Ending extraction in the UK care system

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No matter where we live or how much money we have, we all know there might come a time when ourselves or a loved one will need to be cared for. But over the last few decades, successive governments have undermined the care sector which is a vital part of our society and economy. We make significant investments every year in caring for one another. But it’s not delivering high quality care, or good jobs.

Instead of facilitating the care of children, older people, disabled and learning disabled people, our care system facilitates the extraction of value and wealth from places and local public service budgets. While executive pay booms, frontline workers receive little more than the minimum wage. While local government and central government struggle to pay the bills to meet increasing demand, private company profits continue to rise.

Politicians and pundits tell us that there simply isn’t the money to invest in social care and that we can’t afford to borrow more to build a better system.

The truth is that money exists in the care system but too much of it is leaking out. The reasons for this are complex. They can include poor service design and commissioning, as well as a lack of capacity and resources within local government procurement (which is a result of government decisions to reduce public expenditure on local government as part of austerity). However, care systems are also vulnerable because of the way in which they have become subject to market dynamics. Instead of simply being provided as a public service, systems of care have gradually, over time, come to function more like a commodity or a product to be bought and sold depending on what the state and the individual can afford. This is not unique to the care system – privatisation and financialisation have led to extraction across all aspects of our livelihoods, and the erosion of public values in what should be public goods and services delivered in the interest of the public.

Because of austerity and public service provision being opened up to private markets, social care in the UK is increasingly dominated by the kinds of predatory business models and profiteering that should have no place in the sector. While a handful of investors make a fortune from care provision each year, they do this by making care workers struggle in poorly paid, precarious jobs, which means that care provision is substandard and frequently unsafe by also underinvesting in the necessary facilities and equipment. This system of provision is not meeting the needs or expectations of communities.

Local authorities face growing demand for care services with shrinking budgets, leaving them ​‘over a barrel’. This dynamic fuels predatory behaviour, consolidation and monopolisation by large care providers chasing ​‘economies of scale’.

Who has turned this vital social service into a commodity and speculative asset? How do they continue to squeeze massive profits from the everyday social care delivered in every neighbourhood in the country? And, what should we do about it?

Strong care systems are essential foundations of a fair economy. When we fail to build them, the costs spill over onto families, communities and other public services such as the NHS and police.

A great deal of research already exists on extraction in the care sector. This report builds on that by mapping the main channels of extraction and highlighting successful precedents for tackling them. It is written for those working in communities, local government and regional policy who are trying to make the system work differently, and includes recommendations for national policy to address marketisation of the care sector across the UK.

Drawing on the Reclaiming Our Regional Economies (RORE) programme in the north-east, South Yorkshire and the West Midlands Strategic Authority areas, the report shows both the economic importance of care in these regions and the scale of wealth being drained from them. We focus on adult social care, residential care (care homes), looked-after children’s homes (residential homes) and special educational needs and disabilities (SEND) – forms of care directly tied to local authority duties where local and regional governments have room to act differently.

Our analysis shows how taxes and care bills are extracted from local economies at the expense of the most vulnerable.

Yet alternatives exist. Across the UK, examples show that care can be organised in ways that meet people’s needs while creating good jobs and stronger local economies. This report argues that with imagination, courage and long-term investment, local and regional authorities can build care systems that work in the public interest. Decent care should not be treated as a burden but as the foundation of a fair economy. While our insights come from three English regions, the lessons apply across the UK and beyond.

Image: iiievgeniy (iStockphoto​.com)