Why we need a National Care Service

21 April 2020

The COVID19 epidemic has exposed the glaring inadequacies of social care in the UK. Reflecting how older people receiving social care are often hidden and forgotten, it took several weeks before the government admitted that the daily numbers of people dying from COVID19 only included people in hospital and not in care homes or the community.  Perhaps even more insidious has been an unstated assumption by government that older people will have to be expendable during this crisis because they were expected to be more vulnerable to COVID19.  This is at the heart of a much greater prejudice towards older people and people with disabilities that exists in the UK.

The majority of social care services are run by for-profit companies or not-for profit organisations. Very few care services are delivered by the public sector.  As a result, government is not directly responsible for how services are delivered, how services fit into wider systems of accountability and how they are measured and assessed. Whilst hospitals have a transparent system for recording deaths quickly, care home deaths are recorded by local GPs, along with other deaths in the community and so take longer to be registered. 

The provision of personal, protective equipment (PPE) has been inadequate in the NHS showing how limited government planning and preparation was for this pandemic. However, it again took several weeks to realise that care workers, in care homes and the community, also needed PPE.  This provision has been even more inadequate.

The current public health emergency is expected to continue for many months and there may well be future coronavirus pandemics. This means that public health planning must be given greater priority and has to include the social care sector. The problems with recording of deaths and provision of PPE reflect a lack of awareness in government of the social care sector.

The invisibility of care home deaths and the health and safety of care workers show that social care services can no longer be dependent on for-profit companies, which trade profits against service provision. Care services should be part of a National Care Service which is the direct responsibility of government. It would be subject to national regulations, guidance and central government funding just like the NHS. It would be delivered through local government because care services need to be locally planned, managed and delivered to meet local needs, involving local people and local care workers. Care workers would be on the same pay scales as NHS workers with the same benefits and training. Only then will care services be given the recognition that is needed if older people and people with disabilities are to be cared for with dignity and compassion.

By Jane Lethbridge, Centre for Research in Employment and Work (CREW) and Public Services International Research Unit (PSIRU), University of Greenwich j.lethbridge@gre.ac.uk

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Maggie Davies replied on

How we treat the vulnerable in our society whether old or young, shows whether we can call ourselves civilised. At the moment we are a long way from that.

Kath Morgan replied on

After this crisis, we have to take back control of the care sector, fund it properly, and pay care workers properly.

Maggie Crosswaite replied on

I agree with the above comment

We need a serious rethink of how care staff are trained, and paid, they are doing the dirty work, but not being adequately looked after, which in turn would mean a higher level of care for residents

Jude Bloomfield replied on

The local governemnt managment can include culturally and sensitive diverse provision but with the same conditions, nationally agreed comparable to NHS pay scales, training, security, career advance and esteem as NHS workers - although within the NHS health care assistants also need to be upgraded and recognised with routes of opportunity to train to be SENs and not the underpaid, lowly, immigrant Cinderella within the NHS heirarchy. Likewise cleaners and porters need ot be brought back inhouse and become a directly employed part of the NHS again.

Kevin Riley replied on

What is required is a totally integrated "care" aand "health system both under democratic control.

This article fails to recognise is that until we return the NHS (including CCG's) to democratic control, creating a "new" national care service and will not work.

At the moment we have the worst of all possible worlds with a fragmented NHS (over 257 Trusts and over 600 CCG's all "free from democratic control") and a completely fragmented "care" provision - operated by thousands of Councils with that provision having to compete with all the other responsibilities of local Councils for funding)

What is required is a total repeal of the Health and Social Care Act the return of the NHS to democratic control and at the same time the abolishing the responsibility of local councils for "care" services and making that the responsibility of the NHS as well as "health" services..

Anne Floyde replied on

Care should mean care, in the holistic sense of the word. I personally know of a number of cases of bullying and neglect within the care system as profits are put before people. I wholeheartedly back the idea of a National Care Service.

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