Jude D’Alesio is one of the youngest councillors in Britain, serving on Long Ashton Parish Council in North Somerset.
Losing my part-time job as hog roaster was not how I envisaged the beginning of my Easter holidays. Instead, lockdown created a surge the demand for care assistant roles in my home city of Cardiff.
I could lie to you and say that this was the job I had always dreamed of having, but truthfully I was not prepared to play my PlayStation for a whole summer and needed an activity to bridge the gap to until I resumed university in September.
However, I was not prepared for how much it would teach me about the politics of social care. Indeed, learning everything from how to wake a resident in the morning, how to talk to a person with dementia, how to feed someone in their bed, and how to detect when they about to fall over, was a world apart from my law degree.
But if I learnt one thing as a care worker during Covid-19, it is that we need a new settlement for social care in Britain.
The Prime Minister and the Chancellor were swift in their response to the pandemic in the industry, boosting funding for councils as well as pledging that the promise to do ‘whatever it takes’ applies as much to social care as the NHS. So far, the pandemic has ensured that this valiant defence of social care is replacing the previous treatment of care as the poor cousin of the NHS.
Ensuring that the most vulnerable in society are safeguarded is a noble aim, though Gordon Brown’s proposed ‘death tax’ in 2010 reminds us that a realistic solution is unlikely to emerge from the left. Contrary to what some may think, I found that many of the residents under my care, no matter how mentally impaired, were concerned about their finances. Once, I was asked by a resident to go the bank (unlikely to occur at 2am on a Sunday) so that they could pay for their meals, despite them being prepaid by the family. Elderly residents worrying about their care is funded should not be commonplace in Britain.
It must be acknowledged that care homes were only able to focus all their efforts on beating coronavirus due to much of the normal care bureaucracy, such as routine Care Quality Commission inspections, being abandoned. I quickly learnt that ‘inspections’ was considered a dirty word among my colleagues, who told ironic stories of being distracted all day by inspectors who were, unsurprisingly, concerned with completing their tick box exercises. If this fails to renew the Government’s impetus to cut stifling bureaucracy following the pandemic, I know not what will.
Another benefit which emerged in the industry was the rapidity with which elderly patients were discharged from hospital into care homes. By the end of my stint as a care worker, I learnt that it was not uncommon for a new resident to be arriving every week from hospital, and given that the inert process of discharging elderly patients to care homes was a bane for policymakers, I hope that this new vigour sticks.
There is a paradigm throughout social care of focusing incessantly on negative metrics resulting from regulation: weight loss, bruises and aggressive behaviour, for example. Care homes must become less custodial and prioritise quality of life and happiness, not adopt a box-ticking exercise.
Conscious of how a large portion of my work was spent filling in checklists, I soon learnt why many residents soon spiral into depression upon being admitted to a home. As such, I prioritised engaging in more interpersonal interactions with these people, who often had incredible stories from their childhood and profession – not to mention reassuring Conservative views!
Care homes have seen residency rates fall dramatically, with a simultaneous need to make them safeguard against COVID-19 which has squeezed profit margins (by the end of summer the place was half-empty, with the occupancy rate dropping every week).This coincidence of underlying financial weakness, falling revenues and rising costs means that many homes are on the precipice of closure. However, there is an understandable reluctance by the Treasury to countenance an expansion in the scope of the state.
A report by the Centre for Policy Studies concluded that countries where the state has provided full free social care without restrictions have seen costs spiral unsustainably, forcing them to restrict eligibility and cut back services. Establishing a national care service is, unfortunately, not an option.
So, this is what I propose: a basic level of social care for everyone, funded nationally by taxation, but people buy out-of-pocket top-ups to purchase private insurance policies to cover additional care – a model backed by the CPS. This will end the injustice of some having to sell their homes to finance their care while reforming the structure of incentives to encourage private investment.
Covid-19 has provided the impetus to reform our care system, and if I learnt one thing as a carer it is that change is needed. I hope I am not proved wrong in saying that the energy from Downing Street thus far signals that we have a government which will get social care done