Battered by a seemingly endless wave of workforce, funding and regulation challenges, it would be understandable if adult social care providers lacked creative energy, or a longer-term vision.
But the independent providers gathered in Westminster last week for the Care England Conference 2023 put passion and determination to find ways through obstacles to the fore, despite the scale of the difficulties.
They have a host of reasons to be worried, not least in the face of the latest Sector Pulse Check report – independent research commissioned by national learning disability charity and provider Hft and Care England. This shows costs including utility bills rising by as much as 500% for some, and increasing, unfunded workforce pay leading to 82% of providers being in deficit or facing an increase in their surplus in 2022.
One survey respondent called the current situation ‘genuinely the most perilous period in the organisation’s 50-year history’. And 42% of providers have been forced to close parts of their business or give back care contracts to local authorities.
Turning to workforce capacity, Care England has underlined that half a million more people will be needed in social care over the coming years. But at the conference, the theme was ‘thriving not just surviving’. There was a solid focus on how providers can effect positive change and have agency.
Chief executive of Care England Professor Martin Green struck a positive note. He said: ‘I know that we have the energy, the creativity and the drive to succeed in a tough environment.’
Outlining the scale of the long and short-term capacity issues, chief executive officer at Skills for Care Oonagh Smyth said: ‘We need a workforce that supports people, and we have to build in personalisation and prevention. Social care has to be thought about at the beginning of new processes and strategies.’
What’s crucial, in her view, is ‘the need to engage, engage, engage’. She added that with the new structures for health and social care integration in their early stages, ‘we are hearing that effective social care engagement isn’t happening consistently enough – at least part of that is because our strength and what we can add is not always recognised’.
The Sector Pulse Check highlighted that during 2022 the adult social care sector saw an average vacancy rate of 21%. Ms Smyth was not short of practical ideas, including ‘having a conversation about getting more men into the sector’, and radically changing terms and conditions. International recruitment has ‘definitely boosted capacity and could be part of the solution’, she added. She also emphasised the sector needed to be more inclusive, and while the publication of a NHS workforce plan may be imminent, social care needs one of its own ‘so that at a system level people can see those national priorities and how they translate’.
Speaking the morning after a pre-conference reception where she listened to the concerns of providers, care minister Helen Whately told delegates she was ‘here as part of a Government that backs social care’. She said the Government is ‘working with local authorities to support care providers who want to recruit internationally’. On retention, she said she wanted ‘every care worker to have the right opportunities to develop and progress in their careers’.
Placing the emphasis firmly on assurance, she described local authorities as the ‘linchpin of our social care system’, and said how they commission care is ‘absolutely crucial’. She underlined the introduction of the new assurance and oversight regime for adult social care by the Care Quality Commission (CQC) in April, and said this would help ‘shine a light on social care’.
Chief inspector of adult social care, integrated care, and interim chief operating officer at the CQC, Kate Terroni, looked ahead to the launch in two weeks’ time of the new assurance regime. For the first time, local authorities and integrated care systems will be assessed using ‘completely new’ CQC powers – ‘and it’s been a long time since local authorities have experienced regulation’.
But Ms Terroni said it would be two years – ‘if everything goes as set out’ – before the CQC ‘will have a rating and a view of every local authority in the country’. Meanwhile, pilots will take place at up to five volunteer local authorities over the summer. They will test the end-to end process, and end up with an ‘indicative rating’. The formal baseline period begins in September, followed by a two-year period when the CQC will go through every local authority ‘looking at all aspects of our single assessment framework’.
Next, a lively panel session on health and care integration highlighted gaps in data generally and the need for a consistency of approach across new Integrated Care Systems. And Care England’s social care advisor Richard Ayres said the Government’s emphasis on a Home First policy when moving patients from hospital was ‘mainly driven out of funding rather than out of need or requirement for the service user’.
The focus on Home First was making some care home settings less attractive places for residents, in his view: He said: ‘I think it’s quite disingenuous of some local authorities and some commissioning groups to consider that the Home First approach is the only solution.
‘People come into care far later in their journey with much higher levels of dependency, making some care homes quite an unpleasant environment to live in if you are someone funding your own care, and actually choose to live in a community that is there to support you – rather than having the average person come in through the publicly-funded route and maybe living six to eight months.’
Fee levels were also contentious, he added. ‘I hear quite a lot from local authorities at the moment that they can justify their 5% fee uplift this year when inflation is at over 14%, because they say their average fees increased over a period of time.
‘Well that’s because your dependency has increased over a period of time – because you’ve had people on a Home First strategy, so people come in a lot later with higher needs, with a lot less money, creating a bigger gap between the Fair Cost of Care and the average fee paid by the council.’
Last month The MJ reported only a very small percentage drop in bed blocking numbers following the Government’s £250m in emergency funding for discharges. Mr Ayres said: ‘One local authority that spoke to me last week said we’ve managed four placements in our local authority with our discharge funding, because the provider community do not want to take on packages of care they can’t support or have the wraparound services for. That’s not integration.’
He added: ‘We need to be able to connect with the integrated services to provide wraparound services to support people going from hospital through maybe a care provider service back to their community. And we’re failing at lots of different levels at the moment.’
Jeremy Richardson is chief executive officer at Runwood Homes. He said the way to ultimately resolve this issue is to ‘bring funding together – I think we will forever continue to battle if NHS funding sits in one place and social care funding sits in another place’.
The simple answer is to plug the ‘£10bn shortfall in the sector’ highlighted by Care England’s chief executive, he said. But that is a politically difficult message to take on board, he added.
He put forward a wishlist he believes is in the power of government to address including reducing regulation and making it attractive for people to work in social care.
He concluded: ‘If I was a politician trying to get elected I’d be focused on the initiatives that don’t cost any money. In my view I think there are plenty of things that we as a sector should be working with government on to try to address which cost nothing but would make the lives of people living and working in care homes so much more enjoyable.’
What is clear is that independent providers play a vital role and they deserve to be listened to very carefully by both central and local government.
