Scenario: A change in the weather
UK remains in the EU
Public opinion turned against the government and Brexit as economic uncertainty tipped the UK into recession in 2018. A referendum on the deal in 2019 saw it rejected, and the UK remains in the EU after all – retaining all the associated rights and responsibilities. Increased public spending is being funded by borrowing and increased taxes, enabling the Government to slightly increase the local government grant.
The government’s Care Task Force is investing in education and training to create a clearer, more compelling career pathway for carer workers who want to improve their skills and enter more specialist care roles.
New employment rights raise the minimum wage and in effect outlaw zero-hours contracts. A poor economy at home in the last five years – in contrast to a more stable EU economy – has contributed to a steady fall in migration from mainland Europe. Reductions in benefits for wealthier older people and an Estates Tax on the top ten per cent of estates are helping to fund the state’s burden around social care.
Prospects for investment in education and training would increase, but it may lead to the creation of more qualifications, not necessarily an increase quality.
The increase in social care funding to support integrated care is likely to be welcomed, but it could lead people to believe the issue is resolved, – whilst entrenched challenges remain.
Concerns remain about the nature of an integrated workforce and how staff could navigate this in their careers. This would be exacerbated if integration was dominated by a health service perspective.
With the emphasis in this scenario likely to be on formal skills and professional standards, there may be little room for personalisation and choice.
Technology could create opportunities to deliver more care remotely, with staff that are not formally qualified (or even unpaid volunteers / family members) deployed in those roles which do not require more qualified workers.
Develop person-centred education and training:
Build on the success of the Care Certificate and introduce more training that is values-based and person-centred. Learning providers need to co-ordinate their efforts locally, perhaps through structured cross-sector forums.
Improve the image of the sector
By promoting the exciting future of social care in relation to technology. Involve service users in promoting the benefits of working in social care and how vital and life-changing this work is.
Evaluate existing workforce development models and pilots
It is important to evaluate the success of apprenticeships and other emerging recruitment, retention and training initiatives in order to make business cases for extending and joining-up those that work. This should involve partners across the system including national agencies, training and learning providers and other organisations that represent and support the recruitment and retention of workers into social care and support.
Scenario in full: A change in the weather Open
Political context: Labour / SNP coalition and Brexit abandoned
In 2021, Brexit does not mean Brexit after all. Britain remains in the EU, retaining all the associated rights and responsibilities. This came following a recession in 2018, withering public services and public pressure for a referendum to ratify the outcome of the Brexit negotiations concluded 2019 which were widely unpopular. This second EU vote opened up acrimonious splits in the Conservative government, including between those on the negotiating team. In a dramatic turn of events, in a further referendum the UK public has now voted – by a narrow margin – to scrap the deal and remain in the EU.
After a difficult period, the Labour Party has regained support – both in its heartlands for its anti-austerity policies, and nationally for its opposition to what had become a chaotic and economically damaging Brexit process. Successfully leading the campaign to scrap the deal and remain the EU in 2019, the party went into the 2020 election stronger than would have seemed possible just two years earlier. Receiving the largest number of votes but no governing majority, Labour struck a coalition deal with the SNP and other smaller parties who agreed to park ambitions of another independence referendum for the course of the next parliament now that Brexit – and thus the threat to Scotland’s status within the EU – has been shelved.
Public policy and the economy
Increased public spending is being funded by borrowing and increased taxes on higher earners, on wealth and on big business. Labour’s commitment to spend the bulk of new tax income locally, rather than from the centre, sees a welcome (though limited) growth in the local government grant. Whilst tackling the care crisis has been a priority for local government for some time, it is, as the leader of the LGA remarked in 2020, ‘just one of many crises we need to address’.
Delivered through Local Economic Partnerships and city regions, investment in education and training is being planned on a scale not seen for 20 years. This is focused in the poorest or most unequal areas where worklessness and low wage jobs are most concentrated – including parts of East London.
The new government has introduced new employment rights which raise the minimum wage and in effect outlaw zero-hours contracts. The private and not-for-profit sectors are concerned the economy is not strong enough to cope, but unions and campaign groups highlight the growth in income disparity during the second half of the decade and the dramatic fall in living standards for millions of low income families, which they say must be tackled now.
The Government remains committed to integrated care, and has continued to invest in the integrated system through a revamped Better Care Fund that was launched in 2017. This new fund increased the amount guaranteed to social care but also to the whole system to integrate care, although many health and social care economists continue to argue that it is insufficient to meet growing demand. In a growing number of areas, very larger pooled budgets have been agreed and the creation of more providers who work together to deliver a range of services through one long term contract. In London, the success of the Hackney Devolution Pilot which created a single, community based provider of health and social care, has now been rolled out across the whole of East London. What has emerged is more direct investment in social care from the NHS, with the NHS increasingly commissioning care provision directly (requiring all staff to be given the Living Wage) and employing home care workers.
The new government has created a cabinet minister for social care, launched a new Social Care Quality Strategy and directed more money into local authorities to tackle the growing gap in funding. However, with so many priorities – such as jobs, education and house-building – and a delicate economy, those in the sector wonder how attention (and significant investment) social care can expect in practice.
A poor economy at home in the last 5 years – in contrast to a more stable EU economy – has contributed to a steady fall in migration from mainland Europe, and an increase in those previously in the UK leaving for work in other EU states.
Now remaining in the EU after all, the government is unable to reduce immigration from EEA states even if it wants to. Responding to public pressure, however, the new coalition government has committed to clamping down on non-EEA migration as much as possible.
The social care market
A freeing up of public spending is injecting new resources into local authorities. This will help them to deliver on their commitments in relation to Dilnot, which finally came into force in 2020 and mean that the cost to self-funders receiving care at home or in residential care is now capped (although in practice this impacts relatively few individuals in care). Reductions in benefits for wealthier older people (e.g. winter fuel allowance) and an Estates Tax on the top 10% of estates are helping to fund the state’s burden.
The new government’s Care Task Force is investing in education and training to create a clearer, more compelling career pathway for carers who want to improve their skills and enter more specialist care roles. With pay and workers’ rights a priority, basic incomes for those working in social care – as in other sectors – are beginning to edge upwards. This is encouraging more care workers to stay in their jobs. However, it also means that increased social care budgets – given a fillip by recent injections of cash into local authorities – are largely being swallowed up by pay increases to staff. As a result, the net gain to the sector in terms of increased capacity is negligible, particularly as the aging population means the number of people requiring care has increased.
The fall in migration in recent years has been unhelpful for the care sector. Remaining in the EU should revive that recruitment source (provided more Europeans choose Britain over other EU states) – although with such a high proportion of London care staff historically from outside as well as within the EU, there are concerns that tighter controls on non-EU migration will mean that future supply remains stifled.
The residential care market remains dysfunctional and at risk. A two-tier system is recognised in many parts of the country, with more affluent self-funders supporting a relatively thriving ‘hotel’ offer on the one hand, whilst council-funded and poorer self-funders face a creaking ‘no frills’ experience on the other. As care providers withdraw from this bottom end of the market and councils see the number of places shrinking, more older people – even those with complex needs – are being supported in their own homes instead. This has increased the demand for live-in care, and the need for district nursing services.
For those who do not meet the eligibility criteria, it has also increased the number of family carers supporting people at home, with increasing numbers of carers giving up work. The use of unskilled volunteers has increased, resulting in concerns about safety and quality of support services.