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From The Socialist newspaper, 7 October 2009

Social care in crisis

Care workers protest at privatisation in Waltham Forest, photo Alison Hill

Care workers protest at privatisation in Waltham Forest, photo Alison Hill   (Click to enlarge)

Cuts, outsourcing and privatisation mean vulnerable adults and children are 'falling through the net'. Social care staff are struggling to cope with high caseloads, increasing red tape and worsening pay, terms and conditions at work.
Home care, day services, residential homes, social work, child protection, and services for people with special educational needs, mental health services, support for disabled people, people with learning difficulties and older people...
All our services are under attack from New Labour in government and the Tories and Lib Dems in our local councils. And more of the same is promised.
Paul Couchman, a social care worker and branch secretary of Surrey County Unison, in a personal capacity, analyses what is going on.

A group of women gather in a frosty Glasgow car park at the crack of dawn. Huddled together they look at the day's lists and try to work out how they are going to get around all the elderly people they are supposed to be supporting. Two of their three cars won't start because of the cold. One of the women says: "It'll be midnight before we finish today".

This is 2009 under a New Labour government, a group of home care workers beginning their shift, shown as the introduction to a BBC Panorama programme called Britain's Home Care Scandal.

This programme showed graphically how privatised home care is failing pensioners. The overwhelmingly female workers, low-paid and poorly trained, struggle through each long shift, doing their very best to care for the elderly people on their lists. One by one we are shown vulnerable older people being visited for as little as two minutes each day as the workers are telephoned and harassed by their bosses, urging them to 'move on to the next one'.

Race to the bottom

Unique Care workers on strike against management bullying and harrassment, photo Huddersfield SP

Unique Care workers on strike against management bullying and harrassment, photo Huddersfield SP

In some councils, the tendering process has been refined to little more than an 'e-bay style auction' - rival companies sit at their laptops underbidding each other until the 'race to the bottom' is complete.

The contracts for looking after our mums and dads, nannies and granddads, are awarded to the lowest bidder - in one case just over 7 per hour. The only way the companies can make profits at this level is to cut wages and to fiddle the books - claiming for time spent with clients which doesn't happen. Older people are dying through the pursuit of profit.

The government says that more elderly people want to stay living at home with support, as opposed to going into residential care. The same philosophy drives policies for disabled people and people with learning difficulties. "Independence, freedom and choice" the politicians shout. "Close the residential homes, close the day centres, give everyone freedom and independence".

Socialists believe strongly that all vulnerable members of society should be treated with respect and dignity. They have the same right to a good quality of life as anyone else, including the right to stay at home, live independently, go to work etc.

The truth is, under the present system, these words are a con trick, a smokescreen behind which the politicians can cut back spending on social care, leaving people neglected, alone and abused.

Whilst 'old-fashioned' and 'institutional' services such as 9-5 segregated day centres and foreboding residential homes should make way for more mainstream, community-based and inclusive 21st century services, very little resources are being provided for any replacement services.

Although care workers in some local authorities have fought for and won improvements to pay and conditions, closures are being used as a way to cut costs and get rid of staff. More and more people are now expected to pay for services themselves - provided mainly by private, profit-making companies and voluntary (charity-based) groups. Councils are providing fewer and fewer services under this con trick of 'promoting independence'.


Child protection and the pressure on social workers

One area of social care recently in the news is child protection. The tragic deaths of Baby P in Haringey and others in Doncaster and elsewhere has led to a scapegoating of children's social workers by some elements of the media - most notably the Sun newspaper.

What these headlines fail to show is the reality for workers in social work teams across the UK.

There is a chronic shortage of children's social workers nationally. This is partly because of cutbacks in available training and the introduction of student fees, but also a result of the low status given to social workers generally by successive governments.

In many local authorities, children's social work teams are overloaded with cases, sometimes two or three times more child protection cases than maximum guidelines recommend. Some teams are massively understaffed, with agency workers filling some of the gaps but still leaving social workers working 10 and 12 hour days, six or seven days a week in some cases.

In Surrey, children's services have received a poor rating from the government inspectors and the council's main response has been to blame the workers. A regime of fear has been created with unreachable targets and 'performance' management, coupled with the threat of disciplinary action.

Surrey County Unison branch has gone into dispute with the council over caseloads and has organised four mass meetings of children's services workers - all of which have voted overwhelmingly for industrial action.

We even invited the service director to one meeting, who basically just said: "I'm not here to be nice". The council has thrown a bit of money at recruitment, increasing terms and conditions for new social workers, but have done nothing to alleviate the conditions of work for existing staff.

Unsafe working

Unison has been clear from the start that this is about protecting our members as well as about protecting children. Our union members cannot ensure that children in Surrey are safe if they are being forced into taking more cases than it is safe to do - or working ridiculously long hours, increasing tiredness and stress. Some of our members have told us they only manage to come into work once they have taken anti-depressants.

Talks with management have reached stalemate, with the council still refusing to re-establish a caseload management agreement. Unison will now be appealing to councillors at the personnel and appointments committee and going back to social work teams with a formal ballot for industrial action.

But Unison's national negotiators seem terrified of industrial action. A leading Unison national official even told us at a recent South East conference that: "It is inappropriate for social workers to strike."

Our branch took a resolution to Unison's national local government conference in June calling for support for any social workers taking action - which was passed.

We also called for a one-day local government conference on the crisis in social care which, even though it was passed unanimously, will not happen unless the rank and file members demand it. The national executive initially said they would organise a seminar instead but now a delegate forum has been arranged for February 2010.

If social work teams in Surrey do have to take industrial action we will need the widest possible support from other branches and the rest of the trade union movement to ensure a victory.


The evolution of social care

When capitalism developed, apart from the rich only those who were able to work had any real means of providing for their own needs. Workhouses, orphanages, asylums and long-stay hospitals were built to 'warehouse' anybody who could not play a productive role in the factories and farms.

Ironically, the early pioneers of this kind of segregated 'care' believed they were doing 'good', looking after the needy and vulnerable cast-offs of society. Many institutions were run by religious orders or philanthropic business people but the large institutions became synonymous with abuse and neglect.

In the 1970s and 1980s, disabled people started to speak up and argued for radical change. They wanted the same social, political and civil rights as the rest of society. Many called for the closure of the large institutions and for disabled people (also people with mental health problems, learning difficulties and elderly people) to have more independence.

They argued against the medical model of dependence and institutionalisation and for a social model of inclusion and equality. Slogans, such as "Free Our People" and "Piss on Pity", appeared on the T-shirts of disabled people at demonstrations across the country.

At the same time, a number of investigations were taking place into allegations of abuse and neglect in many long-stay institutions - one of the most notorious being Normansfield mental hospital in London.

Strike action

The workers at Normansfield, the nurses and care assistants through their trade unions, blew the whistle on neglect and abuse. They went on strike in 1976 against the hospital management, demanding increased resources and the sacking of the top consultant. The investigation report commended them for their action. This is an excellent example of health and social care workers taking strike action in support of the people they care for.

The call for the closure of the large institutions coincided with the election of Thatcher's Tory government and the beginning of a determined attack on our public services which has continued under New Labour. The Tories saw this as a great opportunity to make massive savings in public expenditure.

Closing the institutions was to save the public purse millions of pounds. Although there has always been a range of care providers, including businesses and informal (unpaid) care provided by families, this was the start of the major involvement of the third sector (charities and 'not-for-profit' organisations) in what has become known as the 'mixed economy of care'.

The NHS and Community Care Act 1990, under the cloak of 'promoting independence, freedom and choice', sounded the death knell for publicly-run social care.

Social workers became care managers, whose job was to assess people's needs and then to source appropriate services from the 'market'. Care managers had to prioritise charities and businesses when looking for providers of care services and to find the cheapest bidders - compulsory competitive tendering of human services.

Now we have a system of open economic warfare between competing providers, constantly cutting costs, quality of care and staff wages to bid for lucrative social care contracts. Social workers (care managers) have become gatekeepers for scarce resources, forced into commissioning roles they were never trained for and drowning in mountains of financial accounts and paperwork they never imagined when doing their social work training.

Direct payments and individual budgets

Faced with the legitimate call from disabled people for more direct control over their personal care, we saw the introduction of direct payments or 'personalisation'.

Historically, disabled people dependent on care provision had little or no control over their care services. They were told when to get up, when to eat, when to go to bed. They were told if and when they could go out and where they could go. This was partly because they were seen as second-class citizens but also was a result of institutionalised care systems, staff shift changes etc.

Direct payments are a means of paying service users a cash sum equivalent to the level of care they are assessed as needing. They can then use this money to directly employ their own personal assistants (PAs) or use it for transport costs etc.

For many this was real emancipation. For the very first time they had complete control over their own lives, their home routines and their personal care. They could even choose who to employ. But others have found it an unwanted problem, and for workers employed as PAs the story can also be very different. It can be a rewarding and enjoyable job and some excellent relationships have been forged between disabled people and their PAs.

Unfortunately, there are no safeguards and no employment rights - low pay and poor terms and conditions are the norm. As yet, trade unions have failed to recruit any significant number of PAs. One disabled journalist who employs his own PAs even wrote recently that he would rather be dead than have his PA join a union.

Direct payments, individual budgets, self-directed support and other 'new' systems of care provision represent the pinnacle of the privatisation of care. This is a system which is open to abuse of the worker's rights and those of the service user as employer. Vulnerable people can be open to coercion from families and unscrupulous care providers.

Every day stories appear of PAs abusing their employers and of service users mistreating their staff. Thousands of vulnerable people are falling through the net and councils are employing fewer and fewer direct care workers. 'Personalisation' is often personalisation on the cheap.


Organise and fight back

The need for social care workers to organise and fight back is a national one. The only way to defend services is to build the relevant unions, organise in the workplaces and fight back.

Socialists and trade unionists must also campaign for the widest possible unity between workers and service users and for joint control of services along with democratically elected representatives of the wider community at local and national level. We stand beside disabled people, incapacitated people etc, in the fight for equal rights and in defence of their right to control their own lives - but we also defend the rights of the workers who provide for their needs and we support them organising themselves in trade unions.

Socialists need to campaign and fight for a reversal of the privatisation of care services over the past 20 years, whilst standing with service users in fighting for publicly owned and well-resourced services which meet their needs.


Our Homes Our Say

The Elmbridge Care Homes Campaign will be lobbying Surrey county council on 13 October. They will be meeting in the car park at County Hall, Kingston from 12-2pm. The campaign is demanding that Surrey County Council take over three care homes currently run by the YMCA, who want to sell them off. These homes must be kept public. More information at www.ourhomesouray.org.uk.

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In The Socialist 7 October 2009:

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