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The UK’s social care system is an outrage: will any government ever reform it?

Despite 12 white papers, green papers and consultations on social care reform in the past 20 years, Britain’s elderly still live in fear.

By James Bloodworth

My grandmother is terrified of care homes. As she approaches her 92nd birthday she is adamant: “I don’t want to go into a care home.”

She’s already spent time in a care home, albeit as a visitor rather than a resident. My step-grandfather, a Welshman named Len, was a permanent fixture in mine and my grandmother’s life until around ten years ago. Then he started to forget things and behave in peculiar ways: we subsequently found out he had Alzheimer’s. When my grandmother could no longer look after Len he moved into a local residential care home. 

My grandmother would visit Len each day to take him sandwiches and have a chat: in a place full of dementia patients the conversation could be drab and repetitive for someone who retained, as Len did, most of his mental faculties. As Len’s condition deteriorated over the years, my grandmother began to return home with anxious stories of him being left dehydrated or without food. Sometimes she found him in wet or soiled underwear, sitting in an armchair facing a wall on which the word “LOVE” had been stencilled in bold white letters. 

While Len was left mucky and unwashed, his life savings were slowly cleaned out. A widower by the time he met my gran, Len grew up in a poor mining family in South Wales. He joined the air force during the Second World War and over a lifetime was able to buy a house in Somerset where he lived frugally, saving in order to leave something behind for his children. Len had grown up sleeping four-to-a-bed during the great depression, when unemployment among men in Wales reached 43 per cent. He was intent on ensuring his children and grandchildren would never struggle the way he and his brothers and sisters had struggled. 

Which meant that by the time he moved into a residential care home in 2009, Len had accumulated assets worth more than £23,250 (the cap at which means-tested care ceases to be paid by the state) and was thus expected to fund his own care. 

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[See also: The NHS backlog: What happens when waiting lists for healthcare grow too long?]

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Care is a profit-driven sector where the elderly are referred to as “clients”, “customers” and “service users”. Len lived in a care home for five years when he died in 2014. His “care” – a picture of which I have painted already – cost around £40,000 each year. There were 23 other residents in the home paying similar fees. Where the money went is a mystery. It didn’t appear to make its way to the carers charged with looking after Len, who took home the minimum wage.

I worked as a home carer for a short time in 2016 while researching a book. It was the hardest job I’d ever done. Yet despite doing a physically and emotionally draining nature job, carers themselves are frequently treated like “glorified cleaners” as one worker put it to me. I took home less than the minimum wage because I was never paid for travel between appointments. In common with around a third of care workers, I was employed on a zero-hours contract meaning I had no idea what my hours were going to be from one day to the next. 

In 2019, in his first speech as Prime Minister, Boris Johnson promised a “clear plan” to “fix the crisis in social care once and for all”. Care England has called on the government to provide an extra £7bn a year in funding  as a starting point. The government is expected to include social care proposals in next week’s Queen’s Speech; though ominously, it omitted social care funding from its recent NHS reform white paper. 

You would be forgiven for getting a sense of déjà vu. There have been at least 12 white papers, green papers and consultations on social care reform in the past 20 years. A 1999 report commissioned by the then-Labour government criticised the means-tested approach that is still in place today, which it described as “not efficient or fair due to the nature of the risk and the size of the sums required”. Soon after coming to power in 2010, the coalition government set up a commission which proposed a more generous means-test and a cap on lifetime social care charges. 

Yet the implementation of the report was indefinitely postponed by the Cameron government. As was a 2017 green paper for consultation on how people paid for social care proposed by Theresa May’s government.

Other European countries, such as Germany, have successfully reformed social care. Yet state spending on social care in Britain is among the lowest in Europe at £695 per head, compared with £1,530 in Norway, £1,451 in the Netherlands and £1,033 in Switzerland. 

We have a strange and paradoxical relationship with growing old in this country. Politics is ostensibly dominated by the interests of the “grey vote”; the NHS is treated with quasi-religious reverence; and there was widespread public support for Covid-19 lockdowns to “protect granny”.

[See also: Why were more people dying in the UK even before Covid-19?]

Yet parallel to this, when they require care, elderly and disabled people are parcelled up and sold off to the lowest bidder. Eight billion pounds has been cut from social care budgets since 2010. We piously stood on our doorsteps to “clap for carers” last March; yet we pay carers poverty wages and adopt an “out of sight, out of mind” attitude when it comes to dysfunctional care homes, where over 30,000 residents and nearly 900 health and social care staff have died of Covid-19. 

We like to blame the government for the decrepit state of social care, yet in truth, I suspect successive British governments have balked at finding more money for social care because there has never been sufficient public clamour to do so.

It’s a state of affairs that leaves my grandmother anxiously dreading the day she can no longer manage in her own home. She knows the experience only too well. Len, a man who we both loved, who fought the Nazis and who I was proud to call my step-grandfather, spent his final days sitting in soiled trousers in a for-profit care home where even the decorative trimmings were purchased on a shoestring. 

Old age shouldn’t summon this kind of dread. It should be a time to fade away in a comfortable place surrounded by family or empathetic carers. But a better system costs money. And as Len – a stubborn old socialist – liked to say whenever we talked politics, you can’t have European public services with American (or British) levels of taxation.

[See also: Mourning and melancholia: the psychological shadow-pandemic]