The Crisis in Social Care

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2019 National Delegate Conference
1 January 2019

Conference notes with alarm the ongoing crisis in social care and continues to be appalled by the cuts being made to vital social care services.

Conference notes that, although social care has been relatively protected compared to other council services, care spending per adult resident has fallen substantially since 2009-10.

Conference believes that the sector faces a perfect storm in which the impact of years of chronic underfunding has been worsened by increasing demand and the knock-on impact of cuts to other key public services, such as housing and welfare.

Conference is alarmed at the impact these cuts are having on UNISON members responsible for delivering services in such circumstances – care workers who are almost universally underpaid, largely undervalued and often exposed to exploitation.

And Conference notes with alarm that the needs of many of society’s elderly and most vulnerable people are not being met. Nearly ninety people die each day waiting for social care, with the government’s former pensions minister Baroness Altmann moved to comment that “every bit of our social care system is broken”.

Conference notes that there are now 8,000 fewer care beds than there were three years ago and that a record 1.4 million older people do not receive the level of care they need.

Conference believes that inadequate access to social care affects people right across society – whether those in direct need of care, those friends and family members providing unpaid care, or those working elsewhere in public services who are left to pick up the pieces when people are left without the support they need.

Furthermore, Conference asserts that were it not for the ongoing dedication and commitment of the social care workforce the sector would have imploded completely – but no more can the government expect to prop up a creaking system on the backs of UNISON members.

This has been supported by the Social Care Inquiry carried out by the Fair Work Convention in Scotland that evidenced a culture of zero-hours, unpredictable working hours and unstable earnings. The inquiry makes recommendations about how to realise fair work for social care workers by setting out what policy makers, commissioners and leaders in Scotland’s social care sector can and should do.

Conference notes the double jeopardy of social care cuts on the women who make up 80% of the social care workforce and who are both managing impossible workloads and filling gaps in provision when care for children and, increasingly, elderly relatives breaks down as a consequence of relentless cuts. Society still expects women to be the prime carer.

Conference recognises that there are differences in approach across the four countries of the UK. For example, Northern Ireland has had integrated health and social care since the 1970s; Scotland has had free personal care since 2002; and Wales recently moved to curb the use of zero hours contracts by ensuring that homecare workers are offered a choice of contract after three months of employment.

However, Conference notes that underfunding of social care is causing serious damage in every part of the UK. Children’s social care, in particular, is under extreme pressure and UNISON disabled members are often service users who rely on social care services for assistance to stay in work and have a family life.

With an ageing population many older people including UNISON retired members are dependent on social care to enable them to have dignity in later life. Properly funded social care would also make it possible for people to remain in their homes.

Proper funding and major reform are long overdue, so Conference is appalled that the government has repeatedly delayed the publication of its Green Paper on care and support in England.

Social care has for too long been regarded as a poor cousin of the NHS and Conference wants to see a concerted push to begin to raise its profile and standing within society. Social care services complement the NHS and prevent both acute admissions and enable recovery at home.

As such, Conference believes that various piecemeal attempts made to prop up the current failing system will not cater adequately for the needs of our growing and ageing population.

Instead Conference wants to see a longer term, more ambitious vision of where social care should be in ten years’ time, with serious financial commitments to back this up, and a strict timetable for achieving change – as a way of shielding such plans from being blown off course by short term political or economic considerations.

Conference notes that a number of think tanks and Parliamentary committees have now come out in favour of making universal access to personal care free at the point of delivery.

Whilst recognising that it would not be achieved overnight, Conference believes that ultimately the goal should be to bring social care up to equivalent levels of equity and access as those associated with the NHS.

Conference accepts that this would be expensive, but believes that the ongoing failure to invest properly in social care by successive governments is purely a matter of political choice.

Conference notes, for instance, that even with the continuation of austerity policies for most of the public sector, the chancellor still managed to find £2.7 billion for tax cuts in his 2018 Budget – a policy that will predominantly benefit the better off.

Similarly, Conference notes recent work by the Resolution Foundation which found that government could raise as much as £7 billion a year by 2022 by making a series of relatively moderate adjustments to wealth taxes and subsidies, such as entrepreneurs’ relief and inheritance tax.

Conference is encouraged that organisations from across the spectrum – including the Local Government Association, health think tanks, and Parliamentary Select Committees – have all reached the conclusion that some form of taxation reform will be needed to deliver the resources that are so urgently required in the social care sector.

Conference also believes, however, that providing extra money is only part of the solution; there must also be accompanying changes to the way in which care is delivered.

Conference notes that the existing social care market remains completely dysfunctional: there is a hugely fragmented provider landscape in which some areas have hundreds of providers operating, many of which exit the market each year.

Conference believes that social care workers must be recognised as highly skilled professionals, entitled to decent pay and working conditions, proper support and supervision, high quality training and clear pathways for career progression.

Conference remains concerned that the vast majority of social care is no longer provided by the public sector, but recognises that this means thousands of UNISON members working in social care are now employed by private contractors or providers from the community and voluntary sector, predominantly these members suffer from low pay, poor terms and conditions, limited pensions and aggressive management behaviours.

Conference continues to believe that services such as social care are best provided by the public sector, while noting that there is also a need at many local authorities to rebuild the capacity of councils to deliver care themselves if contracts are to return in-house without endangering service users.

Conference notes the success of the Care Workers for Change campaign in the North West region, a large scale organising project which involved the active support and participation of branches. The campaign encountered consistent hostility from employers and developed a multidimensional approach combining workplace organising with political lobbying and community engagement. The campaign has achieved high levels of membership growth with 4,500 new members and 200 new care worker activists who are working to build their union in their workplaces. The campaign has won real material benefits for care workers through bringing pressure on councils to require that their commissioned providers allow access to trade union organisers and that they pay at least the real living wage.

Conference therefore calls on the National Executive Council to campaign with the Labour Party, campaign groups, charities and other allies inside and outside Parliament for the following:

1) social care to finally receive the proper funding it deserves, particularly from the 2019 spending review, as part of a longer term plan to ensure its equivalence to the NHS in terms of access to services and its status within society;

2) for such funding to be raised by collective rather than individual means;

3) for any spending boost to be accompanied by meaningful reform of service delivery to improve the system in the interests of its staff and those they care for – highlighting the current plight of care workers and service users, particularly women;

4) social care workers to be recognised as highly skilled professionals entitled to decent pay and working conditions, proper support and supervision, high quality training and clear pathways for career progression;

5) social care to remain an organising and recruitment priority for UNISON, complementing the union’s high-profile campaigns against injustice, privatisation and underfunding, and building on the successes and the lessons of the Care Workers for Change campaign in developing an effective strategy to organise care workers;

6) encouragement of targeted activity at selected high profile employers for campaigning activity in order to highlight the plight of our members working in the sector, including coordinated action up to and including lawful industrial action where branches are able to lodge legal trade disputes on members terms and conditions;

7) where a private sector provider is facing bankruptcy or liquidation, local authorities to be supported by central government to take over the running of homes in their area to ensure continuity both of provision and of employment for the staff in these homes;

8) to support care workers having a greater voice in the workplace and as part of the wider public debate; and

9) a universal social care system, based on public provision, paid for by general taxation and free at the point of need.

Conference also recognises that to achieve the above demands will require the replacement of this Tory Government with a Corbyn led Labour Government pledged to fund and provide for people’s needs.