The adult social care workforce in England - NAO perspective Aileen Murphie: Director MHCLG/LG VFM April 2019

The ASC workforce: key aspects 1.5m people work in the sector Disaggregated: 20000+ providers Properly skilled and motivated staff key to quality of service Financial & demand pressures are increasing Leadership & ownership of workforce as a policy issue?

Key finding | Vacancy rates by role Vacancy rates are high: RMs – 11% Nurses – 9% Careworkers – 7%

Key finding | Turnover by role Turnover rates are high Average – 27.8% Nurses – 32.1% Careworkers – 33.8%

Key finding | Growth in jobs has slowed Growth in jobs has fallen behind growth in demand Jobs need to grow an estimated 2.6% per year to keep pace

Key finding | Pay for care workers is low 90% of care workers were among the lowest 25% of earners in the wider economy Working conditions can be tough

Challenges | Growing demand on local authorities 9.5% increase in the estimated population in need aged 18-64 14.3% increase in the population in need aged 65 and over

Challenges | Reductions in service spend since 2010-11 Social care spend has been relatively protected: 3.3% reduction ASC (including BCF) Substantial real terms falls in government funding: 56.3% reduction by 2019-20 Spending power fell steadily from 2010-11 to 2016-17 (28.5%) then levelled off Other services have been cut substantially

Adult social care | Unmet need Unmet need is growing across all age groups and all activities of daily living. Growing impact potentially on individuals and services.

Adult social care | Market pressures The average price paid by local authorities for care was 43% less for nursing care and 8% less for residential care. The difference has increased since 2012-13. CMA found: if local authorities were to pay the ‘full cost of care’, additional cost would be £0.9 bn - £1.1 bn under the current system, LAs will not be able to provide services to all those with eligible needs.

Overview | Strategic oversight Strategic oversight and support for workforce planning: DHSC did not have an up-to-date care workforce strategy Roles and responsibilities unclear Local and regional bodies and partnerships not taking the lead on workforce planning DHSC cannot demonstrate that the sector is sustainably funded DHSC is not doing enough to support the development of a sustainable care workforce The ASC Green Paper? One of DHSC’s nine priorities in its Shared Delivery Plan: 2015 to 2020 is ‘to make sure the health and care system workforce has the right skills and the right number of staff in the most appropriate settings to provide consistently safe and high quality care’

Overview | Recommendations The Department should produce a robust national workforce strategy to address the major challenges currently facing the care workforce. The Department needs to understand and plan long-term for the effect on the workforce that integration of health and care, and other potential changes to how care is delivered, will bring. The Department should encourage local and regional bodies to produce workforce strategies that complement the national strategy. The Department should assess whether current initiatives, both national and local, to support recruitment, retention and development are sufficient. The Department should establish how much funding the sector will need over the long term and make the consequences of any funding gap clear.

Overview | PAC views… Funding: The Committee did not think that the department had credible plans for how care could be sustainably funded. The care market: The Department is not delivering on its overarching responsibility for the care market, despite most providers being dependent on public funds. Workforce: Most people working in care are unregulated, which limits the development of a well-trained and professionalised workforce. The low amount of funding given to Skills for Care limits what it can do in terms of workforce development initiatives and the extent of its strategic support to the sector. The care workforce suffers from low pay and low esteem, which leads to recruitment difficulties for providers; Brexit will potentially affect the care sector.  

Overview | PAC recommendations DHSC should: establish quickly the funding local authorities need to commission care at fair prices, to support a workforce of the right size and shape to deliver a sustainable care sector in the long-term. improve its oversight of the social care market, with CQC adequately resourced. understand the impact that Brexit and future immigration policy, could have on the care workforce at both the national and local levels. set out in the forthcoming workforce strategy how it intends to professionalise the care workforce further and consider a mandatory minimum standard for training. secure the funding Skills for Care needs to support the training and development of the care workforce fully and to implement the forthcoming workforce strategy. run a national campaign to promote care, ambitious in scale and scope to change the public narrative around care to positive.  

Thank you All reports are available at www.nao.org.uk Follow the NAO on Twitter @NAOorguk Subscribe to notifications with NAO preference centre View our blog www.nao.org.uk/naoblog Give us your thoughts on the new Code of Audit Practice https://www.nao.org.uk/code-audit-practice/about-code/ Please contact Aileen Murphie with any further questions Aileen.murphie@nao.org.uk