A Sector in Crisis

Social care is in crisis. Skills for Care, the sector body, reports over 100,000 vacancies being advertised on an average day in 2020/21. Vacancy rates were at 8.2% in August 2021, up from a pre-pandemic level of 8%. The impacts of leaving the EU, the pandemic, skills and labour shortages across many industries, and an ageing population, affect the adult care sector deeply and given that the sector was struggling to recruit before these events, it signifies the scale of the problem facing the sector.

Public Sector Pay Comparisons

Research by Community Integrated Care and Korn Ferry found that social care workers would be paid up to 39% more – an additional £7,000 – if they worked in other public funded sectors, with the gap 42% to the NHS. This context of pay and esteem is important to understanding the complex landscape of devolution and the impact it can or could have on this sector.

Mayoral Combined Authorities

Under the current devolution model, mayoral combined authorities (MCAs) are groups of more than two councils that can collaborate and take collective decisions across council borders. Each MCA has its own devolution deal agreed with government and the constituent councils that form those organisations. So, the exact scope and scale of the devolution given to the MCA region can differ.

Adult Education Budget

All of the nine existing MCAs have control over the Adult Education Budget and can, without sacrificing national entitlements, make local decisions over how that funding is allocated. As an example, the West Midlands Combined Authority has created a West Midlands Regional Health Science and Care Services Training Plan. The Plan aims to increase cohesion between training and available jobs in the local economy, while also making entry points and retraining opportunities clearer for residents. It provides a helpful breakdown of pathways, associated courses and the providers that offer those pathways.

Commissioning Social Care

However, the MCA model does not give them control of commissioning social care services, as this remains a statutory responsibility of local authorities. This is where the potential for ‘County Deals’ provides an interesting contrast to the existing model.

County Council Deals

In July 2021, the Prime Minister set out a vision for ‘County Deals’ to ‘take devolution beyond the largest cities’. But as yet, the full detail of what this might entail has not been published and has been promised in the upcoming ‘Levelling Up White Paper’. However, within the associated press releases of that speech, there is reference to giving ‘County Deals’ the same powers as metro mayors, including skills. This could mean that ‘County Deal’ areas would potentially have control of the commissioning of social care and the Adult Education Budget.

Adult Education Budget and Social Care Funding

What this potential ‘County Deal’ could do is allow local areas to support the short-, medium- and long-term recruitment and training of social care staff. Social care operates on very fine margins, and frequently the additional cost of training can be a significant barrier to recruitment. Whether that dual role could generate a step change in the recruitment challenges experienced by the social care sector is not simple to answer.

In a recent discussion with a social care provider, the notion of the integrated health and social care plan came up. They reflected that there are a number of challenges to making that work. First, healthcare is free at the point of use, whereas social care is means-tested and often requires the recipient to contribute to the cost of the service, so the interaction is different. And second, the NHS has a workforce strategy, but there is not one for the social care workforce. Some of these key challenges need to be addressed.

Recommendation 1

Devolution needs careful management to avoid a postcode lottery – while regional or county boundaries make administrative sense, individuals’ lived experience does not recognise those boundaries. It doesn’t really matter how big or small a geography is involved; someone somewhere is always going to live on the edge. Current experience of the devolved Adult Education Budget is off cliff edges that do not support the end user. And that devolution adds complexity for the providers as well, who potentially might have to deal with a growing number of commissioners if they provide services over a geographical area that does not fit with the geography of devolution.

Recommendation 2

Funding settlements need to be provided for a sufficiently long term and with greater notice than is current practice. We can all understand the need for short-term spending reviews driven by the pandemic, but these do not provide sufficient support for long-term service management.

Recommendation 3

Develop a workforce plan for the social care sector, understanding its complexity with public and private funding, the impact of voluntary family care, the number of settings involved, care homes, day centres, and in-home care. Map out the needs for the sector in the long- term using population modelling to understand the implications for an ageing population. Benchmark salaries across similar skill-level roles in other public sector organisations.

Gemma Gathercole, Coventry and Warwickshire LEP