The Future Care Workforce - UK

1 The Future care Workforce Ben Franklin February 2014. Contents Summary and 1. Background: The state of the social care sector in 2. The social care Workforce today: some stylised 3. Future demands of the care 4. Barriers to Workforce growth and how they might be 5. Conclusions and Appendix List of roundtable The Future care Workforce I 3. Summary and Recommendations Already a large employer, the adult social care sector in England will need to add approximately 1 million workers by 2025 in response to population ageing and the implied increase in the numbers of people with disabilities. The Workforce will also have to be increasingly diverse in order to deliver a more personalised service to those in need of care and support. While there is evidence of good practice across the care Workforce , there are a number of persistent challenges which could prevent the sector from evolving as required over the next decade. Many of these challenges are likely to be exacerbated by continued fiscal consolidation, which has resulted in local authorities reducing their expenditure on care services.

2 These challenges include: o Workers are typically low paid and there is evidence of some providers curtailing minimum wage laws. o While working in the care sector can be rewarding it can also be emotionally challenging. The vast majority of care workers have faced verbal abuse (93%). and a significant proportion physical abuse (53%). o Staff turnover is generally high, with higher staff turnover linked to an increased chance of death for those in care . o The prevalence of training and qualifications across the sector is low adding to the perception that there are few learning and development opportunities. o Women make up the vast proportion of the care Workforce (80%) and there is also a high proportion of non-British workers ( ). It will be difficult to meet expected demand for care if recruitment focuses solely on these demographic groups. In order to meet these challenges, this report makes a numbers of recommendations including: o While the funding of adult social care is beyond the scope of this report, it is clear that government funding must rise in line with the needs of the population to ensure that more individuals do not slip through the net and receive the care and support they deserve.

3 O The abuse of national minimum wage regulations is clearly unacceptable. But rather than just penalising the guilty providers ex post, we must identify and address the underlying causes of this at an industry-wide level to prevent it from occurring in the first place. Synopsis The Future care Workforce I 4. The Future care Workforce I 4. 1 million England will need to add approximately 1 million workers by 2025. o Reducing staff turnover is not just about pay and terms of employment, but also about ensuring that employees have the right support structures in place to drive career development as well as supporting them through times of stress or abuse in the workplace. o As recommended by the Cavendish Review, a central quality assurance mechanism is required to verify the qualifications of care workers who undertake learning and development with different providers. Being able to take your qualifications with you from one employer to the next is a crucial part of building a social care profession.

4 O Men, older workers, the unemployed and the underemployed can all play a big role in filling the potential supply gap. In order to entice these individuals into the care sector, providers will need to use innovative promotional campaigns to address persisting stereotypes and target underrepresented groups. o The care sector must learn from examples of best practice both from within the sector as well as from other low pay sectors to identify how it can improve staff morale and retention through relatively low cost measures. o Building a strong reputation for quality of staffing must be seen as a key selling point that providers can use to take advantage of the expected increase in requirement for social care over the coming decades. Synopsis The Future care Workforce I 5. The Future care Workforce I 5. Introduction This report is concerned with understanding how demand for adult social care is likely to change over the coming decades, whether the care sector and Workforce is likely to be able to meet this demand, and finally, what we can do to increase the chances of delivering a care Workforce consistent with expected need.

5 In order to achieve these aims, we begin in Section 1 by outlining demographic trends and the funding pressures facing the sector. Section 2 looks at the current state of the Workforce through a review of recent literature and analysis of relevant data. Section 3 discusses the factors that could lead to increased demand for social care over the coming decades and evaluates past growth projections for the Future care Workforce . Section 4 assesses some of the barriers that could prevent the Workforce from evolving in line with expected demand and discusses how to address them. And finally, Section 5 concludes the report and reiterates the recommendations outlined above. We are also fortunate to have been able to include case studies of positive experiences from those working in the care sector both male and female, old and young - to help challenge some of the pre-existing stereotypes about this sector and highlight its benefits. An interim version of this report was discussed by a roundtable group of social care experts in January 2014.

6 We are extremely grateful for their comments which have helped to shape the report's content and recommendations. Nevertheless, the approach, contents and findings of the final report are solely the responsibility of the author. Defining the social care Workforce The first problem to address in this research project is what or who determines the adult social care Workforce and which regions of the UK we should look at. Neither issues are trivial. The rather arbitrary divide between health and social care is well known, while there are significant differences in the funding arrangements and provision of adult social care across UK regions. Ultimately, for reasons of expediency, our analysis refers to the social care Workforce as defined by the National Minimum Data Set on Social care (NMDS-SC). for England. This is a vast data source that contains detailed statistics on the state, size and structure of the Workforce . Consistent with their methodology, the total care Workforce of England encompasses a broad array of care -related occupations including: Social services managers and directors Residential, day and domiciliary care managers and proprietors Occupational therapists Social workers Welfare and housing associate professionals Nursing auxiliaries and assistants Houseparents and residential wardens care workers and home carers Senior care workers For the remainder of this report, when we refer to the care Workforce we are predominantly referring to the people working amongst this diverse array of occupations.

7 The Future care Workforce I 6. 1. Background: The state of the social care sector in England In contrast to the provision of health care which is free at the point of use, public funding of an individual's social care costs in England is decided using a means test. Those with wealth and assets above a certain threshold must cover their own costs of care (self-fund), while those who fall short will receive some financial support from their local authority. There are currently million people receiving state support for care services in England. The majority receive community based care , while some, particularly those aged over 65, are in residential or nursing care . The over 65s account for the largest proportion of publicly funded care users (67%), though the under 65s still account for a significant share (33%) (Health and Social care Information Centre, 2013). There is limited data on those individuals who exclusively self-fund, but estimates from 2011.

8 Suggest that there are approximately 475,000 self-funders (68% domiciliary, 32%. residential home) (Department of Health, 2013). the number of people in England aged 85 or over will increase from million today to million by 2030 . While the number of people receiving publicly funded care has fallen since 2008, it is likely that demand for adult social care will rise in the coming decades, as the number of older people, and particularly the oldest old increases. The Office for National Statistics projects that the number of people in England aged 85 or over will increase from million in 2013 to million by 2030 (Office for National Statistics, 2013a). With the oldest old the most likely age group to have some form of disability, this demographic trend could drive a significant increase in the need for social care over the years ahead. Ensuring individuals of all ages get the care that they deserve must be a key social policy goal. It is not just important for those in need of care , but also for family and friends who often form a bedrock of informal support, sometimes at the expense of their own health and wellbeing.

9 Yet, a world class adult social care system is going to be a significant challenge to deliver, especially in light of continuing cuts to government expenditure. If the long term average annual growth rate in total council spending had been extended over the last three years, expenditure would be 27% higher than it is today . Total council spending on social care in support of older people rose steadily from 1994 to 2010 but it has since fallen by 6%. If the long term average annual growth rate in total council spending had been extended over the last three years, expenditure would be 27% higher than it is today (see Figure 1). Such a substantial downward shift The Future care Workforce I 7. in spending poses immediate problems for councils in allocating resources to meet care needs, for the individuals requiring care and for the social care providers who receive a significant proportion of their revenues from the State. Ultimately this has contributed to an increasing number of people falling outside of the care system (Humphries, 2013).

10 Figure 1. Total council spend on 65+ care services and difference to the level implied by long - run trend 12. 10 27%. 8. billion 6. 4. 2. 0. 1994- 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 95 96 97 98 99 2000 01 02 03 04 05 06 07 08 09 10 11 12 13. Total expenditure Long term trend (based on average annual expenditure growth rate, 1994-2010). Source: The Health and Social care Information Centre and Author's calculations Against this backdrop is the important issue of the care Workforce the people who make 10%a difference to the lives of those in care on a daily basis and therefore one of the most crucial stakeholders in the debate about the Future of social care . 8%. 6%. % changes year on year 4%. 2%. 0%. 2001 Jul 2001 Nov 2002 Jul 2002 Nov 2003 Jul 2003 Nov 2004 Jul 2004 Nov 2005 Jul 2005 Nov 2006 Jul 2006 Nov 2007 Jul 2007 Nov 2008 Jul 2008 Nov 2009 Jul 2009 Nov 2010 Jul 2010 Nov 2011 Jul 2011 Nov 2012 Jul 2012 Nov 2013 Jul 2001 Mar 2002 Mar 2003 Mar 2004 Mar 2005 Mar 2006 Mar 2007 Mar 2008 Mar 2009 Mar 2010 Mar 2011 Mar 2012 Mar 2013 Mar -2%.