Policy briefing

Social care green paper must address workforce crisis

With the social care system struggling to meet the needs of older people, a green paper to be published this summer will detail the government's long-term plans for reform.

With the social care system struggling to meet the needs of older people, a green paper to be published this summer will detail the government's long-term plans for reform.


Picture: Charles Milligan

Essential facts

Social care is the support required by people because of their age, illness or disability. It is provided in residential and nursing homes, people’s own homes and other community settings.

The social care system is struggling, and often failing, to meet the needs of older people. Age UK, who described the care sector as ‘close to breaking point’, says there has been a £160 million cut in public spending on older people’s social care over five years.

There are now nearly 1.2 million people aged 65 and over who do not receive the support they need with essential daily living activities. This represents an 18% increase since 2016, meaning nearly one in eight of the entire older population now lives with some level of unmet need.

Demand is only set to increase, as the population ages and more people live for longer with multiple long-term conditions. The number of people aged 85 and over in England is set to increase from 1.3 million in 2014 to 2.1 million in 2030.

What’s new?

Plans for sustainable care and support for older people in England will be set out by the summer, the government announced last year. The green paper will detail how the government proposes to improve care and tackle the challenge of an ageing population.

The government will work with independent experts, stakeholders and users to shape the long-term reforms that will be proposed in the green paper. Once the paper is published, it will be subject to a full consultation. The consultation has generally been welcomed as an opportunity to address the flaws that exist in the social care system.  

But, while there is agreement on the need for reform, it will not be straightforward. Since 1998 there have been 12 green papers, white papers and other consultations, as well as five independent commissions.

What will be covered by the green paper?

The green paper became the responsibility of Jeremy Hunt in January, when he became minister for health and social care. In a speech in March 2018 he set out the principles that will guide the government's thinking ahead of the green paper:

  • Quality: providing high-quality care and addressing variations in standards between different services and different parts of the country.
  • Whole-person integrated care: full integration of health and social care that is person-centred. Social care users are promised one plan covering all their health and social care needs based on a joint assessment.
  • Control: integrated health and care budgets.
  • Workforce: a National Audit Office report into the social care workforce in February found the number of staff is not meeting growing care demands and unmet needs are increasing. In 2016-17, the overall turnover rate in social care was 28% and the vacancy rate was almost 7%. Low morale, poor pay and a lack of opportunities to progress are some of the reasons stated for the transient and understaffed workforce. Mr Hunt said social care will be ‘promoted as a career of choice with better opportunities for progression into…nursing’ and ‘coherent’ workforce plans will align with those being developed in the NHS.
  • Supporting families and carers: ahead of the green paper, an action plan to support carers is promised.
  • Cost cap and security: while Mr Hunt confirmed that any new system of funding social care will be capped, people should continue to expect to contribute to their future care. He acknowledged the inequity in the current system: ‘If you develop dementia and require long-term residential care, you are likely to have to use a significant chunk of your savings and the equity in your home to pay for that care. But if you require long-term treatment for cancer you won’t find anything like the same cost.’

Expert comment

Nicky Hayes, nurse consultant for older people at King’s College Hospital NHS Foundation Trust, London

‘Workforce issues must be explicitly addressed in the green paper. We are running on an NHS vacancy rate of 9%, social care is faring no better, and in areas such as London this is higher. Older adults who are frail need skilled care, but we are seeing increasing gaps being filled with bank or agency staff who may not have the necessary experience or skills. This is not satisfying for anyone and leads to burnout and attrition from the profession.

'The Health Education England draft workforce strategy has started to take some direction, but this has only looked for solutions to workforce issues in general terms. The green paper must take the opportunity to confront the specific issues relating to older adults, identifying resources for recruiting, developing and retaining nurses with the right skills. I would like to see a nationally funded older person workforce programme that specifically addresses careers in older adults care, including an overhaul of apprenticeships and unlocking access to specialist skills training and clinical leadership.’


Expert comment

Sharon Blackburn, policy and communications director for the National Care Forum, Coventry

‘We must ensure that the issue of social care is looked at across the whole life span, to help people live ordinary, productive lives well, however that may look for the individual, rather than people being divided by age or medical condition. It should be seen as part of a preventive strategy to help people’s well-being. There needs to be a proper discussion with society about what ageing well means – and how this will be funded.

‘This green paper has to make a difference. We have all the evidence and reports we need. This paper has to provide solutions and be followed by actions. The current state of social care is having a real impact on people’s lives, and the threshold to access that care is too high. There is not one single solution, but we need a plan for now, for five years’ time, and beyond that. People don’t live their lives in compartments or in a way defined by services. We need to respond from the person’s perspective, and any future plans need to be flexible enough to reflect this.’


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