Scenario: Weathering the storm
UK leaves European Economic Area
There has been prolonged economic uncertainty and big employers such as major foreign-owned industries are scaling down their UK operations.
Whilst successful care models are emerging where there is a history of integration work, most areas are too focused on managing day-to-day pressures to follow their example.
There remains a commitment to invest in skills in order to plug the skills gaps likely to be left by a clamp-down on immigration; with big expansion of apprenticeships and workplace qualifications.
A failing economy has narrowed the employment choices for low-skilled workers, stemming the flow out of care into other sectors like retail. However, falling migration has reduced the supply of staff to the care sector.
This scenario could lead to more people who would otherwise choose to work in sectors such as retail, joining the care workforce. While this may be positive, there is a risk that they will not hold the values and skills required to succeed in the care sector.
Furthermore, there would be a significant reduction in migrant labour, which will particularly impact on London and the South East which is very reliant on this source of labour.
This scenario is likely to see an increase in the number of personal assistants, attracting different types of people into the profession.
The NHS would be more involved in providing social care, and its strong brand could be used to attract new workers.
The closure of care homes in this scenario could lead to different kinds of community-based provision emerging, such as more supported living and homeshare schemes, helping to retain existing, and attract new, staff.
In this scenario, more would need to be done to promote the user voice and to ensure co-production of services takes place.
Ensure there is a strong focus on values in training and recruitment
with commissioners and employers supported to be more flexible in their thinking about the shape of the workforce, and focusing on practical outcomes for service users. A national user-led training programme could be set up led by service users to support values- and outcomes-focused recruitment and training. As part of this, apprenticeships need to focus more on developing people’s ‘softer’ skills and accentuate the wellbeing-focused aspects of providing care, in addition to the formal skills, to attract a new wave of younger people to the profession.
Grow skills development programmes and attract care workers from overseas
(as the NHS does with nursing) to counteract any fall in the available EU workforce should the Brexit deal lead to this. This could involve, for instance, having joint NHS and social care recruitment programmes to find workers outside the EU.
Scenario in full: Weathering the storm Open
Political context: Fragile Conservative majority and ‘Hard Brexit’
Rancorous Brexit negotiations ended late in 2019 with the UK failing to join the European Economic Area (EEA) and thereby losing access to the single market and ‘going it alone’. This came as a result of an impasse around the issue of free movement of people. The UK will cease its financial contributions to the EU and is released from all previous EU agreements. Hurriedly executed trade deals with nations around the world have not been favourable to the UK.
As a result, there has been prolonged economic uncertainty and a succession of big employers scaling down their UK operations. Sterling is trading at an historic low against the Euro. Meanwhile, domestic policy and public investment to build the ‘fairer Britain’ promised by Theresa May have largely been shelved as the economy faltered and negotiations with the EU consumed time and resources. The Conservatives went into the 2020 general election more unpopular than any government for a generation.
And yet, a Labour Party which has remained fractious and divided (e.g. three leaders in four years and a failed attempt to form a breakaway party) has not been able to capitalise on this. As a result, the Conservative Party remains in power after 2020, though with a majority of just a few seats.
Public policy and the economy
Prime Minister May’s government is painfully aware that money is tight but with little real popularity and a slim majority in the Commons, they are seeking to put money and big policy ideas behind a revived ‘One Nation’ brand and there are efforts to refocus on public services and invest where possible. This includes a concerted effort to invest in education and training in order to plug the skills gaps likely to be left by a clamp-down on immigration.
A big expansion of apprenticeships and workplace qualifications – including in social care – is one manifestation of this. The policy has the potential to bring more young people into the sector and to enable existing care staff to develop new skills – though providers are concerned they will not be able to match the salary expectations of these new recruits and upskilled staff.
Local authorities are relying increasingly on income generated through local taxation, charges and business rates, with a greatly diminished central government grant (a reduction of 40 per cent since 2016). Relatively strong business rates have enabled London boroughs to weather this change better than most parts of the country – where a poor economy has squeezed this ever-more important revenue stream hard.
Following a series of high profile care scandals involving mistreatment and neglect of older people, the Government pledged more rigorous staff checks for carers (including English language tests) and ongoing monitoring. This is trumpeted as part of a wider ‘voice and choice’ agenda aimed at protecting and empowering older people across their interactions with public services and private companies. Local authorities are being urged to press ahead with personalisation, supported by a new ring-fenced Older People’s Care Budget, but council chiefs argue that this is far too little to do what government demands.
One consequence of integration pilots over the last five years has been the emergence of what are now being called Fully Integrated Care Organisations (FICOs), whereby the NHS is now providing aspects of adult social care itself – including directly employing social care staff. Positive impacts on patients and service users are most evident where there has been progress around electronic care records and the use of predictive tools, enabling local partners to plan and deliver a patient’s care more seamlessly. This is helping to avoid hospital admissions and keeping older people at home for longer. This is turn is enabling the local system to invest more in domiciliary care staff. The greatest successes in FICOs and other new collaborative models are in Manchester and London where ‘total devolution’ is most mature. East London is one area celebrated for its integrated local systems, although recruiting and retaining staff is an ongoing battle which threatens this success.
The UK is no longer bound by EU migration rules. A points-based system has been introduced allowing the government to flex migration in terms of skills and qualification requirements dependent on economic need – and political will.
Whilst there has been a significant net loss of higher skilled EU citizens from the UK in the last four years (leaving through choice rather compulsion) the numbers of unqualified migrants saw a late surge in the run up to the Brexit deal – press coverage of which hardened sections of public opinion further against immigration. Overall, migration has fallen over the last five years, nonetheless. Anti-immigration rallies in some urban areas in England – including outer boroughs in East London – have turned violent, creating a sense of unease amongst overseas and BME communities. Reports of hate crime in the last three years have also risen.
A poor economic outlook and likely further job losses are leading the government to use its new total power on immigration to close the door on low-skilled arrivals as far as possible.
The social care market
A poorly performing economy reduced tax revenues and made government investment to tackle the already-evident social care crises even more limited. Whilst successful care models are emerging where there is a history of integration work (e.g. in Vanguard areas and around Accountable Care Organisations), most areas are too busy fire-fighting to follow their example. One in four care homes have closed in the last five years – creating a major challenge for local authorities trying to place people in residential care.
Falling migration has reduced the supply of staff to the care sector, and evidence suggests that a rise in hate crime experienced by BME and oversees workers in the last five years – particularly amongst women – has impacted on the number willing to take jobs where they are required to be ‘out and about’ in the community.
The impacts of a failing economy have, at least, narrowed the employment choices for low skilled workers, stemming the flow out into other sectors like retail. Care managers complain, however, that too many of their staff are there by necessity rather than choice and lack the commitment to, or aptitude for, the roles they are in. In London, the high turnover of care staff has slowed, but recruitment remains very challenging. Managers fear this will remain the case, as migrant labour into the capital shrinks.
Implementing the delayed Dilnot recommendations in 2020 was a pledge the government did not want to default on in an election year – especially after a well-publicised growth in the number of people selling their homes to fund their care. Whilst councils had been preparing for this, they have warned it will impede their efforts to invest in care and maintain viable care markets locally.
The number of carers (ie unpaid family or friends who care) providing at least 50 hours of support continues to rise – with 1 in 3 carers having to give up work as a result of caring.
Reliance on volunteers and low-level community services remains high, but the apprenticeship scheme offers volunteers a route into employment.