Nothing summed up the sense of crisis around the provision of care in the UK more evocatively than the fate of the measure that was meant to solve it. Having waited a generation for a plan to address the many issues the adult care sector faces, we finally got a package of measures, announced in 2021, and – whatever you may have thought of that package – it was due to come into force later this year.
The centrepiece, as far as the general public was concerned, was a redesigned funding model with an £86,000 individual cost cap. Yet last November, amid rampant inflation and with the economy teetering on the brink of full-blown recession, it was announced that this febrile financial climate meant the package’s introduction was being delayed for a further two years. There’s always a new crisis to supersede the existing ones, it seems.
But if the relief measures have gone away for now, the care sector’s problems – particularly around demand, funding and recruitment – very much haven’t. In fact, they are getting worse all the time.
Nearly one in five people in the UK are now over 65 and, for the first time, there are more people of pensionable age in Britain than children.1 Naturally, as our population gets steadily older, the demand for care increases. Over the past year, the number of enquiries fielded by Home Instead, for example, rose by 27%. And, I understand, this is typical.
A joined-up problem
In a different climate, this level of demand would be great news for growth, but – with proportionally fewer younger people to plug the job gaps and a decline in the availability of overseas labour since Brexit – instead, the sector finds itself in a perfect storm.
One recent study found that staff shortages had risen by 52% over the previous year to hit a record 165,000 vacancies, with almost one in 10 social care posts in England unfilled. And, unsurprisingly, staff shortages are very clearly affecting care quality; three quarters of care homes who had seen their Care Quality Commission (CQC) rating worsen blamed this factor.2
Meanwhile, the NHS is having a well-documented crisis of its own. This is happening in too many areas to explore in detail here, from cancer treatment waiting times to GP appointment shortages. But perhaps the starkest expression came in early March when Office for National Statistics (ONS) figures showed higher-than-usual death levels, with tens of thousands more people dying than normal levels, even after the pandemic’s ravages had subsided.3
In short-termist, emergency-led Whitehall, the normal mindset thinks of these two crises, in care and the NHS, as two different, competing problems which just happen to be taking place in parallel. But any independent, holistic examination reveals that they are in fact two conjoined parts of a wider problem. Because the NHS, too, is buckling under ever-increasing demand and struggling to fill the jobs to cope.
The most obvious pinch point where the two sectors collide is on the issue of so-called ‘bed blockers’. I’m not keen on the phrase itself as it has a tendency to characterise the people it describes as a nuisance rather than real people with real feelings and challenges, not to mention framing them as the problem rather than part of wider systemic failings. Nevertheless, the syndrome it describes, if crudely, is a real one.
Recent figures show that there are currently over 13,000 NHS beds – around a third of total capacity in the service – taken up by patients otherwise fit to leave hospital, up from 10,000 just a year previously.4 And a record six in 10 patients who were adjudged well enough to leave aren’t being discharged because there’s nowhere to send them.5
It’s plainly obvious that you can’t solve the myriad problems of the NHS without addressing the problems in care. Lately there have been some nods in this direction – a £500m emergency ‘discharge fund’ in November – but nothing substantive enough to affect real change. And even the delayed longer-term ‘solution’ may not amount to meaningful change as it puts an increased emphasis on homecare without addressing the issue of provision.
So how do we improve things? I’d suggest the key to beginning to transform the care sector is to change the way it’s perceived.
Care is a hugely under-acknowledged partner in the healthcare ecosystem that has little of the kudos attached to the NHS. No one was banging pots and pans for care workers three years ago but they had as tough a time during the pandemic as anyone. Change can start by giving the whole sector more recognition.
I mentioned earlier the issue of foreign labour shortages in this context and although this is undoubtedly a factor in unfilled jobs it’s also arguably a bigger factor in the widespread misconception that care workers are unskilled and therefore should be cheap. It’s time to completely revolutionise this perception of care work.
We need to change ideas and assumptions around it, the language used to discuss it, practically everything about the way it’s presented. But this change will have to start from within – we need to drive it ourselves and make the wider world take note.
Making the shift
The first and most crucial change we can affect is in professionalising the role of the care worker. We can do this by redefining the way care is framed. Instead of being a generic, low-skilled, across-the-board position, it can be seen as what it is: a series of related specialisms with different knowledge and skill sets required for working with different clients with varying circumstances and conditions. A specialist dementia care worker should not be seen as interchangeable with someone who works with Parkinson’s patients, for example. They are distinct roles with particular demands.
The key to changing this perception is to make training a central part of a career path in care, upskilling our workforce with clinical and social training to help designate more health tasks outside the NHS, which could, in turn, meaningfully contribute to relieve pressure points in the service. A properly trained workforce would be more respected and valued in the wider employment landscape, which in turn would make a career in care more appealing in the first place. This particularly pertains in the homecare sub-sector where there is arguably an even greater negative perception – probably because of an erroneous assumption that a domestic environment makes for an easier workplace; in fact, it merely poses different and frequently greater challenges.
The second key change is to make care and those working in it more tech enabled. We need to keep moving towards smarter systems, that are digitally based, to make the whole sector more agile, more responsive and more efficient. Once again, training and investment are the key to making this happen – and this again goes to making the wider status enhanced and roles demonstrably more skilled.
In giving this sector the allure of an attractive career path, rather than the perception of a dead-end job, we should begin to turn the tide on the staff shortage issue. This shift in perception should start to tempt younger people into the profession in greater numbers – but we certainly should not confine ourselves to that demographic. One lesson I’ve learned time and again since I joined Home Instead is of the hugely underappreciated and untapped talent that older workers can bring. By making a career in care more appealing, and underpinning it with training, we can make it an obvious choice for a second career for older people who feel they have acquired the kind of life skills that can make a valuable contribution.
Older people aren’t a homogenous entity. We employ a number of carers well into their eighties who are frequently older than the people they care for. At the moment this is unusual, but there’s no reason it should be; it can be the most rewarding work possible and many older people can thrive doing it. The silver economy, as it’s known, is a hugely underutilised resource that could help to transform the wider economy.
I’d also hope that the particular model we use – care in the home as opposed to the care home – will become more widely adopted in future, because it gives clients greater comfort and dignity at a more affordable cost. We await with interest any clearer guidance on how the Government hopes to pivot more towards homecare in the future and handle the specific practical challenges around that. But this really is about much more than any one company or approach.
A system for the future
I said before that we will need to drive these changes ourselves. We’ve seen many times before that care is often the last thing on the agenda for politicians at both national and local levels. Yes, we do need to keep lobbying them for help on many fronts. But many of the issues bedevilling both the care sector and the NHS are systemic and successive governments lack the long-term strategic focus to address them. Instead they resort to short-term funding boosts in the hope that this will provide a fix. Not only is this an expensive strategy but it simply doesn’t work.
This is why I’ve become an advocate for a completely new set-up – an independent body to run the UK’s wider health system. This would be comparable to the setting of interest rates being taken out of the hands of ministers a generation ago.
It would stop the NHS and the related care sector being what they are now – an electoral football, kicked about as part of the cut and thrust of party politics – and enable a more focused and longer-term approach that’s beyond the whims of electoral cycles. A revitalised care sector with employees who have higher status and, yes, I would hope are better paid as this change in mindset beds in. You can’t ‘save the NHS’ without making care part of the solution.
References
1 https://www.theguardian.com/uk-news/2022/jun/28/england-and-wales-population-rises-to-record-59m
2 https://www.theguardian.com/commentisfree/2022/aug/22/the-guardian-view-on-the-social-care-recruitment-crisis-pay-staff-what-they-are-worth
3 https://www.theguardian.com/society/2023/mar/09/nhs-crisis-causing-continued-higher-than-normal-levels-of-death-inengland-and-wales
4 https://www.england.nhs.uk/statistics/statistical-work-areas/discharge-delays-acute-data/
5 https://www.telegraph.co.uk/news/2022/10/10/record-numbers-healthy-patients-stuck-hospital-amid-care-shortage/