The current landscape
With more than 11 million people in England and Wales aged over 65, social care has never been so important in maintaining people’s health, wellbeing and quality of life. For too long, however, the sector has faced an uphill struggle to provide the level of care that people need due to challenges relating to staff shortages and poor pay and working conditions.
In England alone, there are around 152,000 vacant adult social care roles. Pay during the last financial year averaged just over £10 per hour. This has a knock-on effect: in August 2023, almost 250,000 adults were waiting for an assessment of their care needs and about 85,000 had been waiting for at least six months. Government’s announcement of the new care workforce pathway in January this year was therefore a welcome step forward in acknowledging and valuing the vital role of the social care workforce in society.
First steps
The reforms laid out by the Department of Health and Social Care mean, for the first time, those who work in social care have a structured career path in front of them with better job prospects and access to accredited qualifications. More than £20m will go towards funding apprenticeships while tens of millions more has been pledged to subsidise training places and establish two new accredited qualifications, one for those working in direct adult social care roles and another in digital leadership.
These are promising developments that we hope will result in building and retaining a more skilled workforce. This should, in turn, increase the quality and timeliness of care for those who need it. We will certainly be watching the development and roll-out of these plans with interest. However, while these first steps are positive, we must ensure that they are exactly that – first steps.
The road ahead
There is still much more to do to make social care a desirable career choice. Low wages have plagued the sector for as long as I can remember, exacerbated over the years by rising living costs and salaries not keeping pace with inflation. Workers and providers are often overstretched due to increasing demand, particularly as more of us are living longer and often with complex needs and conditions.
Social care can also be complicated to access, and many families choose to, or feel they need to, take on all or some of the responsibility of looking after their loved ones. This has led to a ‘silent army’ of unpaid carers who can often experience exhaustion, stress and burnout.
Plenty of evidence exists describing our social care system as creaking under pressures caused by chronic underfunding and the challenges of recruiting and retaining a skilled, knowledgeable workforce. A career pathway on its own will not solve these underlying issues, so how do we create the conditions for these new career roles to flourish?
One obvious change is improving the pay and rewards for care work, but we also need to step back and consider how our future social care system can adapt and expand to meet the pressures it faces. Our view is that innovation in the way we design and deliver services to tackle the sector’s many challenges must play a key role in securing its future.
Tackling challenges through innovation
Done well, service innovation can support people in achieving greater independence, living longer in their own homes and experiencing fewer care crises that result in hospital admissions. For staff, innovation can release more time for care and produce efficiencies, enabling funding to go further and therefore benefit more people.
Our partners in the health sector are already experiencing the difference that innovation can make. The emergence of artificial intelligence (AI) is showing potential in identifying and diagnosing some cancers and other conditions faster and at an earlier stage, for instance. Wearables and digital apps are empowering people to take control of their health and manage their conditions more easily. The development of artificial and bionic limbs can enhance a recipient’s quality of life. Computer algorithms are beginning to predict service demand, track service provision and pinpoint pressure points within the healthcare system.
Government’s Accelerating Reform Fund (ARF), a £42.6m programme for social care, aims to drive forward innovation by, for the first time, funding the scaling up of innovative practice across adult social care and kickstarting a change in support for unpaid carers. This initiative aims to boost the quality and accessibility of social care, accelerating progress towards the social care vision where people have choice, control and support to live independent lives and care and support is of outstanding quality and accessible to all. The Fund is available to all local authorities and will fund at least two projects per region in England.
We will be providing direct hands-on support to ARF-funded projects, helping local authorities to develop partnerships with health and care providers and voluntary and community groups and encouraging co-production with people who need care and unpaid carers. In this way, projects will benefit from shared learning and expert insights so that initiatives are more inclusive and accessible, and we can increase our knowledge of the barriers to innovation and how we can overcome these to scale up and embed new approaches and deliver new models of care.
Government has set out 12 priorities for the ARF to ensure all successful projects place people’s needs at the heart of innovation and ensure no-one feels isolated. These include connecting people to local information, advice and services through social prescribing, using digital tools for workforce recruitment and retention purposes, investigating community-based models of care and the role of local networks and groups in supporting people to age well and promote wellbeing, and understanding the impact of volunteer-led pathways of care.
A significant element of the ARF will focus on the estimated 4.7 million unpaid carers in England. Caring for your loved ones, either because you want to or cannot afford professional care, can be physically and emotionally draining. Through greater innovation, we want to ensure unpaid carers get the support they need through tailored respite, increased access to carer services and greater involvement in care planning at the hospital discharge stage.
Spreading innovation for better care
In social care, innovation does not need to be radical to make a difference in the way care and support is provided. The Shared Lives service, for example, where people aged 16 and over are matched with a carer, move in with them and receive support within the carer’s own home, is generating cost-savings compared with residential care while promoting greater independence. Our independent analysis found that this can result in an average saving of £8,000 for people with mental health needs and £26,000 for people with learning disabilities.
Meanwhile, simple ideas like Jelly Drops water sweets enable care home staff to easily ensure their elderly residents stay hydrated, freeing up time to spend on other aspects of patient care. Wireless sensors in the home can help track routines and alert families and carers if there has been no activity, and smart speakers and plugs can help people execute simple tasks around the home more easily.
We should always be looking at the way we are providing care and asking ourselves if we are delivering it in the most effective and efficient way. As technology becomes more advanced, new opportunities to streamline and improve care and support will be inevitable, and we must grasp these with both hands.
Government’s planned digital leadership qualification and digital skills training will be key in embracing digitisation and optimising new technological approaches, but we must also be actively evaluating the benefits of digital innovation so that only projects that bring the most benefit are adopted nationally.
Of course, innovation is only good if it ultimately works for people who draw on care and support. With everything we do, we must always seek to understand if and how care will be improved. We will focus our efforts on not only identifying innovation in the sector but also how best to scale and spread the best ideas and practices for the future.
We know that improving career prospects, pay and working conditions of social care workers will build a valued workforce and ultimately benefit those who use these services. However, with a growing and ageing population, many of whom are not currently getting the support they need, these measures must be coupled with more innovative practices that can propel the sector forward now and in the long term.
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Kathryn Smith is Chief Executive at the Social Care Institute for Excellence (SCIE). Email: [email protected] X: @SCIE_socialcare