"No one under forty knows what it is like to live in a country where trade unions are a force in the land; where the public sector is a recognised and respected player in the economy; where the idea of a job for life is not meant as an insult..."
Those were the words of the journalists Francis Beckett and David Hencke on the political repercussions of Conservative Prime Minister Margaret Thatcher's victory over Arthur Scargill and the National Union of Mineworkers in 1984.
The forward march of labour had been halted, as the Marxist historian Eric Hobsbawn had written a few years earlier, and a new world beckoned: a dog-eat-dog society in which you had to "do the other bloke before he does you", as John King, another contemporary chronicler of the English working classes, described the ethos which defined the 1980s and early 1990s.
Anger at the wave of privatisations which followed Thatcher's victory over the miners has, for the past thirty-odd years, typically focused on the decline of industry and the private sector take-overs of public transport. We see the consequences of reckless de-industrialisation most starkly in former industrial areas, whose inhabitants Westminster hacks have suddenly noticed because of Brexit. As for public services, we experience the repercussions of railway privatisation whenever the annual inflation-busting increases in the cost of a season ticket hits our wallets and purses.
But one area where the consequences of privatisation are seldom discussed is in social care. Back in 1979 – as the curtain was brought down on the post-war social democratic settlement – 64% of residential and nursing home beds were provided by the NHS and local authorities. By 2012 that figure had plummeted to just 6%. Today the private sector employs over two thirds of all adult social care workers. Around half of those staff work in care homes while 38% are employed in domiciliary care.
The current crisis facing the NHS is, in part, a product of both the privatisation of social care and more recent cuts to local authority budgets (resulting in less money being allocated for care locally) by successive Conservative governments. Predictably, when vulnerable people lack adequate social care they are more likely to turn up at overstretched hospital A&E departments asking to see a doctor, increasing the burden on the NHS and exacerbating the crisis.
If the crisis in social care goes back to privatisation, it is being exacerbated in the present by austerity. According to a recent study, some local authorities are now spending considerably less than the £554-per-week minimum amount recommended for the residential care of older people. Meanwhile competition between providers for what is left of the social care budget – competition being the magical solution to almost every problem for free market utopians – has come to mean little more than a race to the bottom: care staff are very often paid peanuts and put on zero-hours contracts, while in domiciliary care 20-minute home visits are increasingly the norm.
As the population ages, the way we do social care in Britain is only likely to have a bigger impact on the running of the NHS. Currently around 300,000 people live in residential care homes while some 500,000 older and disabled people rely on home care visits for things like washing and dressing. Estimates predict that 1.7 million more adults will require social care over the next 15 years.
Yet while the number of older people in need of care grows, thanks to cuts to local authority budgets the money allocated for care is being spread more thinly than butter smeared on a slice of toast. This is having a knock-on impact on both care staff and the vulnerable people they are employed to look after (or the 'service users', in care company jargon). According to a 2014 report by the Public Accounts Committee, local authorities have cut costs "partly by paying lower fees to providers of care, which has led to very low pay for care workers, low skill levels within the workforce, and inevitably poorer levels of service for users".
Social care has thus become a grim and unrewarding occupation to work in: there is a staff turnover rate of 25.4%, meaning that around 300,000 care workers leave their jobs every year. One care worker I recently spoke to (and who asked to remain anonymous) said that carers were treated like "glorified cleaners" by private care providers. "The fault lies with the care companies, but also with social services for not auditing and policing it properly," she told me. "The carers...do their best, mostly. You get one or two rogue carers, but mostly they do their best."
Yet the fault also lies with successive governments. It is easy to assume that the crises engulfing the social care sector has just happened, like the changing of the seasons or the tide coming in. However, it is at least partly a consequence of politicians of all parties clinging stubbornly to two political sacred cows: privatisation and austerity. Private care providers are behaving as private companies invariably behave – they are cutting costs and demanding a return on their investment of as much as 12%. Similarly, councils are behaving rationally in deciding to spend a smaller share of the cash they receive from central government on social care when local authority budgets have been squeezed by nearly a third since 2010.
It is the crisis in the publicly-run NHS that is currently making the headlines. However anyone who might instinctively turn to the private sector for a solution has not been paying sufficient attention to the appalling – and ongoing – crisis which has been engulfing social care in this country for much longer.
James Bloodworth is former editor of Left Foot Forward, one of the UK's top political blogs, and the author of The Myth of Meritocracy.