Carers UK’s Head of Innovation Madeleine Starr MBE examines the future of care and support services and asks whether a ‘care economy’ could help us grow our way out of recession.
‘Demographic timebomb’, ‘silver tsunami’, ‘agequake’ – all are terms used to describe the potential impact of our ageing and disabled population, and all suggest imminent Armageddon. Is this really how we see the dual good news story that people are living longer and living better with disability? Surely it’s not the medical advances that enable young people with cystic fibrosis to live into adulthood that are the challenge for our modern times? No, it’s finding the right societal response to give older and disabled people, their families and carers a proper quality of life.
Sadly, social care funding has simply not kept pace with rapidly growing demand. What is currently on offer simply does not match the way modern families live and work. However, funding is only part of the issue, and while policy makers grapple with the vexed question of how to pay for care, we also need to think differently about what we are providing.
Failures to provide decent social care not only paralyse families, they stifle economic productivity. Over a million people, often at the peak of their careers, are being forced to give up work or reduce working hours to care, with a loss to the economy of £5.3 billion. Many end up in debt, facing financial hardship into their retirement. We have to reduce the risk of this economic damage, and in this respect care and support services are as much about economic productivity as about social cohesion.
Can the ‘Demographic timebomb’ be turned into a good news story of economic growth? We are seeing increasing demand for better and more flexible services from families willing and able to buy care, from service-users with personal budgets, and from employers who want services that enable their employees to work without stress, much like childcare does for parents. Most people who use care services - and that includes the low level preventive services often paid ‘cash in hand’ such as cleaning, gardening or shopping - are ‘self-funders’, paying for it themselves. So if most of us pay for care – and most of us will have to, subsidised or not – can we demand services that do what we want them to, when we want them to?
All of us have tales of services which leave our older or disabled relatives in despair – the morning ‘wash and dress’ that never comes at the same time, the lunch delivered at 11.00am, the ‘put to bed’ call at 6.00pm, fifteen minute time slots that do not allow for any meaningful human contact, all of which robs people of any dignity or control. We weep in frustration at services to our frail Mum or Dad that require two different agencies to get them out of bed and make their breakfast, but neither of which washes the breakfast dishes! So that job gets done by the cleaner we pay ‘cash in hand’, adding to the crowded scene of people providing what with a bit of imagination could be one integrated service.
How we care for our older, sick or disabled population is the mark of a civilised society. We will always need a safety net of services provided through local authorities to protect the most vulnerable or the poorest in our society. They should be personalised to meet people’s needs, funded fairly, portable and not subject to a postcode lottery. However, the majority of the population not eligible for local authority support also have a right to expect the same quality from the services they buy.
Carers UK is arguing that we should look at care much as we looked at childcare in the 1990s, and see it as providing support for families to live and work. Investment in childcare – through the tax system, through childcare vouchers, through business incentives – enabled new players to come into the childcare market, and increased the supply of childcare to families. We want the same for care, with a National Care Strategy providing the right leadership and the right opportunity for growth, as the National Childcare Strategy did before it.
We want good quality care services provided by social enterprises, the voluntary sector, micro businesses, big businesses. We want these services to be affordable, so that families can use them as much as they need to, creating a virtuous circle of demand and supply. We want them to be flexible and reliable, so they meet real needs. We want them incentivised and recognised as a vital part of economic productivity.
In this new world of care and support services that are fit for purpose, people who can pay for them will pay for them, people who can’t will be supported. We will migrate from an information economy to a new and thriving care economy. New technologies will help people work smarter and deliver new services in new ways, responding to the needs of modern families and reshaping traditional models of health and care.
So can this be fact or is it just desirable fiction? Carers UK believes it is achievable, as evidenced by the experience of other countries who have taken this approach. France has seen the creation of over half a million jobs since the introduction of its Borloo Plan in 2005, designed to grow the sector of what it calls ‘personal and household’ services, and which continued to grow through the recession.
However, this market will not shape itself. Good quality comes at a cost, and we are not always paying it. The result is that many families are confronted with inflexible services delivered by poorly paid care workers, with a high turnover in the sector and huge recruitment issues. But we also know that there are high quality services out there. The question is, how do we ensure investment that allows them to maintain quality while making them affordable? We cannot and should not drive the cost of services down, as we have been doing through local authority mechanisms for years.
Again we can look at lessons from Europe here. France and Belgium have built a powerful case for public investment in care and support services by identifying the ‘earn back’ effects of incentivising them. This reduces the impact of their funding to the Exchequer. These ‘earn back’ effects include additional tax revenues and benefits to employers in terms of workforce retention and improved productivity. They also include the benefits of bringing workers normally paid ‘cash in hand’ into the formal economy - exactly the kinds of services that we should be growing. A care economy would build family resilience, maintain business productivity and create more and better jobs - the oil in the wheels of a functioning society and a thriving economy.
So, how to make it happen? An excellent start was proposed by Minister for Care Services Paul Burstow at a recent Carers Week Summit hosted by Employers for Carers and HM Government at BT – a dedicated Task and Finish group committed to producing a roadmap for action. They will bring together business, public and political interests to tackle one of our greatest societal challenges while unlocking real potential for growth. An exciting additional opportunity comes with Barbara Keeley’s Private Members Bill proposing a duty on local authorities to ensure a sufficiency of supply of care services, a mechanism that worked well for childcare. And who knows, as a final step we might yet see a National Care Strategy which will be a blueprint for providing a 21st century solution to one of our greatest 21st century challenges.
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