UK 'cannot afford' more broken promises on social care

DHSC must produce a reform plan and workforce strategy after years of promising to do so, MPs say
Care workers suffer a "lack of parity with the NHS in terms of pay, conditions and status”, the MPs said. Photo: UrbanImages / Alamy Stock Photo

The UK “cannot afford” any more broken promises by the government on social care reform, a committee of MPs has said.

The Department of Health and Social Care must urgently set out plans to overhaul social care and help providers recover from the Covid-19 pandemic, the Public Accounts Committee said in a report yesterday.

The devastating report paints a picture of a system plagued by a lack of long-term planning, clear information and workforce strategy, with poor oversight and communication between local and national government.

Successive governments have “failed to deliver” vital reforms to a sector that is in desperate need of extra funding, innovation and is too focused on the needs of older adults in care homes, rather than on supporting people in their own homes, it said.

The sector has also suffered from a lack of long-term funding, with local authorities seeing a 29% cut in spending power since 2010-11, it added. The government has announced a series of ad-hoc funding increases in recent years, but that lack of certainty has constrained local authorities’ and providers’ ability to plan for the longer-term. This has constrained providers’ ability to invest in staff training, new accommodation and technological innovation, the committee’s inquiry found.

Meanwhile, DHSC has had poor oversight over local authorities’ provision of care and “appears complacent about the risks of local market failure”, the report said.

The department only collects financial details on around 65 large national providers, via the Care Quality Commission, “which means it does not have a good grasp of how most providers on the ground are faring”, it said.

And now the costs of Covid-19 and a fall in care home occupancy from around 90% at the start of the pandemic to 80% by February 2021 has put many providers at risk of failing, according to the report.

It said while short-term funding provided by the government through local authorities and the Infection Control Fund has stabilised the market, and data around the funding is poor.

“The department does not have a strong grip on the variable levels of support that individual providers received and there have been some reports of providers struggling to access some of the additional funding,” the report said.

The government has committed further short-term funding and free personal protective equipment for care homes until the end of March 2022 – a “welcome development”, the MPs said – but the department “does not have a roadmap” for longer-term support.

The Care Quality Commission has warned that the sector is likely to need extra ongoing support in 2021-22 if care home admissions remain low or if costs rise.

DHSC has a team of officials working on a reform plan. However, the MPs noted that they “do not yet know how ambitious these reforms will be”.

“We are heartened that the department accepts the need for further innovation and acknowledges opportunities around home care. Care policy cuts across many other policy areas and therefore government activity,” they said.

“It remains to be seen whether the government can seize the opportunity to break down silos that can exist across government and finally deliver the comprehensive reforms we need.”

They urged the department to set out a “comprehensive, cross-government reform plan for care” by the end of this year, with “as much focus on support for carers and supporting people at home as on older adults and care homes”.

The reforms should be accompanied by a national strategy for the care workforce that sits alongside the NHS People Plan, the MPs said – noting that DHSC promised to produce a workforce three years ago and has not delivered.

The strategy must tackle “low pay, improve career development and tackle unacceptably high turnover”, the report said, adding that care workers “suffer greatly from a lack of parity with the NHS in terms of pay, conditions and status”.

Summing up their findings in the report, the MPs wrote: “We cannot afford more broken commitments around care reform; now promised sometime in 2021. Reforms must address decades of neglect over support to carers, younger adults and home care. A long-term funding plan should be part of this, to allow local authorities and providers to innovate and improve services.

“The care workforce deserves better treatment. The department must finally step up and produce a workforce strategy which tackles low pay, supports career development and aligns care with the NHS.”

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