Written evidence submitted by Sense (RTR0080)
Sense is a national disability charity that supports people with complex disabilities to be understood, connected and valued. Sense supports children, young people and adults in their home and in the community. Sense campaigns passionately for the rights of the people it serves, and offers practical help and support to families and carers, including information and advice, short breaks and family events.
Sense supports people with complex disabilities including people who are deafblind, as well as those with learning disabilities, autism, sensory impairments and complex health conditions. The people with complex disabilities we represent often require significant or constant care and support from family members or social care, including support with personal care. Many of the people we support are also deafblind, including individuals with congenital deafblindness, and also those who are visually impaired or Deaf or Hard of Hearing who then acquire an additional sensory impairment. While those who have acquired deafblindness tend to have less complex care needs, they are still likely to have communication needs which require the right support.
Sense’s policy positions on social care are shaped by our insight as a provider of care to people with complex disabilities, as well as by our experience of employing a highly skilled workforce in the social care sector. We believe that we are uniquely placed to provide insight and context in this vital discussion.
While providing this care, Sense takes a person-centred approach, putting each individual we support at the heart of planning and developing their own support, giving them choice, control and independence in their lives.
Our expertise in communication allows us to do this. We take the time to understand the way the people we support communicate, which can include signing, symbols, objects of reference, gestures or body language. Whether it’s shopping for food, furnishing a room, following an education or training programme or trying a new activity, we support people to express their preferences and make them happen.
Sense has supported people in residential settings for many years. Last year, we supported 230 adults with complex disabilities through residential care, each of whom have their own rooms, individual care plans and skilled Sense Living staff on hand 24 hours a day.
Last year, Sense Living provided supported living for 105 people with complex disabilities. Supported living gives people with complex disabilities the opportunity to choose where to live, who to live with and what they do every day.
Our skilled staff provide people with the level of support that is right for them, whether that is support 24 hours a day or support for part of the day, such as for personal care or making meals.
Whether it’s shopping for food, decorating their home, taking part in activities in their community, or enjoying creative or physical activity, we enable people in our supported living to communicate their preferences and act on them.
The Department for Health and Social Care should:
– Communicate their preferences;
– Stay in work or look for work;
– Develop and maintain relationships; and
– Take part in exercise or sport.
Good social care should enable people with complex disabilities to express choice, communicate and be understood by staff, develop independent living skills, reduce loneliness and access their communities. The best support puts the individual at the centre of their care and ensures that their wishes and goals are the basis for any outcomes rather than fitting them into existing service provision. Crucially, this type of social care can have preventative value in avoiding more complex needs developing, as well as enabling disabled people to be active citizens in society.
Social care must be recognised not only as a solution for crisis level and urgent needs, but as a valuable resource that enables working-age disabled people to live full and independent lives.
At Sense Living, we use person-centred plans to put the people we support at the heart of decisions about their own care. Using these person-centred plans developed with individuals supported by our services, we have established that five key areas influence the quality of community-based social care:
To put these principles into practice, it is vital that social care providers like Sense can access staff who have had the right level of training, and that these staff are both paid fairly for their work and given the opportunity to advance in their careers.
One of the consistent pieces of feedback we receive at Sense is that the people using our services want to be supported by familiar staff who understand their needs. The support people receive should therefore be as consistent as possible, preferably given by the same member of staff. Evidently, this is particularly difficult at a time when recruitment and retention is proving so challenging.
Retention and recruitment has long been a problem across the social care sector, with turnover at 38.1 per cent in 2019-20. The last two years have only made the problem worse.
Brexit has likely played a part in this. According to Skills for Care, only 1.8 per cent of starters in the sector between January and April 2021 arrived from outside the UK, compared to 5.2 per cent during the same period in 2019. Whilst our staffing levels have not been directly affected, our services have still felt the wider impact of Brexit on the general recruitment market.
The pandemic has significantly worsened longstanding challenges with recruitment and retention. Although turnover in the sector initially decreased slightly during the pandemic, the reopening of other sectors of the economy, particularly retail and hospitality, has made it harder to recruit and retain staff. In research carried out by the Nuffield Trust, providers said that they the easing of lockdown had made it more difficult to recruit as the hospitality sector was able to offer more competitive pay packages than the social care sector.  As a result, the labour shortages that have affected the whole economy have disproportionately affected the social care sector.
Even before the pandemic, our services were losing staff to the NHS, drawn by better pay, conditions and career advancement prospects than can be offered in the social care sector. We are concerned that it will become more of a problem as the NHS introduces vaccination as a condition of deployment, potentially leading to more vacancies in the NHS for people to move into.
Sense’s experience seems representative of the whole sector. In a DHSC survey of care providers published in December 2021, 70 per cent of respondents reported that retention had become more difficult in the last 6 months. In domiciliary care, better pay outside the sector and better terms and conditions outside the sector were believed to be the biggest reasons for increasing difficulties with retention. The picture is similar in residential care, although vaccine hesitancy is also believed to have played a role there.
The low rates paid by local authorities make it difficult for providers like Sense to compete with better pay and conditions in the NHS, and even in other sectors such as retail and hospitality.
While some charitable providers may wish to use their own funds to pay better wages than would be possible using only the rates paid by local authorities, charity law may make it difficult for them to do so.
Although charity law would allow charities to do this if they felt it were in the interests of the charity or its beneficiaries, some charities have governing documents that do not allow them to subsidise statutory funds at all.
No provider, however, should have to consider using their own money to subsidise local authorities’ rates so that they can pay their staff well.
Without parity of pay, conditions and esteem between the NHS and social care, employers like Sense will continue to struggle to recruit and retain staff.
The Department for Health and Social Care should introduce pay scales in line with those for equivalent roles in the NHS.
This would help providers and local authorities to ensure that the care workforce is well-paid, making it easier for social care providers like Sense to recruit and retain staff.
The Department for Health and Social Care should also introduce a framework for standardised terms and conditions in line with those of the NHS, helping to improve recruitment and retention in the sector.
The Government’s proposal for a Fair Cost of Care Fund could enable providers to pay their staff more competitively, providing that it leads to local authorities paying rates that allow providers to pay their employees well. However, neither the White Paper on social care nor the recent policy paper on the Fair Cost of Care Fund made any reference to fair pay. While the policy paper instructs local authorities to ensure that the cost of care exercise they are required to undertake ‘accurately reflect[s] local costs such as staff pay’, this does not rule out the cost of care being calculated on the basis of the low pay that is already commonplace in the sector.
The Department for Health and Social Care should require local authorities’ cost of care exercises to consider the cost of paying care workers’ wages at the same rate as equivalent roles in the NHS.
As a provider of social care to mainly working-age people with complex disabilities, Sense is concerned that local authorities will not be required to carry out cost of care exercises for residential care provided to working-age disabled adults.
The DHSC argues that a cost of care exercise would be less appropriate in the case of residential care for working-age people as the market is more specialist. However, the specialist nature of the support offered by providers like Sense Living is all the more reason to ensure that rates reflect the true cost of providing that care, including the cost of rewarding their skilled staff for the work they do.
The Department for Health and Social Care should require local authorities who benefit from the Fair Cost of Care Fund to put in place provisions to ensure that they are paying fair rates to providers who support working-age adults in all settings, including residential care.
The Department for Health and Social Care should carry out regular assessments of whether the funding allocated through the Fair Cost of Care Fund allows local authorities to pay providers rates that reflect the true cost of care.
Sense also finds that a lack of career advancement opportunities in the sector makes it less attractive than the NHS or even unrelated sectors like retail and hospitality. The sector would be more likely to recruit and retain staff if career pathways were clearer and there were more gateways into senior roles.
We welcome the fact that the White Paper committed the Government to doing this. As a social care provider employing a skilled workforce, we look forward to sharing our expertise with the Government as they develop these career pathways.
The Department for Health and Social Care should work with the social care sector to ensure that the new career pathways and gateways into more senior roles reflect those for equivalent roles in the NHS.
Given the importance of social care as a service in its own right, it should be given parity of esteem with the NHS. The absence of a people plan for the social care sector is characteristic of the many ways in which social care is treated differently to the health service.
While the Government’s recent White Paper on social care sets out what it describes as a strategy for the workforce, this falls short of being a comprehensive workforce plan equivalent to that of the NHS People Plan. With the sector facing a severe labour shortage at a time when it is both underfunded and under strain as a result of the pandemic, the need for a people plan is evident.
The Department for Health and Social Care should set out a comprehensive people plan for social care.
As an employer of a skilled care workforce, Sense understands that having the right quality of staff is just as important as having the right number. Trained, well-paid and engaged staff who are working with the individuals they support to achieve the best possible outcomes are an essential part of delivering safer and better care.
Yet there is little standardised training across the social care sector. At Sense services, we find that very few staff have the Care Certificate when they begin working for us. And as the Care Certificate is very basic, we supplement it with around 3.5 days of additional training.
The Government should introduce targets around the completion of care certificates.
As well as an uneven standard of training for those entering the sector, the lack of standardised roles and pathways towards more senior roles makes it difficult for carers to progress in their careers.
We are already involved in programmes to develop leadership skills within the sector. For example, Sense is working with Birmingham South and City College on a leadership programme designed to support people to develop the values, skills and behaviours needed to progress in the social care sector.
The Government should learn from the example of providers like Sense who are already working on the development of leadership skills in the sector.
Working-age disabled people make up a third of people benefitting from social care, and it is vital that the care workforce understand how to support them. As a provider of social care mainly to people of working age, we have identified the following key areas that are particularly relevant to working-age people with complex disabilities:
Through our work with people with complex disabilities, we at Sense have developed extensive expertise in communication. As good communication support empowers individuals and staff to express and understand needs and choices, it is vital that an understanding of communication needs is embedded across the care workforce.
Support to stay in work
Although work may not be an appropriate outcome for some people with complex needs, other people with complex disabilities are either in, or looking for, work. The social care workforce should understand how best to support people in or looking for work, such as by ensuring that the times of their care visits fit in with someone’s work commitments or interviews/job centre appointments.
Support to develop and maintain relationships
With research carried out by Sense finding that 61 per cent of disabled people are chronically lonely, it is vital that care workers know how to support working-age people with complex disabilities to develop and/or maintain relationships with family and friends. 
Support to take part in exercise or sport
Good social care should enable people with complex disabilities to stay fit. But people with complex disabilities can face additional barriers while trying to stay fit, such as sport centres being inaccessible or failing to offer enough activities suited to someone’s support needs.
The Department for Health and Social Care should use its investment in training and development to ensure that the care workforce understand how to meet the needs of working-age disabled people, including how to support people with complex disabilities to:
The impact of low rates on recruitment and retention goes beyond the issue of low pay. With commissioners paying less for care, day centres cannot afford to run many activities offsite. Some commissioners are even explicitly commissioning only onsite activities. Staff often find the role less fulfilling as a result, and the impact on morale makes it more difficult to recruit and retain staff.
We would be happy to expand on any of the issues covered in this submission, either in writing or by giving oral evidence before the Committee.