Simon Bottery, Senior Fellow, Social Care, The King’s Fund
The former Prime Minister Tony Blair famously said his priorities for government were ‘education, education, education’. Ask a care provider about their priorities at the moment and you are most likely to be told ‘workforce, workforce, workforce’.
The increase in vacancies in the sector has been dramatic and unprecedented. In October 2022, the vacancy rate was estimated by Skills for Care at 11.2%, up from the already record level of 10.7% for 2021/22. The rate a decade ago in 2012/13 was just 3.8%.
The social care sector can’t operate effectively with so many posts unfilled and there have been major implications for people who draw on services, who are now struggling to get their care they need, and for the NHS, which has been struggling to discharge patients from hospital, in part because of the lack of social care capacity.
Despite this, the government shows little willingness to tackle the key underlying issue behind the vacancy rate – pay. During a cost of living crisis, and with low unemployment in the rest of the economy, who can blame social care workers for voting with their feet and taking better paid, less demanding roles in sectors like retail?
Workforce, however, is by no means the only issue facing the sector. The most obvious other problem is charging reform – or rather the lack of it. The government had promised to bring in new measures to limit the impact of ‘catastrophic’ costs on individuals needing care with the introduction of a lifetime ‘cap’ on care costs, and to extend the means test so that more people would be entitled to some state support. But those reforms vanished (or, officially, were postponed for two years) in the financial rescue act by Jeremy Hunt and Rishi Sunak following the calamitous Truss/Kwarteng ‘fiscal event’ in September.
With the postponement of charging reform also want measures to tackle another key problem for the sector – the low fees paid by local authorities to care homes and home care agencies. Much-vaunted ‘fair cost of care’ reforms were postponed, leaving providers still concerned that the rates they receive – at a time of soaring inflation – do not sufficiently cover their costs. The local authorities who commission services share these concerns, with 94% of social care directors believing that funding is insufficient to meet provider costs over the winter.
Other measures in the Autumn Statement, with additional funding provided to local authorities for social care, may alleviate those concerns somewhat, if the money finds its way to the right places, but does little to revise an impression of a government that has lost its way after those Johnson-era Downing Street promises to ‘fix’ social care.
Certainly it has done little to tackle the big trend in social care since 2015/16, which has seen more and more people approaching local authorities for social care help but fewer of them receiving long-term care support as a consequence. Nor has there been any significant increase in help for the unpaid family carers who all too often have to pick up the slack when state support is wanting.
Even progress on integration seems unclear. The welcome introduction of integrated care systems came into force in 2022, offering local authorities the chance of a real say in local systems. But social care providers still struggle to get their feet in the door of ICSs.
Overall, social care policy is a mess, with little sign of New Year improvement.
