Social care in crisis

Yesterday I published an article on the state of social care in the UK. For those who are not in the UK, the short version is: things are really, really bad.

I’ve seen things you people wouldn’t believe. I’ve seen things Andy Burnham wouldn’t believe.

While lying paralysed in a hospital bed, I have watched NHS nurses telling agency staff to just stand over there and do nothing, because they were so incompetent they were making things worse by trying to help. I’ve had the terrifying prospect of trying to explain to somebody who can’t speak English — and yet is working in a spinal unit in a hospital ward — in the middle of the night, why I desperately need them to get the nurse. Because if my autonomic dysreflection isn’t arrested, I’m going to have a stroke and then die.

I’ve had the rather different experience of returning to my ward to find a care worker asleep on the radiator. If the worst three words in the English language are “rail replacement bus”, then the most terrifying for a long-term hospital inpatient are “agency staff”. NHS rules dictate that a certain number of care staff have to be on the ward floor to support nurses as a legal requirement — even if the agency staff recruited to be in line with the law make the work of the nurses harder. When I learned that these agency staff were trained over Zoom before being sent into hospitals, I wasn’t exactly surprised.

Lying behind this sorry state of affairs is the uncomfortable fact that the British electorate wants to have its cake and eat it, three ways over.

There is, for one thing, growing awareness and concern that the social care sector is in crisis. But taxes are already at a historic high, and people don’t want them to go up yet further. And although this is not polling quite as highly as it was last year, there is a clear preference for reducing the level of immigration.

This is what pointy-headed academics like me call a trilemma; it is impossible to satisfy all three preferences simultaneously. If you want more care workers there are two options. You could make starting salaries a lot higher so as to encourage far more people from the existing British population to become carers. Or you can keep starting salaries pitifully low, so that the only people who will take these jobs are immigrants so desperate for the work that they will turn up anyway.

You can read the rest here.