To ensure a sustainable care system its workers must be valued

10 Apr 18

The government must tackle the high turnover of care staff to achieve a more sustainable care system, says the National Audit Office’s Michael Burke.

Compromises may be needed in the funding and delivery of social care in light of the combined pressures of cuts in the budgets of local governments, which spend £14.8 billion funding the care, and the high vacancy and turnover rates in the adult social care sector.

The government will publish a ‘Health and Care Workforce Strategy for England to 2027’ in July to coincide with the NHS’s 70th birthday.

By summer 2018, it will also publish a green paper on care and support for older people.

These are long-awaited reports by the sector – not least because the government has not had a national workforce strategy covering adult social care since 2009.

The reports will affect all of us, from the need for care for those we love, to the alternative services local government could otherwise fund.

Adult social care

Adult social care comprises personal care and practical support for:

  • Older adults who cannot manage the tasks of everyday life.
  • Working-age adults with physical disabilities, learning disabilities, or physical or mental illnesses.
  • Their carers.

Unlike healthcare, social care is means-tested.

For people aged over 65 who qualify for state support, and for working-age adults with learning, physical and mental disabilities, their care needs are funded by local authorities.

In the vast majority of local areas, publicly funded care is only provided to people with substantial or critical needs.

Others in need of care must pay or provide it for themselves. And care is expensive – care packages can be £20,000 per year, or more. Most care is provided unpaid by family or friends (known as ‘informal care’).

Social care spending (including children’s social care) was 54.4% of overall service spend by local authorities in 2016-17, up from 45.3% in 2010-11, as we reported recently in Financial Sustainability of Local Authorities 2018.

Despite this, given the overall funding reductions, spending on adult social care fell by 5.3% between 2010-11 and 2016-17.

The sector also suffers high turnover and vacancy rates. As I detail below, a key reason for this problem is low pay.

So do we have, and can we afford, the people needed to provide the level of care needed for an ageing population?

The workforce challenge

Our comptroller & auditor general Amyas Morse has said: “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.”

It summarised the severity of the challenge that we identified in our February report, The adult social care workforce in England, which highlighted: the health sector is held in higher esteem than the care sector.

There are around 1.34 million jobs in the adult social care sector in England, across more than 20,300 organisations.

Turnover among care staff has been increasing since 2012-13, reaching 28% in 2016-17, and the sector has a vacancy rate of 6.6%, well above the national average of 2.5%-2.7%.

Three job roles are particularly affected:

Care workers – 820,000 in England, providing direct care to people. 7.7% vacancy rate and 33.8% turnover rate. A typical care worker earns £7.50 per hour, which equates to £14,625 per year.

Registered managers – 22,000, who are legally responsible for running care homes. 11.3% vacancy rate and 23.0% turnover rate. A registered manager typically earns £29,600 per year.

Registered nurses – 43,000, providing care to people in nursing homes. 9.0% vacancy rate and 32.1% turnover rate. A registered nurse working in care typically earns £27,900 per year, more than £3,000 less than an NHS nurse.

The main reasons behind the high vacancy and turnover rates are low pay, lack of prestige, lack of career and development opportunities, and competition for these workers from other sectors.

Reductions in local authorities’ funding, combined with rising demand for care, has meant that most providers cannot pay people more.

Similarly, the body tasked with developing staff who work in care has a budget of £23.5m  per year, which equates to only £14 per worker.

A caring future

Our social care report found that the Department of Health and Social Care has not been doing enough to support a sustainable social care workforce.

The number of people working in care is not meeting the country’s growing care demands and unmet care needs are increasing.

As the government prepares its green paper on the future of funding care for older people, and a joint health and care workforce strategy for the summer, we recommend that DHSC, supported by the Ministry of Housing, Communities and Local Government, produces a robust national workforce strategy and that local and regional bodies align their own plans to it.

Investment is also needed to enable those who commission care to set fees for providers sufficient for them to pay staff adequately and afford to offer career development and training opportunities.

We hope that our report contributes to the important discussions around the funding of adult social care.

This blog was first published on the NAO’s website. 

  • Michael Burke, NAO
    Michael Burke

    Michael Burke is a chartered accountant, who works on value for money studies, principally in the health and local government sectors. He joined the NAO in 2013.

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