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As people live longer, more and more are likely to need care services when they get older.
Over 1.3 million people in the UK currently rely on social care. Another three million are cared for by friends and family. In the next 30 years, the number living beyond 85 is set to grow by 180% - and the numbers of those living with dementia is likely to double.
At the same time, there is a national crisis in care, caused by a disastrous mix of privatisation and funding cuts. The last government slashed the adult social care budget by £3.5 billion. Homecare and other community services were particularly hard hit.
In 1993, 95% of homecare was delivered by local councils. That figure is now down to 11%. Some is with the voluntary sector, and the overwhelming majority is delivered by private companies.
Figures for nursing and residential homes indicate that in 1979, 64% of care places were in the public sector. By 2012 this had fallen to 6% - a shocking level of outsourcing. The private care market is big money - with over half a million places, worth an estimated £24 billion.
It was probably not till the collapse of the Southern Cross care home group in 2011 that the public became aware of private equity companies' control of social care. Southern Cross was then Britain's largest adult care home provider. It collapsed after rapid expansion meant it could not pay rent on many of its homes. The welfare of 31,000 residents was threatened.
The privately run Winterbourne View care home scandal followed hot on the heels of Southern Cross. BBC Panorama secretly recorded care workers abusing disabled residents. There is no justification for this sickening behaviour. But scandals like this will only become more common as untrained care staff are forced into impossible working conditions for poverty pay.
Privatisation across adult social care, which started in the late 1980s, is more prevalent than in children's social care. Nevertheless, the private sector is very well established in the children's residential and fostering sector.
In England, 75% of children's homes are privately run, with a further 11% run by charities. Infamous outsourcing firms G4S and Serco, along with various private equity companies, own two of the three biggest foster home placement providers. There are big profits to be made in this sector.
Polly Toynbee, in a Guardian article last year, talked about private investment firm Gravity International. It advertised 18% profit return in one year. A fully occupied four-bed children's home can yield an annual profit of £624,000.
A major concern is that the locations of most children's homes are determined by property prices rather than the needs of children. Many end up living many miles from their family and community. 25% of homes are based in north-west England. Only 6% are in London, even though the capital has the largest and youngest population.
Ann Coffey, Labour MP for Stockport, highlighted other serious issues in a 2012 comment to the BBC. "Homes are advertising very aggressively for children who are much damaged, who have histories of drug abuse, sexual abuse, alcohol abuse." Firms seek the most damaged children, possibly because councils pay more for these placements.
The government is now looking to privatise child protection social work. There was a huge public furore over this proposal last year, with 70,000 signing petitions opposing it. The Labour Party did not oppose privatisation.
The government appeared to back down. Publicity died away - but beneath the radar, the Tories were developing a loophole.
Private companies could still profit from services by setting up a non-profit subsidiary. The parent company can then make a profit by charging its subsidiary for buildings, admin, IT and other services. Similarly, owners or sponsors of school academy chains can make a profit from 'non-profit' academised schools.
Some commentators claim private companies are not interested in running such 'high-risk' services. But we know companies will go wherever profits can be made. The Guardian has reported that Serco and G4S already have a joint contract in one area for forensic examination of children who may have been sexually abused.
The record of privateers like G4S, and notorious private training firm A4E, is one of total failure. A4E forged paperwork and falsely claimed it had helped the long-term unemployed back into work so it would hit targets. G4S had to pay back nearly £110 million to the taxpayer after it charged for monitoring non-existent electronic tags on offenders. None of this has prevented privatisation surging forward.
For staff in privatised social care, there are plenty of horror stories. Public service union Unison produced a 2012 report called "Time to Care" based on testimony from homecare workers.
It described "call cramming": visits are too close together, meaning they can last only 15 minutes, or even less. Staff reported feeling ashamed by rushed visits. Service users had a different care worker on every visit, even when very personal care is being delivered.
Workers also described not being paid travel time between visits, meaning they were effectively earning less than the minimum wage. There has now been a legal ruling that non-payment of travel time is not allowed to take an employee below the (totally inaqequate) minimum wage.
The report also highlighted the compassion and dedication of staff who often undertook work that was unpaid.
Creeping but endemic privatisation in social care has not always attracted the level of publicity that NHS privatisation has. But cutbacks in social care have a knock-on effect on the NHS.
Those no longer needing medical attention can become stuck in hospital because there are no social care places available. Any integration between the NHS and social care must not be used to cut services further, which would only exacerbate the problem.
There have also been significant local disputes involving care workers in the private sector.
Care workers in Doncaster took 90 days of strike action in 2014. This followed pay cuts of up to 35% after being transferred from the NHS to private firm Care UK. The company - owned by private equity firm Bridgepoint - also brought in 100 new employees on far lower wages. Ed Miliband, then leader of the Labour Party and the local MP, failed to visit the picket line or show any kind of public solidarity.
Staff at private company Thera East Midlands struck in 2013 over attacks on pay, terms and conditions. Employees in Salford's mental health services waged a big campaign against privatisation and closures, and service users played a prominent role in the campaign.
Private companies often claim they have to cut their employees' pay and conditions because the public bodies that commission their services do not pay enough. But the answer to this is not to give the private companies more public money to be creamed off as profit.
To end the current crisis, we must end privatisation. All outsourced social care should be brought back into public ownership, under the democratic control of workers and the community. Only then can we guarantee full funding for proper training and facilities, decent pay and reasonable working conditions. Without this, workers - and vulnerable service users - will continue to suffer.
"I am a care worker at Bromley council, south London, providing a service for the most vulnerable adults in the borough.
Having done this job for years, I have come to never expect thanks from the council. Instead I take great satisfaction from doing my job. But now, I face being handed over to a private company, and all the uncertainty that comes with that.
On a typical day, I enter at 8.30am for the team briefing. This is a forum for issues with service users, along with general smooth running of the service. I expect once a private company takes over, this will become a thing of the past: time means money.
Once a week, I and a colleague take out six service users to nearby Bexleyheath via minibus. They play ten-pin bowling, have lunch and look around the shops. Will a private company still allow this kind of trip?
Around 9.30, I gather everyone, make sure they have their coats, have been to the toilet and get onto the minibus safely. I ensure everyone is seat belted. My colleague drives while I keep a watchful eye on the service users.
Once at the bowling centre, we assist with a ramp for those with more complex needs who cannot bowl themselves. Then sometimes our group likes to visit the supermarket to buy a snack before lunch. Most can eat without help, but two have their food cut up.
After lunch, they enjoy looking around the local shops. Their favourites are the pound stores where they buy sweets and chocolates - however we try to promote healthy eating! By 2.45pm we head back to the minibus, to arrive back around 3.15.
We help our people off the bus and take those who need it to the toilet. We wait for borough transport to collect them anytime up to 4.27, or beyond if running late.
Other activities include lunch clubs, baking, arts and crafts, mobility exercises, pottery, an older persons' group, hygiene, bingo, music, computing, photography and sensory exercises.
These activities are so important. Relatives want to know that when their loved ones are in our care, they are not just plonked in front of the television.
So far, we have been told very little about Certitude, who the council wants to hand the service over to. We are told that this is due to "commercial sensitivity". But what about the sensitivity of the people we care for?
That is why I have been taking strike action. I want to protect the service for those I care for."
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Article dated 15 July 2015
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