The adult social care sector in England is currently facing immense and well-documented issues. Providers are struggling to finance care provision amid dispute over the funding rates paid by local authorities. On top of this are immense staffing shortfalls, while some care organisations also point blame toward a lack of cohesion between NHS services and the social care sector.
Dominic Care is a domiciliary care provider in Hampshire providing services for the elderly, people with physical disabilities and people with life-changing conditions. Speaking on The Leaders Council Podcast, its human resources director Corrin Mitchell shared her take on the issues blighting the sector and how they ought to be addressed.
This year, the UK government has invited care providers to share information that will be used to calculate a 'fair cost of care', based on the incomings, outgoings and productivity of care organisations. According to Mitchell, upon completing the exercise, the outcome vindicated what many care sector operators had been saying for some time: that there was a shortfall between what care ought to cost and what local councils were paying for it.
She said: “We and many other care organisations filled in this survey quite recently which is supposed to be around the ‘fair cost of care.’ But they're not actually planning on using this information until the end of next year. The issue is, even if they use the information by that point, it's all going to be out of date.
“There is such a huge struggle in social care as far as funding goes around the clients funded by the NHS or local authority. It does all come down to money. Carers from the CQC perspective are meant to have values and uphold high standards of care, but when it boils down to someone paying for the cost of it, councils want high standards of care delivered in the shortest amount of time. Delivering a high standard of personalised care is not reconcilable with the speed they want it delivered in and the amount they want to pay for it.
“The reason a lot of care companies are calling out for more money is because everything is severely underfunded. Local authorities are expecting a full personal morning care routine for someone who can’t wash or dress themselves to be done in 30 minutes. That’s a huge expectation on staff and a lot of pressure. There is a lot of responsibility in this role and it is a very hardworking one. You need to make sure you’re paying somebody the right amount of money for the effort levels and expectations required of them.”
Highlighting the reasons behind why the annual increase in local authority rates was not enough to fairly finance care, Mitchell revealed that the increases to the National Minimum Wage was proving problematic for care providers to balance their finances.
“I did a quick bit of working out when we did our ‘fair cost of care’ survey and unless our local authorities increase rates by 10 per cent next year, which is severely unlikely, there are going to be more issues.
“In the last couple of years, rates in real terms have been going down. They upped the amount by four per cent in around 2018 and then the most recent increase we had was three per cent, but the National Minimum Wage has been going up too. Last year the Minimum Wage went up six per cent, and this year it’s 6.6 per cent. The increase in funding for our sector is falling far short and most social care companies are then having to charge their private clients more to balance the books. This is where the whole argument around the ‘fair cost’ of care comes from. How can it be a ‘fair’ cost of care if people who have money end up being penalised for the people who don't have money, purely because of this funding deficit? Especially when they’re paying for the same services.”
Discussing the severe workforce issues affecting social care at present, Mitchell echoed warnings from elsewhere in the industry that without resolving the staffing crisis in the care industry, it will only intensify pressure on the NHS. The problem in Mitchell’s eyes, however, was that there is a significant lack of awareness around the issues that social care faces, with the NHS being the sector entity that often dominates headlines.
Mitchell said: “The NHS is often the entity taking up headlines and they’ll talk about ambulances and wait times, and that drums up interest from the public. But nobody ever focuses on social care. With no focus on us, there are never any solutions. The problem is that the elderly population, and the people that need care, they do to a certain degree outweigh the available workforce because nobody wants to do the job.
“NHS performance figures relate strongly to the lack of interest people have in taking up social care roles as much as anything else. The reason there is a lack of interest in social care is because our lack of funding limits what you can pay people and that is a big issue for the sector. Carers can go and work in retail for instance, have far easier roles and earn more money.
“The perception of the industry is also a big problem when it comes to recruitment. There was supposed to be this big social campaign from government and granted, there are resources online that you can download to look at care roles and start a career in the sector. However, the feeling from going around our local area in Fleet, Hampshire, is that there’s nothing out there to really draw people in.”
For Mitchell, a lack of positive engagement with the education sector was also a key driver of the industry's recruitment issues.
“I've contacted various colleges and contacted careers fairs and various places over the years, asking about having us going in and doing talks and having career specialists from our industry speaking to young people. One of the things that I've been told by those local to us is that they don’t think their schools would be interested because the kids wouldn’t consider this sort of work. So, we aren’t invited along.
“It isn’t even suggested that we could attend just to see if it drums up interest. Other than speaking to students on health and social care courses, you get little engagement from education. I think that’s because care roles are undervalued by that sector and are maybe seen as something you go and do as a steppingstone or a last resort. For example, we once had a young person come for an interview with us who was 17. She’d been told by her school that if she couldn't complete her studies at school and get good grades, then care work was the only place she’d find herself without an education. Not only is that offensive to carers who work incredibly hard, but it is also quite demoralising and undermines their status.”
Mitchell also feels that government ministers looking to fix the crisis in health and social care had missed a major opportunity to fully address the staffing issue with the Health and Care Act, a piece of legislation which was passed earlier in the year.
She explained: “As far as the policy goes, I personally think it focuses too much on the NHS, it's got good ideas like joined-up services, but it has completely skimmed over social care as a whole.
“A prime example of this is a really simple thing in our eyes: there are aspects of a carer’s role which although we are able to do them, require the intervention of district nurses, an ambulance crew or a doctor. We aren’t allowed to carry out every type of activity to care for our clients. The issue is that everyone works in silos.
“To elaborate: if we need the paramedics to tend to someone that we care for, it can take five hours for them to complete a call-out. Yet, we could do the job ourselves in minutes but aren’t able to. I think much of that is down to perception again – a feeling that care workers are not qualified to carry out certain health-related tasks.
“The only way to truly achieve linked-up and integrated services would be to raise the profile of social care. Recognition and linkups like this could take the strain off other services like the NHS, but nobody is prepared to do what needs to be done in our corner.”
Listen to the full interview with Dominic Care's Corrin Mitchell on The Leaders Council Podcast below:
