Supporting those who deliver social care: what can England learn from the rest of the UK?

It’s all in the name – social care in its essence is the provision of physical, personal and emotional support to the most vulnerable in our society.

Yet the people who provide that care – be it ‘formally’ through care agency employees, or ‘informally’ through the support of friend and family networks – are undervalued. As need for social care grows as our society ages and people’s needs become increasingly complex, our dependence on the people who provide our care grows ever greater – and this has been only too apparent during the current Covid-19 crisis.

Regardless of that crisis, each of the four UK countries faces common problems around the sustainability of its social care workforce. Many workers are poorly paid, many are in zero-hour contracts, and the opportunities for career progression are few, with a median difference of 50p between a care worker and their senior. With up to 122,000 vacancies in England alone and high rates of turnover, it’s clear that the sector, often plagued with terms such as ‘low status’, ‘low pay’ or worse yet ‘low skill’, struggles with attracting people into work.

Despite some common challenges, responses across the UK’s four countries have varied. So what can these teach England?

Lesson 1: A legally mandated body for centrally driven reform has benefits

In England, there is no governmental organisation that regulates and supports the development of social care staff. Instead, Skills for Care holds a charitable status and acts as the delivery partner for England’s workforce development.

In contrast, the Scottish Social Services Council, Social Care Wales and the Northern Ireland Social Care Council are non-departmental public bodies with accompanying statutory powers and accountabilities around the regulation of the social care workforce, as well as its training and development. Having an organisation that is legally mandated by, and accountable to, government arguably affords greater credibility to the nature of social care work in the other UK countries.

It also helps to put social care on an equal footing with health. Having no organisation on a statutory par with Health Education England for training and workforce planning, or the General Medical Council for regulation, means there is no national body in England with appropriate powers, as there is in the rest of the UK, to “directly enact policy to affect the social care workforce”.

This deficit in England has been recognised by the Public Accounts Committee, which called for Skills for Care to be granted status and support equal to its health counterparts. Given the interconnectedness of the two systems, it is crucial that the national direction for social care workforce policy is developed alongside – or as part of – the ‘people plan’ for health. It is encouraging to see this in the other UK countries, most recently with a strategy for social care roles set out alongside health roles in Scotland’s integrated workforce plan for health and social care.

Lesson 2: Registration is an important but not sufficient step towards professionalisation

A key activity of the regulatory bodies in Scotland, Wales and Northern Ireland is to ensure that all workers who undertake social care work are on a register. Scotland’s came into use in 2003, while registration has been compulsory in Wales and Northern Ireland since 2017. Different social care roles have been brought to the devolved countries’ registers over time and the process is still ongoing.

Registration is intended to enable better planning, a common adherence to Fitness to Practise standards, and a reassurance for both workers and service users that the care delivered will be safe and of good quality.

With a growing interest in England in the ‘professionalisation’ of the social care workforce to boost the status of care work and to reduce the high turnover in the sector, making registration compulsory in England as it is elsewhere in the UK could make a good starting point. Although it’s early days, evidence is emerging in Northern Ireland that registration and its accompanying benefits does have a positive impact on the workforce and the service users it supports, and on retention too.

However, it takes time and resource to get all workers onto a register, and even longer if this involves holding a qualification. Given the size of England’s social care workforce, vast amounts of planning and foresight will be required if the majority of workers are to be registered and centrally regulated.

Potentially unintended consequences of compulsory registration will also need to be considered alongside its benefits. Making qualifications a requirement like they are in Scotland and Wales has the advantage of ensuring all workers share a minimum standard of skills.

But there is a risk this could discourage some people – such as night shift workers – from remaining in their role if they perceive the commitments of undertaking a qualification to be more onerous than beneficial. Such a concern has been raised in Wales. Appropriate measures, such as registering under the condition that a qualification will be obtained in the future, will be essential to minimise disruption to the sector.

Even if registration was to be achieved successfully, it will not be a quick fix for England and cannot alone solve the sector’s workforce issues. Registration is merely one element of professionalisation. Creating a structured career pathway with opportunities for pay progression and professional development at all levels (including into leadership roles) need to go alongside it. Scotland, for instance, has recognised this and developed an enhancing leadership capability strategy that complements development strategies for the front line.

Lesson 3: Informal carers matter too

One consequence of too few professional care staff is that many people instead become reliant on friend and family networks to fill that care need. Across the UK, the most up-to-date figures from the UK Census (even though those are from 2011) estimate that around 6.5 million people are taking on caring duties, and more recent research suggest that this figure has grown over the last 10 years – Carers UK estimated as many as 8.8 million carers in 2019. There is a shared concern in all four countries that these informal carers are not being adequately supported, which impacts on their ability to work and more importantly on their wellbeing.

There are some useful examples from the other countries of attempts to better support carers that England could consider implementing. Scotland, for instance, has introduced a carers’ allowance supplement to bring carers’ allowance in line with jobseekers’ allowance. This actively recognises the value of the contribution made by carers in supporting their loved ones.

It is crucial that any reform pursued by England does not forget the vast numbers of people currently providing unpaid care and consider how best to support them.

Caring for the people doing the caring

Making social care an environment where people want to work – and continue to work – is a challenge shared across the UK’s four countries, and one of the biggest challenges facing the sector.

Better pay that recognises the hard work required in caring jobs is central to the issue. ​Scotland have made a start on this by increasing the pay of all care staff to the Real Living Wage, in recognition of their vital contribution to current Covid-19 efforts. But attracting more people to care in the long term also means tackling challenging working conditions, the lack of career progression, and wider perceptions of care work as low status.

The other UK countries have set off on a path towards professionalisation, supported by statutory workforce regulators with the powers to enact change. While it is early days for much of their efforts, emerging evidence suggests England would be wise to pay close attention to developments and build on their learning.

The debate about the future of social care all too often starts and ends with funding. But effective reform to the sector must go beyond money, and should recognise the central role of both formal and informal carers in delivering social care. Without comprehensive solutions to the workforce crisis and appropriate support for unpaid carers, the sustainability of any reform in England will be difficult to achieve.