New Secretary of State for Health and Social Care, Sajid Javid, faces an overflowing inbox. There are several issues already being tackled with the Good Work Plan beginning to influence decisions, such as the new single enforcement agency to ensure compliance with labour laws, including pay rates and entitlements.
The social care workforce is long overdue a levelling-up of funding and resources, which its partner, the NHS, has long enjoyed, even if it often feels it’s never enough. Its how to do it that has long been the conundrum. The care sector has never had the structural stability of the NHS, which provides a framework of NHS trusts, their management and workforce to lobby for and through which to funnel government spending. Not to mention the collective bargaining power of unions and representative professional bodies, which go to bat for their members whenever the NHS is perceived as being under threat.
Compare that to the social care workforce, who are at the mercy of the over 155 local authorities that commission care packages within their geographical area, each of which has a budget usefully short of that required to deliver quality services. Social care has always had a turnover of staff that every other industry would consider a waste too far. The numbers that leave within six months of starting reflects the reality of what it actually takes to care, particularly in domiciliary settings.
The domiciliary challenge
The talk of a ‘positive culture’, ‘good supervision’ and ‘quality learning and development’ is often far from the reality of the job: domiciliary care workers rush from visit to visit, thanks to insufficient travel time, job satisfaction going out the window on the way. Stress quickly builds up. Workers who come into care because they actually care quickly find that it’s the first thing to go amid the stress and strain of a job in which there’s simply no time.
So, what does the care worker do? They hear from a friend that another domiciliary care provider pays more, promotes training and supports career progression. They jump ship and the cycle continues.
That is not to say that levelling-up domiciliary care is simple a prospect. It is, by nature, an unstable business with unavoidable service interruptions making its management unpredictable. You may have a 35-40 hour schedule in place – but this can be quickly be thrown into chaos by the hospitalisation or death of a service user. These challenges are only exacerbated, however, by the lack of funding, resources and a stable workforce.
The cycle can be changed. But it will only be changed with extra funding and resources. For years, local authorities have not resourced the sector properly. Workforce practices have also rarely been questioned by the Care Quality Commission, which, when looking at domiciliary visit schedules, doesn’t seem to notice the inadequate travel time between visits.
Care homes at least have the benefit of shift scheduling that aren’t interrupted by unpredictable events. However, the pay and working conditions in care homes still lags behind those in hospitals; this is what any levelling-up needs to address. Care homes are changing rapidly and for the better but, to continue this improvement, it’s time to recognise and reduce the disparities between healthcare and social care workers – and this includes the recognition of the contribution that migrant workers make to the sector.
Long due for some joined-up thinking
Ultimately, we need a structure in terms of contracts, provider fees and charges to the service users that – as with the NHS – is separate and applies across all adult care. The local authority model is too fragmented, arbitrary and encourages a postcode lottery of care delivery. A more coherent funding model would, however, support better pay and retention structures that, in turn, would support a general improvement in service delivery.
Such a funding model could also be used to facilitate a training and development framework that includes a pathway for career progression within social care, as well as a gateway between social care and the NHS. Worker competence in the skills it takes to care should also be recognised in the registration system, as it is in Wales and Scotland.
This unified structure between social care and healthcare would remove the competition for staff and stabilise staff turnover in social care – which for too long has been second fiddle in the care orchestra.
It’s time for the Department of Health and Social Care to step up, level up and join up: recognise the strength in diversity of its two partners and plan a post-pandemic legacy to be proud of. After all we’ve been through, it’s time for action, not words, to make our health and social care services the very best they can be. To provide the fairness of access and funding that ensures equality of service for all those who might one day need them – which, when you think about it, is all of us.