RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out

By Claire Hopkins, RIVIAM Digital Care

Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.

In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.¹

Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow^.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.

The challenge

According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”³ Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.⁴ For patients, being stuck in hospital when they are fit enough to leave is also upsetting.

One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.

For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.

RIVIAM’s Solution

With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.

Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.

Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.

A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.

Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.

For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.

Benefits of using RIVIAM’s Hospital Discharge service:

Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.

“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset

To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.

Visit www.riviam.com

¹ The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.

² https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

³ https://www.england.nhs.uk/2023/07/nhs-sets-out-plans-for-winter-with-new-measures-to-help-speed-up-discharge-for-patients-and-improve-care

⁴ https://www.kingsfund.org.uk/blog/2023/03/hidden-problems-behind-delayed-discharges#:~:text=That%20means%20that%20the%20direct,at%20least%20%C2%A31.7%20billion

Using digital across adult social care to enable independence for longer

By Integrated Care Journal

This content is supported by Access Group.

In January of this year, PPP published their report, A care system for the future: how digital development can transform adult social care. The report examined the status of the social care system, focusing on the use of technology to support services, and the steps that need to be taken to support the full digital transformation of the sector for improved care, increased efficiency, and workforce satisfaction.

Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.

The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.

Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.

Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.

Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.

The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.

NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.

A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.

Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.

Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.

Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approac h to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.

Protecting the dignity of vulnerable people through technology

By Gavin Bashar

Gavin Bashar, Managing Director at Tunstall Healthcare, discusses why it’s important to protect the dignity of vulnerable people and how technology can be used to achieve this while improving health and care outcomes.

As the health and care needs of our population change, it’s important to uphold the dignity and rights of those who use health, housing and social care services. There are a number of strategies and innovations that providers can implement to help them deliver high quality services that support the dignity of vulnerable people.

Protecting the dignity of vulnerable people

As the health and care needs of our population change and the number of older people increases, it is important that service providers understand why and how care provision can play a crucial role in protecting the dignity of vulnerable people.

Dignity can be defined as the state of being worthy of honour and respect. When it comes to health, housing and social care services, this particularly focuses on being able to provide care that is tailored to meet the needs of each individual, their circumstances and wishes.

Robust and integrated systems can be well placed to deliver improved outcomes for citizens, reducing their need for emergency and more extensive care, such as hospital admission. The longer that people are able to remain independent without the need for acute services, the more their dignity and quality of life will be protected.

The role of technology

One of the prime objectives for technology-based solutions is to put people at the heart of their own health and care needs, protect their independence and dignity, and achieve citizen-focused outcomes. With the right digital frameworks in place, services can become focused on engaging each individual with their own health and care support.

When technology is embedded seamlessly into care and support services, it can be transformative, helping people to live happy, fulfilled lives in their homes and communities. Digital tools can also be used to ensure timely and appropriate responses to emergency events, encourage greater engagement from citizens, and provide more person-centred care.

Developments in the provision, scale and quality of digital technology can support improvements in how care providers are able to collaborate and provide person centred care. The UK’s transition to a digital communications network brings a once-in-a-generation opportunity to modernise, improve and shift the sector and its thinking from a reactive, to a proactive delivery model. This in turn can improve health outcomes for citizens, deliver efficiencies, and enable people to live independently for as long as possible.

Investment in digital solutions will support health and social care providers in reconfiguring services to make them more agile and integrated, leading to better outcomes. Utilising data and technology to create a connected approach can also provide actionable insights to deliver more informed, and more effective care.

Importance of collaboration

Last year saw the introduction of integrated care systems (ICSs) across the UK. ICSs should help us to integrate services effectively and drive collaboration between service providers, such as care homes, GPs and hospitals. Collaboration across sectors is essential to keep people healthy, reduce inequalities, enhance productivity and value, and support economic and social development. ICSs will play a key role in enabling us to remove silos between health and social care providers, while increased collaboration will reduce duplication and fragmentation, disseminate best practice and progress in technology.

Through collaboration we can create a truly joined up approach where we listen to citizens, understand their everyday needs and work together to bridge gaps in our services. Building on ongoing collaborations will see a system begin to emerge that is better connected and user focused. The latest generation of digital solutions broaden the circle of care to engage families, friends and communities, and promote services that are connected and data-driven.

Strong relationships between health and care providers and end users is vital to ensure users feel both respected and protected. This in turn can lead to clearer communication, giving care providers the opportunity to deliver care that is targeted to the requirements of individuals.

The workplace and a cultural shift

The digital transition is an opportunity to create a clearer and consistent approach to care delivery. Collaboration is essential but to encourage this, a cultural shift must take place. While technology has sometimes previously been viewed as an additional aspect of service delivery, embedding digital solutions into services will contribute to the successful transformation of existing care models, and provide more intelligent insight to improve health outcomes and protect the dignity of vulnerable people.

Increasing system capacity and capability, as well as providing a foundation for future technological advancement, will see health and care services more able to effectively meet the changing demands of the population. There are compelling benefits for all stakeholders when it comes to technology, particularly from an economic and operational perspective. By driving education within the health and care landscape and building on an already shifting culture, we’ll see more professionals become open to the idea of using technology and transfer their skills, knowledge and experience to the people they care for, to create a digitised world.

A dignified future for care users

As people live longer, increased pressure is put on our care services. Technology has the ability to aid the management of this and potentially reduce pressure points. If successful and integrated digital services for citizens can be realised, the benefits flow will through the health and care system. If we get our approach right, citizens can live independently for longer and have more choice and control.

As we look to a more digital future, we must consider how we can best harness the power of the connected world and the value that can come from technology solutions. By committing to investment in more technological solutions, we will reform our services, improve outcomes and place users at the centre of care to protect their dignity.

For more information, please visit www.tunstall.co.uk.

News, Social Care May 5, 2023

Dire state of social care sector undermined pandemic response, study finds

By Integrated Care Journal

Structural weaknesses, unaddressed by successive governments, left social care struggling to provide the service and protection that people needed during the initial waves of Covid-19.

Lack of visibility of the sector, unclear accountability, insecure funding and poor workforce pay and conditions impacted the sector’s ability to implement protective measures in a timely way, according to a new report published by the Nuffield Trust.

The report is the result of a two-year joint study between the Nuffield Trust and the London School of Economics, and looks at issues which emerged with the Covid-19 response in the social care sector in England. Focusing on the initial four months of the pandemic response (February-May 2020), it found that the fragmented nature of the system and a shortage of civil servants working on social care contributed to confusion over who was responsible for decisions and implementation in the Covid response, which, for example, undermined the effective distribution of PPE and testing for care staff.

The study also concluded that successive governments failed to respond to concerns surrounding pandemic-preparedness identified by multiple cross-government planning exercises. Amid a poor understanding of the sector and its capabilities within government, many smaller care providers were unable to effectively accommodate infection control measures and adhere to the slew of ever-changing guidance and regulation, with disastrous consequences for the nearly 20,000 care home residents who died in England and Wales in spring 2020.

Natasha Curry, Deputy Director of Policy at the Nuffield Trust, commented: “What happened to social care at the start of the pandemic represents the consequences of letting one of our most important public services languish in constant crisis for years. Those early months exposed an array of weaknesses within social care that impacted the shape, speed and effectiveness of the response. Many of these difficult challenges could have been eased had warnings been heeded. Governments of all hues have failed to make social care and those who need it a priority.”

Drawing on interviews with sector experts, workshops with social care stakeholders (including people who use care), policy documents, and literature, the report identified areas that could put social care on a more resilient footing in the future.

The report found:

The government, NHS England and Public Health England missed opportunities to prepare the sector for a pandemic, or other crises, in the years immediately before Covid-19. They excluded social care from pandemic-planning exercises such as Exercise Alice. After exercises that did include the sector, such as Operation Cygnus, action was not taken to address the problems that were identified. Once infections took hold in England, the government did not sufficiently apply pre-existing knowledge of infection spread in care settings.
There had been no dedicated director general for social care in the Department of Health and Social Care (DHSC) since 2016. No adult social care representatives sat on the Scientific Advisory Group for Emergencies (SAGE) in the opening weeks of the pandemic. This meant social care leaders felt largely invisible, despite the critical role of the sector.
The wider Covid-19 response, which was perceived to be hospital-focused at the outset, caused many issues for social care staff because the structure of the workforce and what their jobs involved were not well understood. For example, a lack of access to Covid testing and sick pay had far-reaching consequences for staff when self-isolation policies were in place, especially for those on zero hours contracts.
The long-term tendency of governments to allocate funding to social care in the form of sporadic injections of cash limited the scope for strategic investment and had implications for how robust the sector, and its infrastructure, were when entering the pandemic. Many providers of care, which are often small businesses, entered the pandemic with little or no cash reserves.
During the pandemic, the succession of emergency funding pots offered to social care initially took a long time to reach the front line, and their short-term nature prevented strategic planning. While seen as a lifeline for care providers, extensions to the funding were frequently announced with only weeks, days or in one case hours before the end of the scheme and did not allow those on the front line to spend it to meet the needs they could see.
There was a lack of data and information about who uses and provides adult social care services and how to communicate with them. Covid-19 has accelerated efforts to collect data, and this is helping to lay the foundations of a robust source of standard data.
The government did not adequately consider the fragile state and the complexity of the adult social care infrastructure, in particular residential care buildings and equipment. Small organisations, that make up much of the sector, lacked the back office capacity to interpret continually updated guidance and outdated care home buildings struggled to isolate or group together infected residents and to accommodate wider infection control measures.

There has been some positive progress in learning from these problems, with the Department of Health and Social Care (DHSC) bolstering its social care capacity and expertise and the signaling of it as a priority area with the appointment not only of a specific director general but also a chief social care nurse.

Following the first four months of the Covid-19 response, progress was made to plan for ongoing outbreaks in the short to medium term, for instance with the establishment of the social care taskforce in June 2020 and the decision to continue to provide PPE purchased centrally. The smoother subsequent rollout of vaccinations in social care settings pointed to improved collaboration between the government and social care partners, and the prioritisation of carers in the vaccination rollout was widely regarded as a positive step forward.

Adelina Comas-Herrera, report co-author from the Care Policy and Evaluation Centre at the London School of Economics and Political Science, said: “The pandemic has had a tragic impact on people who use social care and those who provide care, unpaid and paid. This has been a shared experience internationally but the evidence suggests that some countries were able to cope better than others. Our research shows that social care in England needs a system-wide reform to be able to respond not just to emergencies, but to the implications of longevity and competition for workforce with other sectors.”

Care Minister, Helen Whately, said: “During the pandemic [the government] supported social care with £2.9bn in specific Covid funding, sent out more than 230m Covid tests to care homes and prioritised social care for Covid vaccinations. We are committed to learning lessons from the pandemic and are investing up to £7.5bn over the next two years to put social care on a stronger financial footing, help reduce waiting lists and alleviate workforce pressures.”

The full report can be accessed here.

All news

NW ADASS issues Data Security and Protection Toolkit support for commissioners

By Integrated Care Journal

The North West Association of Directors of Adult Social Services (NW ADASS) has published guidance to support Adult Social Care (ASC) Commissioners in increasing the implementation of the Data Security and Protection Toolkit (DSPT) across the ASC market.

The DSPT is an annual self-assessment that shows care providers what they need to do to keep people’s paper or digital information safe and protect their business from the risk of a data breach or a cyber-attack. It reassures everyone they work with, as well as their clients and families, that they are taking data security seriously and supports them in running a care service that people can trust.

The initiative is supported by Better Security, Better Care, a national and local support programme that assists adult social care providers to store and share information safely and raise awareness among providers of the importance of data and cyber security. It is led by a programme board whose members include, NHS Digital, NHS England and Improvement, the Local Government Association, the Association of Directors of Adult Social Services and Digital Social Care, which acts on behalf of care providers.

The new guidance provides:

Example wording of DSPT requirements for councils to adopt and adapt as ASC contracts are revised or renewed.
Guidance on monitoring provider adherence to DSPT requirements within contracts as part of the Better Security, Better Care programme.

Michelle Corrigan, Programme Director of Better Security, Better Care, the official programme of support that helps adult social care providers store and share information safely, said: “We are delighted that NW ADASS is providing this support to commissioners. The guide will help councils encourage adult social care providers to evaluate and improve their data security, whether they be digital or paper-based, by completing their DSPT. This is one of many ways local authorities can support implementation of the DSPT among adult social care providers.”

The document is available here and has been developed with input from colleagues at Wakefield, Tameside, Lancashire, and Blackburn with Darwen Councils.

For more information, contact:

Iris Steen, Communications Lead (Better Security, Better Care), Digital Social Care

Email: iris.steen@digitalsocialcare.co.uk

Tel: 07792 636 761

State of social care and support provision has not improved, new report suggests

By Integrated Care Journal

Care England, as a member of the Care Provider Alliance, which brings together the main national associations that represent independent and voluntary adult social care providers in England, published a report on the current state of social care in England this week.

The Care Provider Alliance (CPA) published a briefing this week, The State of the Social Care and Support Provision in England, that highlights the key issues currently afflicting the social care sector. These issues include, but are not limited to:

· The rising cost of living

· Lack of funding to Local Authorities to adequately raise fee rates for social care

· Impact of financial pressures and uncertainty

· Unmet need is unacceptably high and rising

The key message from the report is that immediate government investment into social care is needed now. Without substantial reform and investment to support that reform, achieving long-term sustainability is impossible in the current economic climate. The implication of continued governmental inaction is continued market instability. Provider failure will impact significantly on both the NHS and Local Authorities, who will be unable to commission care and support packages from providers. Lack of action now will also prevent care providers from enabling those who rely on care support to enjoy their rights to live purposeful lives, as active members of families and communities.

Professor Martin Green, Chief Executive of Care England, said: “We require a 1948 moment for adult social care to establish a long-term and sustainable future that will be to the benefit of all citizens and the economy. It is clear that the reforms introduced under the Johnson administration are a starting point but are by no means going to ‘fix social care’ and the current reform proposals may well be kicked into the long grass again.

“The sector stands ready and willing to support the delivery of a much-needed reform agenda that will deliver a clear funding strategy for social care, whilst also developing a range of careers and opportunities that will provide high-quality care and support local economic development. The health of the UK economy cannot be separated from the health of the social care sector, the two are fundamentally linked.”

The report comes after Care England accused Ofgem of predatory pricing by charging “horrendous and financially crippling rates” in an open letter. Care England, the country’s largest representative body for independent providers of adult social care in England, is calling on the government to launch an investigation into the matter.

Energy cost support resource launched for care workers

By Integrated Care Journal

As social care workers and providers grapple with sharply rising energy costs this winter, Community Integrated Care has launched a new programme to support social care workers, people using services and family carers.

Free to access and available to all, Taking Charge offers free interactive webinars and accessible resources, specially tailored to the home-life and working routines of people who work in social care, and the people they support.

Launched by Community Integrated Care, a member of the National Care Forum (NCF), it brings together expert advice from leading energy organisations with the insights and perspectives shaped by the people it supports and their colleagues.

The ongoing energy crisis, coupled with spiralling inflation, is seeing many social care workers and their families struggle financially, and many disabled people are paying more than double the energy bill of the average consumer.

The NCF has been drawing attention to the growing energy pressures and its impact on the sector, alongside the ongoing workforce shortages, for several months, and has called on the government for:

A guarantee that adult social care providers are defined as a vulnerable sector as part of the Energy Bill Relief Scheme following April 2023.
A guarantee that those people accessing adult social care support will be able to access the Energy Price Guarantee following April 2023.
Additional, immediate support for providers to reduce the pressures facing social care workers and meet other operational costs due to rising cost of living and inflation

Professor Vic Rayner OBE, CEO of NCF, said: “The eye watering increases in energy costs is a very serious concern among our members, even after the government capped prices through the Energy Bill Relief and Energy Price Guarantee Schemes.

“For social care workers, the steep rises in the cost of living and energy costs alongside the continued reluctance of government to guarantee the funding for better pay, terms and conditions, means that the next few months will be very hard.

“The lives and wellbeing of the people who access care and support services are also significantly impacted, and many are not enjoying the same support the government is giving to other households.

“It’s encouraging to see such an innovative, co-produced, support programme from Community Integrated Care. This will provide much needed practical support to people accessing care services and care workers. However, this can’t be the responsibility of providers alone, we also need more action from government.”

Care England issues S.O.S. for care sector

By Gabriel Blaazer

Care England has this week written to the newly appointed Prime Minister, the Rt Hon Rishi Sunak MP, calling for the Conservative manifesto promise to ‘fix social care’ to be delivered in his premiership.

Care England’s open letter, signed by Chief Executive, Professor Martin Green OBE, outlines many of the immediate pressures facing the sector, including reform delays, energy costs and the escalating workforce crisis. It asks Rishi Sunak’s new government to fulfil the promise made in Boris Johnson’s 2019 election manifesto to “fix social care”. The sector has been increasingly plagued of late by record staffing shortages, low morale and uncertainty over providers’ ability to meet soaring energy costs.

Recent research has also shown that in-work poverty is widespread among the social care workforce, with one in 10 residential social care workers experiencing food insecurity and material poverty from 2017-2020 – a figure that is likely to be higher now.

“Save our sector”

Titled Saved our Sector, Care England’s letter argues that “any delay to the £1.36 billion funding provisioned for the Fair Cost of Care to address historic underfunding of social care and move fees closer to a Fair Cost of Care will have catastrophic effects.” The Health and Social Care Levy, which was set to provide the additional funding for social care through a 1.25 per cent increase in National Insurance contributions, was officially scrapped this month by Kwasi Kwarteng, the former Chancellor. The government has sought to assure parliament that scrapping the measure will not impact funding for health and social care but it is not yet clear how the shortfall will be addressed.

The letter coincides with reports that £500 million in emergency funding promised by the former Health Secretary, Thérèse Coffey, has yet to materialise. The fund was announced in September by the Department for Health and Social Care as an emergency “adult social care discharge fund… to free up beds and help improve ambulance response times”, however it has been reported that none of the funding has been received by the NHS or social care providers.

Describing the current state of social care funding, Care England say that: “The adult social care sector has been chronically underfunded by central government for far too long. Current funding provisions are insufficient and the government must commit to substantial increases in funding to stabilise the sector and enable it to move towards a sustainable footing.”

Care England also urge the government to release a fully-funded strategic workforce plan to remedy the much-publicised crisis in social care staffing. The vacancy rate for social care staff hit a record high 165,000 vacant posts this month (10.7 per cent of all posts), a situation that Care England describe as “a rapidly worsening crisis”. The number of vacancies across the sector rose by 55,000 in the last year, amounting to a 52 per cent increase.

On energy concerns, the open letter implores the government to immediately announce an extension to the six-month Energy Bill Relief Scheme, which is currently running until 31st March 2023. It states that while the scheme offers “much-needed short-term stability to care providers, [it] does not represent the long-term strategy needed to support the sector through the ongoing energy crisis.” Any move to withdraw the current measures would constitute “an immense oversight by the government,” Care England say, and “more substantial measures [should be] implemented as soon as possible.”

Addressing the new Prime Minister, Rishi Sunak, Martin Green says: “Care England welcomes the Prime Minister to his new role. Speaking for the first time outside of No.10, Mr. Sunak spoke of his intention to ‘deliver’ the Conservative manifesto promises from 2019. Now in office, he is presented with a unique opportunity to finish what his predecessors started and enact the long-overdue reform of the sector promised by his party during the 2019 election, and ‘fix social care’ once and for all.

“Following a turbulent couple of months at the head of government, it is vital that the new Prime Minister steadies the ship and places social care right at the top of his agenda. The stabilisation of the adult social care sector should be the government’s priority in the coming months to secure the future of the nation; for the individual receiving support and care, the staff member and the taxpayer.”

“The issues currently facing social care are immense in both scale and severity and must be addressed as a matter of urgency if the sector is to be saved. Issues around reform, energy, funding or workforce in isolation would be enough to push a provider over the edge: all four simultaneously is catastrophic.

“Care providers deliver essential care to many of society’s most vulnerable; Mr. Sunak has the opportunity and responsibility to ensure these individuals, and the high-quality care they receive, are protected in the long and short term. Care England is looking forward to building on our long history as a critical friend to government, and assisting in a pragmatic government response that is needed to save our sector.”

Cost of living hits social care staff as vacancies soar

By Gabriel Blaazer

As a Health Foundation report finds care home staff are more likely to be living in poverty than other health workers, figures from Skills for Care show the social care vacancy rate has risen to a record-high.

Skills for Care’s annual social care workforce report has shown a drop in the number of care workers in England for the first time in 10 years. It follows a new report from the Health Foundation which finds that care home staff are far more likely to be living in poverty than other health workers, with one in five living in poverty before the latest cost-of-living crisis, compared to one in eight of all workers.

The findings have raised fresh concerns over the viability of a career in care. Despite a stream of pleas for the government to raise the status and pay of care workers, Skills for Care’s report also shows that 80 per cent of jobs in the economy pay more than the average job in social care.

Estimates within Skills for Care’s report show a three per cent fall in the number of posts filled in 2021-22 (amounting to 50,000 posts), the first time a drop has been recorded in 10 years. As such, the vacancy rate in adult social care has risen to 10.7 per cent, the highest rate since figures began in 2012-13. However, the number of vacancies in adult social care also increased by 52 per cent over the last year, up 55,000, and now stands at 165,000 vacant posts.

Furthermore, the starter rate for carers fell from 37.3 per cent in 2018-19 to 30.8 per cent in 2021-22, while staff turnover rates remained at a similar level (29 per cent in 2021/22), meaning that a similar proportion left their roles with fewer staff to replace them.

Taken together, the figures suggest that longstanding difficulties in recruiting and retraining staff are behind the fall in overall workforce numbers, rather than a decrease in demand.

Speaking about Skills for Care’s report, Professor Martin Green, Chief Executive of Care England, said: “This report illustrates the impossible challenge currently facing independent care sector providers. A growing number of people are living with increasingly complex conditions but are being supported through an insufficient government funding pot.

“A lack of government action has had a significant consequence on providers’ ability to recruit and retain staff, with staff being lost faster than they can be replaced. The writing is on the wall and immediate help is urgently required to secure the future sustainability of the sector.”

In-work poverty increasing among social care workforce

Using national survey data from April 2017 to April 2020, the Health Foundation found that around one in 10 residential care workers experienced food insecurity during this time, with 13 per cent of residential care workers’ children living in material deprivation – unable to afford essentials like fresh fruit and vegetables or a warm winter coat. Among the children of all working families, this figure stood at 5 per cent.

Care home staff were also found to be twice as likely to be in receipt of in-work benefits compared to all workers, with around 20 per cent of residential care home workforce drawing on universal credit and other legacy benefits from 2017 to 2020, compared with 10 per cent of all workers.

Given that these figures account for the period before the latest cost of living crisis and Covid-19, the Health Foundation suggests that the picture has likely worsened since 2020; food costs rose by 13 per cent in August 2022 and the annual rate for clothing and footwear was 7.6 per cent in the year to August 2022, up from 6.6 per cent the previous month.

Commenting on the Health Foundation’s report, Hugh Alderwick, Director of Policy at the Health Foundation, said: “Social care workers – who are mostly women – play a vital role in society but are among the lowest paid workers in the UK, and experience shocking levels of poverty and deprivation. Many cannot afford enough food, shelter, clothing and other essentials, putting their health at risk.”

With inflation topping 10 per cent following the Chancellor’s disastrous September ‘mini-budget’, and showing no signs of dropping, there are real fears for the ability of the social care workforce to function under the current circumstances.

Many criticised the absence of a workforce plan in Health and Social Care Secretary Thérèse Coffey’s announcement to the House of Commons in September. The latest reports have prompted renewed calls for the government to issue a comprehensive and fully-funded workforce plan for social care in England, as well as broader measures that tackle the root causes of poverty.

The Health Foundation accuses the government of prioritising the needs of the wealthy over the needs of average workers, although considerable funding has recently been made available to provide support with energy bills. However, they argue that “despite [the government’s] 45p tax rate U-turn, its plan for growth will mostly benefit the richest households.”

“£15 an hour – it’s the least they deserve”

Hugh Alderwick added: “Sustained underfunding of social care has contributed to unacceptable pay and conditions for staff and major workforce shortages, with vacancies in England rising by 52 per cent last year. This reflects political choices. If government values people using and providing social care, it must act to tackle low pay and insecure employment conditions in the sector.

“People on low incomes are most likely to struggle through the current cost-of-living crisis, and poverty in the UK is set to increase. Yet government’s plan for growth prioritises tax cuts over investment in public services – with a further squeeze on public spending likely to follow.”

GMB, the general workers’ union, is citing the report in it calls for social care workers to receive £15 per hour. Rachel Harrison, GMB Nation Officer, said: “Care workers are an immensely skilled, compassionate workforce who do an incredible difficult job. Instead of being properly rewarded, they are expected to survive on a whisker above the minimum wage.

“Essential care is delivered by underpaid and mostly women workers. And without the dedication of our care workers the whole house of cards will come tumbling down. GMB is campaigning for care workers to be paid no less than £15 an hour – it’s the least they deserve.”

Social care: a sector now in perpetual crisis

By Rusheen Bansal

Association of Directors of Adult Social Services reports dramatic rise in numbers of those seeking review or start of social care provision.

The number of people awaiting review of current provisions, start of a service or direct payment for social care, has increased by 37 per cent from November 2021 to April 2022, according to a count carried out by The Association of Directors of Adult Social Services (ADASS) in 83 councils.

Almost 300,000 people are waiting for an assessment of their needs by social workers, an increase of 90,000 (44 per cent) in five months. One in four has been waiting longer than six months. At this rate, the number waiting can hit 400,000 by November 2022, a two-fold increase from last year.

While demand for care is expected to increase in line with winter pressures, peaking around January and dropping in the spring, the findings from ADASS suggest that the typical ‘cycle’ of system pressure is changing, being replaced by a state of perpetual crisis.

To the outside observer, those stating that social care is in crisis may sound like a broken record. For years now, however, stakeholder groups and think tanks have been warning that crippling staff shortages, precarious pay, working conditions and insufficient funding had left a system on its knees, even before the Covid-19 pandemic hit.

A shrinking (paid) workforce

The crux of the issue is relatively simple, if not profound in scale – as Cathie Williams, ADASS Chief Executive put it: “the big reason why almost 40,000 people are waiting for the care and support they need to actually start is that care providers simply do not have the pairs of hands they need to sustain services.”

A recent PPP report, The Social Care Workforce: Averting a Crisis, quotes a 2021 survey of 2,000 social care services undertaken by the National Care Forum (NCF) that reveals how 74 per cent of providers have experienced an increase in the number of staff leaving since April 2021. Indeed, the vacancy rate for care home providers has nearly doubled in the last year, from 5.9 per cent (in March 2021) to 10.3 per cent (in May 2022).

The NCF survey also states that 50 per cent of those leaving highlighted stress as the main reason for their departure, with 44 per cent citing poor pay. Due to poor retention of the social care workforce, existing employees are experiencing an increase in workload that has not been accompanied by an increase in pay thus far.

Care workers are paid a median hourly rate of £9.50, in line with the National Living Wage. However, a high proportion of these workers are employed on zero hours contracts – 41 per cent of social care workers in London are on such contracts. To that end, social care professionals often leave the sector for less demanding and/or better paid jobs such as retail roles or jobs in the NHS, where similar skills are often more appreciated and rewarded.

ADASS has discovered a similar pattern – almost seven in ten ADASS members surveyed said that care providers in their area had closed or handed back contracts. Many more said they could not meet all needs for care and support because of providers’ inability to recruit and retain staff. The implications of this are significant. When people’s needs are unmet (or unknown), this can place a sizeable burden on their lives and on the lives of unpaid carers who may feel obliged to step in. Indeed, over the last ten years, the number of young people aged 16-25 in England and Wales providing unpaid care to family and loved ones has risen to approximately 350,000.

“The picture is deteriorating rapidly”

Councils are simply overwhelmed. The ADASS Spring Survey found that most councils were facing an increase in numbers of people seeking support: 87 per cent said more were coming forward for help with mental health issues, 67 per cent reported more approaches because of domestic abuse or safeguarding, and 73 per cent reported seeing more cases of breakdowns of unpaid carer arrangements. In addition, 82 per cent of councils were dealing with increased numbers of referrals of people from hospitals and 74 per cent were reporting more referrals or requests for support from the community. To that end, the Health Foundation has estimated that an additional £7.6 billion will be needed to meet demand in 2022/2023.

Sarah McClinton, ADASS President, commented: “These new findings confirm our worst fears for adult social care. The picture is deteriorating rapidly and people in need of care and support to enable them to live full and independent lives are being left in uncertainty, dependency and pain.”

In September 2021, the government announced a new ‘Health and Social Care Levy’, effective April 2023 onwards – a 1.25 per cent increase in National Insurance contributions from employed people as well as pensioners. Yet, now more than ever, policy experts recommend that financial planning and smart allocation, elements that have been lacking in the past, are required to reap the maximum benefits from this additional funding. The Levy, which will aggregate to £5.4 billion over three years, has been reported to fund necessary reforms in the social care sector such as improving staff training and recruitment practices, initiatives for mental health well-being and new avenues for career progression. Yet, many regard this amount as insufficient – according to The Health Foundation, a further £7 billion will be required every year to tackle demographic and inflationary pressures and to increase staff pay.

While it is true that the COVID-19 pandemic significantly worsened the social care crisis, it is only one of the many crises that have exposed and underscored the foundational instability of this system. Since the 2016 Brexit vote, for instance, the vacancy rate of social care workers has increased year-on-year. Prior to this, 1 in 20 social care workers were EEA migrants, and since more than 90 per cent did not have British citizenship, many had to leave England. To mitigate concurrent widespread resignations, the government announced a Health and Care Visa that would help fast-track visa applications for those in the healthcare sector. However, care workers are not categorised in the list of eligible jobs.

More than 600 people are joining waiting lists to be assessed for care and support in England each day. Resolving issues other than funding are key for the successful integration of social care into effective healthcare. Greater efforts should be made for recruiting and retaining social care staff, especially younger people, by improving the pay, workload and working conditions in the sector. Otherwise, broken record or not, the system is in danger of collapse.