Care England has warned the Government of a “mounting workforce crisis” ahead of the introduction of the new National Living Wage (NLW) in April.
Source: Care England warns of ‘mounting workforce crisis’ ahead of NLW rise : Care Home Professional
Care England has warned the Government of a “mounting workforce crisis” ahead of the introduction of the new National Living Wage (NLW) in April.
Source: Care England warns of ‘mounting workforce crisis’ ahead of NLW rise : Care Home Professional
by Gordon Carson & Luke Stevenson
To stake their claims to receive more funding in next week’s Autumn Budget, children’s and adults’ social care leaders and experts have submitted a series of requests to the chancellor, Philip Hammond, as the sector tries to convince the government of the scale and scope of the crises facing the sector.
Here, we’ve picked out some of the key messages and numbers from their submissions and other reports, ahead of the chancellor’s speech on Wednesday (22 November).
25% – the real terms cut in central government funding for children’s services, from £10 billion to £7.6 billion, from 2010-11 to 2015-16. Spending on services by local authorities has fallen from £10 billion to £8.4 billion (Source: Turning the Tide)
£2 billion – the estimated funding gap in children’s services by 2020 (Source: Local Government Association)
£605 million – the overspend on children’s services in 2015/16 (Source: Local Government Association)
40% – the reduction in local authorities’ early help services since 2010-11 (Source: Turning the Tide)
7% – the increase in crisis support spending over the same period (Source: Turning the Tide)
29% – the predicted cut in funding for children’s services from central government by 2020. The most deprived councils had already had to cut funding six times more than the least-deprived areas (Source: Turning the Tide)
23% – the level of spending cuts made in the most deprived local authorities (Source: Turning the Tide)
40% – the proportion of council leaders who said they were unable to meet one or more statutory duties for children (Source: National Children’s Bureau)
72,670 – the number of looked-after children in England as of March 2017 (Source: The Department for Education)
The growing pressures on children’s services have been highlighted again in a report by a consortium of children’s charities, including Action for Children, the National Children’s Bureau and The Children’s Society, which warned that councils were being forced to intervene later in children’s lives because of funding pressures.
The Local Government Association, responding to the report, said councils had worked hard to minimise the impact of cuts, but the increase in numbers of children in care and referrals to children’s services had made this harder to maintain.
Richard Watts, chair of the Local Government Association’s children and young people board, said: “With such high demand for child protection services, councils have been forced to scale back the early help that can make such a difference in reducing the need for this support in the first place.
“This report suggests that government funding for early intervention has fallen by £1.7 billion since 2010, leaving local councils with the impossible task of attempting to continue delivering these services while also providing help and protection to the growing number of children at immediate risk of harm.”
He called on the government to use the Autumn Budget to fully fund children’s services. The association has previously warned about a £2 billion funding gap in children’s services by 2020.
£2.5 billion – the funding gap facing adult social care in 2019-20 (source: a pre-Budget report published by The King’s Fund, Nuffield Foundation and The Health Foundation, which said social care “remains on the brink of crisis”)
7% – the real-terms cut in gross spending on adult social care services by councils, from £19.1 billion in 2009-10 to £17.8 billion in 2016-17 (Source: The King’s Fund, Nuffield Foundation and The Health Foundation)
25% – the reduction in the number of older people accessing publicly funded social care, equating to more than 400,000 people, due to tightened eligibility criteria (Source: The King’s Fund, Nuffield Foundation and The Health Foundation)
9.5% – the increase in hours of unpaid care provided between 2009 and 2014 (Source: The King’s Fund, Nuffield Foundation and The Health Foundation)
1.2 million – the number of older people estimated to have unmet care needs (Source: The King’s Fund, Nuffield Foundation and The Health Foundation)
50 – the number of councils who have had adult care contracts handed back to them by providers (Source: Association of Directors of Adult Social Services annual budget survey, 2017)
64 – the number of councils who had experienced the closure of adult care providers in their area (Source: Association of Directors of Adult Social Services annual budget survey, 2017)
6.6% – the overall staff vacancy rate across adult social care in 2016-17 (Source: Skills for Care / The King’s Fund, Nuffield Foundation and The Health Foundation)
10.4% – the vacancy rate in domiciliary care in 2016-17 (Source: Skills for Care / The King’s Fund, Nuffield Foundation and The Health Foundation)
95,000 – the number of people from Europe working in the adult social care sector, compared to 67,000 five years ago. “As a result, Brexit is likely to compound these staffing challenges in social care.” (Source: Skills for Care / The King’s Fund, Nuffield Foundation and The Health Foundation)
£1.3 billion – the amount of money required to stabilise the adult social care provider market (Source: pre-Budget submission by the Local Government Association)
£366 million – social care overspends reported by councils in 2016-17 (Source: Local Government Association)
£824 million – savings required in 2017-18 (Source: Local Government Association)
24% – the proportion of funding authorities in England which say they have enough care provision to meet demand (Source: Family and Childcare Trust Older People’s Care Survey 2017)
The government’s announcement in the past week that a green paper on older people’s social care will be published by summer 2018 has largely been welcomed, though immediate funding pressures remain and are, if anything, intensifying.
Although the government announced an extra £2 billion for adult social care in the Spring Budget, the Local Government Association has said this is not enough to deal with all immediate and short-term pressures on adult social care, and highlighted that the funding stops at the end of 2019-20.
It also pointed out that this funding was followed by the introduction in July of “further, more rigid and unrealistic target reductions on delayed transfers of care”, and the possibility of sanctions if targets were not met.
Although the adult social care council tax precept, which enables local authorities to raise council tax bills by 3% in 2017-18 and a further 3% 2018-19 to help fund adult social care, was a “welcome short-term measure”, the LGA said extra council tax income “will not bring in anywhere near enough money to alleviate the growing pressure on social care both now and in the future”.
It also said the government’s main vehicle for driving integration, the Better Care Fund (BCF), had “lost credibility and is no longer fit for purpose”. Its focus on reducing pressure on NHS acute services “is detracting from local initiatives to support social care and stabilise the perilously fragile social care provider market”.
Source : Social care’s funding pressures in numbers : Community Care
The CQC has joined with a number of partners to launch the ‘Quality matters’ commitment to help drive improvements in adult social care.
Community Integrated Care, Skills for CareCategory: Awards in Care, Care Awards, Care group newsSubscribe
‘…………….By Kate Murray
With only 12% of the care workforce under 25, the sector needs to do more to attract younger workers keen to progress. Photograph: Maskot/Getty Images/Maskot
If it’s at times of crisis that true leaders shine, then there could be no better moment to focus on the leadership that social care needs. For, with demand for services rising but resources shrinking, the social care system is under strain as never before. In the past five years, funding cuts, combined with the impact of the ageing population, have effectively wiped out 31% of the local authority social care budget across England.
It’s a situation, according to Adass (the Association of Directors of Adult Social Services), which is putting older and vulnerable people in jeopardy, at the very time when the Care Act has introduced new requirements for joined-up health and social care.
At a roundtable event, organised by the Guardian and sponsored by workforce development organisation Skills for Care, social care professionals discussed how best to secure the strong leadership social care will require as it faces these challenges.
At the table
There was a recognition from participants that there were some great leaders in social care – but that there was room for improvement, too.
As Pete Calveley, chief executive of Barchester Healthcare, put it, when only 40% of nursing homes with more than 50 beds inspected are considered to be good or outstanding, “that does reflect on the leadership of organisations”. He added: “It is very easy for us to lay the blame on the facility manager when actually we all need to take responsibility.”
Jon Glasby, professor of health and social care at the University of Birmingham, said the sector was well-led – but often in spite of the systems in place rather than because of them. He said:
“One of the major successes is the way social care and local authorities in particular have managed in spite of the cuts they have had to face. Many other services would have been unable to function … I do think we could do more to support some of those leaders.”
John Ransford, non-executive director at care home provider HC-One, also paid tribute to “the sheer adaptability” of leaders in social care. “They have done incredible things with the resources they have,” he said. “My worry is that they will always be expected to do more – that in a sense the sector is a victim of its own success as it has become more efficient and adaptable.”
According to Neil Matthewman, chief executive of Community Integrated Care, a charity providing care services in England and Scotland, nurturing leaders at middle management level is a particular challenge. His experience since joining the social care sector from the NHS was that many managers were not “outward-looking” enough. On the other hand, he added, social care offered the chance for more creativity. “Entering this sector, I’ve found there’s been more opportunity to show genuine leadership,” he said.
Many participants at the event highlighted the need to focus on developing the registered manager role – a key post responsible for the management of care homes and services. Des Kelly, executive director of the National Care Forum, said:
“All the evidence we have is that the quality of the service is absolutely determined by the quality of that individual. But pay rates are nowhere near where they should be for people who are expected to have such a range of responsibilities. It’s a very difficult job.”
The event also heard concerns about developing leaders in smaller care providers, where both resources and time for training are often tight. Michelle Dudderidge, director of specialist provider Hand in Hands, said:
“It’s really important for us to adapt to the changes that happen daily in social care, but one of the biggest issues for us is the finances to be able to develop our staff into good leaders.”
So what are the ways forward for developing effective leaders for these challenging times? Participants had a range of ideas, from developing a professional route for registered managers, to working with the health service to develop leadership training for the new integrated way of working, but with a distinct focus on social care.
There was support for the new concept of the care practitioner to ease nursing shortages in the care sector, while Patrick Vernon, from the National Housing Federation, also flagged up the idea of more collaboration between health, social care and housing. He said:
“You might work in the NHS, you might work in care, you might work in a housing association. How do we make sure those roles are fluid so you can move from one to another?”
More widely, the event heard, efforts needed to be made to encourage new recruits into the social care sector so that it could develop a new generation of leaders. As Kelly put it, only 12% of the care workforce is under 25, with that proportion falling, while 50% of the workforce is over 45, a proportion that’s rising. He said:
“We’ve got to get better at attracting younger people – I don’t think we do the services justice in terms of the opportunities there are to get trained and move up the ladder … Yes they start poorly paid, but there are opportunities.”
Martin Green, chief executive of Care England, an umbrella group for care providers, advocated a civil service style, fast-track scheme for new entrants. But he said a more open culture was also crucial. “One of our challenges is to have a culture that allows people to be experimental,” he said.
“That won’t work if it’s about blame when you get it wrong. The way you are monitored is very much about whether you did it right or did it wrong when we should be saying: ‘You might have got it wrong, but you didn’t divert from the values and culture’, which are the original values of social care.”
The importance of values was stressed, too, by Sharon Allen, chief executive of Skills for Care. The idea of a person-centred approach should apply to the people who work in the sector as well as those it supports, she said.
“We need to ensure what we do is inspiring people with clarity and purpose about how to improve social care. We need to address the problems we face – but also to celebrate the great people who are going to make a difference.”
Bridget Warr, chief executive of the UK Homecare Association, agreed. She said an open culture would help promote the innovation that is now so desperately needed across social care.
“What we know for sure is that we need to do things differently because we can’t go on the way were before,” she said. “We can’t just keep squeezing and still give people a decent service.”
John Kennedy, director of care services at the Joseph Rowntree Foundation, said social care itself did not lack leadership, rather there was a “distinct lack of political leadership”. “Other industries have a voice at the top table when policy is being decided, but with social care that doesn’t happen,” he said.
Perhaps a more unified voice for the social care sector would increase the status of working – and leading – in the sector. But so too would a more profound shift in the mindset of society as a whole.
As Kennedy put it: “We can all imagine ourselves getting ill but we don’t seem to want to put ourselves in that frail place. The recipients of healthcare are seen as ‘us’ and the recipients of social care are ‘them’. We need to get over that.”
That kind of culture change might help tap into some of the potential that participants saw in social care. For Shaks Ghosh, chief executive of the Clore Social Leadership Programme, a key role for leaders was to identify and unleash the innovators of the future. She said:
Ray James, director of health, housing and adult social care at Enfield council and president of Adass, said although social care faced huge challenges, he saw more examples of values-based leadership in the sector than in any other sphere. He concluded: “It’s in that authentic, values-based leadership that the success of the sector in the future lies.”
This content has been sponsored by Skills for Care (whose brand it displays). All content is editorially independent. Contact: Stacey-Rebekka Karlsson. For information on debates visit theguardian.com/sponsored-content
Personal assistants speak out about their isolation as Community Care finds postcode lottery of support and training opportunities
Published in partnership with Unison
Councils are offering inadequate support for personal assistants despite the critical role they have to play in delivering personalised care under the Care Act, according to research by Community Care.
Figures obtained from 117 of England’s 152 local authorities through a freedom of information request show councils are falling short of minimum standards of support published by sector leaders in 2013. Key concerns include:
The 2013 guidance, which was developed by Skills for Care, Learn to Care and the Association of Directors of Adult Social Services (ADASS), includes nine minimum standards and states that, due to the growing number of people receiving personal budgets and direct payments, councils need to be offering support of the ‘highest possible standard’ to employers and their personal assistants.
But personal assistants like Heather, who supports an elderly lady with mental health needs, continue to feel isolated. “I don’t know of any local networks and I wouldn’t know where to look for email addresses I could use to make contact with people myself,” she told Community Care.
“I just feel like there is no support out there. Who do I let off steam to? If I witness abuse or neglect, who do I speak to? If you work for an agency you will always have your line manager, but when you are employed through direct payments you have no point of contact. I have no one to turn to.”
‘I’ve got no support, no manager, and no access to supervision’
Sean, a personal assistant to a young man with complex health needs, has struggled to access support ever since his client’s family switched from an agency to a personal health budget, which is jointly funded by the NHS and the local authority.
“I’ve got no support, no manager, and no access to supervision,” he said. “I can talk to the NHS trainer but although he can try and give advice, the only concerns he can really raise are those related to the health needs of my client.”
Sean is also unaware of any local support groups for personal assistants. “The only place I can think of would be the group I take my employer to and that’s not the best place to do it – everyone’s clients are there to enjoy themselves, not talk about the issues we have.”
A survey undertaken by Skills for Care in 2014 also found peer support to be lacking, but said it was recognised by councils as a ‘desirable intervention’. This was, however, the third consecutive year in which peer support was identified as a gap by the organisation’s research.
Responding to Community Care’s findings, Georgia Turner, programme lead for employer engagement at Skills for Care, said: “That support isn’t more widely embedded is indicative of the challenges local authorities need to work to overcome in engaging a group who often don’t comply with our traditional idea of what a ‘workforce’ looks like.”
Matt Bowsher, joint chair of the Association of Directors of Adult Social Services’ personalisation network, added: “There is something very distinct about the personal assistant role itself and where there is a willingness on all parts to do so, there’s no reason why personal assistants could not be put in contact with one another and offer support.
“The technical means for people to communicate with each other have never been so great, so it’s about how those networks are built, informally as well as formally. Not all of this is about what councils do, it’s about how councils could act as a catalyst for how these networks could be made.”
Our investigation also found a significant variation in the learning and development opportunities available to personal assistants (standard 5 of the advice note).
While 77% of councils provided access to in-house training, the quality ranged from e-learning modules or basic induction sessions to a willingness to provide ‘any relevant training’ to the personal assistant’s role. Other councils only offered free safeguarding training and one said it would open training up to personal assistants “only if there were spaces available”.
Funding was also an issue. Of the councils that made in-house training available to personal assistants, 1 in 10 did not meet the cost. Some councils said they costed monies for training into the service user’s personal budget allocation, but would not meet the associated costs such as shift cover for the personal assistant while they attended training (known as backfilling) – the individual employer would have to fund this. Others expected personal assistants to foot the bill.
Two councils said they considered it to be the responsibility of the individual employer and the personal assistant to source and fund learning and development opportunities.
Sean says the external training he has received since his client’s family switched to the personal health budget has not been as good as when he was employed by an agency.
“When I worked under the agency I had access to a five day training package every year but now I can’t remember the last time I had that. For manual handling we were given a one hour online course, before it would have been at least a day of face to face training.”
Skills for Care’s 2014 survey recommended that local authorities support individual employers to access the Workforce Development Fund, which is distributed by the organisation on behalf of the Department of Health. The fund can be used to access additional learning and development opportunities for individual employers and their personal assistants.
Our investigation found nearly half of councils do not support individual employers to access the funding. Of those that did, some only provided information via email, while others assisted individual employers to complete the full application process.
Personal assistants were also missing out on apprenticeship opportunities (standard 3), with 82% of councils not promoting them.
Heather is keen to pursue further learning and development opportunities on top of her existing NVQ level 2 in health and social care. Although she’s done the research, it’s now down to her employer to agree to her attending and to secure the funding, which is a lot to ask of someone who already has complex needs, she points out.
“I rely on my employer to push these issues but because of her needs she’s not able to that, so it means I just go to a lady four days a week and I’m not pursuing my career.”
ADASS’ Bowsher agrees training for personal assistants is challenging. “The very difficult balance that needs to be struck here is how you create the same opportunities for people where you don’t have the same economies of scale that some of the registered providers do – volumes of workforce, training budgets, ability to fund backfilling cover.
“Wherever possible, training and development needs to take place on the job and it’s very challenging to be able to take a large chunk of time where you as the individual employer can do without your personal assistant.”
He added: “We are going to have to very creative in the way that’s done, we don’t have an infinite sea of resources here that can be provided. And I don’t think anybody wants to be responsible for creating a two tier workforce. Both groups should be equally as attractive to a potential carer.”
Our findings also show that nearly two thirds of councils do not keep a register of accredited personal assistants that employers can access when looking to recruit. Of the councils that did, some held an in-house register, while others commissioned an external organisation to manage it.
The 2014 Skills for Care survey reported a 15% increase in the number of councils providing a register (from 41% in 2012 to 56% in 2014), but said encouraging councils to use one still remained a persistent challenge. The figures obtained by Community Care suggest there has since been a reduction in the number of councils providing this service.
Skills for Care’s Turner said: “We must remember that local authorities are working to ensure their actions keep employers and personal assistants safe, without removing the choice and control that is central to personalisation. Local authorities must focus their efforts on enabling informed decision making and effective risk management, rather than imposing arbitrary controls.”
When asked if personal assistant registers are a service councils would be likely to cut as a result of funding pressures, Skills for Care declined to comment further.
Matthew Egan, professional officer at Unison, said the findings were ‘especially worrying’ given the context of funding cuts that are likely to be exacerbated under the new government.
“If the personalisation agenda is being really pushed then it is incredibly reckless to do it unless you have the adequate levels of training, support and funding in place, which the findings show aren’t currently there. It’s not just bad for the worker, it’s bad for the individual employer – they are both being let down by the lack of support.
“It’s also a postcode lottery – you could be lucky enough to be in a local authority area where the council provides a good level of support and training but a lot of other people are in ones where they are just on their own.”
A spokesperson for the Department of Health said: “This data doesn’t show the whole picture – our survey of local authorities over the last three years show most do have support available to personal assistants and this situation is improving year on year.
“We know there is some variation across the country so in 2013 we published advice setting out minimum standards and we also want to make sure we facilitate the sharing of best practice in our work with partners and stakeholders.”
ADASS’ Bowsher added: “Clearly some time has passed since the Skills for Care and Department of Health guidance was published and we now have data that says very clearly that we need to look at this again and ask ourselves the question what can be done to support individual employers and what can be done to support personal assistants.
“We don’t want people feeling isolated like they don’t have any career development opportunities and there is no one to support them, whether they are an employer or a personal assistant.”
He added: “All of these comments are made in the context of significant and longstanding financial challenges, but I do think the cuts themselves should not be used as an excuse to stop us exploring every opportunity to encourage personal choice and control.”
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