Written evidence submitted by Mencap (WBR0068)

 

 

About Royal Mencap Society and learning disability

 

Mencap is there for the 1.5 million people with a learning disability in the UK and their families and carers. Mencap fights to change laws and improve services and access to education, employment and leisure facilities, supporting thousands of people with a learning disability to live their lives the way they want.

 

A learning disability is caused by the way the brain develops before, during or shortly after birth. It is always lifelong and affects intellectual and social development.

 

About our representation

 

  1. Mencap welcomes this timely inquiry and the Committee’s interest in the health and wellbeing of not only healthcare staff but also those that work in social care.

 

  1. As England’s largest provider of social care to people with a learning disability we have seen first-hand the levels of pressure the workforce was under before COVID-19 and how this has worsened during the pandemic.

 

Social care workforce

 

  1. The social care workforce is highly-skilled and holds a huge level of responsibility for the wellbeing and safety of vulnerable adults. They are trained to provide medication, to undertake peg feeding, to deal with seizures and administer first aid.

 

  1. They also provide non-medical support such as helping people to manage their finances, their health and their wellbeing and provide emotional support.

 

  1. They operate in a highly regulated sector and have to understand health and safety, mental capacity and deprivation of liberty law, safeguarding and often how to positively manage challenging behaviour.

 

How resilient was the NHS and social care workforce under pre-COVID-19 operating conditions, and how might that resilience be strengthened in the future?  

 

The social care workforce was already under significant pressure before the challenges presented by COVID-19.

 

 

What has the impact of the COVID-19 pandemic been on resilience, levels of workforce stress, and burnout across the NHS and social care sectors?  

 

  1. COVID-19 has had a dramatic impact on the social care workforce as many have either caught the virus, have had to support those who have caught the virus and adapt traditional forms of care and support to ensure the people they support remain safe but also healthy and happy.

 

  1. The fact that is has taken a global pandemic for this workforce to become more widely recognised and understood reveals both the under-appreciation that many in the sector feel as well as the lack of understanding among the public about what social are is and what it is like to work in the sector.

 

  1. We very much hope that the greater attention given to social care during the pandemic has shone the value of the social care workforce which is going above and beyond to create a sense of normality and community. In some cases, they are the only contact some people have. 

 

  1. A significant number of our staff have been forced to self-isolate, shield and have even caught the virus itself. The dangers and risks of working in social care during this pandemic can be seen in the tragic deaths of care and support workers across the country.

 

 

What is the current scale of workforce burnout across NHS and social care?  How does it manifest, how is it assessed, and what are its causes and contributing factors?  To what extent are NHS and care staff able to balance their working and personal lives? 

 

  1. Like those in the NHS, the social care workforce continue to be on the frontline of the pandemic and in many areas still operating under varying levels of lockdown.

 

  1. As significant factor in social care workforce burnout is the large number of vacancies in the sector. The CQC found that “staffing levels and pressures on staff time can have an impact on the quality of care people receive”. This has created situations where “staff have not always been able to identify and meet people’s specific needs”[1].

 

  1. While many understand that there is a staff shortage, the scale of this is often underestimated. The Health Foundation found that the adult social care sector current faces a shortage of around 122,000 staff with an estimated 1,100 people leaving the sector each day[2].

 

  1. The shortages in the workforce are not only limited to certain role or levels but are widespread. The CQC found from 2014/15 to 2018/19 vacancy rates for ‘Senior Care Workers’ has risen from 3% to 6% and for ‘Support and outreach’ roles vacancies rose from 5% to 8%[3].

 

What are the impacts of workforce burnout on service delivery, staff, patients and service users across the NHS and social care sectors?  

 

  1. Workforce burnout in social care is not a new phenomenon to the COVID-19 pandemic but has been present through the past throughout the last years. What we have seen during ‘lockdown’ is the exacerbation of this underlying problem which is having a dramatic impact on staff as well as on those who rely on social care.

 

  1. The scale of workforce burnout was revealed in a 2018 NHS Staff Survey which found that nearly 40% of respondents has felt unwell due to work-related stress.

 

  1. This has resulted in a reduction in care capacity that is having a detrimental impact on the ability of the workforce to provide quality care[4]. In their 2019 report the CQC found that, 15% of adult social care providers required improvement and 1% were rated as inadequate[5].

 

  1. It is important to remember that even in those services rated as good, issues of quality remain with the CQC finding that many people continue to report struggling to access care in these settings[6].

 

 

What long term projections for the future health and social care workforce are available, and how many more staff are required so that burnout and pressure on the frontline are reduced? To what extent are staff establishments in line with current and future resilience?

 

  1. If the social care system continues to be underfunded, there is a real danger that the pre-existing pressures on social care staff will increase over time.

 

  1. An article by Glasby et al entitled ‘A lost decade? A renewed case for adult social care reform in England’, predicts that, if the Government continues to under-invest in the system, they will end up paying £3.3bn extra in social care costs just to stand still as a result of increased demand.

 

  1. However, FOI requests that Mencap sent out to all local authorities revealed that the situation is, in fact getting worse rather than better. At least 2,459 working-age adults with a learning disability had the support hours in their care package reduced in 2018/19. Factoring in all Local Authorities, this could have been over 7,000 people - equating to around one in 20 people with a learning disability who receive social care. This will likely result in a huge increase in unmet need as well as numbers of people with complex needs.

 

  1. Social care staff will bear the brunt of this impact and there could be a considerable detrimental impact on their ability to meet needs in future.

 

To what extent are there sufficient numbers of NHS and social care professionals in training for service and resilience planning? On what basis are decisions made about the supply and demand for professionals in training?  

 

Do we want to comment on this?

 

 

Will the measures announced in the People Plan so far be enough to increase resilience, improve working life and productivity, and reduce the risk of workforce burnout across the NHS, both now and in the future?  

 

  1. The Government needs to increase recognition of this vital and skilled workforce by committing to parity of esteem with the NHS through, for example, increasing access to testing and PPE and including social care workers in the list of travellers exempt from border rules in the UK.As a social care provider, we are still carrying most of the costs for PPE and additional staff which is clearly unsustainable.

 

  1. We also want to see greater action to reduce the unequal levels of funding provided by the Government to the NHS and social care. While Ministers have committed ‘placing a ring around social care’, what we have seen is the NHS rightly getting the funding its needs but with social care coming second and often getting inadequate funding.

 

  1. One example of this deprioritisation of social care is the additional provision of £300m to the NHS to plan for a ‘second wave’ of COVID-19 while the Adult Social Care Infection Control Fund is due to run out of funds in September. Failure to provide funding for the sector to prepare for any second wave prevents the sector and the workforce from increasing its resilience.

 

  1. Without adequate recognition of the social care workforce, the Government will struggle to succeed in its drive to recruit more people to the sector. 

 

  1. The social care workforce must have the right skills to support people with a learning disability, including those with complex needs. To achieve this, Mencap believes that accredited national professional qualifications, including specialist qualifications, for social care should be developed. 

 

  1. New career pathways must also be developed to ensure opportunities for career progression and reward performance and experience. Currently, many people do not see social care as a career in the same way as in the NHS which can lead to issues around recruitment and retention of staff. 

 

  1. The workforce must be paid a wage that reflects their skills and responsibility and be valued for the work they do. This should be on a level with their NHS counterparts and, as a minimum, should start at the National living Wage. As such, local authorities should be given sufficient funding from central Government to enable them to commission services to pay staff at this level and, in turn, there should be a duty on local authorities to issue tenders for social care services that, as a minimum, allow for payment of staff at the National Living Wage so that this cost doesn't fall on social care providers.

 

  1. These tenders should be based on achieving good outcomes and improved wellbeing, rather than on the cheapest bid. We would welcome national pay bargaining for a fair wage for support workers from an independent body.  

 

  1. This should be overseen by a national regulatory body who are able to advocate national pay rates and career maps for the sector and develop and quality assure qualifications. 

 

  1. I've also developed some policy lines around sleep-ins, in case we need to go into any more detail following the ruling:

 

 

What further measures will be required to tackle and mitigate the causes of workforce stress and burnout, and what should be put in place to achieve parity for the social care workforce? 

 

 

  1. The Government urgently commit to a review of the social care workforce to ensure a sustainable solution to paying the National Living Wage. 

 

  1. Pay differentials between the NHS and social care must also be addressed as currently many of those who work in social care leave for similar roles in the NHS which are better remunerated, have better development pathways and better conditions[7].

 

  1. For example, health care assistant roles currently have a 7% gap in terms of pay between pay for nurses in the NHS and in adult social are in favour of the former[8].

 

  1. In tandem with this, the Government must also urgently commit to an immediate further cash injection of no less than the Lords Economic Committee recommendation of £8bn into adult social care to: 
  1. This is in addition to a longer-term solution to the underfunding of the adult social care system, particularly in light of the additional pressures on it as a result of COVID-19, and wider reform of adult social care to ensure quality of provision, a reduction in unmet need and equity of access to support for those who need it. 
  2. James have we gotten anywhere in terms of a line on registration for social care workers?
  3. An interesting point was also raised by the Health Foundation who have called for a Social Care Wage Commission. Could be an interesting idea and fits in with NHS parity in terms of collective bargaining power.

 

Sept 2020

[1] Ibid.

[2] https://www.health.org.uk/publications/long-reads/health-and-social-care-workforce#:~:text=Adult%20social%20care&text=Workforce%20shortages%20stand%20at%20around%20122%2C000%2C%20with%201%2C100%20people%20estimated,on%20a%20zero-hours%20contract.

[3] https://www.cqc.org.uk/sites/default/files/20191015b_stateofcare1819_fullreport.pdf

[4] Ibid.

[5] Ibid.

[6] Ibid.

[7] https://www.health.org.uk/publications/long-reads/health-and-social-care-workforce#:~:text=Adult%20social%20care&text=Workforce%20shortages%20stand%20at%20around%20122%2C000%2C%20with%201%2C100%20people%20estimated,on%20a%20zero-hours%20contract.

[8] Ibid.