Carl Rowlands 2nd August 2011 Blog Health and Social Care Share Tweet Co-operative Party member Carl Rowlands gives his thoughts on challenging the commercialised care sector. For more on the Co-operative Party’s ideas for social care, read here. A conflagration of factors appears set to render Ed Miliband’s concept of the ’squeezed middle’ far more appropriate than perhaps even he would realise. As those people lucky enough to have stable, full-time employment are pushed to work harder, there is less time for the older and younger generations. The perpetual crisis in British childcare, only partially mitigated by New Labour’s voucher system, is joined by a crisis in care for the elderly. The collapse of Southern Cross indicates the literal bankruptcy of a care system based on speculation, only open to weak scrutiny. The rising number of old people are effectively abandoned to institutions that often fail to provide minimum levels of care and engagement. The cuts, either Labour cuts or Tory cuts, will not help. Expectations that the young can look after the old, and that the old can simultaneously look after the young, are exposed as hopelessly naive, options only available to the upper-middle class, if at all. As we know, many people currently of working age will not receive a state pension until 70 years old. Still more people will receive no pension whatsoever, and of these, many will spend many of their later years claiming whatever pittance of a state benefit which will exist for those unable to find work later in life. It’s likely that people who are 68 years old and without work will be asked to ’self-help,’ that they should get on their bike and look for work. This is an approach which will lead to misery and poverty. Undoubtably, some will pass 60 years old, having never received a decent income, having never had permanent full-time work, having never owned their own homes, and therefore being unable to take advantage of a property market propped up by speculative funds, if indeed such a property market will exist by then. However, it is one thing to identify the problem, and quite another to propose realistic answers. In fact, many people behave as if the most important problems were quite different, that the problems are somehow related to choice of care home, or a kind of abstract, consumer-style accountability. On the surface, life in Britain will carry on much as before. This crisis is chronic, with deeper causes relating to the collapse of much of Britain’s industry, an ageing population and suburbanisation. However, favourable conditions which prevented the squeeze becoming acute are now becoming less apparent. The property boom allowed many people to recompense a lack of salaried earnings, given a degree of timely speculation. Most of all, the accessibility of credit allowed people to plan ahead, to think in terms of repayments and investment. Now the credit has dried up, we have finally come face to face with the true nature of post-Thatcher Britain and we are still weighing the social cost. Care workers are generally paid low wages, on casual contracts, to look after our most vulnerable people. Staff in a care home for the disabled were filmed systematically beating and maltreating their patients by the BBC Panorama programme. Yet this is only the tip of an iceberg of indifference and squalor, that could be revealed in many other such places. Often enough, we do not offer basic dignity to the elderly; the people who have worked for us, taught us, fed us. Usually, we prefer not to see the details. Perhaps paradoxically, the best hope for change in the standards of care institutions, and the best hope for genuine accountability, lies with making these part-time casualised workers the centre of a new approach. We must take occupations which are considered to be of a low value, and we should upskill and upscale these. The best way of doing this is to create a system whereby care workers have a profession, and must achieve basic levels of proficiency. Where they have full-time work, in one or more institution, and receive a proper salary, as befits their importance. The most effective way of achieving this is to create a guild, a closed shop of employees, whilst specifying a sectoral minimal wage. A co-operative approach, perhaps, but primarily structured around the service providers, rather than the patients as consumers. Anna Coote from the New Economics Foundation has been demanding that care workers on a minimum wage participate in something called ’co-production’ which will involve patients and relatives in a process whereby care requirements are redefined in an unending participative process. This risks placing unreasonable demands on those at the sharp end, those who are struggling, untrained, to fulfill basic hygiene requirements against a contemporary backdrop of exploitation. Improving care will require a radical rethink and a new approach to financing, well beyond the current approach based on commissioning agencies. For whichever local authority is brave enough to tackle the vested interests in the commercialised care sector, it will initially be more expensive.Yet the real obstacle is ideological. Such an approach would rudely contradict the stale shibboleths that argue that markets always deliver, and would need support from a central legislature to enable the creation of new closed shops. Those employment agencies that provided the casual workers, and have themselves contributed to casualisation, will need to be repurposed. Instead, trades unions must be involved from the beginning, central to the emergence of a solid professional community and the creation of a new discipline, with a distinct ethos based on humanism and high standards. Such an approach based on a co-operative system may not fix all of our problems, yet the alternative surely presents itself: a continued, slow unravelling of civilised standards and intensifying levels of squalor. Through it all, a continuing dehumanisation of working people.