Diagnosing the social care crisis

1.2 million older people in our country have some degree of need for social care that is going unmet, and today and every day there are an estimated 90,000 vacancies in the social care workforce. These eye-watering statistics are just two of many I could cite which illustrate the scale and depth of the crisis engulfing social care.

Truly, I wonder how anyone charged with the stewardship of this area of policy and services manages to sleep at night when you think what these numbers really mean in practice: hundreds of thousands of older people struggling to cope at home without the help they need to stay safe and well; numerous families worried sick as they realise that good, affordable care for Mum or Dad is becoming nigh impossible to find. And equally high numbers of committed social care staff who are unable to do as much to help vulnerable older people as they know they need but who have no choice but to rush off to the next house-call, as the provision available has to be spread ever more thinly in the face of rising demand.

Remember too that social care isn’t a service used only by older people, but that almost as much is spent nationally on meeting the social care needs of adults with disabilities and serious illnesses. For these people, inadequate social care provision has just as serious an impact and is now, for example, translating into sharply reduced opportunities for many to socialise and live a normal life. So whatever your definition of ‘crisis’ may be what’s going on in social care surely qualifies. The problems affecting social care are not however new, even if they are deeper than in the recent past. And they have been coming for a long time, driven above all by the ageing of our population on the one hand, and the increasing numbers of disabled people surviving far longer than before as a result of medical advances on the other.

Thoroughly welcome as these trends are, like night follows day they inevitably bring with them increased demands for social care. Yet for well over a decade, successive governments have dithered and ducked the need for a fundamental rethink of a service that is obviously now unfit for purpose, choosing instead periodically to invest just enough to avert its complete collapse and hoping that the next government will grasp the nettle instead. No political party has much to be proud of where social care is concerned and the end result is the near catastrophe playing out today.

One of the reasons why it has proved so tempting for politicians on all sides to look the other way as the situation has worsened is that this is a crisis happening largely behind closed doors: in older people’s homes, and in care homes that are often, unfortunately, not well integrated into their local communities. Family carers are usually too busy and exhausted to campaign for a better deal, and older people themselves too unwell. Meanwhile, disabled people have been so busy battling for social justice in regard to their welfare rights that, not surprisingly, their problems in accessing good social care have tended to receive less attention.

But as we move into 2018 it seems the crisis in social care is now coming more into the spotlight, as it becomes increasingly obvious that deficiencies in social care are undermining the capacity of the NHS to respond to the demands it faces.

Some on the ideological right assert that social care is essentially an individual consumption choice, and others that social care is the responsibility of local councils, not central government, but these arguments are becoming harder to sustain. That’s first and foremost because the NHS and social care are, in fact, interdependent as shown, for example, when older people cannot be safely discharged from hospital because there is no ‘social care package’ available to support them as they recover at home. In addition, the drastic cuts to council budgets place many local authorities in an impossible position in trying to meet rising local need.

The Conservative government has committed to producing a social care green paper – focused on older people – in summer 2018, and to a related workstream on the social care needs of disabled people. The time is surely ripe now for a more fully fleshed out social care policy from the Labour party. This is essential if the party’s thinking on the NHS is to be credible and besides, I would suggest that no party can aspire to govern without having something serious to say about one of the biggest policy challenges of our times, that affects so many of our fellow citizens and their families: the need for a sustainable system of health AND social care.