The delayed Green Paper on the future of social care suggests we need a scheme to pay into for our care, of course we already have this in place now where everyone is covered, but of course govt means a private company insurance scheme, a for profit scheme. The Kings Fund suggest The Health Secretary, Matt Hancock, is attracted to the idea of an ‘opt-out’ insurance scheme for social care costs. Workers would be automatically enrolled and would then be protected against future costs of care (either all costs or, if the scheme had a lower premium, just against catastrophic costs). People could opt out but, if they did, they would need to cover their future social care costs themselves. Indeed, and how might that work Mr Hancock?
What an imaginative neoliberal idea, after all the privatisation of social care has gone so well, what could possibly go wrong ……….
The lack of imagination shown by successive leaders in health and social care knows no bounds. Not only does it do a dis-service to wider society they have created a discourse on care wholly focused on cost rather than values such as compassion and respect. Whether it is children or adult services our leaders continue to focus on framing care as a commodity in which the balance sheet and short term savings are the priority. Yet we know the care ‘industry’ is failing us.
In children and family services Professor Eileen Munro has rightly highlighted the ‘fickleness and failings’ of the market, suggesting caution in establishing a market in child protection which could create perverse incentives for private companies. A headline last year highlights the less savoury side of outsourcing – ‘Now troubled children are an investment opportunity: 18% return on the most disturbed and needy children in care homes is the extreme end of Britain’s outsourcing culture’ (Polly Toynbee)
Over three years ago the King’s Fund highlighted what many in the sector already know, the free market is failing, stating
‘Social Care is now a complex and sprawling sector – more than 12,000 independent organisations, ranging from big corporate chains to small family-run businesses, charities and social enterprises, which makes the NHS provider landscape look like a sea of organisational tranquillity. Less than 10 per cent of social care is actually provided by councils or the NHS – their retreat from long term care provision is virtually complete. But unlike the NHS, when a social care provider hits the financial rocks, bankruptcy not bail-out is the more likely scenario. But a deeper problem is the failure to think through the consequences of shifting the bulk of our care provision to a private business model’.
It is time to move beyond the ‘outsourcing’ of care, where arguably vulnerable children and adults are exploited for profit. Have we forgotten the experience of the vulnerable patients of Winterbourne View Hospital. A hospital set up by a Swiss equity company who primarily saw it as an investment opportunity and when the abuse of its’ patients was exposed promptly closed it down, probably moving onto the next investment opportunity provided by this government in the outsourcing of services.
Sadly government chooses to ignore this aspect of outsourcing.
The issue with ‘outsourcing’ is ideological, aligned as it is with neoliberalism which has nothing to do with principles, values and ethics that should underpin care. At its most basic outsourcing is about profit being made from the lives of those most vulnerable in society. A report published last year by Lancaster University entitled ‘A Trade in People’ expresses this clearly when writing
‘it is clear to us that the way in which the healthcare economy has been encouraged to develop by recent governments turns people into commodities and liabilities. For local authorities and CCGs they are liabilities that they have often sought to export to other areas and for independent hospitals they are a commodity and source of millions of pounds of income and profit.’
Nobel prize winning economist Joseph Stiglitz is clear, we are now engaged in a battle which is ideological, describing free market neo-liberalism as a stifling economic ideology which has run it course.
Neoliberalism has an insidious presence in our lives, much like the air that we breathe, everywhere, yet unseen. George Monbiot provides a compelling argument against this ideology, which values the free market as the place in which citizens can exercise their democratic choices through consumer choice and the private provision of goods and services. Supporters of neoliberalism maintain “the market” delivers benefits that could never be achieved by government, and that the more unregulated the market, the better the efficiency.
Within this framework everything we do, and every person is a potential commodity that can bought, sold and traded for profit. What a world to live in.
Michael Sandel argues the free market is not just a mere mechanism designed to deliver goods, it also embodies certain values, and the problem is these values ‘crowd’ out non market values which are really worth caring about and preserving, such as compassion’.
Please leaders of this country, whatever your political persuasion, be imaginative, be brave, be bold, but most of all be compassionate.