How Market-Based Social Care is Failing the Nation's Most Vulnerable

How would you feel about paying the average UK annual wage (£34,963) just on accommodation? Well, how about nearly 2.5 times that amount? Unfortunately, that is the reality for some individuals living in nursing homes in the UK.

Austerity measures affecting local councils have continued to such an extent that authorities are no longer able to provide enough social care for vulnerable children and adults. Instead of committing to providing for its citizens, continued cuts by the Government have resulted in the rise of 'market-based social care': care provided by private companies, whose primary concerns are profitability over consumer welfare.

While some level of private social care has always existed, the UK’s Competition and Market Authority noted that the proportion of these in comparison to government-owned establishments has risen significantly. A recent review by SIGOMA, a research group under the Local Government Association, has found that the 10% poorest councils in the UK have received, on average, a 28.3% cut between 2010/2011 and 2023. Of course, this has had an impact on their ability to fund social care - in real terms, adult social care spending per head has decreased by 20.8% between 2010-2011 and 2018-2019. Austerity has likewise squeezed the funds of charities and not-for-profits, and as a result, the market has largely been taken over by the for-profit model. 

For-profit care homes work at a detriment to all groups of people involved in the system. For those needing care, these homes tend to have a lower average standard of quality than those run by not-for-profit or council bodies. While there is a care certificate available in the UK, it's not mandatory; to gain this qualification care workers are expected to carry out unpaid training in their own time. This discourages uptake and enforcement by private companies, resulting in under-trained staff.

The widening gap between social care and the NHS also leads to difficulty integrating continuous long-term health and wellbeing plans for those with chronic illnesses or disabilities. During the COVID-19 pandemic, the government’s neglect towards social care services was fully demonstrated when infected individuals were discharged from hospitals into care homes with scarce provisions, leading to over 22,000 deaths and the social care system as a whole being labelled the ‘dustbin’ of NHS services. Currently, delays due to bureaucracy, the high expense of private care, and the lack of a cheaper option have led to thousands of individuals being trapped in hospitals instead of being given suitable supported living options.

This is made worse by the fact that more than 60% of employees in the public care industry are earning less than the Real Living Wage, and the situation is even worse in private companies. The rise of zero-hour contracts within this sector has led to fragmented working patterns and insecurity over monthly income. This has led to a high turnover rate, disadvantageous to both carer and patient – it spells precarity and stress for the former and the inability to form strong relationships with caring staff for the latter.

Ethical concerns have also been raised over the systems in place for children in the care system. While many minors are actively encouraged to participate in their choice of care options - such as the place of residential care, becoming a foster child, etc - social workers are stretched too wide to create a good enough rapport with individuals, and many children do not feel confident or mature enough to make such important decisions about their lives alone. In the case of a well-funded, publicly run service, a wide network of various care options could be maintained to always find the best place for a child. However, due to the prevalence of the market-based model, individuals are often given care options that are far more expensive than they need (e.g. residential homes instead of family-based social work) in order to make a greater profit for the company – especially in the cases where companies have cornered the market, often relating to complex needs or disabilities. 

As a result of austerity, grants given to local governments have been harshly cut and replaced with a recommendation to invest in local businesses and profitable schemes to offset the deficit. Except in a few of the richest regions in the United Kingdom, this scheme has not been successful. Newcastle, one of the poorest regions of the country, has suffered from a 30% reduction in available funds, with many others experiencing similar losses. Since local governments are expected to become self-sustaining under this new scheme, individuals living in these areas will only have access to comparatively lower-quality care, therefore entrenching the cycle of poverty in these areas. 

The eye-watering cost of private residential care and nursing homes, along with its continual increase beyond the rate of inflation, has led to a surge in the rate of informal, unpaid care. Its value is currently estimated to be around 3x the equivalent spent on national spending on care. To avoid paying for residency at a care home or other services, people close to the individual (often family members) give up, either partially or fully, their employment to take on the carer role. This further reduces the overall wealth of the household and turns adult social care into a personal, intergenerational burden.

It is obvious that the market-based care sector is failing both its users and workers and, as seen during the COVID-19 pandemic, is not equipped in any way to deal with additional strain from large-scale health crises.

In order to ensure the well-being of those who rely on these services, governmental austerity measures must be reversed as quickly as possible. Higher taxation on the ultra-wealthy and the diverting of these funds towards local authorities would immediately negate some of the damage done by previous austerity measures. In addition to reviving social care as a public service, we need policy to ensure permanent, fixed-hour contracts on at least the Real Living Wage, as well as financial incentives to complete Care Certificates and other training. Provisions to ensure all individuals receive care are also required to prevent lower-income families from being forced to take up unequal levels of responsibility for their elderly relatives. Finally, for the long-term benefit of the service users themselves, deeper connections with NHS local healthcare services should be forged to create reliable pathways for individuals' long-term health management.

All articles and opinions posted give the views of the author(s) and do not necessarily reflect the views of the Leeds Think Tank, the Leeds University Union, or the University of Leeds.