The current business model for social care in Wales, like the rest of the UK, is under extreme pressure. This vulnerability has predated the present Covid-19 pandemic. Care Forum Wales, the main representative body for the private care sector, has claimed that Wales could lose half its care homes within a year unless urgent action is taken. A Care Forum Wales survey also reported that 84% of respondents said low pay made it difficult for the recruitment of staff. Responding to these long standing concerns the Welsh Government commissioned the Welsh Institute for Health and Social Care to study the variation in terms of employment in the social care sector in Wales.

The study looked at the comparative experience of various social care sectors in Wales including local authorities, independent sector and the NHS. There were (2017) approximately 1350 providers in the independent sector with a workforce of 52,500 and 130 local authority services with a workforce of 11,000. While the study showed variation within sectors there were also important overall differences between the sectors which could account the differing sectoral work experiences.

The median minimum basic pay for front line independent sector care workers was 18% less that for local authorities (£9.74/hr) and 9% for NHS. The differences for maximum basic pay were 32% less for independent sector workers compared to local authority staff (£11.88) and 18% less for NHS health care support workers. Independent sector care supervisors received 32% less in their median minimum basic pay compared to local authority supervisors (£13.37/hr) and 78% in their median maximum basic pay ( LA supervisors £18.03/hr) . In addition the public sector workers were much more likely to receive pay enhancements for pensions and activities such as weekend shifts, holiday cover and over-time.

Compared to 55% of independent sector front-line workers about 25% of local authority staff were in permanent full-time employment while 23% in independent sector were permanent part-time posts compared to 51% in public sector. However there were less differences in more senior posts across the sectors. About 20% of front-line care workers across the independent, local authority and NHS had the equivalent of zero hours contracts. There was some evidence that not all staff were unhappy with the relative flexibility these contracts provided.

The report confirmed that recruitment, retention and staff turnover is a problem for the sector as a whole. While all had concerns about the recruitment and retention of staff this was greatest in the independent sector. These problems were less in more senior staff positions and overall there was a greater problem in recruiting staff compared to retention. While the independent sector felt it was in competition with local authorities for staff, both felt under pressure from the NHS and outside sectors such as retail. As well there were geographical variations with rural areas having less problems that more urban ones.

While pay was an important factor other issues such as the status of social care, work pressures and responsibilities were felt to barriers to recruitment and retention. On the other hand the caring and pastoral aspects of the work were valued by the staff and contributed to them staying in post in despite the poor levels of pay.

The Welsh Government has responded to some of the problems in the sector with others more difficult to address due to ongoing austerity policies and the continuing failure of the Westminster Government to live up to its promised on producing a comprehensive set of proposals to deliver a quality, affordable social care service.
In order to improve the skills and status all all staff care staff will be expected to be registered with Social Care Wales by 2022. Once they have been in employment for more than three months care staff will have the right to choose between a defined hours or “zero hours” contact. And last year (2019) the Welsh Government supported “We Care” a campaign and on-line portal to support social care recruitment.

In the Covid-19 pandemic care staff were provided with a £500 grant in recognition of their work by the Welsh Government. However despite declaring its commitment to the workers in the sector, the Westminster Government refused to exempt the bonus from stoppages such as taxation and NI contributions.

It is clear that most of those who work in the sector are committed to their job and value its humanitarian values even above pay. An unemployment fall-out from Covid-19 might provide some easing of recruitment and retention difficulties but this cannot be seen as a sustainable solution. More comprehensive measures are needed.

For decades social care has been provided on the cheap with the cost, in the first instance, being borne by staff in terms of their pay, work conditions and their opportunities for career progression. This downward pressure was driven by the policies of out-sourcing and tendering and an under-valuing of the public sector. But this policy has more or less come to the end of the road.

The Welsh Government realises this and has commenced a consultation process on legislation that will require local authorities and health boards to regularly assess the financial sustainability of the care sector in their catchment areas. This should provide important information to inform the future shaping of local social care services.

But we need to do more. We must start looking for more radical solutions within the overall context of a National Care Service. As a first step domiciliary care services should be brought back into the public service as their contracts lapse. And we then need to see how this option can be extended to all other workers in the sector.

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  1. Colin Slasberg says:

    Thank you very much Jim – this is important information and encouraging. Your critique applies equally to England.

    Would you agree that the first imperative is to bring about a transformation of the way the Council assesses needs and allocates resources? They have been the silent conduit of the strategy to strip resources from care services through low pricing. James Bullion, ADASS President, described to the Health and Social Care Committee Inquiry into social care the commissioning process as ‘stack ’em high and sell ’em cheap’. Its a shocking phrase, but accurate.

    Do we not have to be careful about assuming absorption back in to direct council provision will, in and of itself, address the issue of quality? It was in the context of 100% direct provision in the 1980’s that created the drive of the disabled peoples movement to create an escape mechanism. Is it not the case that a properly functioning and resourced commissioning process that was tasked to create a market to deliver independent living for all, would be able to price and commission services capable of delivery from the independent sector.

    It would be good to know thoughts.

  2. Jim Gralton says:

    Thanks for your response and for starting with the easy question.

    As far as adult social care is concerned I think Mr Bullion does not fully describe the situation. Over recent decades fewer people are being assessed as being eligible for services but they are getting more hours of care. This would suggest that services are concentrated on people with the highest and most complex levels of need. For those receiving care, the level of support and input has been improving but at the price of many missing out.

    Services are often mass produced in a regimented way. This means that many recipients have to accept services as they are provided but I think social work professionals do make real efforts to mould care packages according to needs. However choice, like eligibility, is being constrained – mainly due to the consequences of austerity.

    The quality of care a person received is also dependent on service values, leadership, training, continuity and affordability. The present model with its difficulties in funding, recruitment, retention and low training levels will inevitably find it more difficult to deliver a quality service.

    But public service provision is no magic bullet. If there is poor leadership, a dilution of values, under-resourcing or lack of commitment to training etc then standards will fall. This is where good regulation, good governance and a capacity to listen to services users and their families / carers is so important.

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