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Would you be willing to pay more tax to fund care? What about paying more towards your own or your parents’ care in old-age or if you find yourself in need of disabled care? What quality of care would you expect? Are you an unpaid carer yourself? Compromises may be needed in the funding and […]


The social care challenge

Posted on March 22, 2018 by

Photo of friendly care worker helping an elderly ladyWould you be willing to pay more tax to fund care? What about paying more towards your own or your parents’ care in old-age or if you find yourself in need of disabled care? What quality of care would you expect? Are you an unpaid carer yourself? Compromises may be needed in the funding and delivery of social care in light of the combined pressures of cuts in the budgets of local governments, which spend £14.8 billion funding the care, and the high vacancy and turnover rates in the adult social care sector. Our recent reports highlight the scale of the challenges facing the government as it plans for the future.

The government will publish a ‘Health and Care Workforce Strategy for England to 2027’ in July to coincide with the NHS’s 70th birthday. By summer 2018, it will also publish a Green Paper on care and support for older people. These are long-awaited reports by the sector – not least because the government has not had a national workforce strategy covering adult social care since 2009. The reports will affect all of us, from the need for care for those we love, to the alternative services local government could otherwise fund.

Adult Social Care

Adult social care comprises personal care and practical support for:

  • Older adults who cannot manage the tasks of everyday life.
  • Working-age adults with physical disabilities, learning disabilities, or physical or mental illnesses.
  • Their carers.

Unlike healthcare, social care is means-tested. For people aged over 65 who qualify for state support, and for working-age adults with learning, physical and mental disabilities, their care needs are funded by local authorities. In the vast majority of local areas, publicly funded care is only provided to people with substantial or critical needs. Others in need of care must pay or provide it for themselves. And care is expensive – care packages can be £20,000 per year, or more. Most care is provided unpaid by family or friends (known as ‘informal care’).

Chart showing decline in all local authority spending in real terms since 2010Social care spending (including children’s social care) was 54.4% of overall service spend by local authorities in 2016-17, up from 45.3% in 2010-11, as we reported recently in Financial Sustainability of Local Authorities 2018. Despite this, given the overall funding reductions, spending on adult social care fell by 5.3% between 2010-11 and 2016-17. The sector also suffers high turnover and vacancy rates. As I detail below, a key reason for this problem is low pay.

So do we have, and can we afford, the people needed to provide the level of care needed for an ageing population?

The workforce challenge

“Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”

This quote from Sir Amyas Morse, the Comptroller & Auditor General, summarised the severity of the challenge that we identified in our February report, The adult social care workforce in England, which was a joint top story on the BBC News. The fact that our report ran jointly with a feature on NHS missed hospital targets, rather than standalone, reinforced a central point of our report: that the health sector is held in higher esteem than the care sector.

There are around 1.34 million jobs in the adult social care sector in England, across more than 20,300 organizations. Turnover among care staff has been increasing since 2012-13, reaching 28% in 2016-17, and the sector has a vacancy rate of 6.6%, well above the national average of 2.5%-2.7%.

Three job roles are particularly affected:

Bullet pointCare workers – 820,000 in England, providing direct care to people. 7.7% vacancy rate and 33.8% turnover rate. A typical care worker earns £7.50 per hour, which equates to £14,625 per year.

Bullet pointRegistered managers – 22,000, who are legally responsible for running care homes. 11.3% vacancy rate and 23.0% turnover rate. A registered manager typically earns £29,600 per year

Bullet pointRegistered nurses – 43,000, providing care to people in nursing homes. 9.0% vacancy rate and 32.1% turnover rate. A registered nurse working in care typically earns £27,900 per year, more than £3,000 less than an NHS nurse.

The main reasons behind the high vacancy and turnover rates are low pay, lack of prestige, lack of career and development opportunities, and competition for these workers from other sectors.

Reductions in local authorities’ funding, combined with rising demand for care, has meant that most providers cannot pay people more. Similarly, the body tasked with developing staff who work in care has a budget of £23.5 million per year, which equates to only £14 per worker.

A caring future

Our report found that the Department of Health and Social Care (DHSC) has not been doing enough to support a sustainable social care workforce. The number of people working in care is not meeting the country’s growing care demands and unmet care needs are increasing.

As the government prepares its Green Paper on the future of funding care for older people, and a joint health and care workforce strategy for the summer, we recommend that DHSC, supported by the Ministry of Housing, Communities and Local Government, produces a robust national workforce strategy and that local and regional bodies align their own plans to it. Investment is also needed to enable those who commission care to set fees for providers sufficient for them to pay staff adequately and afford to offer career development and training opportunities.

We hope that our report contributes to the important discussions around the funding of adult social care. I welcome your comments and invite you to contact us if you would like to discuss any of the issues raised in this blog-post.

Photo of Michael BurkeAbout the author: Michael Burke is a chartered accountant, who works on value for money studies, principally in the health and local government sectors. He joined the NAO in 2013, bringing experience from local government, health and the housing sector. In addition to his current portfolio, Michael has wide experience of auditing numerous health, environment and culture focused bodies.


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12 responses to “The social care challenge”

  1. Judith Watson says:

    I am in my mid eighties. I am fit and well and live on my own with no help either in the house or the garden but… as my income is not great, I object to having to contribute to the care of other people my age. Could there not be a cut-off point, say 80, when people like me would not have to contribute?

    • JanP says:

      What a selfish person. Luckier re health but selfish.

    • Michael Burke says:

      Thank you, Judith and all commentators, for taking the time to read our blog, and for your comments.
      As you will appreciate, the NAO does not comment on the merits of policy but, rather, draws conclusions on whether value for money has been secured.
      It is our understanding that there will be a government consultation that will include questions around the future funding of care for older people, following the publication of the Green Paper on social care for older people this summer. You may like to contribute to this consultation. It is likely that it will be led by the Department of Health and Social Care, in which case the DHSC website will have further details on this, following publication of the consultation.
      Michael Burke

  2. Roger Steer says:

    At the moment the sector is depressed by the low incomes of the elderly; who cannot afford more care.
    Need is exacerbated by the increasinging number of people living alone in homes that are unsuitable if their needs increase.
    In europe the solution is better pension provision; putting an obligation on the family to fund the care of their aged relatives and encouraging , via tax breaks and other means ,the construction of more accommodation more suitable for the elderly. Plus nurses are paid to be productive not by the hour and thus they can be better paid.

  3. Janice Bateman says:

    I would be willing to pay more tax providing it was ring fenced for social care. I have worked very hard as a single parent to buy my own home, with the aim of having something to leave to my children, but would be discriminated against for having assets should I need care either at home or residential.

  4. Roy Jenkins says:

    The Tory Govt are forgetting the most important thing here!
    Which is all the Old People now alive have already paid their way for health care in old age years ago.
    So the young starting work should pay their way now like we old people did back in our days do not see why “I should be charged again to look after my Grandchildren or anybody eles kids starting work now the Govt should place a tax on them not us that have already paid into Govt taxpayer pot for our health needs in old age.
    Therefore stop bleeding the old retired people cash pots and enforce a tax to cover the health costs NOW! -NOW!
    On all them starting work Now.

  5. Brian Parton says:

    NHS and social care budgets need to be merged as a basis for finding a new and more effective means for funding and managing all forms of care. It’s hard to see how the current “playing shops” is anything other than very ineffective and inefficient.

    Whatever the model that emerges it needs to have fairness at its heart. It is fundamentally unfair that someone who suffers from dementia and requires care home residency has to pay for this themselves, on a means tested basis. But, if some one is unfortunate to suffer from cancer, their care is paid for by the taxpayer via the NHS.

    All care should be funded through general taxation on a means tested basis. Clearly some form of cap would be good but the basic principles of fairness and funding need to be established first.

    If some level of cap is considered it has to be much more inclusive than the Dilnot model that only included the “costs of care” (and then only to the level of the local authority equivalent rate) and excluded the “hotel” costs of bed and board, which can run to £00s per week in the average care home.

  6. Paul says:

    I have an 86 year old mother who was diagnosed with Lewy Body Dementia earlier this year. After a recent spell in an assessment hospital time had come to have her cared for as I could no longer cope with looking after her. This is when the hassle commenced. On contacting the Local Authority for help they did a 10 minute assessment and declared she had capacity and could go home with a care plan. No consideration or listening to the family at all. Obviously financially motivated & said they would not fund my mother’s care as she owned half the house with myself (Left to me in my father’s will). I am now in the process of selling the house to fund my mother’s care @ £32k per year. The worst was still to come from the Local Authority who insisted that the room in the care home which I had secured in private for my mother was theirs and insisted she moved out. Luckily this request by them was declined by the care home management. I wonder if others have had a similar experience. It’s all down to money!! I am considering an official compliant against the Local Authority & the way we were treated but its probably a closed shop.

  7. Mrs. CM Wilkins says:

    Rip-off Britain. My husband is totally dependent. We have a care company providing care that was commissioned by the County Council. They charge the Authority for more hours than provided (24.5 hrs per week, when significantly less is provided). We also have to pay a significant contribution. We received no care during bad weather in March, I provided care and have been charged for doing the work!! County Council not interested – so who is being ripped off?

  8. Sad to say that we are still awaiting the governments’ green paper on social care, however, I believe the majority of people would agree to pay extra tax to support this aspect of our health service. We are not ignorant of the deficit and current escalating pressures placed upon the NHS and Local Authorities, all that we want is a sensible plan and some commitment to it from central government.

  9. Dan says:

    I appreciate that this post is more than a couple of years old but has there been any progress made since this time or further statistics published. I believe staff turnover and job satisfaction in the adult care sector is still a major issue.

    • Michael Burke says:

      Many thanks for getting in touch.

      We published a report on the adult social care market in March 2021.

      Paragraphs 22, 3.16 and 3.17 provide an update on the workforce. We concluded that we have not seen any evidence which persuades us to change the main conclusions reached in our 2018 report, The adult social care workforce in England.

      As for data, Skills for Care are responsible for providing estimates of the adult social care workforce. Their latest reports are here Data and publications (skillsforcare.org.uk)

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