Social care sector unprotected in energy price rises

By Gabriel Blaazer

With the country facing a stark cost of living crisis, social care representative bodies are calling on the government to do more to protect the sector.

The cost-of-living crisis continues to be the most pressing issue facing thousands of people across the country. Thus far, government policies announced to mitigate the risk to vulnerable people do not appear to apply to much of the social care sector, which so far, is dealing with the brunt of inflationary pressures without support.

Last week, Care England, the largest representative body for independent providers of adult social care in England, called on the government to take immediate action to prevent a widespread catastrophe within adult social care.

Figures released by Care England and Box Power CIC, a non-profit energy consultancy, demonstrate the extent of the problem the care sector faces. Their data estimates that to secure future gas and electricity supplies from October 2022, care providers will have to pay, on average, £5,166 per bed, per annum. This represents an increase of 683 per cent compared to last year, when those same providers would have paid, on average, £660 per bed, per annum.

Based on the October 2022 market rates, and with 454,933 CQC registered beds, the approximated impact of the rising energy prices over the last year on the sector is over £2bn per annum. Further research from the Centre for Health and the Public Interest (CHPI) estimates the sector’s total pre-pandemic profits before tax, rent payments, directors’ renumeration and repayments on loans at £1.5bn per annum.

The expected rise in energy prices will see profit margins generated across the sector eradicated, driving many providers into insolvency and reducing the potential for investment. Care England have written to Members of Parliament asking them to pledge their support for immediate and targeted support for the sector.

Government financial measures announced so far only apply to people living in their own households and not to people living in social care settings where energy costs are running out of control. Nor does the Ofgem energy price cap apply to social care providers.

In a statement issued by the CEO of the National Care Forum, the association for not-for-profit care and support organisations, Professor Vic Rayner OBE said: “The eye watering increases in energy cost is a very serious concern amongst our members. They are facing price rises of 400 per cent in gas and electricity prices which is totally unaffordable and way beyond anything budgeted or forecasted. This is causing immense pressure for social care providers.

“We need an urgent response from the government that will put a protection around people living in residential care settings – it is important to note that these people do not currently benefit from the government’s announced support for energy costs faced by households – all current and proposed schemes will not address the immediate crisis impacting on care homes right now.

The current energy crisis comes at a time when the sector is experiencing the worst workforce pressures the sector has ever known, with the vacancy rate currently resting above 100,000, and expected to grow. Rayner added that: “we must see parity of support for vulnerable people living in care settings; we need care settings to be included in the domestic price cap, and we need an emergency ring-fenced energy fund which could flow from central government to local care providers.

“Social care providers need assurance now of the financial support that will be available in order to effectively plan for the sustainability of their service provision.”

How Tunstall Healthcare is investing in the leaders of the future

By Tunstall Healthcare

Global market leading health and care technology company, Tunstall Healthcare is investing in the next generation of health, housing and social care professionals with the launch of a new range of Continuing Professional Development (CPD) accredited courses.

Part of ‘Tunstall Academy’, the online courses have been developed by Training Accreditation Programme (TAP) and CIPD accredited trainers. The courses aim to strengthen the knowledge and expertise of professionals in a range of areas related to health and care technology. The first courses available focus on telehealth and a range of other courses relate to the remote management of specific long term conditions including COPD, heart failure and diabetes. A Telecare Assessor course will be available soon, which will be followed by a number of other telecare-focused courses.

Gavin Bashar, UK Managing Director at Tunstall Healthcare, commented: “The role of technology in adult social care has been radically reshaped over the past couple of years, leading to 63% of directors in adult social care reporting that their local authorities are implementing positive investment strategies in digital and technology.

“We must therefore work to upskill staff members in these sectors to improve care service delivery, facilitate collaboration, and build a bigger and better workforce post-Covid. Our specialist training team works closely with participants to help them get the most out of technology for their own organisations and the people they support, and ensure they are ready to make the most of a more digital future as we transition to a fully digital communications network.”

CPD courses enable professionals to stay up to date with current and best practice in their chosen field, enhancing their skills and effectiveness in the workplace. Tunstall also offers a number of non-CPD accredited courses which can be delivered online or in person, designed to upskill people working in monitoring centres and group living environments as well as those delivering telecare and telehealth services.

All courses are designed for a range of learners, from beginners to advanced professionals, and can also be configured to develop skill sets for particular job roles, as well as achieving broader personal and organisational objectives, such as meeting TEC Services Association standards and enhancing customer experiences.

Andy Hart, Head of Technical Delivery and Support at Tunstall Healthcare, added: “People are the greatest asset of any organisation, and at Tunstall we have a responsibility to drive change across the sector as a whole. We are committed to educating and upskilling the next generation of professionals in the use of telecare and telehealth technology to modernise our health, housing and social care systems.

“Technology enabled care solutions (TECS) support individuals to live independently for longer and alleviate pressures on care and health services. It’s crucial that professionals are aware of the benefits of technology within service provision so that it can be deployed effectively, and education plays a key role in achieving this.”

Tunstall Academy brings together a range of initiatives designed to raise awareness of the value and potential of technology across the health, housing, and social care landscape, and to increase the benefits to users, carers, professionals and providers.

To find out more about the training services available, please visit www.tunstall.co.uk/training-services.

The Health and Social Care Committee’s report on the care workforce; what is missing?

By Mary Brown

On 25th July, the Health and Social Care Committee (HSCC) published their report, Workforce: recruitment, training and retention in health and social care.

The report calls for the government to provide its workforce plan for the NHS and social care (promised in spring 2022 but still not yet published), and provides several practical recommendations for the plan. Refreshingly, large sections of the report focus specifically on the social care workforce; a workforce often ignored in conversations around health and care.

The report appropriately recognises the gravity of the situation facing the social care sector, stating that, in comparison to the NHS, “the situation is regrettably worse in social care”, referencing incredibly high staff vacancy and turnover rates and poor working conditions.

Key recommendations in the HSSC report regarding the social care workforce include:

Higher baseline pay for care workers, reflecting the true value to society of the services they provide
Sustainable strategies in terms of pay progression, professional development, and career pathways
Contract choices offered to care workers on zero-hours contracts
A call for the government to produce an externally validated care certificate, provided at no cost to care providers, and is transferable between care providers and the NHS

While the report makes some promising recommendations, it falls short in several areas. On 26th July, Public Policy Projects (PPP) launched its report, The Social Care Workforce: averting a crisis.

This report was based on two roundtables with PPP’s Social Care Policy Network, held in May 2022, made up of key stakeholders in the adult social care sector and a lived experience panel (comprising five individuals with first-hand experience of the social care system). While many of the conclusions and recommendations of the HSCC’s report have parallels in PPP’s report, PPP highlights further areas that the workforce plan should address.

A fairer deal for the social care workforce

The reports from HSCC and PPP are broadly aligned regarding their sentiments and recommendations around pay for care workers. It is evident that care workers must be paid more, and equivalent to, their NHS counterparts.

Both reports therefore include recommendations advocating increases to the baseline pay for care workers, to reflect the true value that care workers bring to society and reduce the number of care workers leaving for better paid jobs in retail, hospitality, or elsewhere. Both reports also agree that there must be pay progression in the care sector in line with that of the NHS Agenda for Change pay scale, providing opportunities for care workers to be paid fairly and to advance their careers.

The two reports agree that terms and conditions, as well as pay, must be improved for social care workers. They acknowledge that zero-hours contracts can provide instability for many adult social care workers, and that care workers do not tend to enjoy the same pension options, sick pay or overtime renumeration as equivalent NHS workers, nor do they receive the public admiration or ‘sweeteners’ (including NHS staff discounts offered by many businesses).

It is no secret that the social care sector is severely underfunded. In order to appropriately pay care workers, both reports agree that local authorities must be appropriately funded to provide the fair cost of care to providers, to ensure that self-funders are not subsidising the cost of workers’ wages. This will require substantial investment from government.

However, PPP’s report provides several additional recommendations for the elevation of the social care workforce. Crucially, PPP’s report focuses on the need for an elevation in the status of care work, to raise the profile of those working in care. The report notes the boost in public sentiment towards nursing that followed Florence Nightingale’s work during the Crimean war, and stresses the need for a similar shift to take place for care work. Not only would this ‘Nightingale shift’ boost staff morale, PPP’s report argues that it would help to address recruitment and retention issues, provided it is accompanied by improvements to pay and conditions.

To kickstart this ‘Nightingale shift’, PPP’s report recommends that the government should provide investment for positive advertising campaigns for social care careers, with clear messaging of the immense value of a career in care and its potential to transform lives. In conjunction with this, it recommends that care providers should be working with careers advisors in schools to promote care work to young people as an attractive and fulfilling career.

Another recommendation in PPP’s report, which was not addressed by the HSCC report, is the potential creation of cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This would help raise the status of social care by actualising a parity of esteem between the NHS and social care workforces. It would also serve to increase the awareness and visibility of the social care system within the NHS, and aide in the integration of the workforces.

More training is not a panacea

Training was highlighted as a key area in the HSCC report. However, PPP’s Social Care Policy Network argues in the report that extra workforce training should not be conflated with the wider issues around attracting and retaining staff. PPP’s Lived Experience Panel were at pains to express that constant training and annual training renewal is often a poor use of time and resources and cannot be a substitute for meaningful sector reform.

Where PPP’s report addresses training is in their recommendation around the proposed Social Care Leaders Scheme, dubbed the ‘Teach First’ of social care. The care sector is in need of strong leadership, as registered managers are not always sufficiently prepared or trained for a job that carries substantial responsibility.

The Social Care Leaders Scheme, proposed by a steering group of leaders from the social care sector convened by the CareTech foundation, aims to attract high calibre talent to the sector by training bright university graduates for leadership roles in social care, emulating the successful Teach First model. The report calls for the government to reconsider its position on the partial funding of the scheme, which promises to elevate the sector, provide attractive careers, and improve leadership structures.

The HSCC report also focuses on mandatory Care Certificates, which should be offered, at no cost, to care providers, and are transferrable between care providers and the NHS. This is undoubtedly a sensible recommendation, and PPP’s report further recommends the establishment of a Royal College of Care Professionals. The institution of a Royal College would serve the dual purpose of professionalising the workforce and secure an elevation in its status, as well as providing a central body which can represent, support, and oversee the development of, the care workforce.

Finally, the report by the HSCC makes no mention of a vital section of the care workforce: volunteers. PPP finds that volunteers can greatly alleviate the burden on social care professionals and improve the experience of recipients of care. It is essential that volunteers are included in the workforce equation.

PPP recommends that the volunteer sector should be integrated into the workforce strategy and planning for social care, given the substantial value it provides. Further, it warns that the government must act soon to seize upon the enthusiasm for volunteering that built up during the COVID-19 pandemic.

For a truly comprehensive workforce plan which will truly elevate social care and reduce the immense pressure on the sector, these recommendations must, too, be incorporated. For more information on the report, please contact PPP’s Social Care Policy Analyst, Mary Brown, at mary.brown@publicpolicyprojects.com

More groups join call for fairer deal for social care

By Gabriel Blaazer

As the race to become the next Conservative leader and Prime Minister of the UK heats up, and the government accepts the recommendations from the independent NHS pay review bodies in full, Care England and Access for Social Care have urged the government to act to protect the standing of social care workers, in statements issued yesterday.

The calls echo recommendations contained in a summary document of a recent Public Policy Projects report on integrated care. The report argues that the social care sector should be placed on an equal footing with the NHS, both in terms of its representation within integrated care partnerships and investments made to accelerate digitisation and modernisation.

Representative groups are increasingly urging the government to ensure suitable plans are in place to protect social care, amid an increasingly dire workforce shortage that is threatening the sector’s ability to provide its services. Vacancy rates in social care (9.5 per cent in January 2022) remain stubbornly above the national average (4.4 per cent from December 2021 to February 2022), while more than 400,000 social care workers left their roles in 2021.

A fairer deal for social care must be a priority

On Tuesday 19th of July, the government accepted, in full, the recommendations of the independent NHS pay bodies, meaning more than one million staff who fall under the Agenda for Change contract will receive a pay rise. This includes nurses, midwives, and paramedics, who are set to benefit from a pay rise of at least £1,400 this year, backdated to April 2022.

Groups who represent and advocate for the social care sector are now urging the government to implement a similar deal for care workers.

While rates of pay for social care work have increased in real terms since 2014, the rate of increase has not kept pace with other sectors, decreasing the social care sector’s ability to compete in the jobs market. Data shows that when overall national employment rates fall, vacancies in social care rise, suggesting that the sector is struggling to attract and retain workers.

The King’s Fund cites “high levels of staff vacancies, sickness absence, turnover, and work-related stress [as] having a damaging impact on staff,” and calls “the case for a fully funded, multi-year health and social care workforce plan… overwhelming.” Although many of these factors were exacerbated by the Covid-19 pandemic, the King’s Fund and other groups maintain that they long predate the pandemic and are the results of successive governments neglecting the social care sector.

In October 2021, the Workforce Recruitment and Retention Fund made £162.5 million available to local authorities to help recruit and retain social care workers, along with a further £300 million in December 2021. However, both funds lapsed in March 2022.

A neglected care sector

Poor staff retention is being further compounded by increased pressure on the social care system. The number of new requests for social care support have increased by 5.6 per cent, while costs have risen by more than a quarter, with areas with higher levels of deprivation being disproportionately affected.

Lack of available social care capacity is also increasing pressure on the acute hospital sector as hospitals have fewer methods of discharging patients safely. This is causing unsustainably high hospital occupancy rates and serving to undermine the wider healthcare system.

In a statement issued yesterday, CEO of Access Social Care, Kari Gerstheimer, warned about a “complete lack of discourse about the future of the social care system,” in the current leadership race, and claims the outgoing Prime Minister, Boris Johnson, has all but abandoned his pledge to “fix social care once and for all.”

The concerns mirror those expressed by UNISON Social Care Lead, Gavin Edwards, who said on Wednesday that “the scale of vacancies is alarming, and not just for those who rely on care and their families. The sorry state of social care is having a disastrous effect on the NHS, causing massive treatment waits, letting down patients and putting unbearable pressure on health staff.

“The care sector is acutely underfunded. Wages are way too low leaving staff unable to cope with the rising cost of living. Supermarkets are paying better rates without the stress, so it’s no surprise that people are jumping ship.”
In Care England’s statement, released on Thursday, Chief Executive Professor Martin Green OBE, said: “The adult social care workforce is our biggest resource. The lack of government action has had an inevitable consequence on the nature of employment opportunities within the sector and has hampered providers’ efforts to recruit and retain staff, as evidenced by the 52% increase in vacant posts in the sector over the past year. This has not only affected the overall financial attractiveness of the adult social care sector as an entity, but also providers’ ability to compete with the NHS.

“As a first step, Care England suggests the Government accepts the recommendations of the Low Pay Commission for the 2023 rates, however, this increase must be properly funded. Simply applying National Living Wage inflation without appropriate funding undermines the ability of providers to aid workforce pressures, especially given the fact that providers are having to pay increases above the National Living Wage annual uplifts as a means of recruiting and retaining staff.”

Kari Gerstheimer added that ”as Sunak and Truss fight it out, there is everything to play for by way of their approach to Health and Social Care. The Association of Directors of Adult Social Services has warned that the year ahead will be the most challenging people needing and working in adult social care have ever faced. I am saddened, however, to see social care being kicked down the road with little mention of any commitments from either leadership contender about the future of the social care system.

“Failure to invest in social care amounts to poor fiscal planning and inefficient use of taxpayers’ money – it harms our productivity because people with unmet social care needs can’t reach their potential, and unmanageable caring roles keep people out of work. It harms those working in social care, who are choosing to leave the sector because of problems with pay. And it harms our health system because a failure to invest early in preventative social care leads to more crisis admissions in critical care.”

Innovation uptake in West Midlands reduces A&E visits from care home residents by 30%

By David Duffy

The West Midlands Academic Health Science Network (WMAHSN) has released its 2021-22 Impact Report, highlighting the innovative solutions that have contributed to improving health and generating income growth across the West Midlands, and nationally.

Key achievements outlined in the report include a 30 per cent decrease in A&E visits from care home residents, across the West Midlands, as a result of the spread and adoption of deterioration management tools such as ‘Stop and Watch’.

Over 1,255 West Midlands care homes engaging in the test and adoption of deterioration management tools to improve safety for care home residents. More than 1,365 patients in the region are also benefiting from the prescription of PCSK9i inhibitors, a revolutionary medicine that helps lower cholesterol.

About the West Midlands Academic Health Science Network

The WMAHSN is one of 15 Academic Health Science Networks (AHSNs) across England and plays a pivotal role in ensuring innovations are shared faster regionally, nationally and internationally. Its goal is to make the West Midlands healthier, more productive and deliver the best possible clinical outcomes for patients.

AHSNs connect the NHS and academic organisations with local authorities, the third sector and industry, and create the conditions to facilitate change across health and social care economies.

Over the last two years, the organisation has grown to support the efforts around delivering its strategic programme themes, which includes cardiovascular disease prevention, mental health resilience, and workforce innovation and transformation.

The new report highlights the WMAHSN’s ability to adapt and pivot its services to address the region’s shifting needs and priorities, including supporting the region’s response to the pandemic. This not only demonstrates its ability to remain agile, but also how the organisation is uniquely placed to support the needs of its partners and future proof the region’s healthcare sector, for years to come.

Tony Davis, Director of Innovation and Commercial at the WMAHSN, said: “It is our mission to transform health and social care through innovation. Therefore, it is inspiring and positive to see organisations across the region adopting these innovations to respond to our complex health, and social care system.

“In collaboration with partners, and organizations around the West Midlands, we intend to keep strengthening our ability to work nationally, regionally, and locally, and maintain the environment we have helped create to improve the overall health and wellbeing of our communities.”

As the WMAHSN approaches its tenth birthday in 2023, the organisation continues to aid local health and care systems, looking at how its workforce supports NHS England and NHS Improvement, and the Office for Life Sciences priorities, ensuring that patients in the West Midlands have access to the best health and care services.

Other key highlights from the WMAHSN Impact Report includes:

Four providers in the West Midlands have adopted HeartFlow, a non-invasive, cardiac test for stable symptomatic patients with coronary heart disease. Over 5,000 scans were performed nationally during last year led nationally by the WMAHSN.
A 30 per cent decrease in A&E visits from care home residents, across the West Midlands, as a result of the spread and adoption of deterioration management tools such as ‘Stop and Watch’. Over half of care homes (63 per cent) in Staffordshire and Stoke-On-Trent have fully adopted the deterioration management tools.
The creation of the QI Notify-Emlap application and a pilot scheme in partnership with The Dudley Group NHS Foundation Trust. The app supports clinicians to use their National Emergency Laparotomy Audit data more efficiently to drive their emergency laparotomy quality improvement work. Early results from the pilot suggests regular usage could reduce ‘Door to Theatre’ time.
Promoting alternative forms of treatment to those from an ethnic minority background, living with a learning disability or autism with the STOMP project. The project aims to reduce the over prescription of antipsychotics, often oversubscribed to these groups, by increasing medication reviews.

To read the full impact report, visit the WMAHSN website.

Report reveals 229% rise in social care needs assessment enquiries

By Integrated Care Journal

The number of social care needs assessment enquiries increased by 229 per cent in the year 2021/2022 compared to 2019/2020, according to Access Social Care’s annual State of the Nation report.

The report, released yesterday, paints a desperate picture of the English social care system, with a significant rise in advice demand far outstripping available resources.

Access Social Care is a nationwide charity providing free legal advice for people with social care needs. Its second annual State of the Nation report is based on a data collaboration project in partnership with Royal Mencap Society, Age UK, Carers UK and Independent Age.

With the use of 74,000 separate data points, the report outlines the key challenges facing people who need social care and looks at the extent to which advice demand and provision has changed.

The nationwide data in this year’s report also shows an increase in enquiries that were identified as needing specialist legal advice in the year 2021/22, compared to 2019/20.

The report also reveals that the number of enquiries regarding concerns about existing social care and support rose by 43 per cent in the year 2021/22 compared to 2019/20.

The wellbeing of both care users and care providers has continued to spiral downwards. According to Access Social Care, pressure on capacity has meant that helplines have been required to take on additional staff and expand opening hours to cope with the increased demand on their services.

Charging has also become an increasingly pressing issue, accounting for 25 per cent of the dataset. Local authorities have been pushed into further unsustainable cost efficiencies, increasing charges for social care to meet budget targets and causing further demand for advice on charging.

Kari Gerstheimer, Chief Executive of Access Social Care said: “Whether we are self-funders or in receipt of state funded care, we will all need social care at some point either for ourselves or for a loved one.

“The Government claims to have fixed social care and continues its promises to help ease the cost-of-living crisis, but the sums don’t add up. Millions of people are feeling the effects of an underfunded system.

“We want a social care system that is properly financed, readily available and fairly distributed. Currently, vital services are overstretched, and people are going without the necessary social care they so desperately need – something needs to change.”

Caroline Abrahams CBE, Charity Director of Age UK said: “The findings in this report provide clear evidence of a system under severe duress.

“Councils are struggling to discharge their responsibilities to people in need of care and support and are having to adopt explicit prioritisation measures to deal with the overwhelming demands they face.

“In these difficult circumstances navigating the always complex social care system is a real challenge. It makes the role of charities who provide information and advice about social care more important than ever, both for the people in need of help and by shining a light on what’s really going on in care services across the country.”

Access Social Care provides expert legal advice to disabled people, elderly people, and their family carers to ensure their social care needs are met.

News, Social Care May 26, 2022

The social care workforce: Overworked, undervalued and poorly paid

By Mary Brown

On 27 April 2022, Public Policy Projects (PPP) hosted a roundtable entitled The Social Care Workforce: Averting a Crisis as part of its report series The Future of Social Care. The PPP Social Care Network, made up of senior cross-sector stakeholders in social care and a Lived Experience Panel, sought to find practical solutions to the challenges relating to the workforce.

The crisis facing social care is fundamentally a workforce one, and low pay and poor working conditions are impacting the experience of staff and end users alike.

One Network member described the long journey they have had with trying to find carers for their son, and how “the problems with the social care workforce have now caused [their] son to receive inadequate care”. For the Network member, it was evident that poor conditions for workers make it difficult to consistently provide high levels of care.

Social care: A fulfilling and worthwhile career

The Network members emphasised that social care can be a fulfilling and worthwhile career. However, one member expressed that “Nobody talks about it.”

“Nobody talks about the difference they’ve made to somebody’s life, somebody who lived at home and couldn’t manage independently anymore, and their friends and family were under enormous pressure,” they explained.

A social care career is a skilled and challenging career route, but tends not to be publicly regarded as one. Social care must become a more attractive and respected career path for students.

Network members with experience working in universities noted that very few students harbour ambitions to go into social care, with greater ambition being shown towards childcare, social work, the NHS or physiotherapy. Put simply by one network member, “there is simply no ambition to be an adult social care worker”.

Improved advertising campaigns offer one solution. One network member shared a heart-warming TikTok showing the day-to-day life of a carer supporting a disabled adult, showing that his profession was not simply that of a support worker, but a “gym buddy”, a “swim coach”, a “karaoke performer”, a “culinary professor”, and a “Lego architect”.

The video showcased the bond he has with the individual he cares for and the varied tasks in his working day, demonstrating the positive aspects of a career in social care. The Network member suggested that it “might inform recruitment campaigns” for social care in England.

A clear career trajectory

Network members were in general agreement that social care requires a clearer career trajectory. If there was a visible route for progression within the system, the sector would be more attractive to young, bright school leavers and university graduates. It was suggested that cross sector career paths should be formed.

“No one in any career expects to progress without spending time in different departments; we need to do the same in social care and for its providers”, said one member.

To attract more people to the sector, there needs to be greater clarity of the differentiation in provision. Not every member of the caring profession does the same job there are a variety of roles, areas of expertise, and levels of seniority which people should be made aware of.

We must make caring into a proud profession in its own right, not something that is ancillary to nursing.

Recognising social care qualifications

A career in social care may be more attractive if it were formally recognised. One Network member criticized the care certificate as it is not an accredited qualification. The only way that the care certificate would be accredited through the QCF would be through the employer hiring a qualified assessor “and the cost of that for the employer is astronomical, so most employers don’t do that”. This makes the care certificate “almost redundant and it certainly doesn’t attract young people to the sector to see it as a long-term career”.

One network member mentioned that Florence Nightingale is generally crediting with “professionalising” the role of nurses, and that the Royal College of Nursing was later founded at a time when, arguably, nurses were performing many of the hands-on caring jobs performed today by care assistants.

The network member added “as far as I can ascertain, They Royal College of Nursing does currently admit some care assistants, but only those working in roles directly supervised by nurses .This excludes most care workers. We must make caring into a proud profession in its own right, not something that is ancillary to nursing”. The network member added that there is perhaps a case to be made for the establishment of a College of Care Assistants or workers.

Care workers should be paid fairly for the value of their work, and the level of skill and expertise required.

Better pay for care staff

Across the Network, there has been a consistent consensus that carers must receive better pay, and the latest meeting showed no change of course on this point.

It was described as “scandalous” that professions such as retail work and cleaning are paid more than social care, despite being less technically and emotionally demanding. One Network member, as a provider of care, expressed outrage that “[they] get to pay £10 an hour in a town where you can get £15 for dog walking, how can this be conducive to successful recruitment and retention?”

While there was widespread agreement on the fact that carers are underpaid, some Network members warned against the idea of increasing pay to be a cure all to the current workforce crisis.

“There is an unnerving conflation between the rate at which staff should be paid for their skills, and whether that will attract them to work in the sector. These two things are being confused. Care workers should be paid fairly for the value of their work, and the level of skill and expertise required, which is not the same as raising pay in the hope that the system would receive an influx of workers.”

This point serves to emphasize that any changes to the workforce must start with a fundamental change in attitudes toward social care work, and “this will then lead to a conversation about what we pay our professional staff”.

Support and collaboration

The latest MHA care workforce report showed a 23 per cent disparity exists in pay between the NHS and comparable roles in social care. “A big part of that gap is salary, but a significant portion comes from disparities around sick pay, payment for additional hours worked, and pensions, which are all benefits that social care providers cannot hold a candle to.”

It was broadly agreed that the social care system should mirror the NHS Agenda for Change pay scale. If the NHS and social care are to work more closely within integrated care systems (ICSs), then staff must undoubtedly be paid the same for equivalent roles.

One network member highlighted that this would facilitate the better collaboration of multidisciplinary teams, ultimately enabling better care. They also promoted the concept of new “cross-sector roles”, working across different departments in health and social care, which would help to facilitate easier patient flow throughout the system.

Without the right support structures in place, the social care workforce will continue to face a struggle in providing quality of care. In order to successfully implement meaningful changes, the PPP Social Care Network could all agree that a fundamental change in attitude to value the social care workforce is necessary.

The roundtable concluded with a sentiment shared by the Network, “Carers need to be paid more money, they need to be supported and valued more highly by society so that they can lead full and active lives”.

For more information on PPP’s work on social care, please contact policy analyst Mary Brown at Mary.brown@publicpolicyprojects.com

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Social care crisis leaves 500,000 adults waiting for care

By Gabriel Blaazer

More than half a million adults in England are waiting for social care assistance, says the Association of Directors of Adult Social Services (Adass), as staff shortages continue to impact the provision of care.

According to Adass’ research, the number of people waiting for either social care assessments, direct payments or reviews of their care has risen sharply over the last year. The research marks a 72 per cent rise in the numbers waiting for support, as similar research last year put the figure at about 294,000.

Adass president Sarah McClinton said the figures represent “a devastating impact on people’s lives,” while the government has said that reforming social care is a priority.

Published in May 2022, the Adass report, Waiting for Care, found that during the first three months of 2022, an average of 170,000 hours a week of home care could not be delivered due to workforce shortages, and that 61 per cent of councils were having to prioritise care assessments.

“The situation is getting worse”

The report states the capacity of the care sector to deliver on people’s needs has been sharply reduced, at the same time as England’s ageing population develops ever more complex care requirements.

It says that “despite staff working relentlessly over the last two years, levels of unmet, under-met or wrongly-met needs are increasing, and the situation is getting worse. The growing numbers of people needing care and the increasing complexity of their needs are far outstripping the capacity to meet them.”

The report also says that the government’s focus “of resources on acute hospitals without addressing care and support at home, means people deteriorate and even more will need hospital care.”

Adass argue that not only are people waiting longer for care, “but family carers are having to shoulder greater responsibility and are being asked to take paid or unpaid leave from work when care and support are not available for their family members.”

This was echoed by Helen Walker, Chief Executive of Carers UK, who has said the current state of social care is putting “even more pressure on even more families who are propping up a chronic shortage of services.”

Changes welcome, but not enough

The government states publicly that fixing social care in England is a priority, and the Health and Social Care Levy passed last month will see £5.4 billion invested into social care over the next three years, including £3.6 billion to reform the charging system for social care and a further £1.7 billion to begin “major improvements” to the sector. The added funding is cautiously welcomed, but critics argue the government needs to go further.

However, ADASS president Sarah McClinton said: “We have not seen the bounceback in services after the pandemic in the way we had hoped. In fact, the situation is getting worse rather than better. Social care is far from fixed.

“The Health and Social Care reforms go some way to tackle the issue of how much people contribute to the cost of their care, but it falls short in addressing social care’s most pressing issues: how we respond to rapidly increasing unmet need for essential care and support and resolve the workforce crisis by properly valuing care professionals.”

Responding to the ADASS report, Miriam Deakin, Director of Policy and Strategy at NHS Providers said: “This valuable report paints a worrying picture of unmet care needs and lays bare the pressures on the social care system, which are having a serious knock-on effect on individuals’ quality of life and independence, as well as the timely discharge of patients from hospital.

“Although hospital patients who are medically fit for discharge are made a priority for assessment, any delay to those assessments means a delay to people receiving the care they need and makes it difficult to maintain the flow of patients through the NHS.

“Equally worrying is the obvious need for more support to help people stay well and live independent lives in the community which would in many cases prevent, or delay, any need for hospital care.

“We must recognise the efforts of social care staff delivering more care in people’s homes over the last year and ensure they are paid appropriately to acknowledge their valued contribution.

“The ADASS report highlights once again the urgent need to properly fund and reform the adult social care system.”

Government failing on social care and health inequalities

By Kari Gerstheimer

The government’s failure to reform social care funding in the Health and Care Act is compounding regional health inequalities, writes Kari Gerstheimer, CEO and Founder of Access Social Care.

Speaking before a Cabinet meeting last month Boris Johnson stated that: “With household bills and living costs rising in the face of global challenges, easing the burden on the British people and growing our economy must be a team effort across Cabinet.” He added that “we will continue to do all we can to support people without letting Government spending and debt spiral, whilst continuing to help Brits to find good jobs and earn more, no matter where they live.”

However, the Prime Minister’s own assurances on protecting the British public from rising costs were set against the Government’s actions regarding the Health and Care Act, which has just been enshrined in law.

The Prime Minister continues to make promises to help the British people with the growing cost burden, while the Health and Care Act leaves those on the lowest income exposed to spending a greater proportion of their assets on care costs, during the worst financial crisis we have seen in generations.

The Government’s own amendment to the Bill, which was subject to a fierce debate in both chambers of Parliament before ultimately being voted through, means that the local authority support people receive to help them meet their care costs, will no longer count towards the proposed £86,000 cap.

This is all the while that the PM has continued to make promises to address the decades-long social care funding crisis and widening health inequalities. The £5 billion in extra money announced for social care over the next 3 years, is of course welcome. But there is no mathematical link between the amount of money and the level of need. The Health Foundation calculates that at least £8 billion are needed per year, just to deliver what councils are legally obliged to.

Failure on “levelling-up”

Research commissioned by Access Social Care, which provides free legal advice for those with care needs, shows that poorer areas with lower council tax and business rate yields have been worse affected by the reduction in the central Government grant for social care.

This means that people living in poorer areas where social care need is often the greatest, are already getting a bad deal compared to other parts of the country, which flies in the face of the much-vaunted concept of “levelling-up.”

Rather than addressing this unfairness, the Government’s amendment is compounding it, by leaving people living in ‘red wall’ areas having to spend a greater percentage of their total assets on care.

The Health and Care Act is a clear contradiction in the PM’s assurance to focus efforts on easing the burden for British people and protecting the public from rising costs. It will instead deepen the cost of living to the poorest of our society and widen long-standing health inequalities.

Access Social Care are already seeing cases where the cost of living crisis means that people cannot afford the social care they so desperately need. The Government urgently needs to do more to ensure that everyone can get the social care they need, at a price they can afford.

The UK must harness data and digital to revamp stroke aftercare – Mike Farrar

By Mike Farrar

Stroke is the single largest cause of complex disability and long-term thinking around stroke aftercare is critical in easing pressure on health and social care.

The NHS Long Term Plan places stroke aftercare as a key priority area for improvement. However, ongoing data shows that the promises to ensure the best performance in Europe for delivering clot-busting thrombolysis by 2025 and increasing the number of patients receiving reviews of their recovery needs (from 29 per cent to 90 per cent), is unlikely to be met.

The stroke pathway has seen significant improvements over the last decade. These include the introduction of hyperacute stroke units, improved brain-imaging, rapid thrombolysis and game-changing thrombectomy. However, it is likely that these interventions will be undermined by the failure to recognise the opportunities to help people return to productive lives after a stroke.

Stroke care is an area that has seen substantial improvement in the UK; while mortality rates have halved over the last 20 years, stroke remains the single largest cause of complex disability. Further to this, recent research from the Stroke Association five-year survival rates remains low.

The Stroke Association estimates that 100,000 people have a stroke in the UK every year, with two thirds of survivors leaving hospital with a disability. There are currently 1.2 million stroke survivors living in the UK, at an estimated cost to the health and care sector of £26 billion a year. This cost is expected to triple by 2035.

Missing parts of the stroke pathway

The provision of rehabilitation and aftercare is an essential element of the care pathway yet is often the least well supported and resourced, a situation not solely limited to stroke care.

This is not unique to the UK and clinicians in the USA are experiencing similar issues. Once a patient has left an acute situation, where the latest interventions, medications and technological advancements have been provided, the same level of attention just isn’t there post-discharge. There is often a marked deterioration in wellbeing with an undetermined longer-term impact.

Stroke aftercare: a faulty mindset

There is an underlying mindset within the system that the priority lies with acute care management and what happens after is less important. As a system, crisis response is generally exceptional, and innovation and resources tend to be focused on this stage of patient’s journey. But there is very little strategy – and the funding treadmill is perpetuated by continually focusing investment on acute interventions. But it is clear that the cost benefit is poor if a more strategic view of the whole care pathway is not taken.

The failure to provide effective rehabilitation immediately after an acute episode can lead to reduced functioning mobility and normal life for the individual. The consequence of this failure is an added cost for the health and care system, reduced economic productivity and can increase social care costs if it leads to patients losing their ability to live independently.

Masking the real data

The data currently collected typically identifies re-admitted patient episodes as a new case rather than allowing the system to recognise and then count it as a re-admission. This often masks the failure of the rehabilitation and ongoing support offered, which could have prevented further problems.

The link to co-morbidities is also missing, with more people dying in the first six months after a stroke from cardiac events, rather than consequences of a stroke – which means we are overlooking opportunities to influence outcomes in other ways.

The cost of high-quality rehabilitation may pay itself back over time but immediate cost pressures in the system can often mean that rehabilitation is not funded as a priority, in turn reducing patient outcomes.

Balancing the funding model

So, what should the path forward be from here? The key to achieving the right balance is to argue the need for a greater use of data and to provide the evidence to build up the business case. There are some professionals and clinicians leading the charge and looking for that evidence to balance the funding model.

The Mount Sinai health system in the USA recruited a randomly selected sample of people who were enrolled in a remote monitoring programme. Of the sample, 90 per cent of the sample had a crisis that the health system could have intervened on. Without the follow-up, these crises would never have been caught.

In Cardiff and Vale in Wales, they’re currently trialling a system that joins up the data to the patient – rather than the episode – to track the re-admissions and the patient’s entire journey through the health system. The data outcomes are providing interesting insights into chronic conditions and helping to modify care providers’ understanding of where they put their money.

The role of data and digital in stroke aftercare

There is also seeing a role for digital platforms to be used for virtual rehabilitation. There are many ways to do this and the growth of digital care technology in local authorities should be used to support and endorse these changes across the whole health and care system. As an example, Visionable’s platform allows any deterioration in health to be identified early to prevent serious problems occurring, including readmissions. As people wait longer for care, this early warning is crucial to avoid patient harm.

There’s a real opportunity to shift the way rehabilitation pathways are approached, and how outcomes are tracked. This dialogue should really appeal to the new integrated care systems and their integrated care boards as the NHS embark upon seismic structural shifts in 2022.

Through system-wide commissioning, there is the opportunity to balance the investment and provide transformation – and to deliver a genuine whole pathway, including more robust rehabilitation services. Enhancing data capture in real-time and making sure the money follows the patient could produce marked differences – not only for the public purse, but in the quality of people’s lives.