Support the workforce don’t blame the families

Richard Banks makes the case for investment in the social care workforce

David Mowat the Parliamentary Under Secretary of State for Community Health and Care recently questioned why it was that care of older people is not seen as naturally the role of families in the same way as care of children is viewed.  Whilst this raises several issues, it particularly appears to show limited understanding of the nature of social care for older people. Actually, social care is provided only to people with very particular needs that for the majority of families are beyond their capacity to deal with.  David Mowat seems under a delusion that social care is in crisis because resources are spent on simple support tasks.  The reality is of physical frailty and dementia that are beyond the capacity of even the most dedicated and caring family.   He did go on to show some understanding of the numbers of ‘informal’ carers and their position particularly in relation to employment.   Clearly the comments were based on his struggle to say some thing, any thing, in the face of the government created crisis facing social care and the NHS. 

Defending the Indefensible

The demographic issues of our population, the lack of any proper response to the resource needs and the position of carers have been known for the last two decades. David Mowat MP for Warrington South occupying a post that has been down-graded from Minister of State is the current defender of the indefensible.  

Part of this problem is that government(s) in England has resisted any attempt to recognise the social care workforce. If he had any knowledge or respect for the skills, knowledge and understanding of social care staff he would not have made such a crass statement. 

Things are not perfect in other parts of the UK but at least the importance of the workforce is recognised The Welsh Government have announced that social care workers will register from 2020, Northern Ireland have confirmed similar plans and Scotland made it compulsory for care home staff to register, with a register opening for domiciliary care workers in 2017.  The administrations of the other parts of the UK clearly see registration as an import part of establishing social care work as a valued professional activity.  Sadly in England social care has remained as a low skill, low pay occupation not worthy of registration and as a result it struggles to recruit and retain staff.  While employers and programmes promoted by Skills for Care (such as apprenticeships) are making progress in recruiting people they do so against a background of confused and incoherent policy from Government that leaves staff underpaid and cut off from establishing a professional status. 

It is now more than 16 years since the Care Standards Act 2000 provided for the registration of social care staff in residential and home care services for children, adults and older people.  England now stands as the only part of the UK that does not use registration to support the professional competence of care staff and to contribute to the safeguarding of people who depend on care staff.  Labour, Conservative-led coalition and the Conservative administrations have all failed to create a registration system for the 1.7 million staff working in social care. Yet the Government has just announced a spend of up to £16m between now and 2020 on what will be the third registration authority in 20 years for the 90,069 (01/12/16 HCPC) social workers 

Social care is a big employer.  It employs more people than construction, the food and drink service industries and several recognised large sector employers.  It is strange then that the workforce is either ignored or patronised by government.  Even stranger since it is one of the few areas of growth in employment.  The social care sector has about 6.4% of total English workforce and staffing demand is set to rise over the next 30 years.  The debate about the rise in the minimum wage (and change of name to ‘Living Wage') and effect of social care again illustrate the complete lack of understanding in government about how social care is organised.  They make no provision for the increased wage bill only latterly allowing local authorities to increase local tax in two piecemeal fuddled policy changes. That increase will not cover the existing funding gap identified by the Local Government Association or the increasing costs of supporting the NHS that fall on to social care budgets. 

Recruitment crisis warning

There is a warning from the last decade when there was a narrowly avoided crisis for adult social care. Recruitment of staff became almost impossible in some areas due to better conditions offered by other industries.  Residential care homes could not fully open and home care services could not recruit or retain sufficient staff to cope with demand. Services to people in need began to suffer as they are again currently. The availability of staff from the new members of the EU saved the day in terms of numbers (there were issues about skills and language).  There were additionally staff from overseas recruited by employment agencies (that had previously provided staff to the NHS).

By 2009 the redundancies related to the economic crisis had ‘freed’ more people looking for work and the crisis of recruitment subsided. There is now again a crisis of recruitment but this time amplified by the start of the well-predicted increase in need as our population ages. This time with Brexit related fear about the status of EU nationals working in this country and other tighter restrictions on immigration there may be further collapse of social care provision due to lack of staff. 

In parts of London over Christmas the home care sector was unable to support the discharge of older people from hospital. The predicted social care crisis preventing the discharge of patients and the lack of support services to prevent the need for hospital care in the first place is now happening.  The problem is not just of numbers but of skills - it takes time and investment to train and qualify social care staff able to work safely and to create personalised support for people.

All of the problems with social care funding and workforce have been communicated to Government over many years but there has been no policy and no action. Rather than attempting to shift responsibility David Mowat needs to start working to invest properly in the social care workforce. This requires proper pay, funded training and setting up a register that ensures we have a safe and competent workforce for the future.