OPINION: An Irish view of the UK’s social care woes ahead of election

Joseph Musgrave, CEO, Home and Community Care Ireland (HCCI)

A leading figure in the Irish social care sector has warned that society “undervalues” care workers ahead of the UK’s General Election.

On a recent Voices of Care Podcast from Newcross Healthcare, Joseph Musgrave, CEO of Home and Community Care Ireland, encouraged global leaders to embrace universal basic capital, claiming “the care workers of today suffer because of society undervaluing care and that there should be a better mechanism to fund and invest in people that deliver care”.  

Speaking to the podcast’s host, Suhail Mirza, non-executive director of Newcross Healthcare, Musgrave said: “Across the world, by 2064, it is projected that more people will die than be born.

“In Ireland over the next decade, we will see a 75% increase in the number of people over the age of 85.

“Today, we have five workers for every person over the age of 65; in 20 years it is estimated to be three workers and in today’s funding system, those three workers will have to bear the social care costs of those over 65.

“This is a global challenge. South Korea is on the sharp end of this right now – double the number of over-65s as under-18s. We need a mature debate about how care costs should be funded.”

According to World Population Prospects 2019 (United Nations, 2019), by 2050, one in six people in the world will be over the age of 65, up from one in 11 in 2019.

On this, Musgrave said: “We are having less children and therefore we’re ageing; that is not a bad thing, but we must change the way we think about that social contract. We’ve never lived so long, and we have never had an older generation that is financially wealthier than the younger generation. The younger generation are finding it harder and harder to own houses, to accrue the same sorts of wealth as their parents. The younger generation is seeing the wealth of their parents being eaten up by social care costs.”

Mirza noted that, in 20 years, the UK will be devoting 21% of GDP looking after the older population; 25% of that on pensions, the remainder on the costs of health and social care – an increase from 15% in 2015.  

Musgrave commented: “We have seen several political attempts to address this challenge, but they have met huge resistance from the demographic most affected – the ageing population. Macron raised the pension age in France, protests erupted across the country. Theresa May proposed quite a radical way of funding social care, and likely lost her premiership on the back of that.

“In the Irish context, I have said that people over 45 should pay extra social insurance to fund social care costs. Those below 45 are still struggling to get on the housing ladder, struggling to send their children to university, to fund childcare costs. Either older people have to pay into social insurance or they’re going to have to accept that some of the wealth they have built up over their lives cannot then simply be transferred to their children, which embeds generational inequality, but instead is used to fund their care because society has helped them accrue all of this wealth. The very fundamentals of the social contract depend on this, and we need to be having this debate now, not in 10 years’ time.

“And I do fear that, if we don’t reform it, this ageing demographic will just collapse that generational contract – younger people will continue to struggle to get on the housing ladder and raise families. With more people now living to the age of 100, we have to be imaginative in how they are cared for, or our system will stop working.”

Turning attention to the role of care workers and greater recognition for the role they do, Musgrave called for universal basic capital for all care workers. “Care does not command the same hourly wage rate as an AI engineer and never will…but how do we better promote and recognise care and its contribution to society?” he said.

“I speak to carers frequently, and what I hear from carers is, ‘I can’t get a car loan, I can’t get a mortgage; my work is not frequent enough; I don’t have enough hours; or I can’t save that much.’ Our system today is focussed on accruing capital; care workers are locked out of that system.

“We can either lock them out entirely or introduce a basic universal capital that says if you do this work for five or 10 years, we’re going to give you access to capital, something meaningful that enables them to get a car, send their children to university, maybe help put money down on a house.”

Mirza noted the challenge this presents to attracting new carers into the system and the pressures we are already seeing from a rapidly contracting care workforce, saying: “And, if we lock them out, we’re going to be drawing from the current cohort and have little hope of meeting the projections of increased demand, because we need to make the sector hugely attractive to graduates and people leaving school.”

Musgrave commented: “We’re going to run out of people to provide the care and the work. Fewer people want to go into it; we’re just asking them to essentially volunteer to be carers. We have to recognise the trade-off carers are making and the contribution they are making to society. Access to capital will encourage more into the sector and reward them for the contribution they make.

“We can either create an underclass of people that provide this care, or we rethink it. At the risk of being slightly populist, Elon Musk does not need $1 trillion. He cannot spend all that money. Society is not about individuals, and we have to say some people are going to have to help pay into a pot to give these people access to this system of accruing capital.”

On the upcoming General Election and the prospect of social care getting a fair deal, he added: “I have got to give a lot of credit to Sir Ed Davey for putting care at the forefront of their message. They are talking about something quite fundamental and calling for a new deal on care. The proposal around a ‘Royal College of Nursing’, a differentiated minimum wage for carers is interesting. Labour and the Conservatives are getting off lightly talking about this topic and both are flirting with the ideas presented by the Dilnot review (which has sat on policy shelves for over a decade), and something the Conservatives have been promising since 2019. I am not hearing anything around far-reaching reforms that would put [care] on a sustainable footing. Both Labour and the Conservatives are ducking it and getting away with it.”

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