The Adult Social Care Crisis

13 Apr

Marketisation of adult social care services and the spending cuts impact on all adult social care services was dramatically illustrated by the collapse of Southern Cross residential care for older people.

Last year the Equality and Human Rights Commission (EHRC) published an investigation into home care for older people. This report is incredibly moving and highlights a service most of us will use in the future to a lesser or greater degree.

Adult social care should be an enabling service that is open to everyone and allows people to live their life to the full. This is far from reality.

The predominantly female workforce try to provide good care, aware that attention to details and daily little tasks can have a massive impact on people’s quality of life. Users of adult social care are by a majority women.

The EHRC looks at social care from a human rights perspective, importantly whether care is respectful and enables people to live as they wish with dignity. The majority of providers appear to fall short of this standard.

Local Authorities have tightened their eligibility for care making it even more restrictive – most now only provide publicly funded care for those deemed to have critical or substantial needs.

Older people who were satisfied with their home care were happy with the professionalism and skills of staff carrying out their work. There were also many reports of people feeling dehumanised, humiliated and wanting to die.

Older people interviewed by EHRC placed a high value on conversation, and their carers having time to chat. The attitude of staff was hugely important – how tasks were carried out was just as important as those tasks being performed.

Interviews with workers found that many valued that their work helped people retain their independence in their own homes; that they provided high quality, respectful care, and recognised that often they could be the only people who their clients regularly see.

However, the vast majority of workers interviewed highlighted things they were dissatisfied with. Most frequently this was not having enough time to deliver the standard of care they wanted – 1 in 4 reported this problem – and not being able to use their own initiative. This approach is called ‘time and task’ where short, minuted slots are allocated to each service user and the care worker given a list of specific tasks that must be done and ticked off.

Of publicly funded homecare, 84 per cent is now contracted from the private or not-for-profit sector. Commissioning often ignores or gives a low priority to the role of social care in tackling social isolation. While often there is a statement about the human rights of the users in the contract there is nothing to make this legal statement a practical reality.

Currently 33 per cent of local authorities are planning to negotiate lower contracts with home care providers over the previous 12 months and a further 19 per cent plan to do so in the coming 12 months.

The race to the bottom on quality is matched by downward pressure on pay and access to training. The median hourly rate for care workers and home carers is £7.81 – with 30 per cent earning £6.86 or less.

In 2011 the NHS Information Centre reported a 2 per cent real terms decrease in spending on adult social care services by local authorities. Current Local Authority funding shortfalls will only worsen this false economy.

The crisis is social care is a feminist issue around which women workers and users can unite to defend.


Gail Cartmail



Gail Cartmail, Assistant General Secretary, Unite the Union

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