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Does the survival of home care depend on a change of the human heart?

Dec 14, 2021 | Blog Post, Thought leadership

Is the idea of the human heart transforming a sector beyond any conceivable merit, or is it the last remaining path that has any possible chance of success?

Not even a global pandemic imbues the revolutionary human spirit required to challenge a status quo that holds the home care sector on the edge of a precipice.

The changes required for home care’s survival are so drastic, it is uncomfortable on every level to contemplate such a major change.

Sir William Beveridge, argued to be the founder of the National Health Service, presented ‘The Beveridge Report’ to parliament in November 1942.

Beveridge harnessed the terrible yet almighty force of the war to drive revolutionary and sweeping social change across the UK, saying:

“Now, when the war is abolishing landmarks of every kind, is the opportunity for using experience in a clear field. A revolutionary moment in the world’s history is a time for revolutions, not for patching.”

The concept of free care at the point of need was born, but forged out of ‘revolution’, not from ‘patching’.

The home care sector has since passed from the state to an internal market and, under extreme pressure, many hoped that the impact of the Covid-19 pandemic would, like the war did for Beveridge, inspire political leaders to intervene and reform in revolutionary terms.

Government promised reform is nowhere near close to a solution

The eagerly awaited white paper on adult social care reform triggered a wave a disappointment and concern from the sector’s leaders.

Coined as a ‘new long-term vision for delivering adult social care’, and packaged in a new boldly-titled ‘Transforming Social Care’ website, sector leaders say that the white paper fails to address the current workforce crisis and high levels of unmet care.

At the heart of the problem continues to be Government underfunding.

Homecare Association CEO Jane Townson made clear to BBC Newsnight that the £1.7 billion promised every year for the next 3 years is nowhere near the amount needed to tackle the crisis happening now and in the future, adding:

“Industry analysts and think tanks estimate we need between £10 and £14 billion to make a real difference.”

This is a shortfall of at least £8 billion.

The LSE-Lancet Commission urged Government to increase funding by £102bn. See our June blog for more details.

During her BBC interview, Jane added that not investing in the community and social care impacts negatively on the NHS.

The NHS relies on home care providers to enable discharged patients to return home, thus freeing up beds for patients arriving at hospital.

“Neglecting people in the community, waiting until there is a crisis, blue-lighting them into an ambulance queue, when they do eventually manage to get into hospital, they sometimes struggle to get out again in a swift way because of lack of capacity, so the NHS cannot solve its problems unless we invest properly in community based social care.” Jane Townson, CEO, Homecare Association

Matthew Taylor, chief executive of the NHS Confederation, said that allocating more funding to the care sector to help increase wages and fill staffing vacancies would have a “much greater impact” on reducing pressures on the NHS.

Matthew added that the NHS beds crisis is now so serious that as many as one in five beds in some hospitals in England are occupied by patients who are medically fit to be discharged to return home.

“It would be better to allocate more immediate funding, from the recent funding settlement to social care services, as boosting the numbers of care staff will have much greater impact on reducing pressures on hospitals and other parts of the NHS.” Matthew Taylor, Chief Executive, NHS Confederation

To help local authorities discharge people from hospital the Local Government Authority issued their Implementing the Home First Discharge Policy guidance.

Nearly all the policy’s ‘top tips’ require people to execute them, and it is people local authorities and home care providers desperately need to increase capacity in the workforce.

Like any sector without appropriate funding, it will experience extreme strain, not least workplace stress and low pay for the people working in it.

Home care’s workforce crisis continues

It is incredibly difficult for many people working in care.

An ADASS snap survey (Nov 2021) found that 41% of councils reported home care closures over the past six months, compared to 21% for the previous period, affecting 1,535 people relying on home care provision.

The impact of closures on vulnerable people is significant:

  • 1.5 million hours of commissioned home care not provided because of lack of staff
  • 204,241 people on a waiting list for an assessment in England
  • 271% increase in people waiting more than 6 months for an assessment compared to the previous survey
  • 20% increase in people who have had an assessment and are waiting for care and support or a direct payment
  • 166,136 overdue reviews of existing care plans

Clearly the state can’t pay for everything, yet the decision to underfund the care sector is causing huge concern, avoidable suffering and far reaching consequences that transcend social care, impacting on the NHS, healthcare, economy and society.

The Health and Social Care Secretary, Sajid Javid, said health and social care “begins at home”.

With 6.5 million people in the UK already providing unpaid care, saving the economy £132 billion per year, this does not appear to be a solution to the care crisis.

The strain on unpaid carers trying to juggle work is so high, 600 people leave work every day to care for a loved one.

Millions of carers suffer physical and mental ill health because of the demands of caring.

Minister of State for Care, Gillian Keegan, said that the unpredictability (for care workers) of income by employers using zero hours contracts is driving workforce churn.

Skills for Care report shows that 56% of England’s 650,000 home care professionals are employed on zero hours contracts in England, and the churn rate is an astonishing 39.1%

However, employers don’t have margin to increase pay to their workforce. This is because local authorities commission care packages at minimum wage rates, hence the call to change how care is commissioned so that employers can pay more.

To put it simply, care work is not typically perceived as an industry of fair pay, but one of significant personal challenge and an over-dependence on goodwill.

Home care’s immunity to economic principles

Home care is a peculiar sector.

With record workforce churn rate (nearly 11,000 have left since April) decreasing the supply of care, and demand for home care reaching new highs, the economic principles of demand exceeding supply do not apply.

Despite powerful economic forces at play, the price of care hardly moves. The economic model stays (more or less) the same.

The Homecare Association’s minimum cost of providing an hour of home care in the UK is £21.43.

The average price paid by councils in Great Britain and Northern Ireland for public funded care is £18.45, which is about 70% of all home care purchasing. People paying privately pay an average £24.94 per hour.

For the majority of UK home care packages, providers are not being paid enough to make the work commercially viable.

The home care sector continues to look to the state to fix the underfunding problem. With appropriate funding, employers could pay their staff more, consequently attracting and retaining home care professionals to grow the workforce.

The price for care is often so low employers pay the workforce the National Minimum Wage, £8.36, or the National Living Wage, £8.91 (from April 2022).

Working in home care is hugely rewarding, yet also extremely challenging. It is often difficult, stressful, regulated work with significant responsibilities to people’s lives.

It is possibly the lowest paid, high-skilled and high-responsibility job in the UK. It is vexing how a worker with such accountability and responsibility is low paid.

Understandably many home care professionals feel exploited, under-valued, and under-paid, and choose to leave.

With pay being extremely low, care professionals turn to other sectors, often retail and hospitality, where pay is better, responsibility much lower and the overall experience is more dignified and valued.

Low pay is no longer a viable solution

Research by Citizens UK into the effect of low pay on care sector employees found that 73% struggle to afford their day-to-day essentials, including buying food and paying bills.

The research showed 87% of carers worry so much about money that it affects their everyday life.

56% of care workers skip meals for financial reasons, with 20% skipping meals “all the time” and 38% said they did so “often” or “occasionally”.

24% said they use a food bank or other aid provider.

Of the 73% of social care workers who said that they struggle to afford their day-to-day essentials, including food and bills, 60% said they struggled “all the time” or “often”.

Of the 72% that said the worry and stress of low pay negatively affects their work, 37% of those said it negatively affected their work “all the time”.

The impact of the pandemic on the mental health of the care workforce has been well documented.

The Homecare Association is working with the Health & Safety Executive to raise awareness of the Working Minds campaign to support and protect mental wellbeing of care professionals.

While support for mental health is important, this won’t increase care professional take home pay, or attract significantly more people to the sector.

The Health Foundation called for a fully funded workforce plan after its research found that 627,000 extra social care staff would be needed to improve services and meet demand by the end of the decade.

There have already been several enquiries this year, each reviewing and analysing the care workforce crisis to some extent.

Enquiries revealing important insights and possible solutions are helpful, isn’t it past time to get on with transforming a sector in crisis?

This is extremely difficult to understand when we know the care sector needs reform to recruit and retain more people now.

Impact of Government policy

Historically the recruitment of care professionals from European countries has bolstered the UK’s care workforce.

Brexit led changes to migration policy mean that care professionals are not able to access the Skilled Worker visa, and they haven’t been added to the Shortage Occupation List, further exacerbating the recruitment crisis.

To support recruitment and retention, Government announced a £162.5 million Workforce Recruitment and Retention Fund for local authorities and providers.

This fund is available until March 2022 “to help to retain existing capacity or increase the staffing capacity of the social care system”.

Whilst the funding is welcome, provided at such a low amount relative to what the sector needs, there is a clear sense that Government expects families, communities, and the private market to do more.

In the private pay market, employers know they need to improve pay and employment package for care professionals, as this is one of the main reasons why care professionals leave the sector.

Without funding in the economic model to pay higher wages, employers are paralysed, often leading to staff churn, diminished quality of care, or closure.

Under such extreme pressure, with no clear way forward, the home care sector is poised to collapse.

Is the human heart the answer to saving home care?

It seems possible that The Beveridge Report led to an entirely new social model principally by seizing an opportunity for transformational change.

Imagining the extreme circumstances faced during and at the end of the war, and the emotions running underneath, perhaps gave the human heart the chance for change, and the vision to achieve it.

Perhaps survival felt like it depended on a radical change of the human heart.

In front of political leaders of the time was a literal levelled playing field; an opportunity to ‘wipe the slate clean’ and do something completely different, not only to survive, but to rebuild and improve.

Today the home care sector faces its own survival.

Phil Pegler, Managing Director of Bluebird Care, one of the UK’s largest home care providers, said:

“…what remains is a need to shift society’s attitude to working in social care.”

Of all the ideas offered by the sector’s leaders, this is possibly one of the most radical and carries the greatest potential for change, perhaps it is also key to the sector’s survival.

Truly shifting society’s attitude to working in social care would require sector-level, systemic change at a scale not seen for nearly 80 years.

Such change would create a new economic model, higher rates of pay, heightened levels of societal respect, empathy and understanding for home care’s role, and a new priority order of political budgetary decision making at an unprecedented level.

Wouldn’t that be extraordinary. A care sector held in the highest possible esteem in a sought-after economy, where the very best of our human attributes are rewarded. Care providers juggle waiting lists for their next job openings; and vulnerable people consistently receiving excellence in care, living their lives with dignity and without avoidable suffering.

In the current context, perhaps this sounds like a fantastical ideal.

I would like to think that Beveridge wouldn’t think so.


Alex Cavell, CCO & Co-Founder of MyHelpa

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