The challenges facing the UK health and social care sector

Nythan Smith, Solicitor, Ridouts

A report conducted by Incisive Health on behalf of Age UK detailed the state of the care market and highlighted a number of areas where locations do not have adequate provision of care to service those in the local area. The report speaks of the challenges that the sector is facing including staffing capacity shortfalls and the continued underfunding of providers to meet the cost of care.

It stands to reason that there are going to be areas where there is a lack of provision throughout the country and the report reflects this fact. A stark finding from the report, which is given more weight given the recent remarks by the Health Secretary, is the state of the domiciliary care market- an area which is thought to be the saviour of the social care sector more generally.

The rate of new registrations vs deregistrations of domiciliary care providers appears to demonstrate that this market is under considerable pressure. In 2016/17 2000 new providers registered and 1600 providers de-registered, this suggests that a significant number of providers chose to exit the market owing to pressures within the sector. Compounded to this is the large reliance on the domiciliary sector on local authority commissioners with 80% of funding in the sector being publicly commissioned. Given this disproportionate reliance on the public purse- which is known to pay below the amount required to ensure the sustainability of the sector- this paints a rather gloomy outlook for the domiciliary care sector. Far from being the sector’s saviour it would appear that this corner of the market is in dire need of being saved in its own right by additional financial injection and more considered commissioning by local authorities.

The social care market as a whole is under increased pressures owing to the might of the local authority commissioner who can pay what it independently sees fit to the detriment of the sustainability of the business of the provision of care. The argument for commissioners paying as little as possible is filled with challenges since local authorities have a duty as under the Care Act 2014 to ensure that there is a sustainable market. Local Authorities’ rationales for keeping payments at a particular level is borne out of their own duty to manage their budgets for the provision of care. This lacks sufficient merit but owing to the significant reliance on the public purse often providers have to accept the level of funding offered.

There remains a significant proportion of vacancies within the social care sector which remain unfilled with estimates suggesting that there is an 8% vacancy rate across the social care sector. For registered nurses the vacancy rate is 1 in 8 which is particularly troubling for the sector which continues to demonstrate a consistent need for the provision of nursing services.

Further given the uncertainty caused by the negotiations by the UK to exit the EU will lead a number of workers to reconsider their position depending on the action that is ultimately taken. Some 8% of all social care staff hold citizenship of another EU country which is significant in and of itself but of more importance is that some parts of the UK are particularly more exposed to these workers with some parts of the South of England having an exposure of 16% of EU care workers. Irrespective of the direction the UK choses to take EU citizen workers will be faced with a decision as to whether they remain or leave and this could have a significant impact on the social care workforce.

Investment in whatever form that will take is likely to follow such is the magnitude of the challenge facing society in making provisions for those that lack the ability to care for themselves. It is hopeful that the Government seeks to impose radical changes to the health and social care sector in order to meet the challenges facing the sector. The social care sector makes an invaluable contribution to society and should be properly recognised as such. The sector faces challenges in relation to the sustainability of the market it is hoped that the Government acts urgently to ensure that the market is properly respected and funded in order to attract the best talent and provide the best care possible to those in need in our society.

Edel Harris





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