Homecare needs recognition not rationing

12 Oct 2021

by Michelle Dumont

84% of MPs agree that care work is skilled work, so why isn’t this reflected in government policy?

More careworkers are reconsidering their career options after eighteen months of fighting PPE shortages, the pandemic, ping-demic, fuel shortages and more - but the sector can’t afford to lose staff.

A careworker and the person they are supporting appear on BBC news — UKHCA featured on BBC Breakfast 5 May 2020.

There are over one and a half million careworkers in this country. To older and disabled people these workers provide the chance to live well and do the things that really matter to them, as well as providing safety and dignity. Our recent YouGov survey suggests that 91% of MPs and 85% of the general public agreed that careworkers make a positive difference to the people that they support.

As restrictions are eased, demand for social care is booming. In a survey of 843 Homecare Association members in August , 89% of providers said demand for their services had increased or significantly increased over the previous two months.

Graph of a Homecare Association provider survey from August 2021 where 57% of respondents said demand had significantly increased and 32% said it had increased. — Homecare Association, provider survey August 2021

Meanwhile, 65% of homecare providers are saying that more careworkers are leaving their jobs than before the pandemic. 95% are saying that recruitment is harder than before the pandemic, with 78% saying it is the hardest it has ever been.

A graph of a Homecare Association provider survey shows 29% of providers say more staff are leaving than ever before. An additional 36% say more staff are leaving than before the pandemic. — Homecare Association, provider survey, August 2021

A graph of a Homecare Association provider survey that shows that 78% of providers say that recruitment is the hardest it has ever been. An additional 17% say it is harder than before the pandemic. — Homecare Association provider survey, August 2021

Homecare job vacancy rates have risen to 11.3% in August.

Skills for care graph showing vacancy rates in domiciliary care rising to 11.3% in August 2021 — Skills for Care (2021) Vacancy information - monthly tracking.

Shortages of staff mean that local authorities, whose resources are already stretched, will have to prioritise care based on what care services are available. The consequences are and will be disruptive and devastating for people that need support and their families.

Why are careworkers leaving?

Our members report that careworkers’ pay and terms and conditions were the greatest challenge to recruiting and retaining workers. It is also true that staff are exhausted, and working as part of short- staffed teams can lead to a vicious cycle. Without sufficient staff, those that are available might be asked to provide care at short notice and may have to deal with increased levels of complaints about late calls – making the job harder than it otherwise would be.

A graph of a Homecare Association provider survey shows that the most common reason employers gave for staff leaving was pay or terms and conditions. — Homecare Association, provider survey, August 2021

The average wage offered to careworkers in 2019-2020 was £8.50 per hour according to Skills for Care . This is lower than the wages paid by many supermarkets.

A graphic from Skills for Care showing pay rates averaging at £8.50 in 2020. — Skills for Care 2020 Pay Rates

Why is this? Around 70% of the care people receive at home is commissioned by local authorities and the NHS , meaning that the public sector bulk purchasing power has significant ability to drive prices down to levels that are be below a sustainable hourly rate – and in doing so they drive down the terms and conditions and pay of the workforce.

The Prime Minister clearly has a policy intention to increase wages, but does this include for those working in organisations contracting with the public sector?

That is the direction in which this country is going now – towards a high wage, high skilled, high productivity and yes, thereby, a low tax economy… in which everyone can take pride in their work and in the quality of their work. (Boris Johnson, Conservative Party Conference, 6 October 2021, from minute 20.40).

Our YouGov survey, conducted in July 2021, suggested that 84% of MPs and 84% of the general public agree that care work is skilled work that requires particular standards of competence, training or qualifications. This included 74% of Conservative MPs. Yet Government procurement practices continue to encourage rates that barely cover minimum wage costs.

Graphs show 84% of respondents agreed that care is skilled work and 91% agreed that careworkers make a positive difference to the people that they support. — YouGov survey of MPs for Homecare Association, July 2021

Graph of survey responses showing 84% agree that care is skilled work and 85% agreed that careworkers make a positive difference to the people that they support. — YouGov survey of general public for Homecare Association, July 2021

What about the National Insurance increases?

In September the Government proposed to increase both employer and employee national insurance contributions by 1.25% from April 2022. Like everyone else, this will reduce take home wages for many careworkers and increase costs for their employers. Over the next three years, this is estimated to raise £36 billion, of which £30.6 billion will go to the NHS and £5.4 billion will be allocated to social care.

Our YouGov survey suggests that only 13% of MPs and 27% of the general public think that the NHS is more important than social care. There is an obvious connection between the two - if social care is not available to support hospital discharges, then it will be difficult for the NHS to address its backlog, even if the NHS has been given resources to do so.

Graphs show that 73% of MPs agreed that Government funding to train the social care workforce is as important as funding to train NHS. Only 14% agreed NHS was more important than social care — YouGov survey of MPs for Homecare Association, July 2021

Graph shows 27% of general public think NHS is more important than social care and 21% disagreed. — YouGov survey of general public for Homecare Association, July 2021

Of the £5.4 billion over three years allocated to social care, £2.5 billion will be allocated to introduce a care cost cap and increase thresholds for individuals paying for their own care. £500 million will be allocated to support the workforce and a further £2.4 billion over three years (equivalent to £0.8 billion a year) will support social care reforms.

Our YouGov survey suggests that 73% of MPs agreed that Government funding to train the social care workforce is as important as funding to train NHS staff. Yet, the £500 million over three years allocated to support the 1.5 million members of the social care workforce works out at little over £100 per worker per year, with minimal prospect of a pay rise for higher qualification levels due to chronically low fee rates from public sector commissioners.

Suppose all of the £800 million a year (£2.4 billion over three years) earmarked for reforms went to improving careworkers pay and terms and conditions (which is unlikely). Across a workforce of 1.5 million this only amounts to £533 per worker per year (before accounting for oncosts, tax and other factors, so this would not be £533 in take home wages). This is in a climate where due to energy cost inflation, changes to Universal Credit and national insurance low-income households could be £1000 a year worse off .

The Spending Review offers the opportunity to address this imbalance.

If MPs believe that care work is skilled work, now is the time to act on it.

The Homecare Association continues to call on the government to:

Fund social care adequately so that homecare workers are paid fairly for the skilled roles they perform, and at least on a par with equivalent public sector roles.
End the practice of councils and the NHS of purchasing homecare “by-the-minute”, alternatively focusing on achieving the outcomes people want.
Support development of an expert-led workforce strategy for social care and a 10-year workforce plan, aligned with the NHS People Plan.
Consider adding careworkers to the Shortage Occupation List.
Create a professional register for careworkers in England, covering all paid social care workers in both regulated and unregulated care services. Registration of careworkers needs to be adequately funded and carefully implemented.

References

ADASS (2021) New rapid survey findings. Available at: https://www.adass.org.uk/adass-new-rapid-survey-findings

Guardian News (2021) Johnson gives speech at Conservative Party Conference - watch live (from minute 20.40-21.00). Available at: https://youtu.be/Lju5Nvbq4Z4

Homecare Association (2021) Market Overview. Available at: https://www.homecareassociation.org.uk/resource/market-overview-2021.html

Homecare Association blog (2021) Health and Social Care Levy – UKHCA view on government announcement about funding for health and social care. Available at: https://www.homecareassociation.org.uk/resource/health-and-social-care-levy-ukhca-view-on-government-announcement.html

Homecare Association blog (2021) Homecare workforce shortages continue. Available at: https://www.homecareassociation.org.uk/resource/homecare-workforce-shortages-continue.html

Skills for Care (2020) Pay rates. Available at: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/Topics/Pay-rates.aspx

Skills for Care and Workforce Intelligence (2021) The size and structure of the adult social care sector and workforce. Available at: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-size-and-structure-of-the-adult-social-care-sector-and-workforce-in-England.aspx

Skills for Care (2021) Vacancy information - monthly tracking. Available at: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/Topics/COVID-19/Vacancy-information-monthly-tracking.aspx