Last week’s opinion poll by the BBC on our perception of public services was leaped on by the Government as evidence that services could be improved despite the cuts.
But the thing I noticed was that down at the bottom, next to road maintenance and policing, the public perception of how services for the elderly had changed was highly negative. Mark Easton of the BBC, who wrote about the poll, observed that ‘cuts in spending have had a particularly negative effect on vulnerable groups whose experience many not be represented in the poll’. And Sir Merrick Cockell of the Local Government Association is quoted as saying that ‘A shortage of funding and increasing demand is making it impossible to maintain adult social care services at current levels let alone to try and raise standards.’
Services for the elderly have been brought under the spotlight by Labour’s Andy Burnham at Labour Conference, making the case for a new integrated National Health and Care Service, and recent controversy about the growing practice of offering 15 minute care visits, which are almost pointless and not very caring. The Care Bill (Government summary here ) returns to the House of Lords next week, and there is now intense debate about its provisions and how the rights of elderly people might be strengthened, not only by capping payments but also by improving the poor training of workers and tackling cases of abuse. The current state of play on the Bill was well summarised by David Brindle in the Guardian this week.
The Bill deserves a lot more attention than it has been getting, and there are opportunities for amendments as it goes through the system. But it is unlikely to deal with what seems to be the core problem: that the combination of growing demand, huge cuts in budgets, and the contracting culture, with less and less direct provision on traditional employment terms, is driving the system away from its central objective and putting increasing pressure on the critical relationship between the elderly person and the care worker.
The well-being of a growing number of elderly people depends on the quality of the service that their care workers provide, but they are increasingly subject to bad employment practice: zero hours contracts and unpaid hours (eg for overnight stays and travel) which combine to put wages well below the minimum wage. Many carers spend more time travelling between short visits than they do in face to face contact with their clients. The Equalities Commission recently warned that the strain in the system was putting at risk the rights of both elderly people and the care workers themselves.
The fully integrated health and social care service that Labour is promising seems like the right way forward. But it is increasingly clear that no system has a chance of working unless more money is put into it.