Cabinet Minister for Social Care: Business Focus

Yesterday the Daily Telegraph revealed that the big care companies have a total debt of £5 billion (http://www.telegraph.co.uk/health/elderhealth/9655229/Britains-biggest-care-home-owners-have-5-billion-debts.html), also yesterday Ed Miliband declared support for the ‘Living Wage’ saying “there are almost five million people in Britain who aren’t earning the living wage” (http://www.labour.org.uk/ed-miliband-speech-on-the-living-wage).

It is probably fair to say that at least one in five of these people are frontline social care workers who are on, or just above, the national minimum wage.

The current minimum wage is £6.19 per hour and the touted living wage is £7.20 per hour, the average pay for a care worker sits neatly in between at £6.65 an hour. So to reach the living wage employers need to find 55p per hour per employee working, on average 40 hours a week for 52 weeks (inc holiday pay) a year. With this applying to over a million people the cost will be around £1.1 billion a year, add into this employers NI contribution etc. and the cost gets higher.

I totally and whole-heartedly agree with the living wage and the benefits of it to social care will be enormous, particularly in terms of recruitment and retention but the real issue is where will the money come from. Most agree that social care funding is in crisis and without promises of extra money to fund the living wage the only place it can come from is existing care services and as noted earlier the debt situation of the bigger care providers hardly suggests that they can afford the living wage whilst maintaining care standards.

Many people easily and comfortably slip in to the idea that social care is a Government run and funded thing yet the reality is, of course quite different. There is no homogenous entity such as the NHS as social care is provided by, according to Skills for Care, approximately 22,100 organisations over 49,700 establishments. Just to put this number in some sort of perspective, the total number of high street bank branches across the UK is just 11,000. This vast, complex myriad of care providers range from the smallest micro-providers to the huge debt-ridden big companies, from not-for-profit voluntary organisations to those owned by offshore parent.

Social care is big business, around 20% of local authority spending in England goes on social care equating to around £21billion per year, so it is no wonder some offshore companies feel there is money to be made, and, of course, this does not include the money paid by those not entitled to local authority support or those who have to pay ‘top-up’ fees to providers.

Yet, despite this seemingly high amount, the payments by local authorities have declined in real terms over the past few years, with eligibility criteria also tightening, and many professionals agreeing that social care needs an urgent injection of real cash to prevent and halt the constant cut back in services.

The business of social care can be as complex as meeting the needs of many individuals who need care services yet everything is the responsibility of a junior minister within the Department of Health.

I truly and honestly believe this needs to change and I would ask you to support my epetition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

The World is Changing, Let's Prepare for the Future

Not strictly a social care blog I will admit, but social care is intrinsically linked hence the reason for putting it here.

The world is changing and, unfortunately, the politicians are failing to acknowledge and address the change that has a huge impact on all levels of society.

We are living longer.

As a result there is a change in the dynamics of society which are only partially addressed by Westminster and, as a result, preparation for the future is woefully short.

Take, for instance, working and the State pension. The age at which the pension can be claimed has risen and will continue to rise over the coming years to mitigate the ever increasing state pension bill. But what notice has been taken of the implications of this? Much is made of the current economic climate, unemployment figures especially among younger people. What we do not here about is the effect of people working longer on the unemployment figures.

It does not take an economist to work out that if people are working longer there are going to be less entry positions available to younger people and where people are working longer the size of the available workforce grows, meaning there is also a need to ensure growth in the number of jobs available otherwise the employment benefit bill will continue to rise.

Ironically, given the current Government approach, one of the areas of employment growth will be needed is in the public sector. As the population ages so will the age related conditions that need to be dealt with by the NHS and its staff, the number of those with dementia will increase dramatically as will other conditions that effect people as they grow older. As the population of the country continues to grow, because of ageing, other public services will need to meet the increasing demand.  It is all very well cutting services to reduce the deficit today but where will that leave us tomorrow?

It is not just politicians that need to adjust to the change in social dynamics. Businesses to need to be aware their customer base is getting older and adjust accordingly. As we age our needs change and it is folly to simply appeal to the younger market (personal bug bear – I do not want skinny jeans but why is it only them available in most shops!), with the high rate of youth unemployment and the fact that people are working longer in life businesses have to consider where the disposable income is!

Institutional ageism has to be halted, older people are now the majority rather than a minority to be sat in the corner and ignored. Some organisations (such as the BBC) have often been accused of ageism (especially with female employees) yet, increasingly their audience have become older people who deserve to be represented.

We are living in an ageing world and as the life expectancy rate continues to grow society will change. Those in charge of policy etc in the country, and, indeed, around the world, need to start changing too, in order to meet the challenges this changing society will bring.

The world is changing, let’s prepare for the future.

Public Service & Private Profit: The BIGGEST Elephant in the Social Care Room

“There were a number of respondents who raised concerns over the business ethic of the care homes they worked for. These respondents felt the organisation and/or general management were driven by profit, rather than providing high-quality care” RCN – Persistent Challenges to Providing Quality Care 2012

If there is to be any resolution of the current care crisis and to ensure the provision of quality care for the most vulnerable adults in our society then the BIGGEST elephant in the room has to be tackled or, at the very least, talked about openly.

The majority of social care provision is delivered by private sector companies who do so in order to make a profit. Direct public sector provision has dwindled and continues to do so as more local authorities look to close or sell care homes.

The reason for this is relatively simply – it’s cheaper. By outsourcing care services local authorities save on administration costs yet more specifically the save on wage costs. Private companies are less bound by conditions that local authority employers have to abide by, particularly in terms of pensions and the myriad of different companies delivering social care means the workforce is fragmented, largely un-unionised which has allowed care worker wages to remain low at a national average of £6.71 per hour (Skills for Care NDMS Data). 

Undoubtedly the poor pay and conditions associated with working in social care contribute to the continual recruitment and retention problems which, in themselves, have an impact on the quality of care provision.

Now there is no doubt that what local authorities have paid in fees for social care provision has dropped, in real terms, over the last few years firstly by lower than inflation increases and more recently by totally freezing fee increases and there is equally no doubt that social care needs greater investment.

There is also the additional fact that many of those who have to pay for their own care provision are forced to pay a higher amount in order to ‘make up’ for the low fees paid by local authorities despite receiving exactly the same quality of care by the provider.

Yet the issue that has to be addressed is what guarantees are there that increasing fees will drive improvement in the quality of care or workers’ pay rather than line the pockets of those who run their companies for profit?

One solution by a respondent to the RCN survey was to suggest a cap on the amount of profit that could be made ensuring the rest was reinvested into the care of residents.

But to flip the argument a little, most people go into business to make money and any threat to the profitability of the care sector would discourage people entering it. With the demographics indicating increasing amounts of social care provision being needed there will be a demand for more suppliers. So what happens if the suppliers are not there? There will then be pressure for local authorities to take responsibility for providing care at the higher costs associated with the public sector.

There is no obvious or easy solution to the dilemma but it is one that has to be recognised as a major part of the debate on social care.