Mary Shannon organised a meeting of our Women’s Forum on social care and inspired by that and other discussions with members she has put together some ideas that are points of principle as to what a National Care Service should/could look like. They are in no particular order, and some may be more contentious than others. But you may like to consider them if you are thinking of responding to the NPF consultation. The deadline for this is 30th June and the link is here.
1. A National Care Service should be universal, free to all at the point of delivery. Social care is fundamental to the well-being of any civilised society.
2. A National Care Service should be funded by progressive taxation. This should be Labour’s goal as soon as possible after getting into government, whilst recognising that other, initial measures may need to be taken, given the huge immediate funding gap to be filled, which shouldn’t fall disproportionately on any particular group, e.g. younger people. To this end we could adopt the National Pensioners’ convention formulation of ‘The risk and cost has to be shared equitably across society’. The important principle here is that like the NHS and state education, Social Care should be a public good as opposed to a private commodity. Central funding from the Treasury would end the current postcode lottery with local councils responsible for funding.
3. All Social Care services currently outsourced to the private sector should be taken back urgently into public ownership and control. At the same time, the present loss and impoverishment of the many user-led organisations which provide invaluable support needs to be urgently reversed.
4. The National Care Service should be based on the philosophy of ‘independent living’ developed by disability activists. This would involve a reversal of the present framing of service users in deficit terms – what they can’t do, which goes back to the Victorian Poor Laws. Instead the service would provide the necessarily individualised support for users of all ages to be able live on equal terms with people who do not need to use the service. Clearly, this would mean different things for different people, both age and ability appropriate.
5. We need a professional, well-paid, career workforce. Paid care is predominantly carried out by women, and in particular, BAME women. It is one of the ‘5 Cs ’ of ‘women’s work’, along with catering, clerical, cashiering and cleaning. The devaluation of women’s paid care work is a product of the structural sexism that keeps ‘women’s work’ low paid, low status and invisible. Care workers need professional status and training with a developmental career path, permanent contracts and decent pay. A Labour government should encourage trade unionism in the care sector.
6. We must provide full support for informal care. Most of the 12 percent of the population who carry out informal, unpaid care, usually for a family member, are women. The presumption is still that women’s role is to carry out the social reproduction that happens in the home, and that care is as integral to this as it is unrecognised. A National Care Service should liberate informal carers, by providing appropriately negotiated care to the service user, and support to the carer, as of right.
7. It must operate on the basis of parity of illness/condition. This is one of demands from the National Pensioners’ Convention, who use the example of the contrast between cancer and dementia. There should be no hierarchy of recognised need between different physical and mental illnesses and conditions.
8. Should health and social care services be integrated? On balance, it would seem to make more sense to keep health and social care services organisationally separate. Health and social care are different services with different objectives. Most social care support has nothing to do with health needs. Social care needs to have very strong links with a range of different services including schools and further education, housing, leisure, community, welfare benefits, children’s, adults and more. If the two services merged, there would be a danger of social care becoming the ‘poor relation’ to nursing, rather than being recognised as different, but equally valuable.
With thanks to:
Carol Ackroyd, Hackney North Labour Party
Peter Beresford, Professor of Citizen Participation, Essex Universtiy
Insa Koch, Socialist Health Association