Sue Himmelweit is a feminist economist, emeritus professor of economics at the Open University, and active with the Women’s Budget Group. She talked to Martin Thomas from Solidarity.
Jeremy Hunt has call for a report on the increasing levels of “economic inactivity” among working-age people in the UK. I think what he’s looking for ways to tighten up the conditionality in Universal Credit in order to get more people into the labour force.
Really the inquiry should be into the conditions under which people can get into the labour market.
There are a lot of people waiting for NHS treatment. You’re unlikely to look for a new job if you’re waiting for treatment that you think might be substantial.
The “economically inactive” may also be people looking after the people who are waiting for the treatment.
And among the new numbers not in poor health themselves, I suspect many are older women looking after grandchildren. Childcare may not be available, or just too expensive to make it worthwhile.
We have multiple crises coming to a head which stop workers being workers, which is, after all, what the system wants them to be.
Our childcare system is the most expensive in the OECD. And it’s fully privatised. A huge number of childcare providers went bust in the lockdowns, and that wouldn’t have happened in places with public sector childcare.
It seems to me a pretty fundamental problem if capitalism runs in such a way that people can’t get to be workers. Government decisions are dominated by very globalised capital, not interested in the British working class, in the way that local industrial capital would be.
It’s the working-out of the decline of the British Empire. Maybe this is what it felt like to be in Rome in the decline of the 5th century CE. The decline is happening faster because of Brexit and all sorts of stupid government policies. But it’s a long-term decline that has to happen anyway.
More broadly, the British government was fairly successful in getting the rest of Europe into adopting its neoliberal policies (or the rest of Europe adopted policies like that anyway). For similar reasons, the rest of Europe isn’t far behind in that process of decline. But in Britain the biggest influences on the government is very mobile capital, which doesn’t have a stake in the local working class. That may be less true of other European countries.
On adult social care, there were two aspects to the Johnson reforms. The main thing was subsidising care for a larger range of people. And a very small amount of it was going into improving the care sector.
Quite rightly, the Health and Care Select Committee pointed out that a lot of money is needed to improve the industry. Even if you wanted just to multiply up a really poorly performing industry, it wouldn’t be possible to do, because it would be impossible to recruit the staff
The Autumn Statement spent some money, not enough, on improvement, and none on the issue who’s going to have to pay for it.
The way I would reform who pays for it wouldn’t necessarily be the same as the Dilnot reforms of 2011.
But his original plan was quite a good one.Then the Tories mucked around with it. They not only raised the cap on individual contributions, they also said that if you currently had subsidised help, none of that went into the cap. Thus it became simply a grant to people who needed care and owned more than £100,000 in property. What Dilnot designed wasn’t a subsidy just to rich people, but that’s what the Tories turned it into.
I would want to have a social care system free at the point of use. The Women’s Budget group has written a proposal on that. It’s very costly, but it’s important for this essential kind of service that it should be free at the point of use, and that we pay for it through general taxation, which is effectively a form of redistribution through the tax system, and not just amongst social care recipients, which the current system is.
The really urgent thing is doing something about the conditions of social care. We need more of it, we need better quality. And we need workers better treated, because without that you can’t get the improved quantity and quality.
As to how it is organised, I think we need a huge variety of different solutions. I’m very much with the people who favour central funding, but it should be local delivery of care, including a range of housing and care solutions.
The emphasis on keeping people in their own homes rather than going into residential care has made residential care into something awful, just a place you go to die. And there’s no reason it needs to be that.
In Australia, for example, there are lots of retirement villages which may have a care home in them. In France they have care homes in localities from which the domiciliary care workers go out. If somebody who is getting care at home gets ill, they can move into the care home for a short time and then move back again and still be cared for by the same people. There are lots of much more imaginative solutions than just either being looked after home in isolation or being put into a collective warehouse.
Many of these imaginative solutions will come out of either the charitable organisations that look after people or local authorities, not top down from central government.
I would like to see care policy mainstreamed in the same way that people talk about equality policy being mainstreamed, so for every policy you think about its implications for care. That seems very crucial for housing in particular, and town planning.
There’s been all this talk about what to do with the high streets? Put care centres in the high streets, so that, for example, people can come and visit them more easily, and you can run other care services from there.
I think regulations now say new-build houses must accommodate wheelchairs and things like that; we must make sure that that’s really done properly.
It will be better if more is social housing. We also need think about ways of supporting owner-occupiers in adapting houses. And the private rented sector? I would abolish that. In the meantime, all this requires much larger resources for local government.
Just turning over the funding of social care to local authorities is a really bad idea, because it’s the the poorest local authorities who have the greatest need and council tax is regressive while income tax isn’t.
The big issue over the next couple of years is public sector pay. The cuts that have been brought in will mean unworkable services and failure to pay workers properly.
The crunch point for public services is going to be over pay. If the government now fixes measly increases in funding and people’s costs are rising, it means a labour shortage.
The people who want to do care work, do a really good job. They really don’t want to be stacking shelves in Tesco instead. And we lose so much from them moving across to stacking shelves.
Things are going to get very bad. And I don’t know if they’re going to get bad quietly, or if they’ll get bad noisily, with lots of protest.
There are good providers in social care; but those good providers are good despite having to make a profit rather than because of being part of a profit-making system. We want to be able to retain them. We need to think of new institutional forms which give them some of the autonomy that they have now, but keep them under a public sector umbrella.
In local government we need to build up capabilities — through the cuts, local authorities have lost expertise in even the commissioning that is all that they currently do. But I’m sure that there must be good people currently working in the private sector who can be brought in.
Some younger adults receiving social care prefer a “market solution”, to be given a pot of money so they can buy their care; I think that is a very low level ambition for the system even if at the moment these people feel and probably do better out of that.
It’s important that those receiving care have some autonomy, but there are lots of other ways to do that besides the market: public sector or non-profit provision, with elements of good choice within them.
If the public sector offered good enough care which met people’s needs and people felt was sort of personalised enough, then there wouldn’t be that many people who wanted to go to the private sector. I would like to see the private sector just dwindling; private for-profit care is basically poor-quality care. I can’t really see a necessary reason to stop people employing their own assistant. Nevertheless, over a process of building up good public care, I would hope to see the private sector fades away rather than is closed down.
With residential care, not so much with domiciliary care, we’ve seen private equity coming in just to extract profits. And the only way to make care more profitable is to treat workers worse, because it’s so labour intensive.
They also use the buildings or the land as collateral. And they become “too big to fail”, so they have a lot of leverage.
The Boris Bill was going give everybody the right to ask for local authority care, in order to stop the two tier market that there is now at the moment, where self-funders are charged more to subsidise the care system because local authorities don’t pay enough to cover the full cost of the care places they buy.
Private for-profit care costs a lot more than it needs to, and it’s poor quality care because competition makes firms cut costs and you can’t cut costs in care provision except by employing fewer workers and paying them less. It’s not good for the workers, but it’s also not good for care recipients.
The notion that the market will deliver choice doesn’t work for care because decisions about care are usually made in a crisis where there isn’t much choice; and after the crisis, the market doesn’t work for delivering high quality care because people don’t know about alternatives. Even if you think consumer sovereignty works in general for a market economy, it doesn’t for care.
There is some advantage in having some grant-funded non-profit operators because they’re innovative and they can specialize in particular sorts of care. The non-profits have got the expertise now that local authorities don’t have any more. Even if that isn’t true for care in general, it will be true for some specialised forms of care.