Last Friday I tried to explain why, despite public expectations having been raised following their experience of the Covid crisis, the next step – the improvement of social and economic policies – is inevitable. These will have to be politically fought for. They will not drop into our laps.
Today I want to explore the reform of social care and how the searing media education that the public have been given about its problems may, if used effectively, have an impact on the need for reform. Whether to reform social care is an issue that now depends on the public and their knowledge and understanding of the problem. We do not need more work on the nature of reform.
For more than 15 years many people have skilfully and powerfully argued the need for a thorough reform of social care. For me the main explanation of our failure do do so is that, compared to the NHS, many people have limited first-hand experience of the social care system, let alone how it is funded. A 2017 Ipsos MORI survey found that a majority of respondents thought the NHS already provided social care, and 47% thought it was free at the point of need. It is this distance – between what the public believe and the reality – that is the most significant political issue. If almost half the public believe that social care is free at the point of need and provided by the NHS, why is there any need for reform?
A call for the “root and branch” reform of social care funding could be resisted by 47% of the population because they fear it may lead to a similar reform of NHS funding. And that would not be popular.
So long as people don’t know how social care is funded, they are shocked when they are told that some people have to sell their houses to pay for it. This is consistent with the Local Government Association’s evidence to the Lords Economic Affairs Committee which suggested 48% of the public did not know what “social care” meant. Once people understand how care is funded, they do not like it. Only 18% of people thought it “fair” or “very fair” that people should have to sell their home to pay for care.
None of this makes the campaign for reform any easier. My purpose in drawing attention to these public misconceptions is to underline my assertion that there is no inevitability that in the post-virus world there must be the sort of reform that many of us want.
But – crucially – the crisis has played a role in changing some public perceptions. Those that watch the news (and numbers have increased during the lockdown along with, I suspect, the intensity of the watching) will have spent much of the last few weeks learning a very great deal about residential social care. Much linked to death and infection. Many more people will now understand the work that residential care workers carry out. “Rhod Gilbert’s Work Experience” as a Social Care worker will have touched many hearts (not least Rhod’s).
And whilst there has not been as much news coverage of domiciliary care, I have seen several five minute pieces following a day in the life of a domiciliary care worker (My mum was a ‘home help’ in the 50s) demonstrating that there is no alternative but to be very close to, and often touch, several vulnerable people every day. Many more people will now know and value what they do.
The public will also have been moved by the tragedy of the growing number of deaths amongst social care service users. Most will have been deeply touched by the care and love that staff give to their charges and even those who have never had one of their own loved ones in residential care will have learnt that carers are in every sense ‘key’ workers. They will remember this.
But many will still assume that those carers (dressed in blue) are part of the NHS and will clap for them as being NHS workers.
I don’t think the crisis will have informed many people about the detail of the fragility of our social care. Few will know much more about its funding. But it will have brought important moral issues to their attention, stirring their emotions. It is these issues that form the basis of a public campaign for social care.
- Social care workers not only exist, but are doing a vital job caring for hundreds of thousands of vulnerable people. We should all care more about both the staff and the residents than we do.
- The other side of this new public knowledge is that it appears, as far as the Government is concerned, that social care service users have been forgotten. This is not only unfair but may have led to many deaths. Given their greater understanding the public may well feel this needs to be urgently addressed.
- During the crisis both residential and domiciliary social care service users were near the bottom of the priority list for PPE and testing. Considering the vulnerability of social care service users, this is clearly wrong. Given the consequences, in terms of people dying, it is puzzling why this was allowed to continue.
- Some people will have picked up the facts that there are staff shortages and that many of them are low paid. The public will be shocked and dismayed to learn how much less social care workers earn compared to nurses. This should be an immediate part of any campaign.
- As in the NHS, the news coverage has highlighted the multi-cultural and multinational nature of the social care workforce. Very few realise that the Government’s current immigration policy will prevent us from allowing more people from abroad to come and do this work. We have heard and seen a lot about the problems of fruit picking but as the crisis develops we will soon hear more about the shortages of social care workers brought about by this policy. This will become a big problem in 8 months’ time.
- We have learnt a lot over the last few days about how our society neglects not just the oldest and frailest, but also younger people with disabilities. There are many news stories about exhausted, loving, carers. At best this has engendered sorrow, at worst anger.
Whilst my overall aim here is to argue, alongside many others, that the Covid crisis has changed the moral landscape on social care, my main lesson is that the main impact of the Covid crisis has been on the consciousness of the public. If we are to have a new social care system then it is there, working with that new public consciousness, that the hard work needs to be done.
We don’t need another Dilnot, a more detailed Green, or more white papers. Dilnot has done his brilliant work. What we need now is for relatives, staff, social care service users, providers, and funders to talk to the public about the moral argument for improvement and change.
There may well be another pandemic. And if social care is in the same fragile and fragmented situation when it hits, thousands more will die. Now that the public know this they, and we, will be complicit in the outcome if we fail to act.
It’s not fair. It’s wrong. It’s dangerous.