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Mark Turner, UNISON Cymru Wales lead officer for social care calls for a National Care Service
Ask healthcare workers for a way out of the NHS crisis and they’ll tell you: give demoralised staff a major boost in wages to deal with serious recruitment and retention problems and relieve pressure on the NHS by transforming how we deliver social care.
Without proper investment NHS staff will continue to leave for better paid, less stressful jobs and services to patients won’t improve. While UNISON Cymru Wales, as the largest healthcare union, continues to campaign for the higher pay rises healthcare workers need, I want to talk now about why society must recognise we will never ease the acute pressure on the NHS without significantly improving care services.
Across Wales, hundreds of hospital beds are occupied by patients medically fit for discharge, but there is insufficient capacity to ensure a care package for them, so they remain in hospital. Meanwhile, paramedics are stacked outside emergency departments looking after patients who should be in those hospitals. As a result, ambulance response times are the worst for many years. Paramedics tell me, in the past they could attend to five or six calls a shift, but now they may do one or two, sometimes spending an entire twelve-hour shift with one patient, waiting for them to be seen by emergency staff. This log jam is causing problems throughout the NHS. We can estimate that millions of pounds are being wasted.
Welsh Government estimates Wales will need another 20,000 care workers by 2030. It’s in everyone’s interests for social care to play its part in helping the NHS, but care is itself in crisis.
Last year, a UNISON/Association for Public Service Excellence (APSE), report, A National Care Service for Wales, concluded people receiving care, as well as care workers, are being let down by the current system of commissioning, outsourcing and the need to turn a profit, and years of underfunding.
APSE described how the requirement to create a profit or, for the third sector, to compete with for-profit providers, means corners are cut, so, for instance, home care workers are allocated too many service users and are not paid travel time and this impacts on service user care. In-work poverty is commonplace, staff turnover is high and vacancies, huge.
It said the £1.2 billion care market in Wales is dominated by private companies and no-one knows how much money is disappearing from the sector in profit or is wasted in the commissioning process. Whilst there are many small private care providers, a handful of multinationals occupy a powerful position. Ultimately owned by private equity firms, they target around 12 per cent profit return for investors, extracting money from the sector leaving care providers struggling to make ends meet. Costs are minimised by squeezing care worker wages and undermining the quality of care provision.
Injecting more public money into care without removing the commissioning model and profit motive, wouldn’t significantly improve the employment conditions of care workers or quality of care for users. As the economics of social care are entangled with the economics of real estate, it would only work to drive up the value of care firms, making them more attractive as acquisition targets, more money in other words, haemorrhaging away as private profit.
The delivery of care by the private and ‘voluntary’ sector has failed. Every pound of public money spent on social care must go towards the provision of that care. A National Care Service, with most care provided directly by local authorities, would put dignity and respect for clients and staff at its heart and alleviate pressure on the NHS.
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