Nationalise adult social care and run homes on the basis of need, not profit

Boosting budgets isn’t enough – care packages should fit around the needs of those using them, writes Emma Lewell-Buck MP



I used to sit in meetings as a local councillor, watching adult social care commissioners pick which contracts should go to which service suppliers. Virtually every time, they pushed, not for the best care home or home help but the cheapest. Budgets were so tight they had to spread the cash as thinly as possible. As a former social worker, and a sitting Labour MP, few things have concerned me more in the last nine years than the creeping privatisation of social care. I want our new manifesto to promise a national agency, properly funded and empowered to give vulnerable adults the care and support they should be getting in a civilised society.

When money is short councils will always struggle to balance competing needs – meaning some will lose out. Two years ago the government promised a green paper on social care but there’s still no sign of it. It’s worth remembering as you read this that it is virtually inevitable that at some point you, or those you love, are going to greatly depend on these services.

The slashing of council budgets since 2010 is no great secret and actually the way they have continued to support this critical sector is nothing short of heroic. While local authorities have seen total income cut by 26% under the Tories and their backers (40% down from central government) the drop in funding for adult social care has been just 6%. Congratulations are due to those councils which have clearly fought so hard for those in our society most in need of protection.

However, research shows nine out of 10 councils in the UK are unable to afford the cost of adult social care. According to the King’s Fund charity, expenditure is now £700m below the level of 2010/11. Not so terrible you might think, but where is the funding actually coming from? The same King’s Fund report shows more and more people paying for their own care at a cost rising at a higher rate than inflation. While it’s been widely reported that councils are often ripped off by less scrupulous private providers (who, let’s face it, are in business to make a profit), what is less well known is that people who pay for their own care are charged an eye-watering 41% more for services than even councils pay (according to the Competition and Markets authority). Meanwhile, the number of beds available in care and old people’s homes is falling year-on-year, increasing competition for places and at home services.

It’s easy to say boosting budgets is the answer but it’s not enough. The real problem has been the commercialisation of a care system which has no place on any balance sheet – and for practical reasons as much as moral and ethical ones.

When councils or individuals buy care, it’s not the same as buying a car or a house. No two care recipients are the same, but markets love standardisation, and there is a tendency to make the people fit the services available, not the other way around. The whole point of any “care” package is that it should do just that – care. When we need care we need it as individuals, not as a case described by a flow chart.

Homes would be run on the basis of need, not profit, with funding not being constantly diluted by the need to maintain margins. Employment in the sector is often precarious and generally poorly paid – and terms and conditions, training and recruitment all vary enormously across the country. A national system would mean easier implementation and development of standards for staff and a proper career structure.

If government isn’t prepared to look after people most in need then who can we trust to do it? With nationalisation comes greater efficiency, transparency and accountability. We’re all just one heartbeat away from disaster. If something terrible happens, people deserve to know they really will be properly looked after.

Emma Lewell-Buck is Labour MP for South Shields