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Achieving a better-paid, better-trained social care workforce

David Pearson, president of the Association of Directors of Adult Social Services, talks to PSE about the challenges and opportunities facing social services in England.

Social care is a statutory, demand-led service – but one where cuts can have particularly devastating effects on the wellbeing of society’s most vulnerable people.

PSE spoke to David Pearson, the president of the Association of Directors of Adult Social Services (ADASS), just after his organisation produced its annual budget survey which painted a bleak picture of the sector’s financial future.

Since 2010, spending on social care has fallen by 12%, while 14% more people are seeking support. This has forced departments to make savings of 26% in their budgets – the equivalent of £3.53bn over the last four years.

Additionally, based on returns from 95% of adult social services departments, the survey shows that despite the “very welcome help adult social care has received from central government, and the faith and finance that local councillors have invested in us as well” the cash invested in services will reduce by a further 1.9% in 2014-15: a sum equivalent to £266m.

Unsustainable

The ADASS report concluded that if the current budgetary pressures continue, adult social care services in England will soon be ‘unsustainable’. Pearson told PSE: “There has been a huge amount of creativity and innovation in social care: local authorities providing better advice and information, and services to help people get back on their feet; the use of exciting technology; the creative use of personal budgets. We are leading the way in terms of innovation in public services.

“There is also the aim to join up services with the health service through the Better Care Fund (BCF) and other arrangements, which we support in terms of delivering better outcomes. This can be a way, if targeted appropriately, of making better use of the public purse.

“However, our survey highlighted that directors were extremely worried and concerned about the fact that fewer people would be able to access support in the future; that councils may face increasing legal challenges; and the fact that such financial difficulty will increase the risk of provider failure. We also might not be able to help the NHS with their pressures as much as everybody would like. That was a significant concern.”

He said the Care Act 2014 is “fantastic” and has rightly received widespread support from across the care sector, as it acts as a great platform for the next 20-30 years.

Pearson added that everyone wants to ensure the aspirations of the Act are met. But to do this, he believes there needs to be a sustainable funding platform for social care – “which, I hasten to add, was only 2% of public expenditure in 2010-11 and has gone down, despite needs increasing”.

Protecting and commissioning services

The ADASS president was keen to acknowledge the hard work local authorities have done to protect social services. “On average, the expenditure of councils with social care responsibilities has moved from 30% to 35%. But councils are having to make difficult decisions between various competing and vital services,” said Pearson.

PSE was told that there are lots of directors and authorities across England already benchmarking their costs and comparing their services with others to ensure they are doing everything they can within the current financial envelope.

Pearson said: “However, at the end of the day, there needs to be greater investment or at least a reduction in the level of cuts in the future – as they are expected to continue. We don’t see any alternative, other than a modest re-prioritisation of public expenditure to ensure the needs of the most vulnerable in our communities are properly met.

“We are one of the richest countries in the world and it seems a reasonable suggestion that we should fulfil our responsibilities in this way.”

ADASS will continue making the case for greater investment in the sector. And, during this year’s National Children and Adult Services Conference 2014 in October, the organisation plans to delve deeper in the Commissioning for Better Outcomes initiative.

“This is all about what good commissioning looks like in response to both the budget and procurement survey,” PSE was told. “This particular piece of work is in response to some of the criticism there has been with regards to local authority commissioning, which has taken place in the context of the budgetary reductions I’ve already mentioned.”

BCF changes

Recently the Department of Health also made changes to the £3.8bn BCF – meaning that up to £400m will be used to effectively ‘compensate’ acute hospital trusts if local plans fail to cut admissions.

However, the alterations were not welcomed by ADASS. It warned that the management part of the fund will “move us further away from a model which balances clear expectations from government with local ability to make them happen”.

Talking to PSE about this, Pearson said: “We are extremely positive about the concept of BCF and joining up services locally. But we were disappointed about the changes to the fund for a number of reasons.

“First, it reduced the level of local discretion. Secondly, social care indicators were relegated and excluded from the overall framework. We thought that a more balanced partnership would be involved, including social care indictors, as well as acute hospital admissions.

“The other aspect of this is that in order to make progress, everybody in the local area is going to have to put their shoulders behind the wheel and actually contribute to transforming services at a local level. A greater level of investment in community-based services will be required if we are going to keep and treat older people at home more than they are now.”

Employer standards

In the June/July 2014 issue of PSE, Sue Messenger, head of workforce at the Local Government Association, talked about the re-launched standards for employers of social workers. The revised version, she said, better reflects the changing context within which public services are being delivered – with a greater focus on partnership working.

Pearson, who is a qualified social worker, said the revised standards set out a ‘template’ for what good employment of social workers is all about.

He also believes the standards are vital in helping make sure that social workers are properly supported, especially in areas like continued professional development, and effective and appropriate supervision.

“We know that a confident, engaged, motivated and skilled workforce is at the heart of what we need to ensure is within social care and health over the next few years,” said Pearson. “We are firm supporters of the new standards in terms of refreshing our commitment to the workforce.”

Future services

Looking to the future, Pearson told PSE: “I would like to see – thinking of the whole health and social care integration – greater parity of esteem for the social care workforce in relation to health.

“What I mean by this is that there are 1.3 million staff working in the health service and 1.5 million people working in social care.

“We have Health Education England, which has a £5.2bn budget. Admittedly, a lot of that money is rightly used to develop and train very highly-skilled doctors and other staff in very complex processes that keep people alive – and that’s absolutely right. However, if you compare that level of investment with how much is invested in the training and development of social care workers, the difference could not be starker.”

He argues that if we want to have a social care workforce integrated as far as possible with health – in a way that we can be proud of – there needs to be greater investment in the training and development of the social care workforce and their overall pay and conditions.

Pearson added that under Section 5 of the 2014 Care Act, local authorities “must promote the efficient and effective operation of a market in services for meeting care and support needs” and ensure that market is sustainable. They must also understand the working conditions of staff across the sector and that those conditions are commensurate with high-quality care.

“My vision is a workforce that has a better level of remuneration, overall, for the work they do; better career structures that will make it easier for people to progress in social care and health – the National Care Certificate is a starting point for that; and one in which there are clear expectations about the level of training and investment for the development of care workers,” said Pearson.

“This is imperative, as we know that investing in training and development today will make a huge difference to the quality of care for tomorrow.”

ADASS Budget Survey 2014

Extract from the report:

Despite everything that is being done to prioritise adult social care, the cash invested in adult social care will reduce by a further 1.9% (£266m) in 2014-15 to £13.68bn. This is the third year of continuing cash reductions and the fifth year of real terms reductions in spending. These five years of real terms reductions in adult social care spending continues to contrast sharply with the health service, which has received real term protection of its spending over this same period. The commitment to partially address this through the Better Care Fund for 2015-16 is very welcome. But the continuing scale of reductions in funding to local government in the same year is a cause for extreme concern.

…Even with all budget reduction pressures councils face, councils have continued to prioritise Adult Social Care and secure increasing value through:

• Protecting investment in prevention – with the cash sum largely the same in 2014-15 compared to 2013-14 – at £923m – although still only 6.8% of the net budget;

• Funding 83% of demographic change of £391m;

• Seeking further efficiency savings of £679m – a 4.9% saving;

• Minimising the impact on the income of people supported – so charges just increasing by £36m largely through changes in national charging arrangements;

• Use of NHS transfer to protect frontline services (49% allocated to protect services in 2014-15 compared to 32% in 2013-14).

…Councils are increasingly concerned about the future as a result of this planned reduction in funding. For 2015-16, even with the BCF (although not new money across health and social care) for the first time significantly more directors agree than disagree that:

• Fewer people will be able to access support;

• Councils will face increasing legal challenge;

• Providers will face financial difficulty with increasing risks of provider failure or worse; and

• The NHS will come under increasing rather than reducing pressure.

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