NCF’s social care must haves for the next government
The next General Election will be called before the end of 2024 and the National Care Forum is calling upon all political parties to ensure that adult social care is a central part of every manifesto. For decades, governments of various political persuasions have failed to bring forward and commit to ambitious reform, and the last few years have been no different, with either delays to announced reforms or scaled back ambition.
Demographic changes in our society, growing unmet need and a difficult workforce environment mean this is a policy area that must no longer be ignored. More importantly, the full potential of adult social care to enable people to live to the full, to unlock economic prosperity and combat social-economic and health inequalities, is largely an untapped resource and one which needs to be at the centre of conversations about reform. Indeed, Future Social Care Coalition outlined in their recently published Carenomics report, a very strong argument that investing in social care is essential for a secure and growing economy.
We are calling on all political parties to:
Policymakers must consider the impact on or possible contributions of social care when developing relevant policy. We want to see an approach to adult social care which recognises how important the availability of and access to a diverse range of adult social care services is to the wellbeing and overall health of communities and enabling people to live their lives to the full. This must involve greater collaboration from other local services that people depend on.
The sector offers a diverse range of care services – not just care homes – which form an ecosystem of care and support for many communities. This includes housing with care options as well as home care, befriending services, day services, personal assistants, employment help, addiction and rehabilitation services, and services which overlap with housing and mental health, as well as the wider VCSE sector.
All too often, the voice of adult social care providers and the voices of people who access care and support are overlooked.
Any new government’s policy agenda must include:
- A commitment to beginning reform within the first parliament of any new government.
- A campaign to make social care transparent, accessible, and intelligible to the general public.
- The articulation of a clear, public identity for adult social care, which is as recognisable as the NHS in the public’s mind and emphasises its diversity of provision for all ages.
- The creation of funded roles to enable the representation of adult social care providers on the membership of every Integrated Care Partnership.
- The appointment of Adult Social Care Leads on all Integrated Care Boards to ensure accountability and good governance, as well as correcting a tendency for systems to see everything through a healthcare lens alone.
- Regular analysis of current and future requirements for social care for adults of all ages, regardless of whether they fund their own care or not. This analysis should be used to inform future policy on funding, workforce, innovation, and commissioning practice to ensure we build the social care capacity we need, and that people want. This should look beyond a narrow health focus, to unlock the potential of social care as one of the key determinants of good health and wellbeing, as well as economic prosperity and societal cohesion.
We need to improve the pay, terms and conditions of care workers. Currently, the skills, knowledge, and expertise of social care workers are not reflected by the level of pay that they receive: 80% of jobs in the wider economy pay more than jobs in social care. Compare this to NHS roles and there is a significant difference; pay for the average care worker is £1 less per hour than a healthcare assistant in the NHS who is new to their role. At present, experience is also undervalued, Skills for Care data indicates that, on average, care workers with five years’ (or more) experience in the sector are only paid 7p per hour more than a care worker with less than one year experience.1
It is no surprise then, that recruitment and retention is one of the biggest challenges for the sustainability of adult social care and is contributing to unmet and under-met need across England. There are currently 1.635m filled posts in social care but 152,000 vacancies in the sector.2 Unmet and under-met need are growing, there are now 5 million unpaid carers3 and requests for care are expected to exceed 2 million in 2022/2023.4 It is also estimated that we will need 440,000 new social care posts to keep pace with demographic changes by 2035 on top of the current shortfalls.5
This pressure is largely being driven by the failure of successive governments to bring forward a workforce plan for social care or properly fund providers to improve workforce pay, terms and conditions. Attempts to introduce reformed career and development structures continue to fail because care and support providers are underfunded by the state. This constrains their ability to offer more attractive pay, terms and conditions and maintain pay differentials which recognise and reward the attainment of additional skills, specialisms, and responsibilities.
We’re calling on a future government to commit to properly investing in the workforce in several ways:
- Pay care workers at a rate according to their skills and competencies determined by an independent review body, aligned, at the very least, with NHS Agenda for Change Pay Bands. This must be fully funded via local or central government funding models.
- Develop a long-term workforce plan for adult social care which models future workforce requirements and seeks to diversify the types of roles available, as well as developing career structures and qualifications. This should be aligned with NHS workforce planning to enable a joined-up workforce and to enhance the quality of care provided by both the NHS and social care.
- Introduce professional registration for all adult social care workers and establish a professional body to represent them. This must be fully funded by the state.
Social care delivers public good, and much of it is funded by the public purse. Not-for-profit care provision ensures that all the funding from either government or citizens is directed towards the delivery of care, so that money remains in the sector and is reinvested into the workforce and to improve the quality of care – rather than leaking out of services.
The not-for-profit organisations we represent place a strong emphasis on the long-term sustainability of their care and support services in the local communities they serve, often having deep roots due to their origins and history in local areas, alongside their focus on person-centred care. As such, many are able to offer specialist provision for people with specific needs, such as people from different faith traditions, veterans, and the LGBTQ+ community.
Many not-for-profit organisations providing care and support are charities or social housing providers, meaning they are not just accountable to the CQC but also the Charity Commission and the Social Housing Regulator. As a result, the organisations we represent, by their very nature, have a very strong culture of accountability, transparency, governance, diversity and person-centeredness.
For these reasons we are calling on any new government to introduce measures to enable the growth of not-for-profit care provision. This should include:
- Putting people before profit through the strategic commissioning and funding of not-for-profit care.
- Developing a pathway to enable more care organisations to adopt a not-for-profit care model.
- Ensuring that regulation has a focus on financial transparency to ensure confidence and accountability.
Adult social care is a key part of the nation’s infrastructure, with the potential to unlock economic prosperity and combat socio-economic and health inequalities in every part of the country.
Social care services are anchor institutions for their local communities – they generate spending which remains within the same community in which they exist and support a much wider ecosystem of community services and local businesses. Collectively, these services are some of the biggest employers across the country, and according to Skills for Care, contribute an estimated £55.7bn gross value added per annum to the English economy.6 For every extra £1bn in social care spending, an extra 50,000 jobs are created distributed across England, with the largest impacts felt in the North East and North West.7
Furthermore, the very nature of social care is enabling to people. As well as improving population health and wellbeing and creating new jobs, good social care enables some people in receipt of care and, crucially, their unpaid carers (often women) to join or return to the workforce if they would like to. It is a powerful tool in addressing inequalities.
If we want to maximise these benefits, adult social care needs proper investment to enable sustainable transformation with specific measures to encourage the building of new sustainable services, digital transformation, and new models of care to meet changing demographics and what people will want in the future. We also need investment in housing and technology enabled care to ensure people are able to remain in the community and independent for longer.
We want to see the development of an industrial strategy for social care which includes:
- A capital investment fund to enable not-for-profit providers to develop and create new services and buildings, with a focus on new models of care, environmental sustainability and the introduction of new technologies.
- A funded national framework for the price of registered and unregistered care which ensures good quality, sustainable care wherever you live and removes the catastrophic costs providers, individuals and families are being expected to pay to subsidise the state.
- A ‘Greener Social Care’ strategy to help the sector meet net zero and environmental sustainability targets.
- Zero-rated VAT for not-for-profit adult social care providers to enable VAT on operating expenses to be reclaimed.
- The establishment of new data infrastructures and a minimum data set for adult social care which allows insights about care to be harnessed. This must be co-produced with the sector and people, and it must balance data burden with data benefit and clarity on data ownership and access. Data is not free, so any strategy must ensure that it meets the costs of increased data reporting requirements.
- A new duty for CQC to promote innovation, improvement and economic development of social care services – the regulator should consider the role of LA and ICS commissioning in enabling this.
If we want a system which enshrines rights, fairness and choice for people, we need to give those with the biggest stake in the system working more power. People should be at the heart of their own care and empowered to shape the development of care services with commissioners and providers. To use the language of the Archbishops’ Commission on Reimagining Care, we need a ‘social covenant’ that sets out the role and contribution of people, communities and government and clear expectations of what support should be available.8 This support needs to be universally accessible, rather than rationed due to the postcode lottery of funding and resources. It will also require a shift towards prevention and anticipatory care which ensures that resources and funding are in place to enable people to get care and support when they need it, where they need it. The underfunding of care and support has led to a reactive approach with the eligibility threshold to access support getting increasingly higher. This must be reversed.
The dignity, independence and wellbeing of people and their families should be paramount. We need to see a situation in which people who draw on care and support have the same choice and control over their life as everyone else – a’ gloriously ordinary life’ to borrow the language of the House of Lords Adult Social Care Committee.9 People should be enabled to live in a place they call home with the people and things they love, in communities that look out for one another, doing the things that matter to them.10
Currently, there is an assumption by policymakers that families will simply ‘step up’ to provide unpaid care. This is deeply unfair on both parties. Carers are left physically, emotionally and financially exhausted, while those receiving care are denied an ordinary relationship with friends and family. The assumption also fails to recognise that there are increasing numbers of people ageing without children or other family who might be able to care for them.
We are calling on a future government to:
- Develop a National Care Covenant, as outlined in the Archbishops’ Report, which is co-produced and sets out clearly the mutual rights and responsibilities of the different parties. This would make clear the role of citizens, families, communities and the state in providing support and paying for it.
- Commit to a strong role for central government to guarantee universal access to care and support, security against the costs of care, and upholding people’s rights.
- Set clear requirements for commissioners to commission in partnership with care and support providers and people who need services.
- Create a Commissioner for Adult Social Care for England.
7 The Economic Value of the Adult Social Care Sector – England, ICF Consulting Ltd, 2018
10 Adapted from Social Care Future’s vision for Adult Social Care: https://socialcarefuture.org.uk/
How can you get involved?
NCF run a regular Policy & Public Affairs network for members. Any members who don’t currently attend the network and are interested in supporting our campaigning activities can register by contacting email@example.com
Vic Rayner, CEO – firstname.lastname@example.org
Liz Jones, Policy Director – email@example.com
Nathan Jones, Senior Policy and Public Affairs Lead – firstname.lastname@example.org
NCF at the Party Conferences
On 25th September 11:30am-12:30pm, our CEO Vic Rayner chaired a joint panel with MHA. The session was packed out and the panel included Daisy Cooper, the Lib Dems Spokesperson for Health and Social Care: ‘Valuing Carers – making care a vote winner in the 2024 election’.
On 3rd October NCF hosted a fringe event at the Conservative Conference in collaboration with a number of our members, frontline care workers and experts by experience on: ‘Valuing People and their Communities: Unlocking the Potential of Not-for-Profit Care’. The session was very well attended, in fact it was standing room only! Our messages about not-for-profit care and the importance of care in valuing people and their communities were communicated very well and we had great input from the panel.
On 10th October NCF is hosted a fringe event at the Labour Conference in collaboration with a number of our members, frontline carers, and experts by experience on: ‘Valuing People and their Communities: Unlocking the Potential of Not-for-Profit Care’. Again, a well attended session with great contributions from our panel, particularly Matt Price who has received care from, and now works in a role, with Community Integrated Care.
Support for NCF’s social care must haves for the next government
“It’s great to see the National Care Forum, a valued member of the Care and Support Alliance, flying the flag for social care investment and reform and taking the argument to all the political parties, in anticipation of the General Election to come. It is no surprise to see the need to improve the terms and conditions of care professionals featuring so high on their list of priorities; there is now such a strong consensus that this is the right thing to do that we hope the incoming government, of whatever hue, will feel compelled to act decisively so that care workers receive a fair reward for the fantastic work they do. There is also an equally compelling case for doing more to support unpaid carers, on whom our entire system of social care ultimately depends.”
“I warmly welcome the inclusion of a National Care Covenant in the National Care Forum’s ‘manifesto must haves’ for the next government. With its focus on setting out the mutual responsibilities of citizens, families, communities and the state, a National Care Covenant would bring much-needed clarity to our complex social care arrangement and ensure that everyone has the care and support they need to live a full life. The Archbishops’ Commission on Reimagining Care engaged closely with the National Care Forum during our work and was pleased to see the creation of its Faith and Spirituality Network. I hope that all political parties will commit to developing a National Care Covenant and putting social care reform at the heart of their policy prospectus, alongside considering the other thoughtful proposals made by the National Care Forum.”
The Rt Revd and Rt Hon Dame Sarah Mullally DBE,
Bishop of London and lead Bishop for Health and Social Care