In this piece, Dr Jane Lethbridge, University of Greenwich, discusses three solutions for addressing the UK’s social care crisis.
Professionalisation, funding & public engagement: 3 ways to address the UK’s social care crisis
What is the problem?
The social care system in the UK is in crisis. With an ageing population, there is a growing demand for social care. However, in 2021-22 only 1.62 million social care jobs were filled out of a potential total of 1.79 million, resulting in 165,000 vacancies, an increase of 55,000 on the previous year. This reflects major recruitment and retention problems rather than a decrease in demand for care workers, due to low pay and a lack of status. There is a vacancy rate of 10.7%.
In 2021-22, the adult social care sector was estimated to contribute £51.5 billion (gross value added) per annum to the economy in England, an increase of 2% from 2020-21. The 2021 census estimated that there are 5.7 million unpaid carers in the UK and that 59% are women. Estimates of the value of this type of informal care range from £58 billion to £100 billion per year. Social care is an important social and economic sector. Its disfunction affects people’s health, their income and employment prospects and quality of life. Action is needed now.
Solutions:
1. Workforce development / professionalise care work, making social care work a profession with standards and good pay and terms and conditions.
Job quality and care quality are often seen as separate issues but Burns et al, 2016 argue that these two concepts must be considered together. They identified two models of residential care: a person-centred approach where residents needs and interests influenced how care was delivered; and a custodial approach, where residents are assumed to be unable to determine how they would like to receive care and so are passive recipients.
Budget reductions cut the number of workers, increased working hours and work intensification, and directly affected the quality of care. However, in nursing homes with a person-centred approach, care workers tried to shield the residents by reorganising work practices and routines. They worked through meal breaks, worked longer hours for no pay, and arranged to share information. Although their pay and conditions deteriorated, the workers were still consulted, allowed to work flexibly, and still maintained some control over their work. In contrast, in homes with a custodial approach, workers focused on physical care and excluded other forms of care. Management focus was on financial cuts rather than maintenance of care, and on reducing maintenance of the facilities. Workers were unable to voice their concerns.
As well as considering job quality and care, building a sustainable future care workforce has to be a priority. In 2023, 75% of the workforce was aged over 25 years old. The recruitment of more young people into the social services sector is essential in establishing a sustainable social care workforce. As many young people lack knowledge of social care services, several social services organisations in Europe have set up schemes which encourage young people to volunteer and gain experience of social services work.
2. Make care a public service which is free at the point of access – care requires empathy and relationship building
The privatisation of care services in England since 1991, changed the way in which care is assessed and costed so that it became a commodity to be bought and sold. As the care sector is a labour-intensive sector, the main source of profit is generated by reducing labour costs. Care was transformed into a series of tasks that ignored the empathetic and relationship-building skills that are a crucial part of care.
Horton (2019) presented an analysis of how the financialisation of care is impacting on care workers in nursing homes in the UK. The use of debt financing and the sale and lease-back models used by private equity owners of care homes has made the sector more insecure. The indebtedness takes away resources from wages, new infrastructure, and other care services. The demands of investors have placed greater pressure on workers through higher workloads, the imposition of targets, and a reduction in the number of workers. Although local authorities contract care homes, the system of regulation is relatively “light touch” and does not expose them to rigorous scrutiny, nor does it look critically at the way in which care workers are treated. Quality of care also depends on workers being well paid, well trained, supported and able to work in a safe environment. The profit motive undermines the basis of high-quality care services.
The Sutherland report (1999) concluded that the most efficient way of providing care was through the pooling of risk by “services underwritten by general taxation, based on need rather than wealth”. It recommended that personal care should be free but living costs and housing would be met from people’s savings and income, with the means-test level raised to £60,000. Seven reports published since 1999 have set out how social care could be funded but no action has been taken.
Scotland has taken a different approach. The Scottish Parliament’s Health and Community Care Committee accepted that free personal care should be adopted on “the basis of assessed need”. The 2002 Community Care and Health (Scotland) Act 2002 was passed, and free care became available for people aged over 65 from July 2002.
A report by the Joseph Rowntree Foundation in 2007 found that the impact of making care free at the point of access in Scotland had resulted in increased demand for care, although this varied between local authorities. There was still widespread support for free care and people were still willing to pay more taxes to fund it.
3. Introduce planning for care
Access to care services will be important for everyone at some stage in their life. People increasingly want to stay in their own home for as long as possible and be able to influence how and where care is provided. Planning for care should involve citizens, unpaid carers, care providers and local authorities/ voluntary organisations.
As a step towards creating a national care planning system, in 2016, Scotland passed the Carers (Scotland) Act which sets out the rights of carers, and a Carers Charter. Carers have a right to an adult carer support plan or a young person’s carer statement. This defines how much care is being provided, arrangements for future care planning, important “personal outcomes” and locally available support (Scotland, 2016). Carers have the right to be involved in the planning of local services, through direct involvement or a carer representative, and in the hospital discharge process of the person being cared for (Scotland, 2016). Providing carers with rights to influence policy helps to make them visible in society.
About the author
Dr Jane Lethbridge is Associate Professor at the University of Greenwich. She specialises in the analysis of global commercialisation of health and social care and its impact on health and social care workers, social dialogue and trade union responses to liberalisation and privatisation. She was Director of the Public Services International Research Unit (PSIRU) from 2013-2018. She published ‘Democratic professionalism in public services (Policy/Bristol University Press) in 2019. She is a member of the Centre for Research into Employment and Work (CREW) University of Greenwich.
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