The care provision crisis – a perfect storm
15 Sep 2021

We at Ethos welcome the Government’s announcement of increased funding of £12 billion a year for health and social care. But the proposals make little mention of the immediate and massive staffing crisis in care provision which has hit Ethos and the rest of the care sector this year. Without immediate action to fix a failing system, the billions will fall on stony ground.

Our chief executive Fae Dromgool examines some of the issues...

Care providers and the social care sector face a uniquely complex landscape. Ongoing regulatory and funding challenges now compounded by the COVID-19 pandemic are making the task of operating in the social care sector anything but straightforward. This year the growth of this staffing crisis has exacerbated the difficulties and Ethos is not immune to its impact.

The social care sector is a keystone of communities employing 1.5 million people in England and contributing £40.5 billion to the economy. Failures will have devastating consequences on individuals, their networks and beyond. 

Unlike NHS healthcare, social care is not free at the point of use. Council funding is only available to those with the lowest means and the care assessment process is often complex, fragmented, unfair and impossible to negotiate.

Local authorities spent £22.2 billion on social care in 2018/19 supporting 841,850 adults. People privately purchasing their own care spent £11 billion. Around 18,500 provider organisations deliver services across 39,000 establishments and 70,000 individuals employ their own staff via a direct payment.

Social care has one of the highest rates of job vacancies in the economy. According to The Guardian, care providers in the UK went into the COVID-19 pandemic with 120,000 vacancies. 

We are now 18 months into the pandemic and the staffing challenge has significantly worsened. The combined effect of the pandemic and Brexit has caused Europeans, who most care providers relied on to fill staffing gaps, to return to their home countries. 

The impact of this mass exodus for the social care sector is now being aggravated by the competition for staff with other sectors, like retail and hospitality. With unemployment still quite low in the UK, at around 5%, and with businesses returning to normal, the competition for staff is intense. 

Large high street and on-line retailers in our area are now offering up to £12 to £16 per hour for entry level roles and care providers simply can’t compete.

Although many social care jobs do not require formal qualifications in England, care is highly skilled and demanding work and it is also characterised by long and unsocial hours.

At the same time, social care is one of the most undervalued and lowest paid sectors. The majority of care workers are paid just over the national living wage, and many are on zero-hour contracts.

We are now battling with added pressure as a result of a decision passed by MPs in July that all eligible care staff must be double-jabbed by November 11. The move has been described as "ill-thought-out" by care sector leaders who fear it will compound the already serious staffing crisis.

NHS figures show that in Shropshire five per cent of eligible staff including agency workers - 185 out of 3,739 - had not received a first dose by August 22.

The COVID-19 pandemic has focused a spotlight on care work like never before. Care workers and other key workers have been applauded and celebrated, yet there is a looming crisis facing the social care sector. 

The challenges of COVID-19 are many and ongoing. The sector already faced enormous challenges prior to the pandemic - longstanding financial pressures, a precarious provider market, limited choice and control for our clients, an undervalued workforce and increasing workforce shortages. The crisis has magnified the issues and local authorities are taking a huge financial hit.

Costs to local authorities and providers during the pandemic will far exceed the Emergency Funding from the Government of £3.2 billion – half of which was made available to up to June 2020 – to support local government’s response to the pandemic, plus a £600 million Infection Control Fund.

The sector estimated £6.6 billion in extra costs, such as PPE, staffing and deep cleans due to COVID-19 at the end of September 2020. There is an £800 million deficit in 2020/21 based on the first three months alone.

Only 4 per cent of local authority directors are confident that budgets will cover their statutory duties this year. Without extra funding, this will impact on the ability to meet needs.

This adds to the uncertainty of future funding and social care reform. Adult social care is still below the 2010/11 level but facing rising costs of provision and growing demographic demand. 

First and foremost, the sector needs the long-promised reform to deliver better and sustainable funding alongside a workforce plan to improve employment conditions – pay and job security – and recognition. We need this reform to happen now, not in one or two years’ time and we need a social care funding shake-up.