Scenario: A sunny outlook… but is social care in the shade?
UK remains within European Economic Area
‘Soft Brexit’ means the UK remains within European Economic Area. The economy performs strongly and retail and service sector jobs are in good supply. Restrictions are made on the number of unqualified EEA migrants.
The NHS is set to receive more funding in order to reduce the number of UK and EU clinicians moving to jobs overseas.
Progress on integrated health and care remains patchy, however, cross-sector investment is helping to make care homes more sustainable, leading to specialist staff being recruited into care homes. It is also starting to generate more attractive salaries and careers (e.g. care coordinators).
The gap between demand for and the supply of carer workers would increase. The care sector would continue to compete with other sectors, such as retail, whilst immigration restrictions would reduce the supply of new employees.
Informal carers (i.e. family and friends) would have to take on additional caring responsibilities. Stronger peer networks may be created to support this, but it would still increase the pressure on carers.
The plan to increase NHS funding risks opening up a greater split with social care, but a co-ordinated approach to recruitment for the whole system could have the potential to build a more flexible workforce, such as care co-ordinators.
The increase in self-funders would lead to a growth in personal assistants and self-employed carers which could bring new people into the sector.
This scenario presents opportunities to develop more attractive careers. The care co-ordinator role could retain staff by enabling them to grow their skills and become ambassadors in the sector.
People could move into care roles later. A ‘Care Next’ scheme could fast-track older workers looking for a career change. There is a risk that the level of pay offered would not compete with other sectors.
This scenario could expand the number of community based smaller ‘micro-providers’, led and managed by local carers and their peers.
Incentivise and reward the care ‘workforce’ – including volunteers and unpaid carers.
This could include: tax relief, child care vouchers and pension allowances for unpaid carers, along with discounts on travel, retail and leisure activities. It could also include supporting communities to augment the pool of capacity to support local people.
Develop and market a wider range of care roles that can fit around the lives of people
That can fit around the lives of people who want a ‘portfolio career’, where they do several different paid roles, including part-time care work. ‘On demand’ roles could also be developed such as rapid response support when someone has a fall, providing work opportunities for people with other work and family commitments. The barriers created by inflexible employment patterns could be reduced, for example, by supporting carers with limited literacy skills to use supportive technology.
Change organisational cultures in order to attract and retain staff.
Job descriptions could give a more realistic sense of day-to-day activities; group interviews could test personal interaction skills; and it may be appropriate to move away from written applications.
Scenario in full: A sunny outlook… but is social care in the shade? Open
Political context: Conservative government and ‘soft Brexit’
A ‘Norway Plus’ Brexit deal was agreed in 2019, allowing the UK to retain access to the single market in goods and services as part of the European Economic Area (EEA). Whilst the UK will still contribute to the European Union (EU) budget, the figure will be less (75 per cent of the previous total) and the UK has also secured a concession which allows it certain ‘breaks’ on freedom of movement, allowing it to place certain limits on immigration.
With positive approval ratings for Theresa May, an EU deal generally seen as good for Britain and a growing economy, the Conservatives were in a strong position going into the 2020 general election. Aided further by a still-divided Labour Party, May sailed to election victory and now enjoys a sizable majority in parliament. On a mandate of fiscal prudence to ‘finish the job’, however, ‘austerity light’ seems to be the government’s guiding principle in relation to public services. Education, health and infrastructure are benefitting from renewed investment to ‘Get Britain Moving’, but most areas of public spending remain squeezed.
Public policy and the economy
The economic outlook in 2021 is optimistic. High profile investment by international firms helped to keep the economy healthy in the run up to the Brexit deal in 2019, and the UK now appears well-placed to gain from the upturn in the global economy. Unemployment is down but at the moment there is little sign of wage increases and incomes remain squeezed.
The signs are that government will invest the proceeds of economic growth in infrastructure programmes in order to set the foundations for a dynamic, business-friendly Britain outside the EU. In focusing much of this spend on the Midlands, the North and Scotland, the government will also be seeking to demonstrate that those foundations for growth and prosperity will be laid more evenly across the UK than in previous decades. In London boroughs where inequality and poverty are big issues, however, councils complain they are missing out.
The NHS is also set to be a major beneficiary of government spending as they work to stem the flow of UK and EU medical professionals to jobs overseas – with better training and pay for nurses the big headline. Although the Government launched another Integration Policy in 2017, rewarding areas doing well on health and social care integration, progress on this front has remained patchy. Building on the success of the
Multi-Specialty Community Provider (MCP) Vanguards, there has been as massive expansion in the growth of single integrated community based care organisations that bring together GPs, mental health, learning disability, social care and voluntary sector provision.
In some areas it is clearly improving outcomes, citizens’ experience and resource management, but in others the impact appears marginal as attempts to trial new models and relationships have been overwhelmed by rising demand.
In 2017-18 there was evidence that more highly qualified EU nationals were choosing to leave the UK and were not being replaced, even though the government guaranteed their residency rights early in May’s premiership. This trend has slowed since negotiations concluded and the economy looked stronger, but remains a concern for the government.
Under the Brexit deal, numbers of unqualified European Economic Area (EEA) migrants permitted to live in the UK are being sharply reduced. This has broad public support, but business leaders are arguing that the economy demands a better supply of young, low-wage migrants from somewhere – EEA or not. Politicians are being slow to decide on a policy and public pressure is keeping the door largely shut on all low-skilled migrants for the time being.
The social care market
Local authorities have in general been unable to pay more for the adult social care they commission, even though they recognise that care providers need to invest in more and better trained staff. This has led to growing numbers of care providers taking only self-funders and a genuine crisis in provision in some parts of the country. Whilst the Dilnot reforms were due to come into force in 2020 following postponement in 2015, the Local Government Association has successfully argued that this existing crisis must be tackled first – and that any available investment must be channelled into supporting local care markets.
Whilst councils have hitherto been unable to pay more for the care they commission, there are at least signs that new models are making a positive impact in some areas. Cross-sector investment by local authorities, primary and acute services is now helping to make care services more sustainable, and successes from the Vanguards Programme (especially around enhanced care in care homes) are leading to more skilled, specialist care staff being recruited into care settings.
This is starting to generate more attractive salaries, training programmes and career pathways – partly in the community through a growth in integrated care coordinator and navigator posts, but more significantly in the residential sector. This is making it harder for home care providers to retain the most able and motivated staff, who are drawn to those enhanced roles in residential settings.
Moreover, at the ‘lower-skilled’ and lower paid end of the care market (ie frontline workers who require limited levels of qualifications), staff retention is described in some (particularly urban) areas as ‘chronic’. A stabilised economy has seen retail and service sector jobs remain in good supply – providing low skilled workers with more choice and less incentive to consider social care as a career. Compounding the problem, London house prices and rental values continue to rise far ahead of salaries, pushing London care workers further from their jobs. As such, it has become even harder to recruit staff for residential and domiciliary care in the last five years, and from a 5 per cent vacancy rate in 2016, now 7 per cent of social care posts are unfilled.
With eligibility thresholds increasing, the number of carers (ie unpaid family or friends who care) providing at least 50 hours of support continues to rise – with 2 in 5 carers having to give up work as a result of caring. This in turn has led to an increase in demand for carer support and advice services. Reliance on volunteers and low-level community services increases. This has some positive impact in terms of community engagement and social isolation, but small organisations continue to struggle to stay in business, with high levels of dependency on volunteers and ‘goodwill.’