I was listening this morning to a thoroughly depressing discussion on social care. A major part of the way the issue has been framed is, apparently, to encourage migration so that migrants can fill the roles that need to be provided. The other was to point to the supposedly five and a half million people receiving ‘out of work’ benefits, a figure that includes, as far as I can tell, four million people who are either too sick to work, in work on low pay or who already have caring responsibilities, and demand that they provide social care on a minimum wage. The underlying message seems to be that care is unskilled, and anyone can do it.
If we look at the way that social care is being provided, the picture is very mixed. The delivery of services has been shaped to match the criteria of commercial markets: individuated services, priced distinctly by activity. So we get tick-box lists of what needs to be done, masquerading as an assessment: dressing people, cutting their fingernails, brushing their teeth and so on. Some of the activities are paid for, and counted as nursing care; others are based on reported needs that, in their nature, are typically out of date. I’ve argued, in How to Fix the Welfare State, for a different (and admittedly rather more expensive) approach: providing teams of professionals who are paid for blocks of time, rather than specifically costed activities, who within that time can identify and negotiate services with the people who receive them. To do that, social care needs a professional structure – including training and qualification – and a pay structure that is commensurate with the skills that are required. We have a long way to go before we get there.