Dr Christine Corlet Walker

Welfare systems across the OECD face many combined challenges, with rising inequality, demographic changes and environmental crises likely to drive up welfare demand in the coming decades. Economic growth is no longer a sustainable solution to these problems. It is therefore imperative that we consider how welfare systems will cope with these challenges in the absence of economic growth. We review the literature tackling this complex problem. We identify five interconnected dilemmas for a post-growth welfare system: 1) how to maintain funding for the welfare system in a non-growing economy; 2) how to manage the increasing relative costs of welfare; 3) how to overcome structural and behavioural growth dependencies within the welfare system; 4) how to manage increasing need on a finite planet; and 5) how to overcome political barriers to the transformation of the welfare state. There is now need for further research investigating the macro-economic dynamics of post-growth welfare systems; trialling preventative, relational, low-resource models of welfare provision; and seeking to better understand political barriers to a post-growth welfare transition. We also make the case for considering post-growth welfare studies as a field in its own right, with the aim of improving coherence and cross-fertilisation between disciplines.

Our current economic system depends on growth to function effectively. Several recent reports have aimed to understand this growth dependency and have sought ways to mitigate it. In light of the long-term slowdown in the growth rate already witnessed in advanced economies and the potential threats to economic growth from climate change, biodiversity loss and social disruption, such strategies are fully consistent with economic prudence.

In many ways, the UK’s adult social care sector represents a microcosm of the growth dependencies observed in the wider economy. The rising demand for adult social care associated with an ageing population creates a dependency on ever-growing production of health and social care services. Rising costs, related to the time-intensive nature of social care, demand growing revenues for care companies to stay afloat. And the use of predatory financial practices by investment firms places unmanageable ongoing financial costs on large parts of the sector.

These growth dependencies can be attenuated or aggravated by physical, financial, legislative, and social factors. The privatised structure of adult social care, combined with an absence of effective financial legislation, creates the conditions that expose care companies to overleveraging, among other risks. Tackling these underlying structures—e.g. through strict financial regulations—would not only reduce the growth dependency of the adult social care sector but would also generate other co-benefits, such as reduced inequality.

The processes and structures creating growth dependency in adult social care apply to other parts of the welfare state too. In this report, we therefore present a systematic approach to identifying, analysing and transforming growth dependencies in the welfare state. Using adult social care as our case study, we explore how growing demand, rising costs and rent seeking can create growth dependencies. We analyse the structures that drive and reinforce these growth dependencies and, in so doing, we identify fruitful levers for transformation and mitigation.

The systematic application of this framework to all parts of the welfare state would enable us to protect the resilience of the welfare state and improve the wellbeing of UK citizens, no matter what is happening to growth. 

Adult social care across the OECD is in crisis. Covid-19 has exposed deep fragilities which have combined to place unprecedented strain on social care organisations. Principal amongst these is the process of marketisation and financialisation of the social care sector. In this paper, we take a critical perspective on this process.

We argue that adult social care is ill-suited to being operated as a market, for four specific reasons. First, it has limited scope for labour productivity growth. Second, local authorities have the power to set prices unsustainably low. Third, there is an inherent lack of consumer access to information about price. Fourth, consumers have scant ability to express preference and exercise choice about providers.

These factors place social care in acute danger of predatory financial practices. In fact, we use primary data from the financial accounts of the five largest UK care home chains to show how debt-leveraged buyouts, intra-group loans, offshore ownership and sale and leaseback arrangements have combined to create a clear moral hazard that is having a devastating effect on the most vulnerable in society.

Financial engineering represents an explicit strategy to shift costs, socialise risks and privatise the benefits of investing in social care. In the process, marketisation has facilitated the conditions for both financial fragility and operational failure.

We argue that post-pandemic recovery represents a once-in-a-generation opportunity to overhaul these conditions and transform adult social care.

Long-term care systems across countries within the Organisation for Economic Co-operation and Development have undergone a progressive marketisation and financialisation in recent decades, characterised by the embedding of neoliberal market values such as competition, consumer choice, and the profit motive. In this Personal View, we argue that these make poor guiding principles for the care sector, identifying the dysfunctional dynamics that arise as a result, and reflecting on the clinical implications of each, with a focus on facility-based care. We outline why providers can scarcely respond to competitive forces without compromising care quality. We explain why the promotion of consumer choice cannot effectively motivate improvements to quality of care. And we explore how privatisation opens the door to predatory financial practices. We conclude by considering how far proposals for reform can take us, ultimately arguing for a rejection of neoliberal market ideology, and calling for sector-wide discussions about what principles would be more fitting for a caring economy.

The involvement of investment firms in the UK’s adult social care sector is a cause of mounting concern. Many of the strategies that investment firms use to achieve returns for their investors expose whole chains of care homes to large costs and increase the risk of bankruptcy and closure. This ‘financialisation’ of care has been implicated in the high-profile collapse of several large care home chains. However, little research has been done looking at the direct impact of these strategies on workers and service users in the care homes themselves.

In this report, we present the findings from a series of interviews with care workers who were working in care homes during, or shortly after, they had been taken over by an investment firm. Our respondents expressed five key concerns about the behaviour of their new employers. Specifically, they felt that their care companies were:

exploiting care staff;
cutting corners on service delivery;
covering up mismanagement;
failing to communicate; and
prioritising profit over care.

We also studied the financial accounts of fifteen of the largest care home chains in the UK and uncovered a large and widening disparity between the pay of directors and the wages of employees. This pay gap was growing particularly fast in investment-firm-owned chains. The pay ratios between the highest paid director and the average employee within the care companies in our sample were similar to those ratios found in large for-profit companies in other sectors, but far higher than those found in public services like the UK’s National Health Service. This disparity existed even for some not-for-profit groups.

Our analysis paints a picture of a sector that is deeply unfair, not only in terms of who benefits from the financialisation of care, but also in terms of who pays the price. We contend that achieving a care sector that works for workers and service users rather than investors and profiteers means removing the profit motive altogether, reducing the size and complexity of care home groups, and strengthening care workers’ rights and voice in the workplace.

Secure housing is core to the Sustainable Development Goals and a fundamental human right. However, potential conflicts between housing and sustainability objectives remain under-researched. We explore the impact of current English government housing policy, and alternative housing strategies, on national carbon and biodiversity goals. Using material flow and land use change/biodiversity models, we estimate from 2022 to 2050 under current policy housing alone would consume 104% of England’s cumulative carbon budget (2.6/2.5Gt [50% chance of < 1.5 ◦C]); 12% from the construction and operation of newbuilds and 92% from the existing stock. Housing expansion also potentially conflicts with England’s biodiversity targets. However, meeting greater housing need without rapid housing expansion is theoretically possible. We review solutions including improving affordability by reducing demand for homes as financial assets, macroprudential policy, expanding social housing, and reducing underutilisation of floor-space. Transitioning to housing strategies which slow housing expansion and accelerate low-carbon retrofits would achieve lower emissions, but we show that they face an unfavourable political economy and structural economic barriers.