Professor of Psychiatry for Older Adults John Wattis is from the University of Huddersfield. Here he writes about the Social Care Crisis and how the current situation has become intolerable.
“About ten months ago I wrote about an approaching ‘perfect storm’ – a coming crisis in health and social care for older people. The phrase ‘a perfect storm’ was echoed today in a letter to the Prime Minister from the chairman of the UK Homecare Association, reported by the BBC . The current situation is intolerable.
Drawing on data gathered by the Charity Skills for Care, the BBC also headlined the fact that over 900 care workers were leaving the sector every day. The data also showed that in 2015-16 around 340,000 adult social care workers left their roles and that nearly two thirds of the leavers left the adult social care sector altogether. The rate of attrition was nearly twice as high as in other jobs. The average frontline care worker was only earning £7.49 an hour, barely over the national minimum wage at the time and not much over half the median average UK salary. Furthermore, one in every four social care workers was on a zero-hours contract, meaning that work was precarious with no guaranteed income. Staff turnover was approaching 30% annually and vacancies in the sector were rife with pronounced geographical differences. London, for example had a vacancy factor of around 10% compared to Yorkshire and Humber at around 5%. Turnover led to problems with providing proper training for staff and, sometimes, a reliance on costly agency staff. From the point of view of old people using the services it was also unpleasant to have different carers all the time with no time to build up a truly caring relationship.
That the current situation is desperate was also recognised in a House of Commons Report on Adult Social Care from the Communities and Local Government Committee. They headlined further disturbing facts including the following:
- Fewer than one in twelve Directors of Adult Social Care were fully confident that their local authority would be able to meet its statutory duties in 2017–18
- 28% of care services were inadequate or required improvement
- 96% of people paying for their own care paid on average 43% more than state funded residents in the same home for the same room and the same level of care
- The turnover rate for nurses working in social care was 35.9% per annum
- Nearly 50% of care workers left within a year of starting
- 160,000 to 220,000 care workers in England were paid below the national minimum wage.
- 27% of care workers received no dementia training and 24% of those who administered medication were not trained to do so
In addition, they found that nearly half of home care workers (as opposed to all workers in the sector including those working in residential care) were on zero hour contracts. They found out a great deal besides and the report is well worth reading.
The knock-on effect of all this is well known. Too many older people are attending A&E departments when their problems could be alleviated by better social care or even by better medical and nursing care in care homes. Work with older people is financially unrewarding and regarded as a low status job. People who can afford to pay for their own care are effectively get taxed at nearly 50% to pay for those funded through local government.
Three things are needed to put this right:
- Adequate funding. The Communities and local Government Committee advised implementing a new social care tax, like that in Germany, where around one per cent of salary is deducted each month from employees, matched by employers, to fund future social care.
- A change in how care is organised. Everybody agrees that the division between Health and Social Care is a false one. However, it is maintained by the simple fact that social care is means tested. This now means that relatively well-off older people are subsidising those for whom local councils provide funding. More than that Roy Lilley suggests that the distinction between private care homes and private nursing homes needs to be abolished and provides a useful list of the medical and nursing care that he believes should be a condition of registration for all care homes
- positive change in our attitude to frail older people. Our culture does not value old people. Sometimes it seems we are satisfied with conditions of care that are scandalous. If the shame of the 18th century was the slave-trade surely the shame of the late 20th and early 21st century is how we treat our old people. This is reflected in the low-status, poor training and only just above subsistence-level pay and conditions we give to front line carers.
The problem is clear. There has been adequate warning. So far, the Government response has been totally inadequate. It is Government’s job to look after vulnerable people in society. It is time they stopped evading this present crisis of their own making. This will get much, much worse without urgent and adequate action. It is no good mouthing platitudes about £2billion pounds (inadequate according to the Communities and Local Government Committee Report) or apprentice schemes (which have value but may also be regarded as sources of cheap labour). Urgent action and real leadership are needed. Let’s hope someone in Westminster cares!”