‘The smell would be even worse’, says Zoe, the social worker I’m shadowing for the week, ‘were it not for the clothes.’ Trying not to touch or breathe, I survey the mounds of sweaters and jeans and dresses interspersed across the bare floorboards. The place is a disaster — junk everywhere, filling the shelves, piling up the surfaces; the sound of broken taps from the kitchen; the living room a living ruin.
I’m on a housing estate in one of the Home Counties and we’ve been called out to see about putting in place a ‘preventative measure’ for Mrs R, a 90 year-old woman at risk of falls. Not having to leap Beecher’s Brook every time she needs a wash will reduce the likelihood of a hip fractures (bad for the NHS) — a logic even I can compute. So we’re there to measure up for a level-access shower.
But, in truth, measuring up for a shower feels like plugging a damn with a finger. Because Mrs R and her 40 year-old schizophrenic son who lives with her are evidently not coping well. Placing them in care — which might mean separating them — is an option. But, in Zoe’s view, ‘it’s not bad enough yet.’
That decision may be a close call. What’s a dead cert is that Zoe’s locality team are being increasingly overwhelmed with similar cases. As part of the Centre for Social Justice’s now two-year long review of older age poverty — which has released a report today — I’ve been placed with one of the most well-regarded, pioneering adult social services departments in the country. Yet even this one has a budget at breaking point and staff who are utterly swamped. ‘No more allocations’, the locality’s team leader radios back to HQ. The sheer volume of visits, the countless number of cases, the plethora of care packages — this team at least is operating at capacity.
Yet while multiple-agency meetings are being convened across the country to deal with cases as complex as Mrs R and her son, what are policy-makers talking about? Protecting the housing wealth of the middle classes. Ahead of the Government’s long-awaited White Paper on social care, public debate has been entirely focussed upon ensuring that those fortunate enough to have accumulated assets will not have to expend them on themselves.
Upon arriving in office, the Coalition Government immediately commissioned a report on long-term care. How to fund the care system fairly — that was the exam question Oxford economist Andrew Dilnot was set. And a year later, in July 2011, that was the question he answered (his main proposal being to set a cap any individual contributes towards their care). But by ‘fairly’ what the exam question inferred was this: why should the have-nots get their care for free on the state while the haves be forced to exhaust what they have accumulated?
Yet not only does this subtle indignation strike at the heart of the way compassionate societies have always operated (any relief for the poorest will always be unfair!), the question also presupposed that our existing system for the poorest works in the first place. Which it patently does not. As hundreds of individuals and charities and providers have stressed to us over the last two years, you have to be half dead simply to qualify for social care. And for those who do get it, provision is all too often woefully inadequate. Home care has largely come to be associated with notorious ‘flying visits’ — care workers who drop by and cram into fifteen minutes a scrub, change of clothes and micro-wave meal. Whilst the care home sector is, to say the least, beleaguered.
Certainly, not all these failings can be put down to a lack of money. As we saw on Panorama last week, there is abuse by individuals and it is inexcusable. Yet with public spending on social care for the poorest standing at a paltry six per cent of what’s forked out on all older Brits, it does seem that our priorities are mistaken. And the impact on the ground is undeniable. For instance, the reason for flying visits isn’t simply care workers clocking off early. More usually it lies with local authority commissioners, under pressure to manage their shrinking budgets, driving down the prices they pay providers. Travel time is rarely factored in, so more haste and more speed.
Next month’s Social Care White Paper comes at an interesting time. Labour is piling in behind Dilnot because they are chasing the squeezed middle. While the Government are eager to mollify the pensioners whose personal allowances they’ve just ended. The Treasury, however, must resist the temptation to run before it can walk; that is, to extend eligibility for care to thousands of elderly homeowners before it radically reforms the current system. ‘We deal with people in poverty, people who don’t have a cent to their name’, says another social worker, as we drive to yet another client. And their care must come first.
Dr James Mumford is a senior policy researcher at the Centre for Social Justice.