In September this year, UK Prime Minister Boris Johnson announced a new Health and Social Care Levy to address the crisis in social care made tragically apparent by the COVID-19 pandemic: as homecare workers struggled to get hold of adequate personal protective equipment, COVID-patients were released from NHS hospitals to nursing homes that did not have the necessary facilities to treat and shield them. The priority given to the NHS meant that it was it only after media reports of high numbers of infections and deaths among care home staff and residents that any attention at all was paid to social care.
Yet, for anyone paying attention, and for those directly affected, reports of understaffing, overwork, lack of equipment, low pay and lack of occupational sick pay came as no surprise. The erosion of working conditions has relied on two factors. First of all, the inequalities of class, gender and race that push people with less bargaining power in the labour market into the kinds of low-paid and precarious jobs to which frontline care work belongs. Second, the goodwill, commitment and sense of responsibility of those working in the care sector to continue doing so against the odds.
Despite the immense importance of care for our lives, caring carries little value in contemporary society
Despite the immense importance of care for our lives, caring carries little value in contemporary society. Overall, we can see how the responsibility for caring is systematically handed down a societal care chain of underpaid and unpaid caring labour based on a core structural feature of capitalist economies: the systemic imperative to expand markets in the pursuit of profitability, which goes hand in hand with a devaluation of the work of care, either by making this work invisible or by offloading its cost.
The systematic underfunding of social care is long-standing and entrenched in Britain, and it has been exacerbated by years of austerity. At the same time, care needs are rising due to demographic changes. Demographic changes mean more of us are living longer, often also with complex care needs, and over the next twenty-five years, the population above the age of eighty-five will almost double. All the while the price for unmet care needs is paid by the estimated one in seven older people already unable to access adequate care, along with the unpaid carers in households and communities, for the most part women, who keep everything going against the odds, often at great expense to themselves.
For many informal carers who faced extra burdens during the pandemic the recent introduction of the right to one week of unpaid leave will not address the continuous challenge of managing work and caring responsibilities while facing economic inequalities. What is more, an already understaffed care sector faces an exodus of staff no longer willing or able to cope, care homes have even been contemplating taking on volunteers to compensate.
Every so often, the social care crisis makes headlines and politicians tinker with the funding. Yet so far, nothing has come anywhere near to closing the funding gap, currently estimated at an annual £1.34 billion at the very least. The new levy is no different. Funded by a 1.25% rise in National Insurance contributions, along with a 1.25% rise in dividends tax, which is a tax on earnings from investments, it is supposed to make new financial resources available for social care by 2023. However, the bulk of this will actually be spent on health and not on social care, as most of the funding will be used to deal with shortfalls in the NHS.
Moreover, nearly half of the allocated funds will actually go towards paying for the reforms themselves (the costs of which will continue to rise in future as more people reach the cost cap). All in all, there will still be funding shortfalls for local authorities, who are the ones responsible for providing social care, and considerable pressure will remain for councils to generate revenue through raising council tax and business rates. Not only does this drive a wedge between those cities and regions that can afford services and those that cannot, the shift toward online retail intensified by the pandemic makes it more difficult to rely on income from local businesses.
And while good quality care depends on good quality employment, only a tiny fraction of the new funding is earmarked for workforce development, which includes things like staff training. There are no funds at all being made available to remedy staff shortages, low-pay and inadequate working conditions in the care sector. Moreover, nothing is being done to address the failures of privatisation, such as the competitive procurement practices that incentivise a race to the bottom and the kinds of financialised business models that extract profits and cause instability, which include private equity firms intent on creating profitable economies of scale, real estate investors interested in the value of care home properties, and offshore corporate structures that enable tax avoidance.
With the new right for those paying privately for their care to have the council organise this for them so that they benefit from the lower rates charged by providers to local authorities, there could well be even more pressures on pricing and less option for providers to cross-subsidise. All the while, the care sector continues to lose staff who can no longer bear the conditions, while it is also beset by the knock-on effects of post-Brexit restrictions on migrant labour.
The political thrust of the new levy in the area of social care is personal financial protection, not fundamental reform of the way that care is funded, provided and regulated. The government is responding to voter concern over the cost of care in old age, and addressees are care recipients fearful of losing financial assets. Central here are two promises. First of all, the introduction of a cap of £86 000 on the amount of money an individual must pay privately for the cost of care across their life-time. Second, changes to the means thresholds for financial support claims.
To date, one can only apply for support with the cost of your care if one’s total assets amount to less than £23 250. In future, those with assets below £20 000 can apply for the cost of their care to be covered entirely. At the other end of the income spectrum, individuals with assets up to £100 000 will be able to claim some support. However, these policies are premised on the fact that a person’s care needs first have to be deemed eligible before even qualifying for the means-test.
Yet here, the direction of travel has already been set: in response to the long-standing problems of underfunding, local authorities have had to significantly tighten eligibility criteria and enforce such criteria more stringently in order to reduce the amount of claimants, leading to a decrease of the number of older people receiving community-based support by over a quarter between 2009 and 2013, even as the older population increased.
the reforms are for the most part geared towards helping a small number of wealthier households and families protect their assets
As a result of the changes, more people will indeed be entitle to state funded support, but critics have pointed out that all in all the reforms are for the most part geared towards helping a small number of wealthier households and families protect their assets, while taking the money from all working people. In fact, these working people include the many underpaid and unpaid carers for whom the levy will not bring much of a change for the better. Moreover, younger people, particularly of the millennial generation, will have to pay more while being less well off than their predecessors at the same age. In particular, property price inflation leaves young adults facing high rents and locked out of homeownership, and makes inheritance more important.
There are three facets to this logic of welfare. First of all, it is divisive. The financial anxieties of care receivers over the cost of care are played off against the needs of care workers for adequate employment and working conditions. Second, it is residual. The idea that care is viewed merely as help for those without the economic means help themselves sits deep within the psyche of a liberal individualism. Third, it is extractive. Neoliberal reforms have built on individualism to further elevate personal responsibility to primacy, while the simultaneous marketisation of care enables the further extraction of much needed financial resources through the privatisation of profit.
All the while this system is upheld by the underpaid and unpaid feminised, racialised and classed labours of care. The reliance on families means that women are for the most part picking up the tab, especially where households cannot afford to buy in expensive services. Alternatively, the work of caring (along with other domestic work) is off-loaded to lower-class women, often women colour or migrant women employed in precarious or informal arrangements. These dynamics will only become more entrenched as the government returns the responsibility for care to the home with renewed vigour, while too little is done to really change the structural conditions for caring.
Emma Dowling is a sociologist at the University of Vienna. Previously she has held academic positions in the UK and Germany. She is the author of The Care Crisis – What Caused It and How Can We End It? (Verso, 2021), out in paperback with a new afterword in February 2022; contact: firstname.lastname@example.org.
TO CITE THIS ARTICLE:
Dowling, Emma 2021. ‘Care Crisis Continued: Logics of the New Levy’ Discover Society: New Series 1 (4): https://doi.org/10.51428/dsoc.2021.04.0005