Social care: alone, new training and qualifications aren’t the answer

The workforce of care workers is the largest in England’s health and social care system with 860,000 filled posts across the country but nearly one in eight positions remain unfilled. Meanwhile, five million people are providing unpaid care for loved ones and 400,000 are awaiting assessment or review.

Independent health think tank the Nuffield Trust says that the announcement will bring England in line with the other countries of the United Kingdom, but a much broader solution will be needed to tackle the deep-rooted issues within social care. While average pay is just above the national living wage the Trust says that poor pay progression is a big factor that makes the sector unattractive. A care worker with five years of experience earns on average only six pence more than a new joiner.

Paying better wages

Nuffield Trust researcher Cyril Lobont explains: “As an organisation we fully support the development of a more professionalised workforce and better professional development. But we want to drive home the point that it needs to be linked to better pay, and terms and conditions. It’s not enough to just tell a care worker with 10 years of experience that they are valued and give them a few certificates. You really need to accompany that with better pay and things like a competitive pension scheme.

“The Department’s announcement talks about this professional development framework but doesn’t really talk about rewarding staff in material terms for undertaking that development. You need to give people some degree of financial incentive to stay in the sector. People working in care often aren’t doing so primarily for the money, but you need people to believe they can make a career out of it and at least live comfortably on the wages for the long term.”

The government’s announcement means that for the first time there will be a national care career structure and a new accredited qualification in England that will be introduced to help recognise the work being done by 37,000 workers. There will also be funding for hundreds of apprenticeships and digital training to help care providers embrace the latest technology.

Providers cease trading

Last year 40% of decision makers and executives in the care sector who were surveyed for the Markel report The Care Sector: Navigating turbulent times said that a respected training qualification would make it easier to retain staff. Nevertheless, the report found a variety of reasons for the difficulty in recruiting and retaining staff, including low wages.

Lobont says that local authorities are often unable to purchase care for people in receipt of state funding at rates that allow providers to pay their staff fairly and meet all of their other operating costs. This often means providers charge those who fund their own care more to cover the shortfall.

A £1.7 billion commitment to reforming the adult social care system that was made in 2021 appeared to decrease by 58% in November, meaning that only £729 million is now allocated to be spent between 2022 and 2025.

"At the end of the day the issues are extremely deep-rooted and really need a comprehensive package of reform"

“We know that the Care Quality Commission, in its State of Care report, found that quite a few providers were ceasing trading either because of a lack of funding or a lack of staff, or both,” says Lobont. “It also stated that funding pressures meant that providers were less able to invest in quality care – having enough staff, having those staff adequately trained, holding on to experienced staff, and of course improving the quality of infrastructure.”

In fact, the most recent data shows that the number of care workers in England increased slightly in the past year but this was heavily reliant on overseas recruitment, often from countries where salary expectations were considerably lower, such as India, Nigeria and the Philippines. Whilst staff recruited from abroad are just as capable of providing excellent care, administrative and onboarding processes can be longer and much more difficult, and the international labour market can be volatile.

Tinkering around the edges

Technology could provide part of the answer to the social care dilemma. Technology now exists, for example, that allows people to live for longer in their own homes because it can spot irregular patterns of behaviour which might be caused, for example, by a fall, and alert medical professionals.

Lobont says: “Technology requires investment too. If the social care sector is just running on fumes, there isn’t the capacity to make the sort of well thought out, long-term investment in tech that is needed. Also, the workforce needs to be well prepared for technology. If you just give an over-stretched workforce some new technological solutions that they’re not well trained for, you’re not going to get the outcomes you want.”

Other projects that have sought to improve social care include the introduction of Integrated Care Systems that were intended to get the NHS and social care working more closely together. So far, the Nuffield Trust says that while there is some evidence of data sharing, progress towards integration has been slow and inconsistent across the country.

“There has been plenty of tinkering around the edges of social care and trying to tweak little things but at the end of the day the issues are extremely deep-rooted and really need a comprehensive package of reform to deal with them,” says Lobont. “The way you really solve market sustainability is through local authorities being able to afford to pay providers a cost of care that allows them to pay their staff fairly, update to 21^st century facilities and afford their gas and electricity bills, and so on.”