As the New Year bells fall silent, the work of 2023 begins in earnest. The turmoil and challenge of 2022 makes it likely that most of those working in care will not be starting the year refreshed and recharged; more likely they will be peeking over the horizon with trepidation about what the next 12 months may bring. Fair assessment? Or grounds for optimism? Let’s take a look at the year ahead and see what it is likely to bring.
Winter pressures
The notion of winter pressures is something with which all those working in care will be familiar. The ‘surprising’ arrival of winter often brings a flurry of roundtables and engagement with care providers that begins in October and ends in November and which can be frustrating to all parties. Nothing systemic is resolved and, once the headlines are exhausted, the attention gets shifted on, and people get forgotten. Members tell us repeatedly about the things that would really make a difference; they are most definitely not rocket science, and of course involve having people at the heart of all decision making.
Integration – the journey continues
This year we will be having discussions about all things health and care integration in earnest with the new bodies in town, the Integrated Care Systems (ICSs). 2023 will mark their first full year in operation. We know that the proper engagement of care providers has been patchy at best, and frustrating and unproductive at its worst. This has to be one of our positive objectives for the year ahead. There’s an increasing number of voices advocating for proper social care involvement at the top table, and we will continue to push for this. With this in mind, all eyes will be on the forthcoming investigation into ICSs commissioned by the Chancellor and being enacted by Patricia Hewitt, and the Health and Social Care Select Committee report on accountability following its inquiry.
Regulation
The world of regulation was expecting a seismic change in early 2023. However, right at the end of 2022 it became clear that the date for instigation of this regulatory shake up has been delayed. The Health and Care Act of 2022 brought new powers to the Care Quality Commission (CQC) to enable it to take a more system wide view as a regulator and, with that, bringing a need to regulate both local authorities and ICSs to look at their role in ensuring good health and care for the communities they serve.
This runs alongside the introduction of a Single Assessment Framework for all services that CQC regulates. The implementation of this appears to have been more challenging than anticipated, and the latest pronouncement only specifies that it will appear later in the year.
At a time when there are calls for more and more decisions to be made at a local level, and huge pressures on all parts of the system, a delay in understanding how this is really working in practice seems unhelpful for those who are already experiencing a system that does not meet their needs. It is hoped that a proper explanation of the reasons behind the delay and clarification on when the reforms will be implemented will be forthcoming early in 2023.
COVID-19 Inquiry
As we move forward in the year, we are expecting the COVID-19 Inquiry to take centre stage. There are only three modules that have been outlined in detail, and they cover preparedness, engagement and the health service.
The way in which the Inquiry has been structured means that it is likely that there will be a social care perspective in each and every one of the modules. However, there will also be a dedicated module for social care which we anticipate hearing more detail on early in the New Year. The way in which this is scoped and shaped will determine how much the other vital areas – such as vaccination, PPE, community health and the rights of people receiving care and support – are wrapped up in this one module or need to be spread throughout.
Workforce
It is likely that the workforce challenges of 2022 remain, and are in many cases amplified in the year ahead. The very compelling Unfair to Care report from Community Integrated Care at the end of 2022 laid out in no uncertain terms just what needs to be done to ensure that care workers receive parity of pay with comparative jobs in the health service.
As many other colleagues in public services enter into periods of industrial action, the focus on the importance of pay to reward people’s contributions to communities should not exclude that of care staff. We know that there is to be a significant increase in National Living Wage in April of this year, but it remains a stain on our sector that this minimum level of payment remains the majority pay level for front line care staff. Local authorities received funding at the end of 2022 that was to support workforce recruitment and retention, and it is hoped that care workers are directly benefiting from this £200m additional funding, however, it is frustrating that it is once again short-term and rushed. The Care Workers’ Charity continues to report increasing calls on its funds and the ongoing cost of living crisis is putting pressure on colleagues in every part of our sector.
Escalating costs
Rising costs are impacting on all elements of care delivery. This includes the costs of fuel to deliver homecare, energy prices within care and support settings, food costs, uniforms, trips out and of course salaries and meeting terms and conditions. Alongside that, many organisations are facing huge concerns about the rising costs of borrowing.
The double whammy of massive care inflation – where everything in the basket is rising exponentially – alongside the increased cost of loans will make the beginning of the year a truly uncomfortable period for many. It is imperative that there is full recognition of this in the local government fees that will be being communicated in the first few months of 2023.
The draft local government settlement was put out for consultation on 19th December, and it details the additional funding put forward for adults’, and children’s, social care as well as the overall uplift. Government frames the overall uplift, which is the total allocation from central government to local authorities, as a 9% uplift intended to cover the inflationary costs inherent in their delivery of services. Clearly a core and growing proportion of their overall spend is on social care, so it certainly should be expected that this uplift is reflected in fee rates for the year ahead. However, this also recognises the very significant increases that are likely to face self-funders of care, and this is of course against the poorly communicated backdrop of the postponement of the introduction of the social care cap and adjustment to the means test.
Providers are likely to find themselves having to manage some complex communications as they move between navigating fee rates with authorities, and understanding the implication for self-funders in order to ensure sustainable services for the year ahead.
Innovation
In light of the many problems facing those delivering and receiving care, it is fair to say that finding a positive note can be a challenge. However, innovation remains both an opportunity and a necessity if we are to find a way to deliver the care that people want, at the time that they need it.
The Care Innovation Hub provides a great showcase to bring together people who want to make change happen. Colleagues from Think Local Act Personal were at the heart of the last challenge, and it made a huge difference to all the teams, but it was of particular note that the mentoring and support offered by a colleague with lived experience transformed the ideas of the winning team. People receiving care and support, and the workforce, have to be at the heart of all future innovations in the sector, whether digital, environmental or in models of delivery. We ignore their voices at our peril.
International opportunities to learn
Learning from across the world has to be an important strategy for us all in 2023. The growing focus on international recruitment across the care sector shows us that the delivery of care is very much a global enterprise. The NCF has teamed up with Scottish Care to co-host the Global Ageing Network in Glasgow in 2023. This will bring speakers and experts from all around the world to the UK to share their knowledge, and of course to learn from what works in the UK.
In a time when everything we talk about seems to be predicated by terms like ‘challenging’, ‘difficult’ and ‘worst ever’, it is vital to open our eyes and ears to hear about the art of the possible.
Whilst the year ahead feels heavy, it is ever more important to see ourselves as part of a global ecosystem that is evolving at pace around the world. We should take strength from that, as social care matters to us all. CMM