Providing care is a shareholder’s dream – and that’s what needs to change

Care is the essence of life. We give and receive it from the day we were born to the moment we die. To be human is to care and be cared for. So how we care matters. It tells us what we think it means to be human. Andy Burnham wants to find a long-term solution to this deep and abiding issue. It’s a tough ask. Everyone agrees wholesale reform is needed. We are living longer and need looking after in our old age. There’s no avoiding it. The average lifespan for men has risen from 58 in 1950, to 79 now – for women it’s 83. The Prime Minister’s goal is to provide care that is free at the point of need, much like the NHS. This is rightly ambitious and much of the focus right now is on how we pay for it. But we should consider how we care, before we ask who’s writing the cheque. Burnham has long toyed with setting up a National Care Service, mirroring the NHS. This suggests a cookie cutter, one-size-fits-all approach that is established and run nationally. But this form of social care treats us as rather passive subjects of the central state. It would be a well-meaning but unwelcome step back to an era where decisions are made for us, not with us. Exaggerating to make the point, it’s as if we’ve forgotten that the Soviet Union didn’t actually work. And where state intervention has failed, the private sector has filled the void in many areas of our life from water, to energy and transport. In social care, a whopping 85 per cent of care homes are now operated and owned to make a profit. In many aspects of our lives, the market can efficiently provide good service at reasonable cost, but not in social care. There is little to be done in terms of innovation to provide a better service at a lower cost and therefore a bigger profit. Instead, costs are cut, and the biggest cost is labour. Our loved ones, who are in care because they are weak and vulnerable, are prey to poor quality service and ever rising costs. In this race to the bottom, many care homes are owned by private equity firms, which are run ruthlessly to extract as much profit as possible. The ultimate owners often live far away in the USA or the Middle East. This sector is hugely profitable, with returns of around 8 per cent going to shareholders across the globe. So, can we care better, in a way that is rooted in human connection, interdependence, and kindness? The answer is yes. And is not something we have to invent or imagine because it actually exists in some of our most resourceful and imaginative communities. If Burnham and other political leaders want to see how social care could be both really social and caring then go to South Yorkshire, to Sheffield and Doncaster, where through the Citizens Network they will find practical examples of what a 21st century system of care looks like. What matters most in these places is the principles behind how they care. For them it is local, built around neighbourhood communities of around 5,000 people, a number that’s big enough for scale but small enough for connections to be meaningful. The practise is then centred around experience, ingenuity and commitment to people who know and rely on each other. It is more about the person than the institution, wherever possible keeping people in their home connected to the places and people they love. Run on a shoestring, it’s about testing ideas that support local delivery. People are given budgets that stay with them and their place, and are not extracted by companies or providers so that wealth is locked in and local resilience is established. This way we don’t just care for each other, we care for our community. We all got a taste of this approach during Covid, when neighbours, family, friends helped each other, while the clunky Volunteer for the NHS scheme never took off. Some aspects of our life are too important to be centralised or commercialised. If we want a caring society then the job of the state isn’t to outsource our love for each other, commercialise it or force us to passively receive it, but to give us the resources to provide it efficiently, effectively and empathically for each other, by each other. After all, we all need caring for.