It is firstly political: power of central government versus local authorities. Government funds our NHS and local authorities fund Social Services. Grants to local authorities from government have been progressively cut while they have been given more responsibilities. The balance of funding comes from council tax. Many local authorities are struggling.
Finances are thus the second reason. When councils are cash-strapped and have statutory responsibilities, they are forced to raise the threshold for non-statutory services. This meant that, as a social worker, you had to spend increasing time at your computer to justify why support was needed. Instead of going out to assess more clients, paperwork took up more of our time to secure the care that we knew people needed.
Home care used to be council run and home helps could do housework and shopping. As budgets tightened personal care had to be prioritised. Private care agencies sprang up to fill the gap and soon expanded into personal care. Council carers were used for highest priority cases and may well no longer exist.
The public/private divide is the third reason. Councils exist to provide a service, but if private agencies don’t make a profit they cease to exist.
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The fourth reason is values. Carers fill an essential and valuable role, yet usually on a minimum wage. A good carer is worth their weight in gold to the person they support. How dare we pay them so little? They have barely any career structure for advancement. Do we value our elderly, sick and disabled so little that we don’t ensure better services support them?
Care homes are now also private and close if they don’t make a profit. Most people wish to be supported at home but can’t unless services are available. Government is belatedly recognising that lack of funds for social care is short-sighted and results in bed blocking, impinging upon our NHS.