Scanning the headlines this week, a casual reader could be forgiven for thinking that the problems in adult social care in the UK can be addressed by funding alone. Those at the service delivery end, however – from the local authorities commissioning care to the care workers, patients and their families experiencing the day-to-day reality of the system – see a very different story.
Adult social care is broken. Years of marketisation and outsourcing have left the UK with a service where large market players dominate, particularly in areas such as nursing and residential care: extracting taxpayers’ money and the savings of older people for shareholder gain. Proposals to fund social care through National Insurance Contributions, then, are not only wrongheaded and insufficient to the task, they also miss the wider point of what ails the sector as well as the opportunity to truly reform it.
In April this year, we at CLES released Reshaping ownership within adult social care, a policy and practice guide for local government to re-animate the demand of decency for service users over dividends for shareholders. In the report, we called for adult social care markets to be reshaped, using a community wealth building approach, so that services are run by the state, with a plurality of providers – co-operatives, community businesses, social enterprises and the like – augmenting existing core services.
This may require greater insourcing but also some shift towards service delivery by the voluntary, community and social enterprise (VCSE) sector, which has a key role to play in the delivery of services such as adult social care. As such, it is entirely appropriate for commissioners to seek to involve the many organisations and individuals who, whilst not directly part of local government, are equally passionate about public values and offer a unique contribution to the delivery of public services.
To illustrate this vision for adult social care, the publication draws on a number of examples of progressive local practice. In Newham LBC, for example, the council are building on their strong commitment to community wealth building by reforming the home care sub-sector using a form of social licencing. Providers must have a good knowledge of the community’s geography, facilities and services and must operate from an office in Newham. They are required to actively recruit care workers who reflect the Borough’s diverse population, specifically in relation to gender, culture/ethnicity and language. They are also required to pay their workforce the London Living Wage and to adhere to the principles of the UNISON ethical care charter.
In practice, this creates a strong disincentive for larger more extractive providers to enter the market. As a result, Newham now have locally-based small SMEs delivering their homecare service, who are required to operate there with a concern for the wider community and workers, alongside the pursuit of profit.
Similarly, in Wigan, spending on adult social care is understood by the council as a key site for shaping employment opportunities and conditions for local people. The Wigan Deal and the Council’s Ethical Homecare Framework have driven up employment standards, fundamentally reformed the economy of the care sector in the Borough and supported the development of dozens of social enterprises.
As these examples – and the others explored in the report – demonstrate, by adopting innovative commissioning techniques, framed by a community wealth building approach, it is possible to move from a system that favours wealth extraction towards one that promotes more locally generative forms of ownership. And – crucially – it is possible to do so in such a way that promotes choice and control for service users.
Over the last 30 years, Britain has shifted from having a market economy to being a market society where large swathes of public services are outsourced to the private sector. For too long, we’ve seen the challenges of health and social care in isolation from their impact on local economies. We should be building a new public service movement based on democratic and citizen involvement – one which demands a complete overhaul of who owns and delivers adult social care.
Tom Lloyd Goodwin is associate director of CLES – the national organisation for local economies