have a poor record of controlling spending explosions. But this waste of money is a patch on politics. Social welfare should be individual and rooted in communities, not serve the needs of bureaucrats and billionaires. Behind this debate lies deep questions for a nation that ignores those in need or locks them up in institutions far from the warmth of a real home. Unfortunately, the secondary status of social welfare reflects our society’s sad lack of real concern for elderly and disabled citizens who depend on its services.