If Engels was living today he would be visiting care homes in Manchester, not factories.
In the Covid-19 pandemic more people have died in care homes than in hospitals, with current estimates north of 22,000 fatalities in care homes in the UK. This awful reality is being seen in Canada, USA, Spain, Sweden and across the western world. Further casualties must be expected. Social care is not just about elderly people in care homes, millions of people are living in their own flats and houses with support and 1 in 6 residents living in care homes is of working age. But care homes for elderly people are now the battle ground.
Care homes rely on low pay, zero-hours and migrant labour. They were financially unsustainable even before Covid-19, and the pandemic has broken the model wide open. A battle is starting for the new normal in social care and the defenders of care homes are lining up for the fight. As in a medieval campaign so far we can see four camps limbering up. For convenience we can call these camps the Corporatist, the Capitalist, the Collectivist and the Community. So let’s examine their battle plans in turn.
The Corporatist camp believes that good practices will prevail, and that better regulations and smarter procurement will provide the answers. It especially likes non profit providers such as the big charities and social landlords because they talk the same language. The generals in the camp are the Care Quality Commission and Public Health England, with their local lieutenants in the new Clinical Commissioning Groups. Their two weaknesses are their stores are empty and they don’t know when they have been out-manoeuvred.
The Capitalist camp believes that their ruthlessness (which in public they call innovation) will see off all other options. This camp has the best supply lines; donors with large levers inside government, thinktanks, and some media. The property bubble has given them superprofits by signing offshore mortgages and putting the winnings in a different company, leaving the care home accounts looking bleak, leading to more excuses for even less pay and worse job security. The big reductions in overnight wages is a recent example. Their weakness is they can’t help attacking each other, even though they pay lobbyists to say they have a united front and a common interest in serving humanity.
The Collectivist camp is newer. They believe that care homes as a business model are fine, it’s just the bosses that need fixing. Their generals include the TUC and the We Own It campaign, and their battle plan is to nationalise care homes as a sister arm to the NHS. Their battle cry is for a new National Care Service. This campaign has some merit, social care has always been the poor relation of the NHS. The mass eviction of tens of thousands of delayed discharge hospital patients (bed blockers as the troops would say) despite many being Covid-19 infectious will haunt many decent people in the NHS. The suspension of the Care Act and subsequent wholesale evictions from hospital wards showed what community care means inside the NHS when push comes to shove. The weaknesses of the collectivist camp are that they see care homes as an industry, and they underestimate the power of the big hospital barons to suck the money out of community care. To be fair, others make the same mistake.
Finally, away in the far corner is the Community camp, the smallest band of fighters. They aren’t new to the battle, they’ve been skirmishing in the shadows of policy since the 1960s and maybe earlier, with groups such as the National Campaign for the Young Chronic Sick which helped the Labour party pass a law in 1970 to liberate disabled people from a lifetime spent in a hospital bed to live independently by taking responsibilities away from the NHS and giving them to councils with social services departments. The 1970s and 1980s saw more campaigns against segregated care institutions, and the idea of independent living with support in the community started to take hold. Scores of disabled people visited Berkeley in California to learn how disabled people there passed on their knowledge to the next generation through centres for independent living. The campaign for independent living rumbles on, and the generals in this camp include the Reclaiming Our Future Alliance and Disabled People Against Cuts. Their weakness is that ten years of austerity, and marginal funding for years before that, has left their organisations empty or gone.
So, which of the Corporatist, Capitalist, Collectivist and Community campaigns will prevail in the coming battle for the new normal in social care?
We know that independent living has saved lives when compared with care homes. Given the international crisis in social care, the leadership failures in many western governments, and in response the rise of localism and mutuality as the most resilient response, it’s too soon to write off the community campaign for independent living.