Social care: a vision for the future

What are the challenges within the care home sector?

We heard from the larger care groups - Four Seasons, HC-One, Sanctuary Care and Barchester on challenges faced by care providers and proposed solutions.

Providers are concerned about the stability of the market due to the lack of long-term funding solutions and the reduced fees paid by local authorities which puts pressure on self-funders who are charged more for their care. The lack of prioritisation of social care by the Government was often mentioned, as well as the Government's lack of vision for the health and social care system as a whole and the interplay between the NHS and social care.

The sector has consistently faced recruitment challenges in the form of high staff turnover and vacancy rates, a message voiced loud and clear at the event. It is widely known that the detrimental effects that this can have on the sector. The issue stems from the perceived low status of care workers, low pay and the need for more training and support.

The mood amongst providers was one of over-regulation and under-investment in the sector. It was impossible to avoid the topic of the criticisms faced by the CQC of its new regulatory regime, the Single Assessment Framework. Aside from that, of particular note was the CQCs new expectation of care providers to demonstrate how they are reducing their environmental impact and meeting the Environmental Social and Governance (ESG) requirements under the Well-Led quality statement of the Single Assessment Framework (and Regulation 17 - Good Governance).

Notwithstanding the challenges in the sector, there are innovative companies who are prepared to take a long-term view and invest in the sector and financial institutions. Lloyds Capital prepared to advance capital for such investment from their healthcare fund - particularly in technology projects involving the moving of hospital care to the community. The vibe from the discussions indicated more favourable market conditions with a more stable government, lower interest rates and inflation.

What solutions were suggested?

There were many suggested solutions - some focused on the care sector, others on the NHS and some solutions on how both sectors work together. It was highlighted many times not only the lack of investment in social care but the worrying state of the NHS. Shared opinion was that the private sector is filling in the gaps and capacity issues within the NHS, but to achieve NHS recovery private sector investment is essential.

Another money related solution suggested was increased funding to support recruitment and retention of staff in the sector; but also the need for more national social care recruitment drives and recruitment drives focussed on recruiting more men into the sector. The solutions were not solely focused on money per se, such as the education, training and development required to support individuals to work in the sector. Barchester has gone as far as to set up its own academy for its staff. However, a national initiative is required.

Despite the challenges, it was acknowledged that putting residents first is vital. From the outside looking in - a good reputation can assist care providers in negotiations with local authorities. However, the internal culture is what matters most, and will inevitably lead to a good reputation. Naturally, this requires maintaining high standards and learning lessons when things go wrong - an example provided was learning from inquests.

How likely are we to see reform?

The sector is placing hope in the Skills for Care - Work Force Strategy developed with active sector players, with the aim of improving the quality of roles in adult social care. The strategy showed that the sector has a vacancy rate three times higher than the wider economy and that international recruitment is key to workforce growth. The strategy addresses both short and long-term requirements and was designed to complement the existing NHS Long Term Workforce Plan. Skills for Care has expressed its desire to work with the Government on its plans for social care.

International recruitment has increasingly been a sticking plaster for workforce challenges faced by the sector, but visa changes threaten recruitment. From 11 March 2024, care workers arriving from outside the UK, were no longer allowed to bring family with them on their visa. Following the visa rule changes, the number of Health Care Worker visas granted decreased dramatically, demonstrating that international recruitment is a short-term solution to a deep-rooted problem. Domestic recruitment and retention are necessary, especially when the sector's vacancy rate was high during record levels of international recruitment.

The Employment Rights Bill featured in discussions on the day. The sector has voiced that zero-hour contracts are not necessarily 'exploitative' but provided bank staff with flexibility which would be missed if they were 'forced' to accept permanent contracts. The Adult Social Care Negotiating Body will agree minimum levels of terms and conditions, including pay rates, which will then be binding on social care employers. This will be closely watched, as the intention to pay above the National Minimum Wage, which is set to increase from £11.44 per hour to over £12 per hour in 2025, needs to reconciled with the reduction in pay gap between frontline and senior staff which could lead to reduced take up of senior roles, as well as the lack of funding in the sector to pay for the proposed increase.

Recommendations for care providers

There are no quick fixes to the challenges faced in the sector, but sector leaders are pushing for both short- and long-term solutions. As a provider, keeping residents at the centre of all you do will result in the maintenance of high standards and a good reputation which is valuable when negotiating preferential terms with local authorities to stop businesses running at a loss, sale of the business or even insolvency. Also, keep up to date with the changes in immigration and international recruitment to ensure safe recruitment practices and compliance with regulatory requirements.

We will continue to provide updates on many of the areas covered in this article. Do contact us if you require more information or support; as a firm we have the experience to assist care providers in meeting these challenges.

For more information, please contact Michael Delaney in our Employment team on 07909 912 564, or Gemma Nicholas in our Healthcare team on 07747 481 986. Alternatively, please complete the form below.