In a move paralleling the attack on the NHS, an assault has been launched on social care...
While the government has been forced to appear to rein in its plans to privatise the National Health Service – though vigilance here must be the watchword – little attention has been given to the other part of the Health and Social Care Bill: social care. This, along with a host of other measures, will have a devastating effect on both the ageing population it is claiming to support, and the existing social care workforce through marketisation of adult social care in England and Wales.
The heart of the plan is to end the existing provision of adult care by local authorities and the NHS by allocating personal budgets to all individual adults in need of social care so that they may buy a personal package of care.
By April 2013, all “service users” – those adults with assessed social care needs – will be on a personal budget. Firstly, this means that all local authorities must move all existing service users, mainly elderly or disabled people, from direct provision of care packages such as residential care, domiciliary care, day centres and so on, to means-tested direct payments that require the service user to buy their own package of care.
Apart from the fact that many people will not want to change their existing package of care that they have become used to, they will be prohibited from using their direct payment to buy any services from the existing in-house (directly provided by local authority) service. This means that the person needing care will have to compare the market to buy a private package of care. Those with a certain level of savings or property will have to pay for their own care, maybe by selling their house, for example.
Clearly the intention is that in-house services will close and the workforce, with all their experience, will lose their jobs. The government sees the way forward as “mutuals”, private companies, or user-led organisations (ULOs) selling their services to the elderly and disabled. The workforce will no doubt be encouraged to set up cooperatives or similar bodies. The elderly and disabled will become employers – most of them for the first time in their lives. It is expected that social workers will be moved out of local authority control, their General Social Care Council will be abolished and their roles downgraded.
But how will these personal direct payments be funded? The Dilnot Commission, which is due to report in the summer, is expected to recommend firstly, a national threshold for care as opposed to local authority set eligibility criteria and a voluntary private insurance basis for funding this care.
The financial services sector will be encouraged to come up with care insurance products so there will be plenty of scope for making money there! There will be a new regulation and inspection regime, providing less inspection and scrutiny due to the “strengthening of user influence”. Inevitably this reduction will give more scope for cheating and abusing vulnerable people.
Pioneered by Labour
These proposals are not new: they were pioneered by the Labour government during its drive to privatise and marketise health provision. They reflect a continuation of the drive by the Thatcher government and continued under Blair to privatise everything that moves and to fragment employment and consequently working class organisation.
Before Thatcher, it was clear to all that the working class comprised all those who had to sell their labour power. Today, the concept of the working class is defined by commentators as that “small white underclass”, many of whom don’t work at all. This is our problem today, that we don’t see ourselves as the working class.
The social care reforms will create a fragmented workforce, scores of thousands of individually employed personal assistants. Will they see themselves as part of the working class and join a union? As well as the fragmentation of the workforce, the social care reforms represent the destruction of this last bastion of the welfare state. ■
• See also news story, page 3.