Mary Dejevsky

Make way for Ubercare

We badly need an Uber-style care system

Make way for Ubercare
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There is much to be faulted in Uber, which has branched out from delivering people into delivering meals, under the unappetising name UberEats. But even I, someone who can rarely bring herself to write the word ‘sharing’, as in economy, without inverted commas, am prepared to give credit where credit is due.

Uber has made private door-to-door transport accessible to far more people than before. It has thus done a lot of people a favour and hugely expanded the market, harnessing new technology to do so. It has provided jobs for people who did not have them, or who prefer to work in the semi-autonomous Uber way. It’s made me, a diehard sceptic of the ‘sharing’ economy, wonder whether a form of Uberfication might not be just the thing to shake up our so-called ‘care system’ which, as I have recently discovered, is not fit for purpose.

Mary Dejevsky and John Sutherland discuss where social care is getting it wrong:

A while back, knowing that I would be going away for a week, I set out to find help for my husband, who has Parkinson’s. Of course, this was not the first time we had faced the conundrum. But it had always been possible to muddle through. A combination of gap-year nephews, super-helpful neighbours and Meals on Wheels just about sufficed. (And a special shout-out here to Meals on Wheels, a service that finds itself suddenly, and inexplicably, under threat.)

Alas, though, the condition — the disease — progresses. And this time, something more was needed. In sometimes rough and ready ways, I look after my husband with no outside help, and I am happy to do so. I am generally with him, at home or away, for 50 weeks out of 52. If only — and this was the question I asked — there were some way I could be replaced for the remaining two.

The answer, after two months of research and requests that soon escalated into pleas, was no. Two weeks before my planned departure, I received an email from a pleasant person at my husband’s GP surgery, who rejoices in the title ‘care navigator’. Her title alone tells you most of what you need to know. ‘It seems’, she wrote, ‘that we have exhausted all avenues… you wanted something in place for when you go away, but I don’t think that will happen unless you organise care privately.’ So there we are, two months on, right back where we started.

My two-pronged approach had begun with my husband’s GP and the council’s ‘adult services’ department — which sounds a little like a porn channel, while being distinctly less keen (I imagine) to have you sign up. Have you tried, everyone I eventually spoke to asked hopefully, Parkinson’s UK, your Parkinson’s nurse, your GP, other voluntary organisations, Age UK?

And I could truthfully say, yes, I have tried them all. I have visited in person; my mobile phone log testifies to the cumulative hours spent on hold; to the messages left unanswered, to the universal reluctance to give full names and direct numbers or emails — though they demand chapter and verse from me every time I call.

On the way, I have learned a whole new vocabulary, in which ‘assessments’, ‘packages’ and ‘allocation’ (or rather ‘de-allocation’ in our case) loom large, and everything, but everything, requires a ‘referral’. I have also glimpsed a way of working in which everything is chopped up into ‘tasks’ which presuppose solutions — an approach singularly unsuited to chronic illness where there is no foreseeable timescale and no cure.

All this is before you meet the means test — which almost any middle-class person who has obeyed the command to ‘save’ will fail. Either you pay in full for the ‘package’ the council social workers compile, or you pay for ‘private providers’ (which the council strongly hints you will prefer). So it’s back to sheaves of printed lists — and choices no one will help you to make lest they be held liable. The agencies also seem to run something like a closed shop; with rates rarely published in the name of competition that barely exists.

Let me give you an idea. Two half-hour visits in the daytime, plus ten hours of night cover — no nursing, no medical duties, just ‘cover’ — comes in at £1,700 or so a week. This is more than half my husband’s Disability Living Allowance for a whole year (he remains on the old system) — and a multiple of what I can earn working part-time. Double the fees at many care homes. And they want people to stay in their own homes?

We are told the care system is in crisis, and it surely is, though not necessarily for the single reason — ‘the cuts’ — that is routinely given. Wasteful, confusing, patronising and — perversely — protectionist, it is ripe for precisely the sort of disruption that Uber and its ilk have brought to transport. Many of the care services, such as they are, are already private, so why not an efficient system of carers who are centrally managed and vetted, but sell their own services? Why not have pricing according to market demand, open and reliable appraisals from actual users and the sort of flexibility that new technology allows?

Uber has given both the customer and the driver power and freedom. It has given many of us the experience of having our own chauffeurs: polite drivers, super-clean cars, perhaps a newspaper, madam, for diversion, or the radio station of your choice? It’s also shaken the traditional taxi trade out of its complacency. Furious London cabbies are right that the value of some of that shaking can be questioned. Is satnav really a substitute for the Knowledge, has the unregulated proliferation of vehicles not brought congestion and pollution in its wake?

But look at the benefits. And would London cabbies have started actually to round fares down without Uber? Or installed machines for card payments in months rather than years? Remember what a song and dance they used to make if you even hinted you might pay by card.

If there was ever an industry that needed to be shaken awake, it’s the care industry — unresponsive, entrenched and utterly unprepared for the great masses marching towards old age. While I was preparing this article, news arrived of an Airbnb-style venture for childcare in this country and a home-care franchise in the US adapted from Uber. Also starting up over here is an Uber-style app offering university students wanting to dent their loans to help with sundry tasks around the home. All in all, Ubercare is surely an idea whose time has come.

Mary Dejevsky has worked as a foreign correspondent in Moscow, Paris and Washington, and a columnist for the Independent.