Caring for Britain: Can our troubled social care system recover?
Illustration by Tracy Worrall
As the new government struggles to balance the books, Sophie Church hears how the already beleaguered care sector fears further cuts
Politicians of all stripes agree the social care system is struggling. Almost 2,000 care homes have closed in the past six years, with some areas losing up to 40 per cent of care home beds. Sector leaders blame a lack of funding, with care homes unable to pay staff adequately. Now, the cost of living crisis has given them renewed cause for concern.
Larger care homes in more affluent areas of the United Kingdom may be able to weather an economic downturn. But for smaller providers, in which residents are more likely to receive care funded by their local authority, challenges are magnified. And for those care homes operating in the most deprived areas, where council budgets are increasingly strained, the challenges can seem insurmountable.
Attempts to reform and repair the care system have been attempted by successive governments. Most recently, former prime minister Boris Johnson introduced a 1.25 per cent rise in National Insurance to boost the social care coffers, only to have it reversed by his successor Liz Truss in her now notorious mini-Budget.
We are not the only care home considering asking the bank for a loan to be able to continue giving our residents a home
One of Rishi Sunak’s first acts on becoming Prime Minister was to reappoint Helen Whately to her role as care minister, a position she held during the most challenging months of the pandemic, raising hopes among care leaders that he will take an interest in the field.
However, with Jeremy Hunt warning that his autumn statement had been accompanied by decisions of “eye-watering” difficulty on the economic front, care leaders fear for their future.
Reports suggest the government could delay the introduction of a £86,000 cap on personal care costs from October 2023 to 2025, or even scrap it completely. Until an announcement is made, the care sector contemplates an uncertain future.
According to the Care Quality Commission, there are currently 300,000 job vacancies across the health and social care sector. While many industries in the UK are facing staff shortages – partly due to tighter immigration rules post-Brexit – the social care sector is particularly vulnerable because it cannot afford to pay its workers more money. More than a quarter of the UK’s residential care workers currently live in or are on the brink of poverty, with one in four children of care workers growing up in poverty.
Michelle Maples from Harlow has worked in social care for more than 20 years. During that time, she has seen many of her colleagues forced to leave jobs they cherish. “We are finding it increasingly difficult to provide the level of care our clients deserve. Many of my co-workers have left social care to find more highly paid jobs, even though they love what they do, and the people they care for. It’s excruciating for people like me to say goodbye to those we care for, just because we cannot afford to work in this industry,” she says.
Professor Martin Green, CEO of Care England, says social care requires both short-term fixes, and a long-term plan of action. “Caring is a very difficult and complex job, so it is difficult to attract workers at the best of times. We need to explore how recruiting from overseas can help solve the issues, but we also need a clear 10-year strategy from government about how they can get control over the workforce,” he says.
In September, then-health and social care secretary, Thérèse Coffey, announced a £500m Adult Social Care Discharge Grant to facilitate the redirection of patients fit for discharge into social care, and to help care homes recruit more staff to treat them. However, Green says this extra injection of funding “wouldn’t actually make much difference to pay and conditions,” only offering “some extra money for training, but not very much.”
What is needed, in his view, is “a complete review of the training, development and career pathways in social care”. Reviewing all social care qualifications in line with NHS qualifications would mean workers could move more flexibly between different services, creating a more integrated, streamlined health system in the process.
While ministers could arguably act swiftly to improve staff retention and recruitment, care homes say they need much more help to cope with rising external costs. Paying utility bills, for example, has become increasingly difficult, especially for homes in more deprived areas. Joyce Pinfield is vice chairman of the National Care Association, and also runs Greenacres Care Home in Scunthorpe. “It has been almost impossible to get a quotation for gas prices,” she says. “When I did finally get a quotation, it was well over a 1,000 per cent increase, which took me from paying £9,000 a year to over £89,000 per year. That’s a phenomenal amount of money to pay.”
We are finding it incredibly difficult to recruit and retain good quality staff
Although the government has agreed to financially support businesses, this aid will last for only six months. “The National Care Association had been lobbying for the government to make care homes a special case, because care homes are by nature, homes for people,” Pinfield continues. But with Hunt’s announcement that homes would only be supported until April, reclassifying care homes from businesses to domestic dwellings would be irrelevant.
It is these type of inconsistencies in social care support that so bother Green and Pinfield. “Our residents who are eligible for the winter heating allowance get it paid directly, instead of it going to the care home, to the people who are actually paying to keep them warm,” says Pinfield. “It does seem a very strange anomaly.”
While life for most has returned to normality following the pandemic, care homes are still paying for Covid-related expenses, Green says. Care homes are also facing skyrocketing insurance costs, due to underwriters bracing for an influx of post-Covid claims that never actually materialised. Some care homes are now facing a 550 per cent hike to their insurance quotes.
These issues affect care home owners across the board, but some more than others. In recent years, local councils have increasingly been edged out of the market by private companies, which currently own 84 per cent of care home beds. Some companies have become embroiled in allegations of tax avoidance, while others are accused of driving down staff pay and providing a reduced level of care for residents. Despite this, larger care home chains saw their profits rise by 18 per cent on average during the pandemic. The highest paid director across care home providers, at Barchester Healthcare, was paid £2.27m in 2020, up from £2.02m in 2019 and £699,000 in 2015.
In contrast, Pinfield says, smaller, not-for-profit care homes in more disadvantaged areas will be the ones to suffer as the current economic instability continues. “I’m sure we are not the only care home considering asking the bank for a loan to be able to continue giving our residents a home,” she says.
With new Health Secretary Steve Barclay said to have an open mind, Green hopes the government will collaborate more closely with organisations like his. “I have so many ideas I’d like to run past Mr Barclay; from using social care as a means of levelling up in really left behind areas of Britain, to using social care as a means of promoting the green agenda,” he says.
“The new health secretary needs to know one thing – that there are people around this sector who are really anxious to work with him, to find solutions to the immense challenges we face.”
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