We’ve said it for so long, it’s beginning to get tiresome. We’re facing a crisis in care of monumental proportions. The system is creaking. We need more people to take on caring roles to meet the needs of an ageing population.
According to the International Longevity Centre, we may need to more than double the current homecare workforce of around 600,000 over the next decade. At the commission on the future of the homecare workforce, Shereen Hussein of King’s College London said she wasn’t optimistic about our ability to meet that demand without some significant changes.
This commission, led by Paul Burstow MP, is focusing on the homecare workforce. He is also leading a review on residential care – we are finding many of the same issues. Indeed, they are often the same workforce – transitioning between residential and homecare as personal circumstances change.
Care workers are paid badly, have little autonomy or chance of career progression and are part of an oft-maligned workforce. Recent scandals in residential care have highlighted negligence and abuse. It’s absolutely right that poor and sometimes criminal practice should be exposed, but we do little to highlight or reward the often excellent care that many people provide while working for low wages and with terms and conditions that few would willingly accept.
Health and social care should be more closely integrated through strategic planning and day-to-day practice, but this means asking care workers to deal with increasingly complex needs without a system for registration or widely recognised accreditation as care workers become more skilled and experienced. Bouncers and hairdressers are registered, care workers aren’t.
There’s no getting around the money issue as we’ve discovered. We’ve heard from Angeleça Silversides of HealthWatch Kensington and Chelsea how in high-cost, high employment areas it’s difficult to recruit and maintain a high-skilled workforce never mind the higher-skilled workforce required for integrated care. Colin Angel of the UK Homecare Association said that very few councils are paying the recommended minimum hourly rate of just over £15 per contact hour – which is making it hard for homecare providers to pay well, provide training and make enough profit to stay in business.
We could redesign the system so it’s fit for purpose and does what we want homecare to do – help people live dignified and independent lives for as long as they can in a place that’s familiar to them. We must make that opportunity now. Alan Long, executive director of Mears Group, said: “When Mears entered the homecare market we thought we could deliver change that would support well-paid, well-trained workers delivering the right care. Too often we have felt constrained by a system that’s time and task focused and leaves little discretion to workers or providers.”
Despite the fact that social care represents a huge proportion of council spend, there isn’t much room to change in terms of cash. Local authorities are genuinely constrained by finance and competing priorities. Mat Hunter of the Design Council thinks there is slack in the system, but the capacity for change is in thinking in new ways. This has to centre on that vital relationship between care worker and care recipient – only by addressing the needs of the workforce can we have the workforce we need.
The social care workforce of the future must reward and recognise care workers and give them certainty and a career path. Integration can save money through preventing hospitalisation and residential care, but a well-trained and sustainable sector will almost certainly require more money in care. More importantly, though, there must be a will to change, in order to adapt to the needs of a changing society.