In her first address to parliament as Secretary of State for Health and Care, Therese Coffey announced a £500 million fund under her plan for care. Described in official DHSC documentation as a “discharge fund”, it is intended to help free up hospital beds over winter and help retain and recruit more care workers. Details are still emerging about how the money will be allocated, but DHSC officials have made clear that local areas will have autonomy in deciding how it is spent, enabling them to tailor solutions to suit local areas.
As an additional boost to tackling the growing problem of delayed discharges, the money will be welcome and may go some way to enabling people to leave hospital more swiftly over winter. But for those hoping for a more substantial intervention into the struggling social care system, this £500 million will be seen as a drop in the ocean against a funding blackhole already estimated to be around £3.7 billion next year. Indeed, the Health Secretary herself described the fund as a “down payment” ahead of future rebalancing of funding across health and social care.
A short-term social care solution for a long-term problem?
Although the fund featured under C for Care in the ABCD plan, the money is intended as a fix for an NHS problem. A clear focus on the NHS ‘back door’ is understandable given the pressures within hospitals, and the harmful impact of unnecessarily long hospital stays on people unable to be discharged. However, it is unlikely that a relatively small temporary fund will magically fix the myriad factors underlying the problem.
For a start, as this QualityWatch analysis shows, delays to discharges are not just due to social care capacity constraints – many other factors and sectors (such as capacity in community NHS care and internal hospital processes) are also at play.
Secondly, the temporary nature of the funding will not tackle the deep-rooted problems at the heart of the care system. This is the latest in a long line of short-term injections of cash that have become a feature of social care funding over the last decade. The sporadic nature of funding has exacerbated the impact of funding shortfalls. For instance, the lack of certainty over when the next tranche of cash would land has perpetuated poor commissioning practices. This frequently sees care commissioned according to tasks and staff time rather than outcomes, or individual care packages being purchased with little regard for the longer-term or wider context.
In residential care, budget pressures in councils have seen them paying low fees to providers and this has limited the ability to invest in infrastructure. 28% of care home rooms are not en-suite and fewer than half are in purpose-built estates. Many providers have become dependent on self-funders for financial survival – on average charging 41% more for services.
The ramifications of this short-termist approach to funding can be seen in the state of the social care workforce. Vacancy rates, which had been creeping up pre-Covid, have rocketed in the last year as long-standing issues of pay and poor conditions have been exacerbated by burnout, cost-of-living pressures and stiff competition for staff from other sectors. The DHSC’s plan for care rightly recognises the need to support more people to work in care and pledges to refresh its recruitment campaign, develop knowledge and skills, and invest in learning. But without a commitment to reform pay and transform conditions, providers will likely still struggle to fill gaps in their workforces.
The £500 million pot for social care could theoretically be used to boost pay – perhaps through bonuses – but, divided across the 1.5 million strong workforce, the amounts would be modest. Besides, care workers cannot be turned on like a tap and recruitment takes time. Recruitment in home care, in particular, is far from straightforward – home care workers usually need to be able to drive and to have access to a vehicle, so the cost of fuel and a backlog in the driving test system are further factors that may deter potential recruits.
The £15 million fund for boosting international recruitment may be helpful around the edges, but the number of staff likely to be recruited via this route is unlikely to be sufficient to both fill current vacancies and allow for much-needed expansion of capacity.
Given the long lead-in time for international recruitment, the likelihood of new staff being in place before winter is slim. The government’s own Migration Advisory Committee said in its report earlier this year that the fundamental issue in this workforce is pay and, until that is addressed head on through realistic and sustainable mechanisms, immigration policy is not the solution to “all, or even most, of the workforce problems in social care”. And, when the winter money comes to an end, without a certain and sustainable source of funding, recruitment challenges will inevitably give way to retention challenges.
Long-term hope
The plan for patients refers to longer-term ambitions for sustainability and change – with a shift of funding from NHS to social care – and that offers some hope to this beleaguered sector. But the abolition of the health and social care levy, and the as-yet-unknown implications, adds yet another layer of uncertainty to the backdrop. The government’s down payment may prove to be just too small a deposit to prevent this fragile system from crumbling completely.