What evidence has the new Government offered to show its support for social care?
Information accurate at time of publication.
Liz Truss’s tenure as the Prime Minister began on 6th September 2022, following Boris Johnson’s resignation. In the October issue of CMM, Mark Adams, the former Chief Executive of Community Integrated Care, recalled the former PM’s comment, ‘We’ve reformed social care.’ Mark wrote, ‘Well, in the true spirit of the pantomime that was Boris Johnson’s term in office: Oh no, you didn’t.’
The Conservative Party Conference Speech on 5th October detailed the tasks assigned to the Health Secretary, Thérèse Coffey. The NHS continues to dominate the Government’s health agenda, with the publication of the Government’s People Plan for Patients. The main points: ensuring patients can expect GP appointments within two weeks; ensuring those needing urgent care are seen on the same day; getting ambulances out there faster to improve A&E; busting the COVID-19 backlog and bolstering social care, so everyone gets the care they need.
The Government also promises to support care providers to switch to digital records and will test and scale technologies to support people to live fulfilling, independent lives. However, plans have changed and the Chancellor of the Exchequer announced that the 1.25% rise in National Insurance, also known as the Health and Social Care Levy, will be reversed from 6th November.
Workforce recruitment
Across social care, there were around 165,000 vacancies in 2021/22 and around 1.62 million filled posts. According to a Care Provider Alliance report, vacancies are up 52% in the last 12 months against a 48-year low in unemployment. The Department for Work and Pensions (DWP) said it will promote careers in adult social care to jobseekers.
The Government is developing the knowledge and skills framework, career pathways and ongoing investment in learning and development to support progression for care workers and registered managers.
However, as Dr Philippa Waterhouse, Senior Lecturer in Health and Social Care at the Open University, highlights, the role of the care worker has significantly changed in the last two decades. Sector reforms and population change have transformed ways of working and intensified demand for social care; it’s therefore important the Government considers the role of care workers today and beyond.
Funding of £15m has been allocated this year to increase international recruitment of care workers, supporting providers with visa processing, accommodation and pastoral support. However, findings reveal that overseas recruitment costs £3-5k per annum and, in some locations, accommodation cannot be sought.
Delivering the care cap
The Government said it will work with local government to deliver the ‘cap and means test’ reforms by October 2023. However, the County Councils Network (CCN) warns the system is under serious pressure, with councils facing a ‘perfect storm’ of financial and workforce pressures that mean the Government should push back its introduction to October 2024.
The CCN says inflation will add £3.7bn of additional costs to existing services by 2023, whilst councils face a workforce crisis with thousands of vacancies unfilled. CCN warns councils will be unable to recruit an estimated extra 5,000 staff over the next 12 months to undertake an additional 197,000 care and financial assessments needed, which is a 45% increase on current levels. This extra demand will create longer waits for care packages; at present, there is a waiting list of almost 300,000.
Improving pathways
The Government’s £500m Adult Social Care Discharge Fund promises to ‘inform further action from next year to rebalance funding across health and care’ and will help to ‘establish a strong and sustainable social care sector with greater accountability for use of taxpayers’ money.’ The fund will support discharge from hospital and bolster the social care workforce, to free up beds. The Government will hold the local NHS and local authorities to account for implementation. Simon Bottery has shared his commentary here.
The new Prime Minister and her Government have made a good start in relation to social care. During her campaign, she committed to delivering an extra £13bn to the social care sector; this is in stark contrast to the £3bn we should have been offered by her predecessor.
In a short time, Ms Truss has delivered a new ministerial team, headed by the Secretary of State, who is also Deputy Prime Minister, and the new ministerial team has committed extra resources for international recruitment and established a task force to improve the process. They have abolished the health and social care levy, which was putting enormous pressure on social care providers; they have committed to tax cuts, which will help social care employees; and also made statements about the interdependence between health and social care.
These are good initial steps. Now we are looking for a Government that will have a clear strategy for social care, including a 10-year plan for the workforce and a real commitment to ensuring social care is funded sustainably. More widely, the sector needs to be reframed to make care a valued and properly rewarded career. The sector requires a 10-year workforce plan, akin to that of the NHS, where career progression, pay and rewards are identified. We need to develop some clear skills and competency frameworks, and a set of portable qualifications so that people can easily move between providers, and this must be done with a matter of urgency.
We need parity of esteem with the NHS, and the Government should focus on delivering outcomes. Rather than thinking about systems and processes, it needs to shift its focus to people and outcomes. This may include a significant shift of resources between health and social care. Undoubtedly there is much to do but, in the first month of the Government, half of it has been overshadowed by our national mourning for her late Majesty. I consider the Government to have made a promising start.
Professor Martin Green OBE, Chief Executive, Care England
@ProfMartinGreen
This Government, like most of its predecessors, has not shown any real support to social care and this fiscal statement continued this trend. It has shown a good amount of (vote-winning) support to families paying privately for social care, but often these families should not be paying at all.
The lack of finance in social care and healthcare is exacerbated by the prevalence of investment houses taking money out of the system by paying dividends to shareholders. But even without this, all social care providers are struggling to meet the needs of those they care for with the income they can currently generate. Bed prices have risen by well below the rate of inflation for so many years; it is now cheaper to stay in a care home, with all the benefits that come with full board, entertainment and care, than it is to stay in a B&B.
If this Government is serious about supporting social care, it needs to address the growing gap between social care and healthcare; otherwise, problems within the sector will only get worse.
Funding to meet the real needs of the individual, rather than finding the cheapest option, will save money. We see budget wars within the NHS and local authorities that are extremely detrimental to the health and wellbeing of those we care for. Commissioners often select homes for individuals because they are ‘cheaper’ without taking into consideration the specialist care that person might need. Because they haven’t been given the right environment, the care of that individual ends up costing more elsewhere in the NHS. Placing people in unsuitable environments also causes great risk to themselves and those around them.
Another priority must be addressing staffing issues. We won’t be able to attract more people into the industry, and keep them here, until politicians acknowledge the value and worth of care staff. They must address the care industry’s inability to match wages in other sectors, which is currently forcing workers to make traumatic decisions to survive. Many carers have no choice but to seek employment elsewhere. We must give them a real choice and a career that is fulfilling and rewarding, but we cannot do that if we cannot pay them.
Neil Russell, Chairman of PJ Care
@sprat_neil