Stretching the limits of social care

Demand for services for older people means the social care sector is growing, but how will it cope with the challenges of recruitment, funding and regulation? David Brindle reports

Social care is booming. This may seem strange, given its well-publicised funding crisis, but demand for care and support of the growing numbers of older people is driving growth in the sector at a rate that most of the rest of the UK’s recessionary economy would dearly love to share.

New figures from Skills for Care, the sector skills agency, suggest that an estimated record 1.63 million people were employed in adult social care in England last year. They worked in 1.85m “job roles”, a figure up 4.5% on 2010 with the increase attributed largely to a 15% rise in personal assistants recruited by people taking personal budgets in the form of direct payments.

The number of organisations providing social care services is put by Skills for Care at 22,100, an increase of 1% on 2010, despite commercial problems exemplified by the collapse through financial mismanagement of Southern Cross, which was the biggest care home chain. Investors have proved undeterred by the headlines, focusing instead on the underlying demand growth and snapping up the Southern Cross homes and any others that have come on the market.

All is not rosy

The National Children and Adult Services conference, the annual summit of the social care sector, opens today and is being co-sponsored by HC-One, the largest company to rise from the ashes of Southern Cross. Its presence at the sector’s policy high table this week is a timely reminder of just how deftly the collapse was dealt with, largely by the sector itself, little more than 12 months ago. All but a handful of homes were transferred smoothly and no resident was rendered homeless.

But not all is rosy in the social care garden: far from it. Growth is itself a source of difficulty in that it is running in line with Skills for Care’s previous forecast that, short of any unexpected game-changers, the sector may need to employ as many as 3.1 million people by 2025 – a staggering and seemingly impossible-to-achieve number.

To get anywhere near that figure the sector will need to radically change its recruitment practices. At present, 82% of employees are women and only one in five is under 30. More than 50% are aged between 40 and 60, with the average age being 43. This is surely far too narrow a profile, especially with employee turnover rates running at a typical 19% a year, but the job suffers from an image problem that deters young and male candidates.

Funding continues to be a huge issue. Although the coalition government has now apparently endorsed the idea of a cap on individual liability for care costs (but not for costs of board and lodging in care homes), there seems to be deadlock with the Treasury on how such a cap should be funded, whether it should be universal or voluntary, and whether it should be set at the level of £35,000 as recommended by the Dilnot commission.

In an interview for this supplement, Lib Dem care services minister Norman Lamb digs in on the principle of universality and, while saying he retains an open mind, pours cold water on the idea of funding or part-funding from existing NHS or social care budgets. Such a prospect, he says, is “difficult to imagine”. He may, however, need to call in independent testimony to convince the Treasury.

While the deadlock persists, care fees continue to rise and people in parts of southern England are being quoted as much as £2,000 a week for a bed in a nursing home. According to market analysts Laing & Buisson, 41% of people in care homes are now fully responsible for their own fees, and 55% are paying all or part of the fees as the state’s funding role diminishes.

A third persisting challenge is regulation, highlighted by both the Southern Cross affair and the scandal at Winterbourne View, the former long-stay private hospital near Bristol for people with learning disabilities – 11 former staff this week face sentencing for their roles in a shockingly abusive regime.

The prospect of a repeat of either episode terrifies ministers, so we can expect to hear soon of moves to toughen economic regulation of the sector, improving early warning of the kind of financial problems Southern Cross ran into, and cracking down on Winterbourne View-type units in the independent sector. Common to both agendas may be efforts to hold the owners of care companies, as well as senior management, to account for negligence.

Lamb talks in his interview of setting down a “very firm line” in the government’s final report, due shortly, on the policy implications of the Winterbourne View scandal. That line is expected to be significantly tougher than anything said previously. Whether it extends to ordering NHS and council care commissioners to stop using private long-stay units will be a fascinating test of the coalition’s commitment to localism.