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Watchdog slams government over failure to sustain social care workforce

It has to face up to growing care needs, plan for, and fund them, says National Audit Office

Caroline White

Friday, 09 February 2018

The adult social care headcount is far too small to meet the nation’s growing care needs, and the government is failing to support a sustainable workforce, concludes a report* from spending watchdog, the National Audit Office (NAO).

The estimated number of jobs in the sector across England, excluding 145,000 personal assistants for personal health budgets and 91,000 care posts in the NHS, was 1.34 million in 2016-17.

But the vacancy rate was 6.6%—well above the national average of up to 2.7%. And in 2014 the Centre for Workforce Intelligence forecast that the country would need two million full-time workers by 2035 to cope with demand—equivalent to a 2.6% expansion every year.

It is widely acknowledged that workers in the sector feel undervalued and have few opportunities for career progression, particularly compared with similar roles in health, says the report.

In 2016-17, around half of care workers were paid £7.50 per hour or below (the National Living Wage was £7.20 in 2016-17), equivalent to £14,625 annually.

This, along with tough working conditions and a poor image, makes it hard to recruit and retain workers to the sector, it points out. Turnover has been increasing since 2012-13, reaching 27.8% last year.

And population trends suggest that demand for care will continue to rise in tandem with the increasing complexity of need.

But the social care market is operating in challenging circumstances. Care providers, already under financial pressures, are incurring additional costs as they are forced to rely on agency staff.

Local authorities spent 5.3% less on care in 2016-17 than they did in 2010-11, and spend is expected to reduce further over the next two years due to continued government funding cuts and the need to make further efficiency savings. Uncertainty over funding is limiting local authorities’ ability to plan future spending on care, says the report.

Nearly two thirds (65%) of independent providers’ income comes from local authority-arranged care. Most local authorities pay homecare providers fees below the recommended minimum price for care, nor do they stump up the full cost of care home placements.

If this continues, providers might not continue to invest in areas with high proportions of people in receipt of local authority funded care, warns the report.

The government has no national strategy to address this workforce challenge and key commitments it has made to help make the sector more attractive, through enhanced training and career development, have not been followed through, it says.

The NAO has not found any evidence that the Department of Health & Social Care is overseeing workforce planning by local authorities and local health and care partnerships, which commission care, to meet the challenge.

In the absence of a national strategy, few local areas have detailed plans for sustaining the care workforce. It’s been almost a decade since the government produced a national workforce strategy, the report points out.

The NAO recommends that the Department of Health & Social Care produces a robust national workforce strategy with the support of the Ministry of Housing, Communities and Local Government, and that it encourages local and regional bodies to align their own plans to it.

It must also invest more to enable commissioners to set appropriate fees for providers, so they can pay staff adequately and afford to offer career development and training opportunities, says the NAO.

“Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society,” commented Amyas Morse, NAO head.

“Pressures and demands on the health and social care systems are increasing, so the [government] needs to respond quickly to this challenge by giving the sector the attention it deserves and needs, instead of falling short and not delivering value for money.”

Anita Charlesworth, director of research and economics at think tank, The Health Foundation, agreed. “There is growing consensus that there is an urgent need for comprehensive and nationally led workforce planning for health and social care services,” she said.

“If providers are putting all their efforts into day-to-day financial survival, they are less able to plan and invest in the future, and forced to rely on short-term measures,” she added.

“These challenges don’t just have financial consequences—they impact on the quality of care that thousands of people receive. It is time that the vital importance of the people working in social care is recognised with a nationally led workforce strategy,” she insisted.

A government green paper on reforming care for older people is scheduled for publication this summer 2018.

*The adult social care workforce in England. A report prepared by the Comptroller and Auditor General, Department of Health and Social Care, February 2018.

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