I believe that providers have learned some critical lessons about resilience and preparedness over the last two years, but whether the sector can ever be truly ready for this winter remains questionnable.
There are too many unknown headwinds our sector faces, both for individual services and for the united coalition of the Care Provider Alliance (CPA), which represents more than 70% of all social care and support colleagues.
The social care sector is facing extraordinary challenges this winter and beyond if no interventions are made to support it.
While demand continues to rise, the Health and Social Care Select Committee has stated that social care and the NHS face the greatest workforce crisis in their history. It is concerning to note that this shows a worsening position for the first time on record. This month’s State of the Adult Social Care Sector and Workforce in England report from Skills for Care highlights an ever-deteriorating position on staff vacancies.
On top of this, after decades of underfunding, providers are faced with inflationary pressures of circa 10% on everyday essential items, and fuel and energy bills are rising by some estimates of over 400% without any commensurate increase in contracted income. These expenditure pressures make retention and recruitment of staff harder than ever as they threaten overall financial sustainability.
The aims of CPA
All members of the CPA remain committed to ensuring that people of any age can maximise their independence and lead fulfilled lives with access to high-quality care and support when they need it most.
With this in mind, the CPA will continue to work with those in the Department of Health and Social Care (DHSC) and beyond; we are focused on establishing relationships with the new administration at all levels and across all Government departments whose policy makers have a role in creating a sustainable social care sector.
Furthermore, we will continue to engage effectively with the commissioners of care and support services – both within integrated care systems and local authorities – to ensure the whole of our adult social care system is recognised as an essential part of a wider health and wellbeing offer.
We need to work on coming together with the NHS to create a firm foundation which cements our collective aims, vision and ambitions in order to have a truly integrated workforce plan.
We must also remember and reiterate that, alongside providing meaningful care and support to a wide range of people, the adult social care sector is estimated to contribute £41.2bn per annum to the economy in England, and as such we are not an insignificant part of the working population.
The current picture
It is important to acknowledge that sector pressures are not just experienced when we move into the winter months; they impact us all year round. The vast majority of our members are small- and medium-sized enterprises, with very limited financial and physical resources.
Margins are tight and providers are already working at full capacity and beyond, before adding operational pressures such as increasing prices of fuel.
CPA is aware that, in the homecare sector alone, providers need an extra £107m a year to cover the rise in fuel costs. Homecare provision will be key to any discharge policies that emerge from the Truss Government going forward and this part of the sector therefore needs to be supported.
Other data adds to the real concerns that more providers could be on the brink of collapse. The South East Social Care Alliance reported in its market stability survey that workforce pressures are the worst most providers have ever seen them. The evidence shows that 90% of providers reported that the situation regarding workforce pressures is either worse than it’s ever been or somewhat worse, and 74% of providers suggested fees are not meeting the real cost of care.
It is important to consider all the other pressures faced by providers too, like the Fair Cost of Care (FCoC) exercise.
Since September 2021, when the charging reform policies were first proposed in the Government’s Building Back Better plan, the CPA has been working with providers to analyse the operational and financial impact of the FCoC. We have found that:
- Engagement across the sector has been good, with 53% of care homes in England participating in the FCoC process, attending meetings, registering on the national tool, and discussing with us the approach taken by their councils.
- Providers talked with us at length in FCoC workshops around the National Living Wage (NLW) annual uplift applied by most councils to care workers’ pay. We have advised DHSC it is not an accurate indicator of costs incurred by providers, and that councils continue to fund below the cost incurred by providers to meet their NLW uplift obligations.
- Providers also incur an increase at circa 130% of the base salary costs to account for holidays, sickness, training and other on-costs.
We will continue to represent providers as the Fair Cost of Care exercise moves forward, however it is critical that we find a solution to the funding gap between the FCoC rates and the true costs being absorbed within the balance sheets of our care services. One suggestion would be to change the retrospective budgeting approach taken by the Treasury and paid to local authority funded providers.
We are keen to ensure high-quality care provision remains the default position and that we can all work towards improved outcomes for the people we support. That is why there is still more for CPA to do on the FCoC and we will continue to advocate for
a fair and realistic funding settlement for the sector.
Steps for providers
The UK has this year seen extremes in weather, fuel shortages, contagious disease outbreaks and outbreaks in COVID-19 continuing. Providers face so many circumstances that can disrupt the day-to-day activities within their services, but business continuity plans can help.
Primarily, business continuity planning is about how you might go about maintaining services in any given circumstance, rather than about how best to resolve specific issues. Without any desire to create additional work within operational services at this busy time, it is critical to have a business continuity plan in place and to review it regularly to comply with the expectations of contracting local authorities, healthcare commissioners and the Care Quality Commission.
It is good practice to have a robust plan in place which is communicated through teams to avoid reactive actions. It is also vital to keep staff versed in the latest plans to ensure continuity of care and support, and to ensure that your business can continue if a problem occurs.
CPA’s business continuity planning guidance and resources are available to everyone online. Last year, we added power outages guidance and support planning information for providers and, while we do not cover everything that can happen, our templates offer a good starting point for reviewing your plans.
There will of course be community engagement plans locally you can access as well. Consider linking up with the strategic arrangements your council and NHS teams have in place to tackle cold weather alerts and any surge in demand for services.
Lastly, it is not only operational continuity we are focused on this winter. People are at the heart of everything we do here at CPA. Our sector provides amazing support for so many people, from helping people to learn a new skill or visit the doctor, to caring for the most complex individuals with clinical nursing support. We also know how much successful care services rely on good leadership. People’s experience, expertise and opinions should underpin good care and support planning at a local, system and national level.
If you are running a business this winter and things are getting really tough, get in touch with your national or local care association, even if you are not a member. We can offer practical support and advice and ensure that you are not alone.
On behalf of all of us here at CPA, I wish to extend a huge thank you to everyone working this winter, whether it is your very first day or you have years of experience. We know that many of you have worked tirelessly – so thank you. Our communities and the people we support value everything you do, as do we who represent you in our collective fight for social care.
Nadra Ahmed OBE DL is Chair of the Care Provider Alliance and Chairman of the National Care Association. Email: [email protected] Twitter: @CPA_SocialCare
How are you feeling about the winter ahead? Are you confident that your service will be able to handle additional pressures, or worried at what the season might bring? Share your thoughts and feedback in the comments.