Jamie Hale (Solidarity 546) makes a number of points that strengthen the central argument in Solidarity 544 for public ownership of social care. A strengthening of workers’ rights for those in the sector, including higher pay, proper contracts, sick pay and holiday pay, would mean less rushed workers providing care and support for people without having to whizz round multiple people, with very differing needs, over a short space of time, and with minimal training.
Jamie points to the importance of direct payments and the management of care institutions by those who live in them.
A charter drawn up by service users and workers is part of what we need. Will it be possible to include all residents, in all institutions and homes, in management, directly or via election? In a home for people with dementia, that seems neither right nor desirable. Do their rights of control transfer to those who have power of attorney over their affairs? In some cases, families are probably worse placed than the professionals to make the decisions. And, since they are not using the service themselves, can they have the kind of say Jamie thinks is important?
Direct payments for social care to those who can manage them effectively, whether on their own or with the support of other services, are desirable for the autonomy of those receiving support, but come with pitfalls. They can leave people more vulnerable as they have to manage and account for the money, become an employer, deal with the problems of having to stop employing individuals. Some people will find such responsibilities an additional burden even if they are in a position to take them on.
And then some service users getting direct payments will find that their needs cannot be met by the suppliers they have a choice from, many of which will be agencies with workers on poor terms and conditions.
A direct-payment system can only be as good as the services available on the market. Services via guaranteed public sector provision, with adequate training and job security exists, would be a big step forward.
Much is already done by the public sector (rather than via market allocation) to match children or young people with suitable placement or foster care. In social care that sort of attention seems some way off, but we can surely learn something from it.
As long as the sector is warped by a drive for profits, then those with the most complex needs and without their own wealth are going to lose out.