The English health sector is seen by the rest of Europe as one of the most efficient and equal on the continent. Above all, it’s free in most cases.
The reality is that health services are facing the biggest crisis of all time, especially those under the responsibility of local authorities.
Birmingham, Britain’s second largest city, is no exception. “The challenges facing the city council […] have never been greater”, reads a report by Birmingham Health Directorate.
The city council anticipates making further cuts of £123 million by 2021/22 and the adult social care service will suffer cuts unlike any other branch.
On a sunny but cold day of early November, a group of employees took their lunch-break on Victoria Square, in front of the council. They were enjoying the sunlight when the peace was disturbed by several women singing to a war song rhythm.
Home care workers were on strike. They protested to make their voices heard by the councillors.
Following the stairs leading up to the square in a move like a cavalry, they progressed in a large pack holding banners. They were dressed up with beards, ties and jackets to convey the message that high wages are a man’s privilege.
The city council announced additional cuts to the budget in July and home care workers have rallied many times since. It stated that employees will have lighter shifts which would therefore lead to pay cuts. The service has been on strike for 32 days of the year so far.
On this day in November, the protestors were satisfied with their protest because they entered the council during a live session, so all those present were then aware of what care workers are willing to do to defend their jobs.
But are Birmingham’s councillors to blame? Most of the resources of the local authority comes from national government grants. Since London closed the tap in 2010 during the austerity period, Birmingham has had to deal with vital cuts.
Adult social care services are a strategic part of a city council’s mission to serve the ageing population; people live longer and therefore often need more assistance.
According to Skills For Care, “the population aged 65 and over from 2017 to 2035. This population is projected to increase between 2017 and 2035 from 10 million to 14.5 million people in England”
The same organisation estimates that an increase of 40% in the workforce should accompany the rise of the ageing population.
In Birmingham, the public sector follows the exact opposite logic. The adult care services are placed more often in the hands of the private sector.
Although, Birmingham is not the exception. In every local authority, the private sector employs an overwhelmingly higher number of employees than the public sector.
Caroline Johnson, branch secretary at Unison says: “we used to have 45 elderly residential homes in the city provided by the council, we used to have a really big home care service with 1,100 workers providing everyday home care and it’s all gone”.
Despite the growing loss of the public social system, Birmingham remains the local authority that spends the most funds on adult social care.
The challenges are important: 10,815 people over 65 suffer with dementia. A report from adult social care directorate states that “there are significant numbers of young adults who have disabilities or suffer from mental illness”. People aged between 18 and 64 represent 61% of the population. This figure is predicted to have risen by 8% in 2035.
On the other hand, in a report called “How are we doing”, the city council is ranked 15th out of 16 similar local authorities, such as Liverpool and Leicester. This rank is aimed to measure the performances of adult social care.
So, to improve the quality of its services, the city council has decided to adopt a preventive strategy. The idea is to develop tools and equipment to ease the lives of people who face difficulties in order to help make them more independent.
In other words, having good equipment means adults would be more comfortable at home, as well as being much safer. They also might need less medical assistance, therefore easing the strain on the National Health Service.
This strategy has been developed in Birmingham by Dr Graeme Betts. He became the Director for Adults Care and Health in 2017 on an interim basis. It’s under his influence that the Adult Care service may change.
Interestingly, the evolution of the net expenditures shows a conflicting reality. Birmingham spent less money in prevention and early intervention than last year. Overall, it still represents a small amount compared to the care activities.
But there is a more striking contradiction. The budget for the financial year 2018-19 shows the Corporate Director service expenditure has rocketed of 75%, going from £9,705 million to almost £17 million.
It’s a questionable reward for a managing team whose service arrives 151st in a rank of 152 local authorities.
Despite attempts to reach the city council, no one answered emails and a secretary was the only reachable person on phone. Among care workers, only Caroline Johnson was allowed to speak publicly to journalists.
Listen to the audio story to understand more about the situation of care services in Birmingham.
Interim directors are responsible for managing the activities of the staff and they advise the councillors of the potential implications of political decisions. The corporate directors are less well-known than councillors and while they aren’t officially in any party, every concrete action goes through their service.
What is happening to the adult care service is very similar to the bin strikes, which also shook Birmingham in the summer of 2017. Last year, an important dispute was ongoing between the bin collectors and the city council.
At this time, Stella Manzie was Birmingham city council chief executive. Specifically, she was interim chief executive. Interims are called or sent to local authorities to resolve a crisis. Usually, their mission doesn’t last long.
Stella Manzie has her own way to resolve crises, and she was nicknamed “chopper” by strikers for her reputation of cutting jobs and services.
Interestingly, Ms Manzie worked for Rotherham local authority before Birmingham, along with Graeme Betts. And M Betts was also appointed in Birmingham at the same time as Ms Manzie.
A well-informed source at Unison, which conducted both bin and care workers strikes, says: “the two high-profile managers seem to follow each other. Manzie has probably put Betts at his current position in Birmingham and he’s likely to follow the same methods”.
Dr Graeme Betts as well as Cllr Paulette Hamilton have refused every interview requests. Therefore, it has not been possible to get any other official statement alongside the council’s report.
The bin workers are believed to have influenced the former council leader John Clancy’s resignation in September 2017. This has motivated the home care workers to continue protesting. But a councillor would resign only if he commits a grave political mistake, as John Clancy admitted he did.