On 21 June the Today Programme reported on whether or not the government was holding a meeting to discuss fixing social care. The Prime Minister promised in 2019 that a plan on adult social care was virtually ready. We are all still waiting to hear about a meeting, let alone a well thought out and adequately funded plan.
Legislation is currently going through Parliament on arrangements to integrate social care run by local authorities and NHS community and acute services. There are ambitious goals in the draft legislation including improving health for all, reducing health inequalities and encouraging the NHS to contribute to the social and economic development of local areas. NHS leaders are enthusiastic about these goals but achieving them without clear policy on the funding of adult social care is highly problematic.
In March this year the Prime Minister and the Chancellor published Build Back Better, a plan for post pandemic economic growth. It is a comprehensive report full of great plans and ideas, focussing on infrastructure, skills and innovation, delivered in ways that address geographical inequality, the challenge of global warming, and the advantage of our freedoms from EU restrictions. I was particularly pleased to see the promised investment in further education, long neglected by governments in favour of universities. The least well-off young people are more likely to be in FE, and more likely to stay local for their employment. Building back better is highly reliant on people who have the skills to build.
While both the NHS reforms and wider Build Back Better plans are encouraging in their ambitions, returning to social care illustrates the fundamental weakness in these grand ambitions. This government, like others before it, is unwilling to be honest with the public about the trade-offs, the tensions and the difficult choices. It is unlikely that the skills revolution and innovative technology will be able to solve the fundamental problems of funding social care for an increasingly elderly population. Childcare faces similar challenges and inadequate funding decrease in particular women’s opportunities in the labour market. Our current economic model requires both parents to work to achieve a reasonable income standard. The government has responded by offering working parents increasing amounts of free childcare for working parents. However, the funding of the childcare is inadequate to provide the quality of childcare that will improve school readiness and support higher female labour force participation. Women are also more likely than men to leave the workforce early to care for elderly parents. Indeed, women who delayed having children are often caught with dependent children and elderly parents to care for. Both adult social care and childcare are industries dependent on a largely female low pay workforce. A reasonable proportion of women working in both areas are dependent on in-work benefits. Over half of poor children now live in a household where at least one adult is in work.
There are two big areas of reform that must be part of the solution to both adult social care and childcare, and they are inter-related. First, FE colleges need to be much better at addressing the gender divide in particular industries: more women in construction, more men in care. This will only happen if pay and conditions for care is greatly enhanced. Improving career progression in care is also critical. Turnover is high because wages only increase slowly with experience and there is limited promotion into management roles. The key to better pay and conditions is dependent on much higher level of government support for both adult social care and childcare. Hence the second reform is considerably more difficult. We need to convince the British public that better public services require more generous funding which can only be delivered by a fairer tax system. Capital gains and inheritance tax are both clear targets for reform.
Both the US and the UK are setting out ambitious social and economic plans to improve their economies overall and reduce the unacceptable levels of inequality that have been growing for decades. But inevitably in the short term there will be winners and losers. Those with broader shoulders should be willing to take a larger share of the burden, but they are often the most skilled at avoidance.
Naomi Eisenstadt is the Independent Chair of the Northamptonshire Health and Care Partnership, a former anti-poverty advisor to the Scottish Government and founder of Sure Start centres in the UK. Naomi is an advisor to CPP’s Women in the Labour Market research programme.