We need a National Care Service

national care service image - with faded images in circles

Fundamental reform is needed to create a system fit for the future.

The pandemic has exposed the fault lines in the social care system, which requires substantial reform if its many structural, financial and operational weaknesses are to be tackled, says UNISON in a new strategy document released today (Wednesday).

Care After Covid: A Vision for Social Care sets out how the fragmented, crisis-riven sector could be transformed into a national care system. One that the union says could cope with the day-to-day challenges of caring for vulnerable people and be better prepared for a future health emergency of the same severity as the current pandemic.

Improved regulation and government oversight, better staff pay, stringent UK-wide professional standards, robust workers’ rights, and strategic long-term investment could help create a resilient care system that resembles the NHS more, says UNISON.

Significant emergency funding is crucial to protect the elderly and disabled from Covid-19 and any future crises, says the document.

Prior to the pandemic, the House of Lords Economic Affairs Committee called for an immediate investment of £8 billion in the sector. But far more will be needed before the end of the current Parliament if a care system is to be created that’s fit for purpose, says UNISON.

The extra cash should be used to invest in the workforce and fund local councils. This is so they have the resources and expertise to step in and take over care homes – if providers go bust – and run care services themselves.

In future, social care must become an important economic sector providing high-quality, well-paid jobs and no longer seen as a drain on the public purse. It has the potential to be part of the solution for local economies that have lost jobs because of the virus, says UNISON.

Care staff must be paid at least the real living wage – currently £10.75 in London, £9.30 an hour elsewhere – and there must be a new standard employment contract that includes sick pay, hours to be worked and payment for all the time they’re on duty.

Currently, many care workers are on zero-hours contracts, with little job security and without paid holidays or sick pay. Staff working out in the community and moving between care appointments often aren’t paid for their travel time, while some providing overnight care are not paid for every hour of those shifts, despite being on call.

The pandemic has exposed the poverty pay of care staff who earn so little some have had to choose between feeding their families or risking their health, and that of those they care for. Many couldn’t afford to take time off to self-isolate. Workers have been forced to make ends meet on statutory sick pay of just £95.85 a week and food banks, says UNISON.

UNISON assistant general secretary Christina McAnea said: “Social care is the forgotten frontline, but the time for talking is over. For too long the care system has been weighted towards price and profit. Nothing less than a national care service will suffice.

“Vulnerable people have been pushed from pillar to post as owners and care providers jostle for a bigger slice of the pie.

“Underpaid, undervalued and undermined staff are at breaking point. The Covid-19 crisis has further exposed just how desperately the care sector needs reform.

“The NHS must be its inspiration. Any reform must build on the few positives to come from the pandemic – that care staff are highly skilled people, providing quality care, despite the many challenges they face.

“Never again should there be vulnerable people dying in their thousands in care homes because of poor planning, ignorance, or the relentless pursuit of profits. The government must introduce fundamental reform to create a system fit for the future, providing care for everyone who needs it.”

Care After Covid: A Vision for Social Care makes a series of recommendations, including:

  • Everyone working in the care sector should undergo a minimum level of training to drive forward professionalisation and raise standards.
  • Care workers must be added to the government’s shortage occupation list. Many are from overseas but proposed immigration changes will prevent anyone earning less than £25,600 from coming here.
  • Local authorities responsible for sourcing care for local residents should only purchase services from providers that pay their taxes, recognise unions, provide staff with standard work contracts and pay at least the real living wage.
  • There must be a move away from the complex commissioning model to a national care system, based on the NHS, where care is free at the point of need.

Notes to editors:

A number of care workers have talked to UNISON about their experiences of working through the pandemic. Their names have been changed:

  • John, a care worker employed by a private healthcare company, said: “Care workers are exposed to danger and risks to their lives every day. At my workplace, staff were only tested for the first time a week ago and only recently received adequate protective equipment (PPE) – the masks we received are very thin. I can’t afford not to work. My wife who works in a care home is in a similar situation.”
  • Sue, a care manager, said: “When the pandemic started, I had to store masks in a box in my car to use only when a client became sick with the virus. There just weren’t enough because of supply issues and it was hard to get hold of aprons too. Things are better now but it’s still a challenge getting hold of PPE because the guidance changed and we’re using it all the time. Everyone in care is after supplies.”
  • Lisa, a night care worker supporting adults with mental health conditions, said: “The people I care for find it hard to understand the concept of social distancing. I have to give them their medication, which means I’m at arms-length from them. At the start of the pandemic I was doing this without a mask, which put us all at risk. We didn’t have any hand sanitiser. Staff brought in their own so we could share and protect each other and the people we support. Thankfully things have improved a lot. I’ve been in my job for 10 years and love it. Although I’m not paid a lot, what I’m doing is rewarding and is making a difference.”

UNISON assistant general secretary Christina McAnea has been appointed to the government’s social care task force.

UNISON’s social care vision document will be subject to further consultation among UNISON lay structures, once Covid-19 pandemic is over.

UNISON is the UK’s largest union, with more than 1.3 million members providing public services – in education, local government, the NHS, police service and energy. They are employed in the public, voluntary and private sectors.

The full document can be downloaded here (it is a work in progress as above)

A summary leaflet is available here