Covid-19 and Adult Social Care

Out of the multitude of lessons the United Kingdom had to draw from the pandemic, two in particular stand out. The first is that any satisfactory public health response requires all aspects of the “front-line” receiving satisfactory investment, before and not just at the onset of a pandemic flu event. The second is that targeted policy support for workers, their job and financial security and investment in their skills pays long-term as well as immediate dividends. These two lessons come together with the deep and long-standing problems facing adult social care (ASC).

An Underfunded and Undervalued Sector

The principal lesson has at last been grasped: ASC and care workers have been underfunded and undervalued for far too long and this must change. This broader (and even blunt) lesson of “more investment” itself is however on its own insufficient, and the principle of ‘targeting’ must be emphasised in order to understand and address ASC’s problems through new policy support. These problems centre around ASC’s present – and potential – workforce and elevate a role not just for new policy and financial investments, but also for the employment support and employability sector that ERSA represents.

The Employment Model

ASC’s labour problems come in with four interlinked elements:

1. low pay,
2. inadequate skill provision,
3. low security, and
4. poor public esteem for ASC and carers.

These feed into a vicious cycle where retention and recruitment become enormously difficult for the sector. It is not difficult to see why.

Skills for Care reported that in 2020 the median hourly rate for a care worker in was £8.50. (The state of the adult social care sector and workforce in England 2020/1) This was an increase of £1.57 since 2012/13, but is still very low.

When poor contractual security is brought into view, one can see why ASC has such long- standing problems retaining and recruiting staff (staff turnover in ASC staying stubbornly around 30% for several years). Around a quarter of ASC staff are employed on zero-hour contracts with this number reaching 42% for domiciliary care workers (Skills for Care, October 2020).

The sector is also marked by a very high level of part-time working. With the low levels of pay and job security there is little appetite for workers to acquire – or for employers to invest in – higher levels of social care skills and training.

Given the pay, the low levels of job security and professional development, it is not difficult to see both the tragically low levels of investment in ASC but also the result. When we add into this toxic mix the low level of public repute for care work in comparison to the NHS, these challenges of recruitment and retention become harder still.

We Know what Needs to be Done

In 2019/20, the Care Quality Commission said: “There needs to be a new deal for the adult social care workforce that reaches across health and care – one that develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation” (State of Care 2019/20 Report).

A year earlier, the House of Commons’ Communities and Local Government select committee concluded: “A stable and skilled workforce is essential to the provision of quality care and keeping pace with demand for social care in the coming years—an estimated 500,000 more care workers are needed” (The State of Social Care, June 2018).

Active Labour Market Policies as part of Wider Reforms

The key message is that active labour market policies (ALMPs) funded and deployed by the Department of Work and Pensions (DWP) cannot help to fill the 100,000 and more vacancies in ASC in isolation from wider reform of the sector.

Recommendation 1

Targeted ALMPs to fill job vacancies in adult social care need to be deployed alongside wider employment policies which provide higher pay, employment security, skills development and promotion of work in the sector. At the governmental level, there must be deeper coordination between the DWP and Department for Health and Social Care, the Department for Levelling Up, Housing and Local Communities and the Department for Business, Energy and Industrial Strategy to join-up policies on pay, employment rights, skills and promotion.

Recommendation 2

Targeted ALMPs to fill job vacancies in adult social care should include investment for employment support providers to encourage prospective groups, like recent and young care leavers, to take up a career in social care and for training providers to encourage participation in apprenticeships in social care.

Recommendation 3

Targeted ALPMs towards meeting the vacancy needs of adult social care must operate at the local level. Local Authorities are responsible for the delivery of adult social care in their communities. Job Centres, local councils and local employment support providers are hugely important in helping adult social care employers fill care worker vacancies.

Andrew Morton, ERSA