The State of Social Care, Insights from David Brindle

What are your thoughts on Skills for Care’s recent annual report on the adult social care sector, which shows vacancies increasing by 52% and as a result the first overall shrinkage of the care workforce?

For those of us living this awful reality day to day, and trying to sustain services, the report came as no surprise. The care charity I chair is far from alone in handing back service contracts in areas where we just cannot recruit at pay rates we are funded for. But all credit to Skills for Care for researching and packaging the shocking data so accessibly and with such impact.

For me, one of the report’s most telling stats is that care workers with more than five years’ experience now get, on average, just 7p an hour more than new starters. This shows that relying on ratcheting up the National Living Wage to attract recruits, without doing anything to maintain pay differentials, undermines retention and deters people from forging lasting careers.

Let’s hope Chancellor Jeremy Hunt has the report on his Treasury desk and shares it with his new colleagues while practising what he was preaching about both the social care and NHS workforces when he was chair of the Health and Social Care Select Committee.

How should the Government be looking to plug this massive workforce shortage?

Long-term we must have a proper workforce plan, based on credible forecasts of need for care and support and showing just how the required staff are going to be recruited, trained and enabled to build rewarding careers in the sector. It’s not acceptable for politicians to go on ducking this on grounds that responsibility lies with individual employers.

Short-term we need emergency measures – and I mean emergency – to get more pairs of hands on the job. That must include making it much easier to bring in migrant workers, a serious further cash injection so that employers can pay worthwhile incentives to recruit and retain people and a publicity blitz highlighting the range and flexibility of opportunities and their undoubted job satisfaction.

Commentators regularly point to social care as a key driver of delayed discharges from hospital – should the Government be prioritising funding for local government rather than the NHS to address this issue?

In an ideal world we wouldn’t be talking about funding either local government or the NHS because the two structures would work together seamlessly. The sad truth is that we remain a long way from that, although there are pockets of excellent collaboration and integration.

A big and very welcome change in recent months has been the growing number of NHS leaders who have come out and declared: ‘Don’t give us the money, give it to social care where it would make more immediate difference to the whole system.’ There are mixed feelings in social care about using the delayed discharge argument, as opposed to arguing for proper funding for care and support on its own merits, but in my view this is no time to stand on the purity of our principles.

Social care seems to suffer from a poor image which is compounded by continual talk of it being in crisis. How can its profile be improved so it is more attractive to recruits?  

So often we hear people say they are ‘just a care worker’. These are skilled professionals who may insert catheters, administer insulin or change wound dressings. During lockdown, some were responsible for verifying deaths. The poor material rewards are one thing, which must be addressed, but the unjustifiably lowly status is another and it’s something that the Government must also tackle in partnership with sector leaders.

At root of the problem is a widespread lack of understanding of what social care is all about. As is often said, people start to find out only when they or a family member needs it. Previous awareness campaigns haven’t really cracked this problem. Could it be a challenge – dare I say, pro bono – for the brightest and best of the PR world?

There are fears in the sector that social care is too commonly being side-lined in the formation of Integrated Care Systems (ICSs), particularly with regard to involvement at Integrated Care Board (ICB) level. What can be done to ensure that it is central to structural transformation and commissioning discussions?

It’s still early days for ICSs, which became statutory bodies only in July, but there are growing signs that social care isn’t always getting the focus intended and promised in their design. Predictably, the new approach to mapping health and care pathways and commissioning the right services is working best in those places where there was good joint working previously.

Elsewhere, tensions are showing in complaints that local government is being marginalised in set-ups dominated by the voices and interests of hospital trusts. As with any innovation, there should be a review after a suitable bedding-in period – say, two years? – but it needs to look at more than whether councils are happy with their say. In particular, it must gauge how social care providers are being heard – both locally-based companies and non-profits and national ones like my own charity, which lack an obvious channel through a regional trade association. And of course, ICSs must be challenged to show how they are co-producing care pathways with people who draw on services.

The Labour Party has thrown its weight behind the idea of a National Care Service at conference and lambasted the CQC’s record of regulating private-equity-backed care providers. Is Labour being realistic in its promise to ‘kick out’ private equity and implement national standards when it comes to delivery of care and terms and conditions?

In short, no. But there’s a big difference between conference rhetoric and realpolitik. Shadow ministers are being careful to stress that their vision of transformation of social care is a 10-year programme and that the sector will remain a mixed economy.

The current Fabian Society-led review of the roadmap to a National Care Service will no doubt temper wilder claims of overnight and revolutionary change. But having said that, the sector needs to clean up the least savoury parts of its act.

Those providers that are backed by private equity – only a small part of the overall sector – need to demonstrate far greater transparency, far greater evidence of being good employers and far greater understanding of the developing values set of social care if they want to stay at the table under a change of government.

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