The recent House of Commons Health and Social Care Committee’s report had some damning things to say about the failure to plan for our health and social care workforce needs. It ran to 77 pages and generated a fair amount of media coverage, yet the report could only scratch the surface of the 154 pieces of written evidence it received. Dig into this and we get an even more vivid – and often alarming – picture of the state of social care. These are snapshots of individual experience, submitted in January 2022, and they may not be fully representative, but they nonetheless point to concerns that workforce shortages are impacting on service quality and financial viability, while also flagging worrying problems about issues such as management quality, lack of training and racism.
On service quality, for example, the Norfolk Care Association – which represents social care providers in Norfolk and Waveney – said recruitment was particularly difficult in its area and believed this was resulting in too many below-par CQC reports due to ‘unsafe staffing levels’. It said, ‘It’s clear to see in Norfolk we are struggling with recruitment and retention to the extent that it is having an effect on safety.’ The disability charity, Papworth Trust, meanwhile, spoke of the impact of staff shortages, and resulting increased use of agency staff, on their residents, ’We must ask the question; what does inconsistency of staff, or a change in their ratios from 2:1 to 1:1, limit them doing? We need to consider the detrimental impact this staffing crisis is having on the individual’s quality of life and their independence.’
Another provider said it was having to turn away potential residents because of staff shortages and was concerned about the impact on its financial viability. Rapport Health and Care told the committee that over three months its nursing home in Tonbridge had declined around 50 enquiries because of lack of staff, with a potential annual loss of revenue of £3.8m. This was despite receiving calls ‘almost daily’ from Tunbridge Wells Hospital wanting to discharge patients.
Providers were facing staff issues that had their origins well before the pandemic. In its evidence, Dimensions – a large not-for-profit provider – highlighted the issue of management quality. In its exit interviews with departing staff, it found that local leadership was commonly cited as a reason for leaving. It believed that decades of underinvestment in social care meant ‘too many of those managers lack the soft leadership skills to cope’.
Another, the Mortimer Society, said underfunding meant it was unable to give staff the training that would help to retain and motivate them saying, ‘All care staff undertake induction training leading to the Care Certificate and we encourage staff to undertake further training. However, there is limited funding for this and without increased funding of residents’ fees there cannot be adequate provision of training for staff at all levels.’
Perhaps the most disturbing evidence came from Prema Fairburn-Dorai, of Primary Homecare, who said it had looked to recruit from overseas to tackle staff shortages but found this had generated problems with some existing staff, who had been ‘intolerant, judgmental and unhelpful’ to the new recruits, coupled with ‘undertones of racism’ from some of them. It sometimes found similar problems with clients’ attitudes but said, ‘If we make it clear that we will not tolerate such behaviour, we are not always supported by the local authority and are criticised for handing back the care package.’
Overall, the committee’s report – and the wider evidence submitted to it – should be essential reading for anyone who still thinks that social care will be ‘fixed’ by the current reforms to eligibility and the introduction of a cap on lifetime care costs. The evidence shows that the problems go far, far deeper and will require sustained action and investment to tackle. The worry is that the Government shows no sign of providing that.