By Integrated Care Journal-
Social care is a pivotal sector in our society, providing physical, social and emotional care to children, young adults or elderly who need extra support. Social care is about ensuring one’s dignity and independence. In the context of unprecedented challenges for the sector, all major think tanks have called for more resources for social care to meet unprecedented patient demand.
Among them, the Health Foundation, an independent charity working to improve health and care outcomes in the UK, has been one of the main advocates of this cause. Anita Charlesworth, Director of Research and Economics at the Health Foundation, is certainly keen to stress the importance of social care in England. Few could blame her; the sector currently employs over 1.5 million people and contributes significantly to the labour market in more disadvantaged communities.
People working within this sector are fundamental to the delivery of high-quality services across England. However, according to Anita, there are numerous interconnected issues in the sector which have stark implications impacting the entire workforce.
Improving public understanding
Widespread opinion from service providers and the wider community is that social care funding has been subject to dangerous levels of neglect by the Government. Spending across the sector is lower in real terms now than it was a decade ago despite growing demand for services and an ageing population in Britain.
“There has been lots of research showing that public understanding of social care is very low,” says Anita, “and this has a number of negative impacts”. She believes that this lack of understanding has made it harder for the sector to address shortfalls in funding because people assume the situation is better than the reality. As a result, the public, and to a degree industry, have failed to hold politicians properly accountable for their inaction.
Anita outlines how the nature of the system makes it difficult for the public to understand. Currently, social care is commissioned by local authorities and provided by a sprawling network of 18,500 independent providers across 40,000 different settings.
“Because of the fragmentation in social care,” argues Anita, “we have relatively little data that shows what's happening in terms of quality of care. All those issues that would allow real public accountability get lost in this void in the system. ”
Low pay, insecure contracts and lack of development
Among the challenges facing social care, workforce is perhaps the most complicated to address. Anita identifies low pay, poor working conditions, insecure contracts and a lack of relevant, in-work training available as major contributing factors to workforce shortages.
“In some ways, what is surprising is not that a third of people leave but the two-thirds of people that stay in the sector despite such poor terms and conditions. We really have to admire them"
Anita Charlesworth, Director of Research and Economics, the Health Foundation
Those working in the social care sector earned an average wage of 8.30 per hour 2018/19. Furthermore, a quarter of the workforce is on a zero-hours contract and only 50 per cent of them have a sector-specific qualification.
What is even more remarkable, she argues, is the lack of career and pay progression available to those working in social care. The difference in hourly earnings between a care worker just starting their career and another who has been in the job for five years is just 15 pence.
Social care also suffers from a high staff turnover rate meaning skills are lost and the quality of care can drop. Illustrating the scale of the issue, the Skills for Care report: The state of the adult social care sector and workforce in England, published in October 2019, found that “the staff turnover rate of directly employed staff working in the adult social care sector was 30.8 per cent in 2018/19. ” This equates to approximately 440,000 people leaving their jobs over the course of the year.
High turnover rates are primarily due to a lack of financial reward for staying in the social care sector, as well as restricted opportunities for developing skills. “There is a very limited career structure, probably linked to the fragmentation of the sector and the lack of registered professions and careers,” Anita says. Currently, there is no registered workforce for social care.
“In some ways, what is surprising is not that a third of people leave but the two-thirds of people that stay in the sector despite such poor terms and conditions. We really have to admire them,” she adds.
Another area that needs improvement is training and development. As Anita explains, the number of apprenticeships in social care in England fell by half in 2019. In response to this, she is calling for more investment in on-the-job training. “We are not offering people an opportunity to come into the sector and build their skills or gain formal qualifications that they can apply within social care or in other careers. ”
Anita identifies three areas that the Government must address promptly if it is to tackle the workforce crisis: competitive pay, the introduction of permanent contracts and increasing opportunities for skills development within the sector.
Maintaining international workforce
International recruitment is another challenge that social care will increasingly need to manage over the coming years. It is widely expected that there will be a decrease in international recruitment with the end of free of movement for EU citizens.
International staff make up 17 per cent of the total adult social care workforce in England. According to the King’s Fund, the sector “would struggle to function” without a significant contribution from non-British nationals.
While the Government explores new options to control immigration Anita has concerns about an international recruitment policy that relies on a points-based system for social care staff. However, she confesses to be unsure about the way forward. “It is really difficult to see quite what we're going to do, but we need to do something,” she says.
Although the government expressed its willingness to facilitate the recruitment of international staff for specific sectors, it is yet to clarify what will be implemented and how.
Time for solutions
It is important to recognise that, although workforce represents a massive challenge in social care, it is not the sole problem to be overcome. Finding a sustainable funding solution is another issue that successive governments have failed to sufficiently address. In the short term, Anita argues that the most straightforward move the Government could make is to properly fund the current system.
In doing this, it should guarantee that a significant portion of the new funding goes towards meeting current workforce needs and implementing the CARE Act to ensure that people with real needs have access to high standard care.
While the Government has outlined numerous commitments to deal with the social care crisis, lofty ambitions will not be possible in the continued absence of the social care green paper.
It is also important to remember, as Anita astutely notes, not to look to address this problem constantly through the lens of the NHS “our main motivator for doing something about social care should be because it is the right thing to do for the people who need those services. ”
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