Executive Summary

During the peak of the first lockdown, people gathered on their doorsteps to clap for carers; now we must properly reward them. Reimagining the care system should therefore be at the heart of the plan for a just recovery, centring the needs of care workers and care receivers. Critically, a transformed care system is also key to a green recovery. Care work is green work. Care work – both paid and unpaid – is a socially vital and collective service that contributes significantly to individual and collective wellbeing by addressing a core human needs; it also by its nature tends to be low-carbon work. Care work also embodies the principles of reparative action, reciprocity, and a focus on meeting needs that is at the heart of a Green New Deal.

In designing the more just and sustainable decarbonised economy of the future, care must therefore be recognised as a service that needs to be substantially expanded and better valued. The Green New Deal should not be limited to bold industrial strategy for tradable sectors such as manufacturing and technology; a strategy for transforming care work should also feature as a key pillar.

Economic policy debates in the UK increasingly pay attention to adult social care; however, they tend to approach it as a ‘low productivity’ sector in which productivity must be raised to both increase wages and tackle the UK’s ‘productivity problem’. There are a number of fundamental issues with this approach. The first is an overly simplistic understanding of the relationship between productivity and wages. The second is a neglect of the distinctive human dimension of care as a service – where increasing productivity would, beyond a certain point, inevitably lead to a deterioration in quality. Finally, the approach fails to appreciate the significance of care as a collective service that secures wellbeing, rather than simply a source of income.  

To bring about a transition from a sector dominated by for-profit provision to one that puts the needs of people first, an alternative, people-centred industrial strategy is needed for adult social care in England. Such a strategy would not narrowly target the private sector, but would rather focus on increasing and strengthening public provision, as well as innovative forms of cooperative, voluntary and community provision. Anchoring this transition, we believe that the public sector must return to its historic role, delivering the majority of adult social care. Rather than being narrowly directed towards raising productivity, a people-centred industrial strategy would aim to increase the social value of adult social care, in an expansive sense. This would encompass:

  • Developing care services which meet the holistic needs of care-receivers, securing them a full set of ‘capabilities’, rather than treating them as a maintenance problem serviced in 15-minute slots.
  • Ensuring a real Living Wage, as well as dignity, fulfilment and opportunities for creativity in work for care workers, through new models of care provision as well as through more funding.

People-centred industrial strategy, then, is concerned not just with increasing productivity through a narrow lens and boosting the efficiency with which wealth is produced, but with reshaping the distribution (or ‘predistribution’) of wealth.

The strategy aims for a radical overhaul of adult social care over the next decade, without leaving local authorities responsible for delivering services exposed in the process. Alongside national-level measures to enable long-term transformation, it includes local authority-level measures to enable interim reshaping.

The strategy is summarised in fifteen key recommendations. It should be emphasised that the proposed strategy applies to England, rather than Scotland, Wales or Northern Ireland (for which adult social care is a devolved responsibility). This focus was chosen as it is in England that attempts to reform social care are least developed, and change is thus most needed. There is nevertheless much that will be of relevance for transforming care in the other nations of the UK and indeed throughout other countries more broadly.

  • Recommendation 1: Establish a new funding settlement for adult social care, (including free personal care for over 65s), based on progressive taxation.
  • Recommendation 2: Local authorities (with central government support) should commit to a full transition to public, cooperative, non-profit and community-only forms of provision by 2030.
  • Recommendation 3: Introduce a suite of measures to tackle financialisation and improve transparency in private care provision, as part of the transition away from private for-profit care. 
  • Recommendation 4:  Bring care home properties that are privately owned by a company that is not the care provider into public ownership.
  • Recommendation 5: Introduce a robust national system of social licensing for all care providers, requiring a real Living Wage for all care workers, and leaving space for local authorities to add their own additional requirements.
  • Recommendation 6: At local authority level, commissioners should experiment with a range of other measures to reshape provision for the better, including pre-qualification criteria, Fair Tax Mark accreditation, creative use of service specification design and local spend policies.
  • Recommendation 7: Establish a new national innovation mission directed towards ‘Dignity in Adult Social Care’, built around a major fund to support diverse new models of provision, to be devolved to local authority level.
  • Recommendation 8: Ring-fence a segment of mission funding for building the capacity of local authorities as the orchestrators of innovation.
  • Recommendation 9: Ring-fence a further segment of mission funding to set up a review of adult social care inspection, tasked with developing a new set of participatively-developed metrics.
  • Recommendation 10: Introduce compulsory registration for all adult social care workers in England, along with the development of a suitable variety of pathways for registration. The cost of registration should be covered by employers.
  • Recommendation 11: Significantly increase resources allocated to Skills for Care, and work with key stakeholders to define appropriate forms of continuous training, to be enforced through social licensing regulation.
  • Recommendation 12: The UK government should legislate to establish a new system of sectoral collective bargaining for Adult Social Care in England: the Adult Social Care Sector Forum.
  • Recommendation 13: Introduce a new statutory requirement to decarbonise the sector by 2030 with care providers - backed by a new Decarbonising Care Fund - required to set out measurable plans to reach net-zero by the end of the decade, including through upgrading their building stock and decarbonising supply chains.
  • Recommendation 14: Establish a properly funded state system to provide social and emotional support services for informal carers in all parts of the country.
  • Recommendation 15: Introduce a full package of measures to promote a fair gender distribution of unpaid care, including reduced working time, improving workers’ rights and access to flexible working, and wider actions to tackle gender inequalities in the labour market - whilst continuing to improve gender balance in paid care work.

To read the full report please see the PDF here.

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