The Covid19 crisis has exposed the failings of the UK’s social care system. These have been evident for many years, but the crisis may make it possible to consider reforms which would previously have seemed politically impossible.
Most people don’t think about their likely need for social care in later life (unless perhaps they experience the problems facing an elderly relative). Most overestimate the support available for the state. The consequences can be severe for individuals and financially disastrous for some.
Some people are lucky: a quarter of all 65 year olds will never spend anything on social care, but others will face very large costs, with one in ten needing to spend over £100,000. No individual can tell which will happen to them. So some hoard their money in case, some try to insure themselves against the risk, and most make no preparation at all. Some of the latter find all their money swallowed by unexpected bills in later life.
An unpredictable lifecourse risk of this kind can only be fairly managed by the state. It can do this by providing a safety net for those who find themselves destitute, by requiring everyone to insure themselves privately, or by providing a universal service free at the point of use (like the NHS).
How the system is failing
The present system fails on three counts. First it is unfair, because it affects individuals at random. Second it is underfunded, because it is not seen as a core part of the health service. This makes the host of private providers vulnerable, and when they fail, the state has to step in to protect the residents/recipients. Third, despite the high levels of skill involved, the workforce is severely underpaid (as has been recognised in the present crisis).
Governments have repeatedly failed to grasp this issue, because there is little political pressure (since most people don’t want to think about old age), and the costs of reform have been seen as too big. However, the Covid19 crisis has changed peoples’ perceptions both of social care, as infections and deaths of care recipients and staff have soared, and of what is a “large” cost. Now may be the time for action. I suggest two reforms:
“Nationalisation”. A system where social care is delivered through thousands of independent, privately owned homes and domiciliary services, makes it extremely difficult to manage a crisis of the kind we are experiencing. We cannot get emergency protective equipment to them quickly; we cannot easily intervene to manage those who are ill and protect those who are not; and we cannot even discover promptly how many people are ill or dying. When the costs of providing care spiral under this sort of pressure, private providers fail, and the state has to step in to protect the care recipients. Local Authorities used to be major providers of such care. Perhaps their role needs re-establishing as the main provider of care for most people.
Pay reform. Care work is demanding and highly skilled, but undervalued and underpaid. The Covid19 crisis has changed public perceptions, and there is widespread public support to paying them better. The care workforce is much more widely distributed across the country than workers in many other sectors. A substantial injection of wages into this group would not only improve their lives, but would inject money into left behind communities, providing support for a range of local enterprises and services.
This would need to be paid for by higher taxation of those on above average earnings. There is probably now a public appetite for such increases. Those who would lose financially in the short term would benefit both from better management of infectious diseases (which can affect anyone); from reduced financial risk in the long term; from reliable access to care when they need it; and healthier local economies.