Central government needs to get a grip on dire staffing and finance problems facing the nation’s social care sector by taking a strategic lead, according to a cutting new report from the National Audit Office.
The public spending watchdog said that despite the well-documented demographic pressures of the ageing population and eye-watering staff turnover rates, there was no evidence that Department of Health and Social Care – as it was rebranded last month – had produced a workforce strategy for care since 2009.
Its report on the adult social care workforce in England paints a picture of departmental inaction against a backdrop of growing care demands, increasing levels of unmet need, and a shortage of staff to provide services – a situation driven by low pay, and the lack of a career path.
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According to the NAO, there were around 1.34 million jobs in the adult social care social care sector in 2016-17, including roles such as care workers who visit service users in their homes to assist with daily tasks, registered managers, and registered nurses.
Half of the roles identified were paid at the minimum wage and the annual turnover rate for the sector reached 27.8% last year, while the vacancy rate was more than double the national average at 6.6%.
The adult social care staff identified work for more than 20,000 different organisations. Industry rates are dictated to a large extent by local authority financial constraints, which the report said had seen annual council spending in the area decrease by 5.3% since 2010-11, driven by "continued government funding cuts and increased financial pressures".
While the delivery of adult social care is historically a responsibility of local government, the quality and extent of provision has a direct impact on demand for NHS services, exemplified by the phenomenon of "bed blocking", or delayed discharge, in which demand for hospital services increases when patients cannot be released because there is not enough community support for them.
The NAO said the Department for Health and Social Care did not appear to be overseeing workforce planning by councils or local health partnerships. Its report called on the department to work in conjunction with the Ministry of Housing, Communities and Local Government to produce “a robust national workforce strategy” and encourage local and regional bodies to align their own plans to it.
It said the department also needed to invest more to enable commissioners to set appropriate fees for providers, so staff could be paid adequately and employers could be offered career development and training opportunities.
The report also stressed that better integration between health and social care services was not expected to reduce the projected demand for social care staff.
NAO head Sir Amyas Morse said the department had to up its game against the backdrop of predictions from the Centre for Workforce Intelligence that the adult social care sector would need two million full-time equivalent staff by 2035.
“Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society,” he said.
“Pressures and demands on the health and social care systems are increasing, so the department needs to respond quickly to this challenge by giving the sector the attention it deserves and needs, instead of falling short and not delivering value for money.”
The report authors said DHSC’s last workforce strategy, Working to put people first: the strategy for the adult social care workforce in England, was published in 2009, under the last Labour government, and was only available on the National Archives’ website.
It acknowledged the existence of a draft workforce strategy document, published for consultation by Health Education England in December 2017, but said its coverage of social care was “short and lacking detail”.
DHSC said that the Care Act made it clear that local authorities were required to shape their whole local markets to ensure that they were sustainable, diverse and offered high quality care and support for people in their local area.
“We recognise there are challenges in the social care workforce – that’s why we’ve launched a consultation on the adult social care workforce and committed to publishing a health and care workforce strategy in the summer,” a spokesperson said.
“At the Spring Budget we provided an extra £2bn funding to the sector and we have just announced a further £150m for 2018-19. We will publish plans this summer to reform social care to ensure it is sustainable for the future.”
The spokesperson was referring to the anticipated social care green paper.