Analysis

Funding and workforce issues increasing 'fragility' of social care, says CQC

The latest Care Quality Commission report shows there are not enough adult social care services to keep up with growing demands

The latest Care Quality Commission report shows there are not enough adult social care services to keep up with growing demands

  • 1.4 million older people do not get the care they need
  • The social care system needs urgent reform and government plans have been delayed for too long
  • Social care and community NHS teams should work together locally where they can
Picture shows residential/nursing home being squashed by two piggy banks. Over the past decade social care spending by local authorities has fallen by 5%
Over the past decade adult social care spending by local authorities has fallen by 5%. Picture: Alamy

The Care Quality Commission (CQC) inspects close to 23,000 different adult social care services in England and more than four in five are rated good or outstanding.

The problem, according to the regulator, is that there are not enough services to keep pace with the growing demand.

The CQC’s annual state of care report says the number of residential and nursing home beds has fallen over the past five years, and the increase in domiciliary care is not enough to keep up with demand.

The report points to Age UK figures that show there are now 1.4 million older people going without the care they need – up by one fifth in two years.

Lack of funding and high vacancy rates

22,949

adult social care services inspected in England

(Source: Care Quality Commission)

The major cause is a lack of funding. Over the past decade spending on social care by local authorities has fallen by 5% and while the government promised £1.5 million more in the recent spending round for 2020-21, analysis by the Health Foundation shows this is still well short of the 3.4% extra the NHS is getting each year until 2023.

Providers report they cannot recruit the staff they need to expand services and the effect on the workforce has been profound.

The vacancy rate is increasing among nurses, care workers and support staff – with the nursing workforce seeing the highest proportion of unfilled posts at 10%.

Social care services are in a fragile state, adding further strain on the NHS 

CQC chief executive Ian Trenholm says it is clear the system is in a fragile state.

He points out the effect this has on the NHS – more than half of emergency departments are rated as substandard because they are being overwhelmed by patients, partly as a result of the lack of care in the community.

84%

of adult social care services rated as good or outstanding

(Source: Care Quality Commission)

He adds that the NHS can tackle this by investing more in community services. The report cites the example of East Lancashire Hospitals NHS Trust which has set up an intensive home support service to provide extra care from nurses, physiotherapists and occupational therapists to keep people out of hospital.

Mr Trenholm also believes the failure to agree a long-term funding solution for social care is driving instability and without sustainable funding the NHS will not be able to cope on its own.

Government plans for social care have been delayed for too long

Since the 2017 election, the government has been promising a green paper on social care funding.

Such a promise came after plans launched during the election – dubbed the dementia tax – had to be shelved.

A working group was set up to advise ministers but plans to publish the proposals were delayed on numerous occasions.

‘We are hearing the same problems year after year. We desperately need the system to be reformed. Now, with the stalemate over Brexit, we still cannot move forward’

Dawne Garrett, professional lead for care of older people and dementia, RCN

The Department of Health and Social Care promised the proposals would be published in due course before it was announced there would be a general election in December.

RCN professional lead for care of older people and dementia Dawne Garrett
Dawne Garrett. Picture: David Gee

RCN professional lead for care of older people and dementia Dawne Garrett says the delays have gone on too long.

‘Sadly, we are hearing the same problems year after year. We desperately need the system to be reformed. Now, with the stalemate over Brexit, we still cannot move forward.’

10%

vacancy rate for registered nurses in social care

(Source: Skills for Care)

‘Social care should be the number one domestic priority once the government is in a position to get back to domestic policies.

‘But it is not just about funding – as this report acknowledges. The workforce is a huge problem. There is a high vacancy rate for nurses in social care – nursing homes are de-registering and older people are living in residential care and their own homes relying on carers and healthcare assistants for complex needs. It cannot go on.

‘We have had an interim NHS People Plan, but it falls into the same trap as before – we think about the NHS and social care workforce as separate, but we can’t keep ignoring the needs of the social care system.’

Merging social care and community NHS teams at the front line

British Geriatrics Society nurses and allied health professionals council chair Clifford Kilgore
Clifford Kilgore. Picture: Chris Balcombe

British Geriatrics Society nurses and allied health professionals council member Clifford Kilgore agrees, saying: ‘Community NHS teams and social care teams are working together locally where they can. But so often we hear from our social care colleagues that the funding and resources are just not in place for them.

‘It means we can do the intermediate care and rehab, but where the system falls down is when older people need social and personal care to allow them to live at home. That is why people become stuck in hospital.

‘We need to rethink the approach. The time has come to think about merging social care and community NHS care at the front line and ensuring there is a universal and consistent service available to people who need it.’

Where do the parties stand on social care?

All three main political parties have said they want to reform social care.

Conservative Party logoConservatives

While the Conservatives failed to put forward proposals while in government, one of the options discussed included introducing a levy or tax on the over-forties to help fund some type of universal access to services.

Labour Party logoLabour

Labour promise to introduce free personal care. The policy, unveiled at the party conference in September, would cost an estimated £6 billion a year and bring England in line with Scotland, which has had free personal care since 2002.

Liberal Democrats

Liberal Democrats

The Liberal Democrats say they would put a penny on income tax in the short term to help relieve the pressure on social care, as well as public health and mental health. A cross-party commission would then be set up to develop a sustainable long-term plan.

Can technology provide a solution?

The Care Quality Commission’s annual state of care report report stresses the importance of embracing technology to help improve services and find innovative solutions to pressures on the front line.

It cites the example of PatchCare, an app-based service developed by domiciliary care provider Caremark.

It works by putting clients in touch with care workers through the app. The care staff, usually two working together, are given no more than ten clients across a small local area.

They are then able to keep in regular contact between 7am and 10pm, reducing isolation and allowing the service to adjust its visits according to needs.

There is also a facility to put clients in touch with each other. One of the examples cited by Caremark included two people who struck up a close friendship after they were put in touch with each other because of their shared interest in painting.

PatchCare was trialled in West Sussex earlier this year and, following its success, is now being implemented across Caremark’s services.

Caremark national development manager Emmie Baker says: ‘The beauty of PatchCare is in its simplicity and its focus on delivering personalised care, moving away from time and task-orientated care.

‘It’s clear that people improve when they have more personal control and autonomy with their daily lives.’


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