openDemocracyUK: Analysis

Joe Biden is fixing social care whilst Boris Johnson won’t even talk about it

Investment in social infrastructure makes sound economic sense – but Downing Street would rather leave women to pick up the pieces

Sarah Bedford Dan Button
21 June 2021, 3.23pm
If Joe Biden can act to fix social care so quickly, why can't Boris Johnson?
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Kevin Lamarque/Reuters/Alamy

This morning it was reported that a ‘do or die’ meeting to agree on a plan for social care, between the prime minister, the chancellor and the health secretary, scheduled for Tuesday, will not go ahead.

Whilst members of the UK government can’t even manage to talk effectively amongst themselves about the problems in social care, in the US, Joe Biden’s new administration is getting on with fixing them.

The new president’s infrastructure plan, intended to boost jobs and aid recovery from COVID-19, includes a $400bn investment to expand access to home and community-based services for older people and people with disabilities.

Biden’s plan sets out how care workers – the majority of whom are women of colour – “have been underpaid and undervalued for too long”. It continues: “The president’s plan makes substantial investments in the infrastructure of our care economy, starting by creating new and better jobs for caregiving workers.”

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Meanwhile, British chancellor Rishi Sunak is reportedly vetoing proposals to cap care costs and invest in the creaking system as “too expensive”.

As the Biden government recognises, fixing social care is not just a cost, but an investment in our social infrastructure, one with returns both economic and social – driving local economies and having wider benefits down the line.

Biden’s plan sets out how care workers ‘have been underpaid and undervalued for too long’

If people were supported by care at an earlier stage – rather than waiting til they’re in crisis, as at present – the Local Government Association also estimates that every £1bn invested could generate more than £7bn of benefits, including £1.9bn of financial savings.

So why is the British government waiting? If Biden can act so soon into his tenure, why can’t we match this ambition with a plan to tackle the care crisis here in the UK?

Who picks up the pieces?

Without more funding, of course, it is predominantly women who end up picking up the pieces by providing unpaid care. Even before the pandemic, there were 9.1 million people providing unpaid care to loved ones, according to Carers UK – a figure that rose further over the past 15 months. Almost 60% of these unpaid carers are women.

And the number of people whose care needs simply aren’t met also continues to rise. A decade of cuts to local authorities – responsible for providing social care – means most councils now restrict publicly funded care to those with the very highest needs, and exclude those with any significant assets, often including the family home. So currently, homeowners may end up paying huge sums of money for their care, while others must rely on family members supporting them – or simply go without. In 2019, Age UK estimated there to be more than 1.5 million people over the age of 65 living with unmet care needs.

We need care before a crisis

It’s about to get a whole load worse. The Association of Directors of Adult Social Services warned last week that local authorities were facing a “deluge” of requests for adult social care from people who are in crisis. The pandemic has meant people’s health has declined while they wait to access healthcare. Many have been discharged from hospital without adequate support elsewhere. And there has been an increase in demand for support for people with mental illness, victims of domestic violence and rough sleepers. Combined with “an ongoing lack of resources”, this means “people needing support face longer waits for less care”.

As well as immediate funding to plug the gap, social care needs a long-term plan for reform, which doesn’t just increase funding in line with demand for acute care, but also – crucially – aims to prevent avoidable care needs.

Many of those currently in crisis and seeking care could have been supported at an earlier stage. The increased demand that we are currently facing is partly a consequence of leaving things until they get to acute levels.

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Disabled people have seen their support cut or frozen as councils have used legal loopholes created by emergency legislation – and the risk is more to come in the second wave.

So whilst supporting those with high needs tends, rightly, to be the most pressing priority, we simply can’t afford to carry on neglecting people with lower levels of need, either. By doing so, we miss opportunities to intervene early – before ill health and other problems escalate and cause both avoidable harm and increased cost pressures further down the line.

Acting early would save lives – and money. And that’s even before we get to the returns from more people taking up social care jobs, having better paid work in that sector, and more people who are currently providing unpaid care being able to take up employment if they choose to.

Getting to where we need to be will involve redefining social care so that it delivers a much broader purpose. The 2014 Care Act signified a shift towards a new approach, placing an emphasis on promoting the wellbeing of older and disabled people, or to “help[ing] them achieve the outcomes that matter to them in their lives”. But introduced at a time when government funding for local authorities was being significantly cut, it has done little to alter the direction of social care away from the dominant ‘life and limb’ model, where the care system is tasked with ensuring people are fed, washed, dressed and little more.

All eyes are on the government and their promise to publish proposals for long-term reform of social care later this year. With rising numbers of people needing support, and powerful benefits that could flow from enabling it, delaying this vital investment cannot be an option.

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