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12 April 2017

Opinion piece by Holly Dagnall: My views on the recent 'damning' government report on Adult Social Care

Holly Dagnall, NCHA’s Director of Care and Support, responds to the latest Communities and Local Government Committee report on adult social care.

"On the 31 March 2017, the Communities and Local Government (CLG) Committee report on Adult Social Care was published. The Independent Newspaper called it a ‘damning report’. The report focuses on some specific areas of concerns and echoes the issues that providers like ourselves have been raising for a number of years.

"It is not at all surprising to read that the report finds that inadequate funding very seriously affects the quantity and quality of adult social care provision. The report draws particular attention to some shocking key facts noted about the workforce. For example:

  • 47.8% of care workers leave within a year of starting (NCHA is 34%);
  • The median hourly pay for a care worker is £7.40 (NCHA is £8.16 16/17 rates);
  • 49% of home care workers are on zero hour contracts, compared with 2.9% of the workforce nationally (NCHA is 9%);
  • 27% of care workers received no dementia training and 24% of those who administer medication were not trained to do so (100% of our staff receive Dementia Friends training and for those staff working with individuals with dementia, specialist training is provided. 100% of our staff delivering medication have medication training and annual refreshers).

"In Care and Support, we benchmark ourselves regularly against other providers across the region and nationally to ensure we stay ahead of other providers in terms of pay, terms and conditions of employment and good working practices.

"We do this both because we believe it is the right thing to do and because we have a strong commitment from our Board of Management to do so. I’ve highlighted the how NCHA compares in red above.

"Importantly we attempt to reach the right balance of providing services at a price which local authorities will pay, whilst protecting, as far as we can, a competitive pay and benefits package to our staff. It is not an easy balance to reach. 

"Over the last year we have had to hand back care contracts to local authorities, and transfer over 100 staff from NCHA Care and Support to other providers where we just couldn’t afford to continue to deliver the services at the prices the Local Authority is prepared to pay, whilst maintaining our pay levels.

"We are not alone. The CLG Committee report also found serious threats to care providers’ financial viability, which means providers failing, exiting the market and handing back contracts for provision of care service. Also that the pursuit of low fees is the driving factor in commissioning for many councils and has this undermined their relationships with care providers.

"The report also notes a trend which we recognise only too well. Councils are providing less support and where support is commissioned, it is concentrated on those with the highest needs. This is significant for us both in terms of the impact this has when we are managing shared accommodation for individuals with very complex needs and behaviours, and in the pressures managing only very complex care packages for people has on our staff and managers; a fact that only makes recruitment and retention in our sector harder.

"There are glimmers of hope on the horizon though!

"Firstly the CLG Committee welcomed the additional £2bn promised by the Chancellor to help fund social care over the next three years. Whilst it is noted that it falls short of the amount required to close the social care funding gap, it is a step in the right direction and the report makes further recommendations for more funding for the future.

"It is certainly the case that providers like NCHA, with much better terms and conditions of employment and pay levels for staff, are under pressure when trying to develop and retain services from a cost perspective. However, we have had some success in growing some services and we continue to be a provider of choice for a number of local commissioners, despite our higher costs. So we are starting to buck the low cost / low value trend. It is reasonable to assume that this will continue as more money comes in to the social care system over the next three years.

"Finally, poor quality commissioning is recognised as a real barrier to market development, innovation and quality. The CLG report recommends a much closer emphasis on better quality commissioning and market shaping from the Care Quality Commission to Local Authorities. Commissioning practice is something that at NCHA Care and Support we are increasing frustrated with, so I really welcome this recommendation.

"The next step is the Government announcing a Green Paper on the long term funding of social care. The purpose of a Green Paper is to promote discussion and propose possible causes of action in terms of policy and legislation. It is likely that some fairly radical proposals involving increased taxation will be on the table. The challenge will be whether this government can succeed, where so many others have failed, to any get cross party support to properly tackle the funding gap for social care."

Notes:

Communities and Local Government Committee – Adult social care report published on 31 March 2017 is available to download as a PDF here: https://www.publications.parliament.uk/pa/cm201617/cmselect/cmcomloc/1103/1103.pdf (opens in a new window)

Communities and Local Government Committee – Executive summary: Adult social care https://www.publications.parliament.uk/pa/cm201617/cmselect/cmcomloc/1103/1103-executive-summary.pdf (opens in a new window)