“In a word? Dire.”
It’s not every day that I jump on a call with a CEO who’s so frank. I've just enquired, cautiously, how things are in the care sector where he works. His short answer speaks volumes.
"For all the havoc Covid-19 has wreaked," he continues, "at least it’s brought the care home crisis to the fore. That was long overdue."
We talk about the Coronavirus care home support package from the UK government. It includes funding, which is timely and urgent. But it won’t solve another burning issue: staff shortages.
“Listen, there’s no limit on the amount of care hours we could complete. The problem is, we can't carry out care without care workers. Right now, we’re losing over 40 carers a month. By the end of the year, we’ll be losing about 250,000 hours of care.”
Hiring good people in the care sector is hard. Keeping them? That's even harder.
Why aren't care workers staying?
Some of the reasons are obvious. The 2008 financial crash hit an already underfunded sector hard; the years (in fact, over a decade) of austerity that followed have depleted it further.
Dig a bit deeper and more reasons come to the surface. Unpredictable rotas. Zero-hour contracts. Unsociable hours. Large chunks of downtime in the middle of the day. Long travel times between shifts.
All these factors take their toll. Plus, it can be lonely work, particularly in home care, where there is no hub for interaction with colleagues.
An under-resourced frontline bears the brunt of all this, so it’s not surprising that they move on when they can. The care sector has a higher staff turnover than any other in the UK. Half of staff leave their roles every year.
That means that care homes are continuously trying to recruit. Recruitment takes time and money – both in short supply.
So, the few resources available are diverted towards finding new people instead of keeping them.
Where does this leave us?
Brexit exacerbates all this. Employers will no longer be able to recruit EU citizens for so-called lower-skilled jobs in the care home sector, due to the government’s new points-based system.
Increasingly, young staff look elsewhere; the average carer age has shot up to 47.
It’s a vicious circle that, at some point, becomes a downward spiral.
As the number of care staff decreases, the need for care increases. This is partly due to demographics. Between 2001 and 2015, the elderly population in the UK grew by 38%. The Lancet predicts that the number of people over 85 who need 24-hour care will double by 2035.
There has also been a rise in the number of people with long-term health conditions, like diabetes and dementia. Today, that figure hovers at around 12 million; that number, too, is projected to increase as people live longer.
We want people to live longer. But we also want them to have good quality of life, and that depends on the care they receive.
The impact on patients
As anybody who has a family member or close friend in a care home can testify, people in care need continuity.
Building a patient-carer relationship takes time; building trust takes even longer. All leaders in social care I have spoken to emphasize how crucial that familiarity is.
And when that continuity is lost, it hits the patients hardest. Nobody wants this – least of all support workers.
And yet it’s hard to make the case for continuity, at least on the basis of 'hard data'. How do you measure the value of reassurance, or the comfort that comes from having known a carer for some time?
Like so many other aspects of care, it’s unquantifiable.
Some related research does point to evidential support. One recent study showed patients who saw a succession of different GPs were twice as likely to be admitted to hospital.
But really, all this tells us is something we already know.
Care workers and Covid-19
Covid-19 has brought the crisis in social care into stark relief, and compounded it.
As care workers have had to self-isolate, continuity of care has been interrupted even more. Plus in many cases, the continuity of visits by family and friends has all but disappeared.
And it doesn’t stop there. The CEO on my call explains:
"We have staff working in different settings who are already exhausted and traumatized. They're grieving, their clients have passed away. They can't just ‘snap out of it’ as they’re expected to.”
He's troubled by the current situation, but also by what lies ahead. Visiting restrictions look set to get worse along with the weather. Winter is challenging for the healthcare sector at the best of times.
"How are they going to enter this new marathon when they've barely recovered from the last one?"
So where do we go from here?
Call me old-fashioned, but we need to start from values, and value-ing.
The things that matter in social care are empathy, trust, respect and dignity. We need to think that through. If we care about what vulnerable people need, then the sector needs to be supported better, at every level.
1. Cultural recognition
Recently, the government has been using the word ‘essential’ a lot. Seven months into the pandemic, we’re finally learning what it means.
Many of us are used to a life of freedom, the luxury of endless choices. Covid-19 stripped all that away, leaving us with a simple truth: our ‘essential’ need is to stay alive. And often it’s the labour of frontline staff that makes this possible.
Until recently, many were almost indifferent to that essential-ness. A 2019 poll found that, while 87% of people thought the NHS should be protected from government cuts, only 34% thought social care should.
Even now, the NHS continues to dominate the public conversation. But, for the first time in years, the care sector has featured regularly in the news alongside it. It’s moved to the heart of public conscience, with greater levels of sympathy and acknowledgement of the huge sacrifices required.
The government previously defined social care staff as ‘unskilled’; over recent months, this has been replaced with ‘key’ or ‘essential’ workers.
Now, this needs to be reflected in pay, work-life balance, and career structure.
2. A defined career structure with solid training
In Labours of Love, Madeleine Bunting gives an example of a care nurse who has worked for 15 years without a pay rise or promotion.
Sadly, this isn't uncommon. It’s a symptom of a larger cultural blindness to the levels of skill and expertise involved in care work – an assumption that it merely requires low-skilled repetition and routine.
In reality, care relies on a range of different types of expertise – medical, psychological and technical. It also draws upon human qualities like empathy, flexibility and equanimity, as well as a solution-focused mindset.
At a more senior level, care work requires knowledge and understanding of different medical and age-related conditions.
This should be reflected in a career progression that tracks experience, professional development and learning, with an associated salary structure.
That would encourage more, and younger, people, to join the social care sector with a view to a long-term career.
3. A happier work environment
When care workers quit – what happens? Typically, they don’t pursue a different direction. Instead, they move on to another care organization that offers something they have been missing.
Often, that is a friendlier culture, a stronger connection with colleagues and managers, a sense of belonging… Because these small things matter, when it comes to quality of working life.
How can care organizations create a sense of community that contributes significantly to happiness at work?
This can be particularly challenging in a sector where so many people work shifts, or are dispersed because their main remit is home visits.
Plus, how can you create a sense of ‘togetherness’ at a time when we are discouraged (or even forbidden) from getting together with other people?
This is an area where recent advances in technology can make a difference. Platforms like Blink, developed specifically to engage and connect key workers, already have a track record of making carers feel part of things.
Carers deserve to feel seen, appreciated, trusted and included.
When physical proximity isn’t an option, technology that supports communication and connection can be the difference between whether a worker leaves or stays.
4. Less paperwork
I've never met a care worker who cites admin as part of the reason why they want to do the job.
So it’s ironic that social care staff spend more time doing paperwork than they do providing care.
When budgets shrink, this balloons even further. Some admin is inevitable. But forcing care workers to do it without strong digital resources? That can be avoided.
When carers have to focus on admin, it’s at the expense of relationships and communication. Paperwork requires a narrow field of attention. The administrative burden squeezes the capacity for more expansive qualities like empathy and compassion.
Blink alleviates this by automating tedious and time-consuming processes. Mental space is freed up, leaving carers to focus on the human and practical dimensions of their job.
5. A fairer VAT regime
Welfare services provided by regulated social care companies are exempt from VAT. This means they don't it to charges for their services to help the vulnerable.
But current VAT policies mean care organizations can't reclaim VAT for business expenses. If that was possible, care organisations could make savings which, as Yvonne (CEO at Kare Plus) notes, could be reinvested into businesses:
"With this comes the ability to recruit, helping more people to go back into work and have a secure income."
I've been following this movement for a while, and I'm excited to see it pick up momentum. Martin Jones, CEO at Home Instead Senior Care, has launched a petition to campaign for this vital change. You can check it out here.
I'd urge everyone to sign and share it.
It will take significant extra funding to tide the struggling care sector over.
But small, step-by-step actions can lay the groundwork for bigger reforms.
Such reforms can help stabilize the system, slow down staff turnover, and deliver more benefits to care workers. All of which will, in turn, mean happier care receivers.
Some devolved nations have already introduced positive new measures during the pandemic. The Scottish government has required payment of the real living wage to staff in the care sector. The Welsh government has given care workers a bonus.
It's not enough. But it's a start.
The bottom line is that we all have a duty of care. The way we treat care workers is an index of our compassion as a society, and the value we place on human life.