Written evidence submitted by the Working Group to the All-Party Parliamentary Group (APPG) on Adult Social Care (WBR0104)

Written Evidence Submitted by the Working Group to the All-Party Parliamentary Group (APPG) on Adult Social Care Re: Health and Social Care Committee Inquiry. Workforce burnout and resilience in the NHS and social care

About the APPG on Adult Social Care:

The APPG on Adult Social Care is a cross-party initiative which aims to bring key stakeholders from across the adult social care sector and Parliamentarians from both Houses to find a solution to the many challenges facing the social care system. It is Co-Chaired by Helen Hayes MP, (Labour), The Rt. Hon. Damian Green MP, (Conservative) & Baroness Greengross OBE, (Crossbench). Baroness Brinton (Liberal Democrat) is a Vice-Chair of the Group. Further details of the members of the APPG available here.

About the Working Group of the APPG on Adult Social Care:

The Working Group of the APPG on Adult Social Care advises the members of the APPG. The Working Group consists of representatives: National Care Forum (NCF), Think Local Act Personal (TLAP), Home Group, the National Co-Production Advisory Group (NCAG), Methodist Homes Association (MHA), Skills for Care, Anchor Hanover, Choice Care Group, Care Tech, Dimensions, Affinity Trust, Nourish Care & CIC. Further details of the Working Group available here.

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. In July 2029 the APPG published its report – The Future of Adult Social Care – to highlight the challenges facing the social care system, the importance of achieving a cross-party solution to create a sustainable future for social care and how social care can be an enabler for people to live good lives. In particular the report made the following recommendations:

2. The APPG for Adult Social Care should play its role by engaging with government, policy makers, Parliamentarians and the wider adult social care sector to help facilitate a debate as to what the future of adult social care should look like. This debate should lead to a vision that builds on current best practice in the adult social care system, and its leadership and capacity to innovate.

3. A cross-party solution is key to providing a sustainable vision for the future of the adult social care system – commitments must be undertaken to build a shared political consensus, so that the existing strengths of the adult social care system can be further developed and built upon. 

4. The APPG welcomed the previous announcement by the Health & Social Care Secretary – The Rt. Hon. Matt Hancock MP – to commence cross-party talks on creating a sustainable future for social care. The tragedy and pain of the Coronavirus, has shone a much needed spotlight on our social care system and the importance of cross-party talks commencing at the earliest opportunity.

5. The Coronavirus has also raised the public and media’s awareness as to the importance of social care, the commitments and resilience of its workforce, and the overall lack of funding in the system. After many years of delayed reforms, stalled activity and it being a low political priority, we now have the opportunity to begin the process to finally create a sustainable future for social care. This would be a worthy and long overdue legacy from the tragedy of the Coronavirus.

6. This sustainable future for social care – based upon a cross-party solution – is a prerequisite for our society to answer this, and all of the questions posed in the terms of reference for the Committee’s Inquiry. Until we do so, we will continue to see a social care system which faces undue pressures, rising levels of unmet need, as reflected in the ever tightening of eligibility criteria by commissioners.

7. By creating a sustainable future for our social care system we will – as the APPG’s report the Future of Social Care stated, draw on existing best practice, the leadership and innovation which already exists in the social care system, and help to position social care as a positive enabler for older and working aged disabled people to live good lives. As one of the APPG’s recommendations in our report stated:

8. There should be a stronger focus on adult social care as an enabler to help care and support people to live more independently, with a more positive portrayal of the value and benefits of working in the sector, with a greater appreciation by wider society of the value and high skills of the workforce.

9. Our Society, Government, political parties and wider stakeholders all have the opportunity to use the tragedy of the Coronavirus to provide leadership and help to create a sustainable future for social care. The APPG on Adult Social Care is here to play its role in helping to achieve this goal. As one of the APPG’s recommendations in our report stated:

10. The APPG for Adult Social Care should play its role by engaging with government, policy makers, Parliamentarians and the wider adult social care sector to help facilitate a debate as to what the future of adult social care should look like. This debate should lead to a vision that builds on current best practice in the adult social care system, and its leadership and capacity to innovate.

11. Securing sustainable funding for the social care system – to ensure it has a sustainable future in the long term - is vitally important to address the many challenges facing the workforce due to Covid19. Investing in the social care workforce is important to position social care as an enabler for working aged people and older people to live good lives. The tragedy and pain of the Coronavirus provides an opportunity to create a sustainable future for social care as its lasting legacy.

12. The APPG’s report The Future of Adult Social Care highlighted increased funding as the most popular improvement chosen by stakeholders who responded to our Inquiry. The APPG’s Working Group believes that a cross-party solution, and the commencement of cross party talks at the earliest opportunity, is key to providing a sustainable vision for the future of social care.

13. Ongoing uncertainty as to the publication of the Government’s proposals on the reform of social care has led to a further lack of clarity as to what the long term might look like. While we welcome injections of funding, such as the £1bn promised for adult and children’s social care in 2020/21,[1] such commitments do not provide commissioners and the wider sector with the certainty they need to plan properly. A clear national policy framework for social care funding is required to ensure people are able to plan for the future and commissioners can adequately allocate the resources available to deliver good lives for people in their local communities.

14. Sufficient social care funding should support older and disabled people to live with dignity, respect and independence. Demographic changes – such as an aging population and longer life expectancy - means social care will need the resources required to meet the demands placed upon it and deliver the ambitions of those who receive care and support.

15. Delayed transfers of care, particularly in relation to elderly people, have a significant impact on the NHS. It has been estimated that since 2011, almost four million hospital beds have been lost to the NHS due to problems securing social care.[2] Delayed discharge is an unnecessary cost to the NHS. Social care should be life changing, an enabler to living a good life and funding arrangements should be in place to facilitate these aims. 

16. There will also be additional costs faced by the social care system as a consequence of Coronavirus. These extra costs will be due to higher costs to supply Personal Protective Equipment (PPE) and staffing costs for example. It is important that these additional costs are factored in by the Government, Local Government and Commissioners when allocating funds in future.

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?

17. The APPG believes that the greatest asset in the adult social care system is the adaptability, commitment and high-skills of its workforce. The workforce is highly-skilled – with opportunities for career progression – particularly into more specialist care services such as dementia and learning disabilities for example. Working in adult social care can be a hugely enjoyable and rewarding career choice, which provides diversity, purpose and deep satisfaction. However, the workforce is historically paid low wages and salaries – despite the skills and commitment of the people who work in it – and this issue must be addressed as part of any programme of change and reform of social care.  

18. The public’s enthusiasm for #ClapForCarers helped to raise the profile and understanding of the social care workforce and provides an opportunity to help create a cross-party solution for a sustainable future for social care. In doing so, a worthy legacy of Coronavirus would be additional resources into the social care system, so that people who work in social care receive much better pay.

19. In the context of Coronavirus and the impact it has on the workforce, it will also be important to consider the future mental health needs of the social care workforce and for commissioners and Local Authorities to be mindful of this in their allocation of resources in future.  

20. To help raise the value and profile of the social care system and the people who provide care and support the APPG’s report – the Future of Social Care – made the following recommendation:

21. The Office holder of the Secretary of State for Health and Social Care should be encouraged to use their full title and wear an adult social care badge alongside the NHS badge, to help raise the public profile of adult social care.

22. We welcome this move by the Health and Social Care Secretary, and would encourage the Government to utilise the sentiment behind this gesture to follow through on its commitment to achieve a ‘cross-party consensus’ on social care and instigate cross-party talks to achieve this aim at the earliest opportunity.

23. The social care workforce in England is bigger than the NHS workforce: in 2018, the number of people working in social care was estimated at 1.47 million.[3]  However, there are still significant shortages. In September 2019, Skills for Care published a report on the state of the sector’s workforce.[4] It highlighted that in England, the average vacancy rate was 7.8% which equates to 122,000 vacancies. The turnover rate of staff was also significant with the report stating 440,000 social care sector left the sector in just 12 months. The APPG welcomes the government’s new campaign in light of the Covid-19 outbreak to recruit social care workers, however its target of 20,000 is still relatively modest and we would encourage it to be even more ambitious.

24. Some of the challenges facing the recruitment of people into the social care system could also be exacerbated by the immediate implementation of proposals on access requirements for people entering the UK to work, and we would encourage policy makers to review these for their likely impact on the social care system.   

25. The low status and pay of people who work in social care – along with consistently misleading perceptions that social care is low skilled – when it is high skilled – also inhibits recruitment into social care.

26. During the process of the government implementing any future Workforce Strategy to tackle issues around recruitment it will be important for the Department of Health & Social Care to engage with a range of stakeholders, including employers in the sector, on workforce issues. Social Care providers are well placed to advise and provide insight on best practice, and work to ensure that the pipeline of new recruits is closely aligned to other government programmes in involved young people, TLevels, traineeships, sector based academies and apprenticeships for example, in driving forward an agenda on the social care workforce.

27. Attraction recruitment and retention is one of the sectors main area of costs, having an employer led social care talent pipeline initiative would reduce the waste and costs of poor recruitment, whilst recruiting for values and career progression will make our sector more attractive, especially post Covid.

28. It is also important that we achieve genuine parity of esteem between health and social care, with significant steps taken to ensure that social care receives the same status and respect as that of health. Parity of esteem between health and social care has the potential to attract new talent and improve recruitment prospects for the sector. As the APPG’s report – The Future of Social Care – made as a recommendation:

29. Parity of esteem between health and social care is essential, if we are to realise the benefits of establishing a vision for the future of adult social care...with a more positive portrayal of the value and benefits of working in the sector, with a greater appreciation by wider society of the value and high skills of the workforce.

30. There will also be opportunities to build on recent initiatives during Coronavirus regarding staff redeployment from other sectors into social care. These initiatives have seen collaborations between social care providers, professional recruiters and various sectors such as hospitality to attract new people with appropriate skills and values into the social care workforce. Values based recruitment has also proven to be a success at recruiting and retaining people into the social care workforce.

31. Greater emphasis should also be made as to the societal benefits of a thriving social care system, and the valuable contribution of people who work in social care, to support people to live independently and ensure good lives for vulnerable people for example. As the Coronavirus has highlighted, people who work in social care are highly committed and driven to provide excellent care and support, because of the transformation impact it makes on peoples’ lives. A society which betters understands and appreciates the impact of the social care workforce – with better pay as a consequence – will go some way to meeting the challenges in recruitment.

32. The care sector has struggled with the notion that our workforce has a low barrier to entry and are largely deemed as low skilled and for those who have no career aspirations. Those familiar with the sector will know that in reality, the roles are now highly technical and skilled, and that the social care workforce has both extensive training, development and career pathway opportunities.

33. It is also important to recognise the vital contribution of informal carers, such as family carers, many of whom are children, and ensure we provide them with appropriate support, advice and networks. Informal carers carry out their roles with compassion, commitment and without reward and we welcome initiatives such as Carers Week 2020 taking place later this month to shine a light on what they do and raise the profile of issues which need to be addressed. 

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?

34. The single most important reform to address the challenges facing the resilience and burnout of the social care workforce is the long term is the creation of a cross party solution for a sustainable future for social care. As the APPG’s report The Future of Social Care stated as a recommendation:

35. A cross-party solution is key to providing a sustainable vision for the future of the adult social care system – commitments must be undertaken to build a shared political consensus, so that the existing strengths of the adult social care system can be further developed and built upon.  

36. It is also important that in the process of establishing reform the Government engages with a wide range of stakeholders and listens to a wide spectrum of people, to reflect the diversity of provision and support in the social care system, including people who access care and support. As the APPG’s report The Future of Social Care stated as a recommendation:

37. People with experience of regularly using adult social care must be fully involved in the co-design and co-production of adult social care services.

38. This sentiment and philosophy should be reflected in the Government’s engagement of key stakeholders and we would encourage the Select Committee to use its Inquiry on workforce burnout and resilience as an opportunity to engage with people with lived experience, including people who receive care and support, informal carers, and people who work in the social care system, as part of its deliberations.

39. The Working Group to the APPG on Adult Social Care would welcome the opportunity to work with the Clerk to the Committee to facilitate oral witnesses to the Committee’s oral evidence session. We would also encourage the Committee to continue to facilitate the use of remote technology to facilitate a range of witnesses from across the country, both for this and all future inquiries.

This is not an official publication of the House of Commons or the House of Lords. It has not been approved by either House or its committees. All Party Parliamentary Groups are informal groups of Members of both Houses with a common interest in particular issues.

November 2020

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