Social care needs a transformation comparable to the transformation of UK healthcare seven decades ago through the NHS. It seems likely such a policy, for a public care and support system, would be popular, if strong enough voices argued for it. At the moment the forces campaigning for anything like it are weak, but the issue is centre-stage as never before.
When the Tories produced their “plan for social care” — taxing workers more to produce extra money for the NHS and a much smaller amount for care services (later) — the Labour Party embarrassed itself by its lack of alternative ideas. Now Keir Starmer has expressed a “preference” for taxes on “assets” — while eschewing any clear and aggressive call to tax the rich. Ever keen to identify fixes so they can avoid targeting the wealth of the rich, Labour spokespeople have also started to talk about billions that can supposedly be freed up by caring for more people in their homes.
The hierarchy of the TUC, meeting 12-14 September for its Congress, has pushed a more emphatic and left-wing-sounding version of Starmer’s kind of plan.
Both Labour and the TUC have avoided:
• Clarity on how much money they want to raise
The (broadly right-wing) Institute for Fiscal Studies has disputed the Tories’ claim that their “health and social care levy”, through an increase in National Insurance, will raise £30 billion over the next three years, suggesting it will be more like half that. Even according to the government, only one sixth, about £5 billion, will go to social care.
We could well be talking about less than a billion a year, in a system which has lost £700 million of funding since 2010 despite constantly rising demand. Demand will only rise further. Care and support services are not just used by old people, but many using them are old, and the number of over-65s could increase by half by 2040. Some figures suggest the care “funding gap” could grow from under a billion today to over £10 billion by 2030.
The labour movement needs clear campaigning proposals on a wealth tax, capital gains tax, corporation tax and taxes on very high incomes. The Resolution Foundation has calculated that previous estimates of the wealth held by the super-rich have underestimated it by about £800 billion. More than that, we want public expropriation of the big banks and financial institutions, so their vast wealth can be used to fund the jobs and services people need, including in health and care.
• Clarity on how much services should cost users, or whether they should be free
The Tories’ proposal is supposedly for a cap of £86,000 on lifetime care costs, along with means-tested support for those with less than £100,000 in assets. If you own a house worth half a million, this isn’t great; if you own one worth £150,000, it’s disastrous. But in addition to that, the cap covers costs for direct care, not for accommodation!
The number of people who have to sell their home to pay for care might fall from the current 17,000 a year, but not necessarily by much. On top of all that, the new cap will not kick in until October 2023.
Social care and support services should be completely free, funded from general taxation, like the NHS is despite erosion.
• Clarity on the pay and rights of care workers
Clarity here is crucial for those who work in social care: 1.6 million people, more than in the NHS. It is crucial for meeting the sector’s growing needs, including curbing and reducing the existing staff shortage of over 120,000.
At present that shortage is expected to grow to 170,000 by the end of the year. (This is also an additional reason why the labour movement should support free movement of workers into the UK.)
A quarter of care workers nationally and 40% in London are on zero-hours contracts. Pay is low, the median being only pennies above the legal minimum wage, now £8.91 an hour, and declining relative even to other low-paid jobs.
Sick pay is a huge issue. In June, the best part of a year after the government claimed to have funded full isolation pay for all care workers, Unison - the largest union in the sector - reported that a third of workers were receiving only Statutory Sick Pay of £96.35 a week, while 11% got nothing.
These realities degrades care workers’ living standards and mental and physical and health; and, despite often heroic efforts, degrades the service they can provide to those they care for.
At the end of March there had been very nearly 30,000 excess deaths in care homes as a result of Covid-19. In Scotland, the proportion of Covid deaths in care homes is about a third! The death rate among care workers was twice as high as in the general working age population.
The Labour Party has had little to say about sick pay or wages. It seems not to have actually dropped its support for a £10 an hour minimum wage, but equally seems reluctant to talk about it. TUC officials have been calling for £10 an hour in the care sector; but the GMB just put a motion through TUC Congress for £15. £15 was the demand raised, before GMB did it, by rank-and-file care and support workers’ network Care and Support Workers Organise (CaSWO).
Workers at the Sage nursing home in North London, members of the United Voices of the World union, have been campaigning over the last year for £12 per hour, as well as sick pay and annual leave parity with NHS workers, union recognition and other demands. They have struck twice and may strike again soon.
We need to fight, in the care industry, in other industries and in terms of law, for a significantly better minimum wage, a ban on zero hours contracts and full sick pay for all workers.
• Clarity on who should own and provide services. Should they be in the public sector, or predominantly private in one form or another as at present?
We should not advocate handing more public money to private care providers, which include, for instance, care homes chains owned by hedge funds. The kind of changes needed in care and support services will be very difficult to implement in a largely privatised and heavily fragmented system. How do you raise wages for all care workers when they are employed by thousands of mostly private organisations? The more radical the conditions and restrictions imposed on private providers the more irrational the system of private provision becomes. What about small private groups which would just close down if forced to pay decent wages?
All of it points towards public ownership, as does the need for radical changes in how services are run. A public care and support system could improve the working lives and living standards of many of hundreds of thousands, create hundreds of thousands of good, socially essential jobs and transform the care provided to millions.
Who would argue to establish the NHS if it didn’t exist now? That is the level of ambition the labour movement needs.
There should be a drive in the unions and Labour Party to win the arguments for such a transformation. As with so many issues, Momentum could make a difference here - if it understood and wanted to do it. Unison ignores its conference policy for public ownership and runs a joint campaign for more public subsidies with private care bosses and Tory MPs. Forces actually advocating a more radical policy are relatively weak and somewhat divided.
CaSWO’s demands, mainly focused on care workers’ rights, conclude with “democratising social care” by bringing it “into democratic public ownership, guided by co-production of workers, disabled people and those in receipt of support”. It held protests for them in Manchester, London, Preston and Newcastle on 4 September.
There is a small campaign, mainly driven by NHS campaigners, for a “National Care and Independent Living Service” and a small campaign, mainly driven by disability activists, for a “National Independent Living Support Service”. That division reflects differences and debates about the relationship between providing social care through institutions and support for individuals to live independently.
Socialists and labour movement activists can help the growth of trade unionism among care and support workers. There is lots of anecdotal evidence that union membership in the care sector has grown. The setting up of CaSWO, which involves workers in Unison, Unite and United Voices of the World (but not so far GMB), is reflective of that.