Conclusions and recommendations
Introduction
1.The case for making a sustained investment in social care has never been stronger–the toll the pandemic has taken on this sector means that social care is no longer a hidden problem, but one that the country as a whole understands. We urge the Government to now address this crisis as a matter of urgency. (Paragraph 10)
Current funding problems in social care
2.It is clear from the evidence we have heard that funding shortfalls are having a serious negative impact on the lives of those who use the social care system, as well impacting the pay levels of the workforce and threatening the sustainability of the care market. An immediate funding increase is needed to avoid the risk of market collapse caused by providers withdrawing from offering services to council-funded clients and focusing exclusively on the self-pay market. (Paragraph 32)
3.The crisis in social care funding has been brought into sharp focus by the COVID-19 pandemic, and this must now be addressed by Government as a matter of the utmost urgency. The funding increase we are calling for is significant at a time when public finances are likely to be stretched, but the pandemic has made it clear that doing nothing is no longer an option. Providing adequate funding for social care will also help the NHS, and may itself have positive economic and long-term social impacts, given that social care is an important part of the economy. (Paragraph 35)
4.We believe the starting point must be an increase in annual funding of £3.9 bn by 2023–24 to meet demographic changes and planned increases in the National Living Wage. However such an increase alone will not address shortfalls in the quality of care currently provided, reverse the decline in access or stop the market retreating to providing only for self-payers. Further funding to address these issues is therefore also required as a matter of urgency. (Paragraph 36)
5.Alongside such a long term funding settlement we strongly believe the government should publish a 10 year plan for the social care sector as it has done for the NHS. The two systems are increasingly linked and it makes no sense to put in place long term plans for one without the other. Failure to do so is also likely to inhibit reform and lead to higher costs as workforce shortages become more pronounced with higher dependency on agency staff. Reducing the 30% turnover rates typical in the sector will also require a long term, strategic approach to social care pay and conditions. (Paragraph 37)
The social care workforce
6.It is vital that the supply of PPE to social care providers is protected in the event of any future surges of coronavirus so that providers can be confident in their access to PPE. (Paragraph 43)
7.The Government must ensure that standards for weekly testing for care home staff are maintained including rapid turnaround times and that regular data is published on the number of tests delivered to social care staff and residents. In addition, the Government should consider extending routine testing beyond care homes to other care settings, particularly domiciliary care and consider including a named key relative in routine testing. (Paragraph 45)
8.Improving the level of recognition afforded to social care workers must be a key focus for the Government to safeguard the future of the social care workforce. Not to do so would be to fail the many thousands of care workers who have worked so tirelessly during the coronavirus pandemic. Building on initial steps such as the CARE badge and recruitment campaigns for social care, there are a number of practical changes which the Government must make to improve the level of recognition felt by social care professionals and to support the future sustainability of the workforce. These are detailed below and in our recommendations. (Paragraph 49)
9.We welcome the Government’s commitment to bringing forward a long-term solution to low pay in social care. It is essential that this solution provides a sustainable basis for continued rises in pay above and beyond increases to the National Minimum Wage and in line with increases given to NHS staff. Evidence from the Health Foundation and others demonstrates that this must be supported by investment: the Health Foundation estimates that to increase the average pay in social care to just 5% above the National Living Wage, while meeting future demand, would cost an extra £3.9bn per year by 2023–24. (Paragraph 54)
10.The Government must use the forthcoming Spending Review to ensure that there is a sustainable funding settlement to provide for competitive pay for social care workers which ensures parity with NHS staff and is reflective of the skilled nature of social care work. Parity could be achieved by linking social care pay to equivalent bands of the NHS Agenda for Change contract and introducing meaningful pay progression. (Paragraph 55)
11.Inadequate employment conditions undermine the sustainability of the social care workforce and have been brought into sharp relief by the coronavirus pandemic. As well as addressing issues of pay within the social care sector, we recommend that the Government bring forward proposals to support the improvement of employment conditions in the sector, including reducing the over-reliance on zero hours contracts and improving the provision of sick pay. (Paragraph 58)
12.The Secretary of State has committed to increasing the alignment between the training of NHS and social care staff and his stated ambition being to make it easier for a registered nurse, for example, to move between the NHS and social care is an important one. We await more detail about how this increased alignment will be achieved. It is important that this increase in alignment of training is not focused solely on nurses and other social care workers with a registered qualification, or allowing care staff to more easily move to higher paying roles in the NHS. Establishing a clear career path with substantial training opportunities, more effectively aligned with the NHS is vital for all entrants to the social care workforce. (Paragraph 62)
13.As part of its long-term proposals for the future of social care, we recommend that the Government work with Skills for Care and the social care sector to bring forward a plan to streamline the training of social care workers in order to improve routes of entry to the profession and improve career progression for existing social care workers. The plan should include proposals to improve alignment with training for NHS staff and to improve the professional recognition of social care staff. We further recommend that the workforce development fund be expanded to implement the plan, ensuring that all staff are able to access funding for training and career development. (Paragraph 67)
14.The Government must ensure that transitional arrangements are in place to ensure that social care workers can continue to be recruited from overseas for as long as it takes to build sufficient resilience in the domestic supply of social care workers. We agree with the Migration Advisory Committee (MAC) that building this resilience will depend on improving pay and other workforce issues in social care. (Paragraph 72)
15.We are concerned that lower qualified social care workers and those without qualifications at all are not eligible for the new NHS visa, not least because it undermines parity of esteem between the health and social care sectors. The Government should accept the MAC’s recent recommendation to add senior social care workers to the shortage occupation list. We welcome the MAC’s plans to conduct further research on the social care workforce: this research should consider the impact of new immigration rules on the ability of care providers to recruit to less senior roles. (Paragraph 73)
Longer term reform of social care funding
16.The current system is unfair, confusing, demeaning, and frightening for the most vulnerable people in our society, and their families. It is therefore essential that the Government tackle the problems in the care sector as a priority. The success of the reforms in Japan has demonstrated that it is possible for a Government to grasp the nettle and take decisions on social care which, though they may be initially difficult, lead to positive and lasting change which is widely accepted by society. (Paragraph 89)
17.The Lords Economic Affairs Committee’s report makes a persuasive case for the introduction of free personal care. This would cost around £5bn per year, which is only a small fraction of what is currently spent on NHS care. It would also simplify the current confusing arrangements for people who need care, and would put social care on a more equal footing with the NHS by ensuring that all basic care needs are met free at the point of need. Free personal care was also recommended by a joint report of the Health and Social Care Committee and Housing, Communities and Local Government Committee in 2018. (Paragraph 101)
18.We also strongly endorse a lifetime cap on care costs which could be implemented swiftly under the provisions of the Care Act 2014. Such a change would focuses resources on the most severely affected people, protecting those with very high care needs–and remove the injustice which sees the NHS cover certain types of extreme care costs but the social care system not cover others, including those with dementia, motor neurone disease or many other neurological conditions. Any reform package must therefore introduce a cap on care costs to protect people against catastrophic costs. We believe this should be set at the level specified in Sir Andrew Dilnot’s original report, namely £46,000 which will cost around £3.1bn by 2023–24. (Paragraph 102)
19.The COVID-19 pandemic has had devastating consequences both for vulnerable people using social care, and for the committed professional workforce that provide that care. These challenges have been exacerbated by long-standing funding and workforce issues which need to be recognised by the government in a social care reform package that must be brought forward before the end of this financial year. (Paragraph 103)
20.We believe that the starting point for the social care funding increase must be an additional £7bn per year by 2023–24 to cover demographic changes, uplift staff pay in line with the National Minimum Wage and to protect people who face catastrophic social care costs. This represents a 34% increase from the 2023–24 £20.4bn adult social care baseline projected budget at today’s prices. In this report we have not examined how such an increase could be funded but we recognise the challenges involved and the need for innovative thinking to address them. (Paragraph 104)
21.But we are clear that this is only a starting point. It will not provide any improvement in access to care, which is urgently needed and would be improved through introducing free personal care as recommended by previous select committee reports from both the Lords and the Commons, which we continue to endorse as worthy of consideration. The full cost of adequately funding social care is therefore likely to be substantially higher than £7bn, potentially running to tens of billions of pounds. We recognise these are substantial increases at a time of severe financial pressure but the evidence we have heard both from those who use social care, and frontline social care workers suggests that the gravity of the crisis now facing the social care sector requires a bold response if we are to recognise the sacrifices made recently by the social care workforce and—most importantly—look after vulnerable people in our society with the dignity and respect they deserve. (Paragraph 105)
Published: 22 October 2020