The Government's Build Back Better plan must tackle the plight of adult social care workers left without ‘a proper employment structure,' says the UK's leading expert on health inequalities.

Professor Sir Michael Marmot highlighted workers ‘servicing the poorest, most vulnerable members of our society – going into people's homes to have to change the nappies of older people and deal with the ulcers on their legs'.

‘Then to be told by your employer that you haven't got time to make them a cup of tea and to chat with them. Half of you are not earning a living wage and are operating in the gig economy. It's  appalling.'

He added that part of the Build Back Fairer plan for growth published earlier this month ‘is looking at the nature of work and employment and what does it mean to have a good meaningful job'.

‘My guess is that of the people who are working in adult social care a large proportion are utterly committed to what they do. The they ought to have a proper employment structure and training and be properly recompensed.'

Professor Marmot was speaking at the closing third day of New Local's Stronger Things event.

Asked by the chair of New Local Professor Donna Hall for his verdict on the Government's ‘levelling up' agenda and whether it was going to address ‘all the inequalities you've highlighted so articulately', he said: ‘In theory it could, in practice it won't.'

He continued: ‘It's not just giving a bit of money to a few Conservative-led boroughs. That isn't going to solve these problems. It would be better to reverse the regressive nature of the cuts.

‘If you're in Liverpool and you've had 40% cuts over a decade and you are told there are more cuts, that does not mean that austerity is over. That means you are cut to the bone and you are still having to deal with the fact that you're cut to the bone.'

He said he opposed any focus on a ‘meritocracy narrative' that said people were entirely the authors of their own destiny.

‘If we have bought into a whole system that says if you went to a good university and became successful you're right to be rewarded and if you didn't do any of those things you've only got yourself to blame.

‘And then other people come along and blame you as well. It's a terrible state of affairs. Build Back Fairer has got to reverse that. It's got to recognise that those care workers that really upset me because they are so poorly treated are very valuable members of society.'

He added:  ‘So I think it's not just that we mustn't blame people for their poverty. We must move away from a culture that invites people to blame themselves for their situation, when in fact we can create the conditions for everybody to lead lives of dignity.'

Professor Marmot was asked by Professor Hall if ‘the £37bn of public money spent on a privatised system of test and trace' was good value for money.

He replied: ‘If we had spent the money that we spent on test and trace and given it to local public health within local government, the counter factual is what would have happened? I don't know. My guess is it wouldn't have been worse, and it may well have been better.'

‘£800m was taken out of local public health budgets from 2012 on. Suppose that £800m had been restored and then there had been extra money to do the test, trace and isolate. My guess is that it would have been done better.'