Social care in England
Social care in England is defined as the provision of social work, personal care, protection or social support services to children or adults in need or at risk, or adults with needs arising from illness, disability, old age or poverty. The main legal definitions flow from the National Health Service and Community Care Act 1990 with other provisions covering responsibilities to informal carers. That provision may have one or more of the following aims: to protect people who use care services from abuse or neglect, to prevent deterioration of or promote physical or mental health, to promote independence and social inclusion, to improve opportunities and life chances, to strengthen families and to protect human rights in relation to people's social needs.
Local commissioners, mainly based in councils oversee a market with many different types of social care provision available, either purchased by public bodies after assessments or accessed on a self funded basis by the public. These include community support and activities, advisory services and advocacy, provision of equipment to manage disabilities, alarm systems, e.g., to manage the outcome of falls, home/domiciliary care or daycare, housing options with levels of care support attached, residential nursing home care, as well as support for informal carers.
Social care is frequently used as a synonymous term with social welfare, and as an alternative to social work. The term often implies informal networks of support and assistance as well as services funded following assessments by social work and other professions.
Social care in the modern context encompasses many areas of need, each with a level of specialist services. These can be broadly categorised as follows:
- Adults – this includes support for older people, people with mental health problems, learning or physical disabilities, those with alcohol and substance misuse problems, the homeless, prevention of abuse or neglect, domestic abuse and associated support for families and carers. Older adults are routinely given cheaper care and less favourable care than younger people with similar needs and/or disabilities. This is considered ageism.
- Children, young people and families – this includes preventative family support and child protection services, child placement, fostering, adoption, working with young offenders, children and young people who have learning or physical disabilities, or who are homeless, as well as support for families and carers.
- Workforce – this includes the provision of resources, training and support for those working in social care.
Social care has long existed as an informal concept, through family and community support and charitable works. In mediaeval times, social care had been provided by monastic foundations, but at the Reformation, that support ended, because the monasteries were dissolved. The loss of monastic social support (and education) was one of the declared grievances behind the Pilgrimage of Grace.
After briefly experimenting with harsher approaches to the destitute, the Tudor establishment passed the Elizabethan Poor Law (in 1601), which made civil parishes (a local government unit) responsible for providing basic health, domestic care, housing, and employment support, to those in need; this was one of the earliest Acts of Parliament to offer statutory support. The ‘care’ to be provided could include payments, food, apprenticeships, boarding or referral to a workhouse.
Originally the workhouse was simply a labour exchange for small pieces of low value work, which were usually carried out in-situ. In the late 18th century, a generous system of income support - the Speenhamland system - was established on an ad-hoc basis in parts of the country, and promoted by the Tory Prime Minister William Pitt the Younger, but others thought it was too generous, and were worried that it would lead to people not bothering to work. As a result, the Whigs passed the Poor Law Reform Act, which turned workhouses into harsh, almost prison-like, environments; it is these reformed workhouses which lead to the notoriety of the workhouse concept.
Under the Poor Law Reform Act, civil parishes were encouraged to form Poor Law Unions with other nearby civil parishes, and establish a joint workhouse, which were to require to operate in a manner that was so harsh and basic that people would only resort to workhouses if they were absolutely destitute and had no other option. The workhouse would provide shelter, meals, and basic social care, in return for unpleasant, harsh, and menial work; only those who were so frail that work was impossible were to be excused. All support outside the workhouse was to be abolished.
Meanwhile, the rise of industrialisation, lead to a rapidly more urbanized population, causing great social deprivation. It also bought a decline in the support provided by family and close-knit communities as people became more mobile and moved to different areas for work. However, the increasingly wealthy middle classes, now having enough time and money to engage in leisurely pursuits, established voluntary organisations which sought to alleviate these difficulties, providing rudimentary social work, and medical services. Mutually owned societies also developed, providing medical support to their members, when needed, in return for insurance-like subscriptions; some of these Industrial and Provident Societies later merged to become national not-for-profit health organisations, such as BUPA, which survives into the 21st century.
Many workhouses established infirmary sections to house frail inmates. Under the Tory government of the late 1860s, the Metropolitan Poor Act transferred responsibility for the frail poor from Poor Law Unions, in the Metropolis (the urban area around London), to a new Metropolitan Asylums Board. The Act also combined the funding of the Poor Law Unions into a shared Common Poor Fund. The Metropolitan Asylums Board established new asylums to house and treat the frail poor, and was empowered by the Metropolitan Poor Act to charge the cost of medical treatment to the Common Poor Fund. Outside the Metropolis, many Poor Law Unions moved support for the frail to new locations, away from provision for the able-bodied poor.
Over the early 20th century, responsibility for social protection was gradually transferred away from workhouses, and a distinct separation grew between policies to support income maintenance and those to support frailty. In 1906, the descendants of the Whigs - the Liberal party - came to power, and reversed their earlier opposition to Speenhamland-like systems, by bringing into force the first means-tested pension for people aged 70 and over; the able-bodied elderly no longer required the workhouse. In 1929, as one of his last acts in office, Stanley Baldwin (the Tory Prime Minister), passed the Local Government Act, enabling - but not compelling - Local Councils to take over responsibility for frail people who lived within their area. In the early 1930s, the Unemployment Assistance Board was established to provide income support to the unemployed, removing the able bodied from workhouses.
Local Councils had been introduced in the later 19th century as a governmental unit large enough to take over from the boards which ran the many public services which had been introduced over the century. Most of them were not keen on taking over responsibility for medical services for the poor, but many were willing to take over from infirmaries and asylums that focused on simply providing social care, and often re-labelled them as care homes. The development of social sciences such as psychology and sociology bought social structures under further scrutiny, and opened the way for social work to become an area of academic study, and Local Council involvement, creating a professionalised role.
Since wounded military staff were treated by medical officers within the military, the use of mass-conscription in World War II had meant that a much larger portion of the population had state organised medical services available to them. With an eye on future expectations of the public, Churchill commissioned the Beveridge Report into the future of welfare and health services. Once the war had ended, all the main parties promised to act on the Report's recommendations and made manifesto promises to establish a national health service; in the later 1940s the NHS was directly created as a result, absorbing the medically focused asylums and infirmaries (many of which had been renamed hospitals by this point). The workhouse concept was formally abolished.
Paying for social care
The Institute for Public Policy Research and Age UK both maintain that social care elderly people receive should be free for those who need it. The need for social care for older and disabled adults is rising due to an aging population and increased numbers of disabled adults. Caroline Abrahams of Age UK said, “The problems facing social care are national, but for too long successive governments have left local councils to carry the can. That’s been grossly unfair to local communities and above all to older and disabled people, more than 1.5 million of whom now have some unmet need for care. This is such a big problem now that to have credibility at this election every political party that aspires to govern needs to bring forward a policy to fix care, once and for all.”
The provision of social care by Local Councils was not changed at the creation of the NHS. As a consequence, Local Council provision continued to be limited to the poor. One of the first acts of the Conservative Prime Minister Ted Heath was to pass the 1970 National Insurance Act, introducing Attendance Allowance as a universal welfare payment for those needing social care.
The majority of those receiving adult social care in England continue to be expected to pay for it if they are able to - though Attendance Allowance, and its equivalents in other age groups (components of Disability Living Allowance, and Personal Independence Payments), provides a source of funding for the individual. However, for complex care needs, and residential care, this is often not enough money to fully cover the cost. Financial assistance is available from local councils, to cover the remainder of costs, but it remains Means-tested, and is thus targeted at those whose assets and income are not sufficient to pay for their care. Some local authorities have schemes which enable care costs to be postponed, though evidence suggests this is not currently available at all local authorities
Sir Andrew Dilnot conducted a review of the social care system for the Cameron Government, and proposed a universal lifetime cost cap of around £73,000, on the basis of pooled risk, like an insurance arrangement. He also proposed the introduction of personal budgets for every care user, allowing them to spend the funding for their social care as they see fit, rather than having to use the council provider. These changes were legislated for, and passed into law, but Local Councils demanded that the changes be delayed until after the next election, claiming that they did not have the money or ability required if they were to implement the changes immediately; the change was postponed until 2020, and has not yet been commenced.
Independently of the Dilnot proposals, the administration of Attendance Allowance will be transferred to Local Councils in 2020, meaning that assessment of care needs will be merged with assessment of funding eligibility, for those who qualify for Attendance Allowance (individuals who have reached State Pension Age). This will also allow the money to pass directly from central government to the council, without needing to pass through the care user's bank account in-between; personal budgets mean that the care user still has control of how the money is spent (though it will no longer be possible to spend it on frivolous things that do not contribute towards care).
A court decision means many care workers are entitled to back pay for overnight sleep shifts. Many local authorities, charities and companies providing care say they cannot afford this and will fold without financial help from the government. The problem remains unresolved with some care providers facing possible bankruptcy.
Systemic funding problems
The rapid improvements in population health that the NHS brought about caused a significant increase in life expectancy, but in turn, this caused social care to be required for longer. By the end of the 20th century, compounded by the retirement of the post-war baby boom generation, the aging UK population, combined with increasing salary demands by NHS staff, led to the NHS finding it difficult to fully fund healthcare, with a corresponding impact on the cost of social care. In 2015, Professor Martin McKee of the London School of Hygiene & Tropical Medicine, said that "since 2009, ... the number of people aged 85 years and over has increased by 9%. To maintain current levels of social care would require an extra £1.1 billion, ..."
The Local Government Association estimates a £2.6bn funding shortfall by 2020 and fears some councils could be challenged in the high court for not providing a statutory minimum standard of care.; they blame historic under-funding and increasing numbers of old people. The Centre for Workforce Intelligence estimates that two million or more extra carers will be needed by 2025 in England alone, for both in-home care and care homes, due to growing demand.
According to the UK Home Care Association, councils should be willing to pay up to £16.70 for an hour's care, but on average pay £2 less; some firms maintain they cannot recruit or retain staff. In March 2019 the average invoice rate for state-funded care in the person's own home was £16.88 per hour. The Association calculates that as leaving providers with an average loss of £1.68 per hour. The Care Quality Commission remarks that the lack of an appropriate level of payment increases pressure on hospitals and reduces care quality. Carers currently prioritize the most important work and leave some jobs undone that their old or disabled clients need because there is insufficient time for everything:
Unless social care is properly funded, there remains a growing risk to the quality and safety of care, and the ability of services caring for our elderly and vulnerable to meet basic needs such as ensuring people are washed and dressed or helped out of bed. (Councillor Izzi Seccombe, of the Local Government Association)
In turn, the problems in care funding mean that targets for home care, which should prevent patients staying in hospital unnecessarily, are being missed in the majority of cases.
Care homes for the elderly are becoming insolvent in record numbers; 69 home care companies closed during the first 3 months of 2017, and BBC research established that care firms ended contracts with 95 UK Local Authorities claiming they could not provide the service for the money they received. One supplier association, Care England, claims that care homes should make a 12% profit; its spokesman, Martin Green, alleges that the care home sector is at a tipping point, claiming that “the government is abdicating responsibilities for social care to local authorities. I think it owes more to the protection of vulnerable politicians than it does to the protection of vulnerable adults. ... The government should be ... giving clear expectations to citizens about what they should expect from the system and what they should expect to pay for...”
Councils blame the 'squeeze on their finances by the government'. Although council tax rose substantially since 1997, under the Blair Ministry, subsequent restrictions imposed by the Cameron Ministry have seen it erode back towards 1997 levels; as a consequence, under the Cameron Ministry, Age UK claims that subsidised social care spending fell in real terms from £8.1bn (2005–06) to £6.3bn (2014–15) - a fall of more than one-fifth (they have chosen not to compare present funding levels to 1997 funding levels). The Local Government Association spoke of an 'unaddressed crisis' while the NHS Confederation describe recent government budgets as a missed opportunity to reduce pressure on the NHS. Additional money the government put in was insufficient to prevent further cuts to social care in 2017.
One in four elderly care home residents are having families pay a top up to the fees for them because, for example, the alternative would be that the relative would be placed so far away that visits from relatives and friends would be impractical. Families are urged to read up their legal rights and challenge unreasonable council demands. 26 local authorities had over a third of beds in homes designated substandard. Caroline Abrahams of Age UK said, "The sad truth is that following years of underfunding and neglect, the social care system has now more or less completely broken down in some parts of the country". The government is urged to invest and reform social care.
Due to funding shortfalls adult social care is at risk of collapse in many parts of England. This could leave vulnerable adults without the care they need. Councils plan to cut care due to increased demand and reduced resources. The Association of Directors of Adult Social Services maintains that three-quarters of Councils surveyed claimed they would cut the care they provided and nearly half said they would increase charges. Just one in five of those needing care get council help. Firms providing care and care homes are closing through lack of funds. Unless funding for social care is increased a major social care provider going bankrupt could leave large numbers of vulnerable people without the care they need.
Demand for care for older and disabled people is rising while supply is falling. 1.4 million people do without basic care they need, such as help getting out of bed washing or going to the toilet. Care homes and domestic care providers are closing through lack of funds.
A number of campaigners condemned the lack of extra funds for social care in the 2016 Autumn Statement. A Conservative ex-MP, Stephen Dorrell, claimed it was a mistake to not invest in social care, and believes a small investment can bring significant improvements. However, the government allowed councils to raise council tax by an additional 2% for the purpose of paying for better social care.
The Local Government Association claims the change is too little; their spokesman, Conservative Lord Porter, said that services are “at breaking point ... extra council tax income will not bring in anywhere near enough money to alleviate the growing pressure on social care both now and in the future”, claiming “our most vulnerable continue to face an ever uncertain future where they might no longer receive the dignified care and support they deserve, such as help getting dressed or getting out and about, which is crucial to their independence and wellbeing.”.
The shadow chancellor, John McDonnell, responded to the budget by saying “Tonight, many elderly people will remain trapped in their homes, isolated, and lacking the care they need because of continuing cuts to funding,” Dave Prentis of Unison said, “a growing number of elderly people are getting no care at all. Scrimping on social care is a huge false economy. Older people are often stranded in hospitals, unable to go home, using beds needed by other patients. This turns up the heat on our already overstretched NHS, which has also been forgotten about.” Improved social care is most needed in poorer areas, but as those areas are poor, councils cannot raise the necessary funds.
The 2017 budget gave councils access to an extra £1 billion provided centrally. However, Nigel Edwards of the Nuffield Trust thinktank, said that this would cover only half the £2bn funding shortfall feared in 2017-18. He added “More and more vulnerable people are therefore going to be denied the help they need in the next year”. The Competition and Marketing Authority fears lack of funding will force care homes to close, Andrea Coscelli of the CMA said, “Care homes provide a vital service to some of the most vulnerable people in society. However, the simple truth is that the system cannot continue to provide the essential care people need with the current level of funding. Without substantial reform to the way that councils pay for and commission care, and greater confidence that the costs of providing care will be covered, the UK also won’t be able to meet the growing needs of its ageing population.”
The Housing, Communities and Local Government Committee of the House of Commons reported in August 2019 that the social care system was on the verge of collapse, with "an opaque source of revenue, partially funded by tax systems that don’t spread the burden equally." The Centre for Health and the Public Interest cautioned that a large increase in public funds for the sector could just produce bigger profits for privatised operators, since many firms lack financial transparency.
Long term solutions
It has been claimed that the majority of British people are willing to pay more tax to fund better social care; Norman Lamb (Care Minister under the Cameron–Clegg coalition) said, “This shows the clear appetite for paying a bit more to ensure that our loved ones get the care they need. With over a million older people going without the care and support they need, this has become a moral imperative,".
In her manifesto for the 2017 general election, the Prime Minister, Theresa May, announced that she would scrap the care costs cap proposed by Sir Andrew Dilnot, and abolish the current means test. Instead, all care costs, including residential care costs, must be paid for by any individual user whose total assets, including the value of their home is greater than £100,000. At present, in many councils, care users who have more than £23,000 and require residential care must sell their home immediately to fund their care; this has been criticised for making it impossible for the care user to their home. Under the Prime Minister's manifesto proposal, that requirement will stop. However, in the present system, for people receiving care in their own home, the value of their home does not count towards the £23,000 threshold; people with less than £23,000 in savings but with a house worth £4 million (a situation comparatively common in Central London) are currently able to receive council funding to cover 100% of their care costs. Under Theresa May's proposal, the value of the home counts - so a person with a house worth £4 million would have to pay all of their care costs until their assets have been depleted to £100,000. Political commentators including extreme opponents of the Prime Minister, like Polly Toynbee, have called the proposed package of changes brave but Tim Farron said [it was a] "callous blow for people who have dementia and other long-term conditions, like multiple sclerosis and motor neurone disease, and of course their families. It is not just a massive mistake but a cruel attack on vulnerable people the length and breadth of this country." It appears the Conservatives have made a U-turn and now plan a regressive tax that will hit those with relatively low savings hardest.> Conservatives plan an unspecified cap on total spending and as of 23 May 2017 they say they will give no more information till after the election. Jeremy Corbyn said the Tories, “haven’t explained to the millions of people, who are desperately worried at the moment about what kind of care they are going to get in the future, desperately worried for children as well about how their parents are going to be looked after,” he said.
Caroline Lucas of the Green Party was quick to brand this a tax on dementia, a claim which other political opponents took up. Unhappy at the change, Sir Andrew Dilnot responded, “So people will be left helpless, knowing that what will happen is that if they are unlucky enough to suffer the need for care costs they will be entirely on their own until they are down to the last £100,000 of all of their wealth including their house.” Carers who have moved in with an elderly relative to care for that relative may lose their homes when the relative dies and the state insists on selling the home to recoup care costs. Opinions on Theresa May's proposal varied substantially. Some libertarian Conservatives, like James Delinpole, condemned the policy and the Labour party leader Jeremy Corbyn branded it a death tax.
In April 2019 the Labour Party announced that it would spend £2.8 billion to increase the number of home care packages for vulnerable people. This would be used to develop the social care workforce by providing more training, increase Carer's Allowance and raise the earnings threshold for it in line with the National Living Wage. £350 million per year would be directed to people with autism and learning disabilities, preventing them being unnecessarily detained in mental health hospitals.
William Laing, founder of LaingBuisson said that it was ‘highly unlikely’ that cross-party consensus on how to overhaul the social care system could be achieved and that "if you really wanted to professionalise the service and pay people, not the minimum wage but a decent career structure, then we’re talking about several billion pounds."
The National Audit Office maintains there is no clear evidence the care sector is ready for Brexit. The care sector is fragmented and relies on 24,000 companies providing services, there are no central arrangement to stockpile equipment and supplies, like syringes and needles, also incontinence pads, which mostly come from or through the EU. Auditors were concerned that the Department of Health and Social Care did not know what proportion of the 24,000 UK nursing homes and other providers of social care, which are often small businesses, had acted on its advice for, “robust” contingency planning over a no-deal Brexit.
People who receive social care
Large numbers of people who need social care miss out because councils have insufficient funds. Central government funding for English Local Authorities was reduced by 14% in real terms from 2011 to 2015. Residential homes for old people are closing because those who run them cannot manage on the money they receive. Cuts due to austerity mainly affect people living in the poorest areas. Despite rising poverty, money spent on disadvantaged families in the 20% of English councils with worst poverty, reduced by £278 million in 2016-17 following years of cuts to central government grants. Changes that are planned to distribution of local government funding, will replace a deprivation-based funding system with funding from local council tax and business rates, and will perpetuate indefinitely funding cuts in poorer areas unless there is a safety net. Maintaining social care in poor areas came through double digit cuts to youth justice, family support, homelessness and substance misuse services, showing a large movement from prevention to expensive crisis management.
Age UK maintains three elderly people in the UK die every hour after asking for social care and not getting it. During the 18 months between the 2017 election and the 2019 one, older people will have made 1,725,000 unanswered calls for help for care and support. This according to Age UK amounts to 2,000 futile appeals a day, or 78 an hour. Caroline Abrahams of Age UK said, “Social care is not some kind of nice-to-have optional extra – it’s a fundamental service on which millions of older and disabled people depend every day. It is appalling that one and a half million older people in our country now have some unmet need for care – one in seven of the entire older population.”
The effect of cuts on the health and well being of old people is impossible to quantify. The number of older people not getting care rose by 50% between 2010 and 2016. Increasing numbers get family or friends to help with care costs. Cuts to central government grants force councils to reduce the social care they pay for while simultaneously the numbers needing care increases because people are living longer and more need social care. Care is sometimes inadequate because carers are poorly trained. There has been a great deal of investment in helping people live longer but less has been done to help ensure that longer lives are worthwhile and fulfilling. Areas of social deprivation where people most need social care are least able to raise the necessary funds through council tax to pay for it.
1 in 8 of older people (1.2 million) got no help for care in 2015. 300,000 had trouble with 3 tasks or more, including dressing, washing, and going to the toilet. Fewer than half those requesting care in 2015 (1.3 million) got it. 11 councils rejected over three quarters of applicants. Treatment of dementia patients was often problematic because care staff got insufficient training. Families reported patients not getting medication, staying in dirty clothes for days or going missing when homes were not secured. As of 2018 one in 7 older people had unmet needs and received no social care. Age UK maintains 1.4 million people over 65 now unmet need for help with matters like getting up, washing and dressing. Patients unable to leave hospital because there is no social care to enable them to be discharged – costs the NHS in England £289.1m a year, Age UK calculates. Amyas Morse said, “I cannot see that the amount being spent on social care – which is now less than it was, and with other signs of pressure in that system – I can’t see that that can be sustainable.” David Behan of the Care Quality Commission, said that Theresa May should show the courage Clement Attlee showed who set up the NHS and provide for older people. Currently provision is so inadequate Britain is not the “civilised society” it ought to be.
The official inspection body, the Care Quality Commission, warned the sector was at "tipping point" - with the lack of care having an impact on hospitals through rising accident and emergency attendances as vulnerable people sought help.
What care people receive increasingly depends on what they can afford and on the postcode lottery (where they live) rather than on need. Insufficient investment in NHS services weakens objectives of keeping people independent and away from residential care. Local Authorities will soon have insufficient funds to carry out statutory duties. Poorer elderly people and people in deprived areas are more likely to have unmet needs.
Polly Toynbee wrote that some disabled people are issued with incontinence pads so care visits to take them to the toilet can be rationed.
Analysis previously published by Age UK suggests almost 1.2 million people aged 65 and over do not receive the care and support they need with essential daily activities such as eating, dressing and bathing. That figure has shot up by 17.9% in just a year and almost by 50% since 2010, with nearly one in eight now living with some level of unmet need, it says. (Guardian report)
The government is planning changes and psychiatric patients with conditions like disabling anxiety may receive less. Mark Atkinson, of disability charity Scope, said: "It is unhelpful to make crude distinctions between those with physical impairments and mental health issues because the kind of impairment someone has is not a good indicator of the costs they will face. Many disabled people will be now be anxiously waiting to hear as to whether or not these tighter rules will affect their current PIP award. The government must offer clarity and reassurance that these new measures will not negatively affect the financial support that disabled people receive now or in the future, and that they stand by their commitment to making no further changes to disability benefits in this Parliament."
Social care costs will rise significantly by 2025 because people are living longer and more are developing dementia. Researchers, led by academics from the University of Liverpool and University College London claim, “Public and private expenditure on long-term care will need to increase considerably by 2025, in view of the predicted 25% rise in the number of people who will have age-related disability. This situation has serious implications for a cash-strapped and overburdened National Health Service and an under-resourced social care system,”
The Institute for Public Policy Research maintains most dying people would rather end their lives at home or in a care home. Lack of funding prevents this in many cases so people die in hospitals experiencing poorer quality of care at the end of their lives. This is a false economy as hospital care is more expensive.
Child social care
Councils are expected by the government to be largely self-financing. The government has steadily removed hypothecated funding for child social care, and for safeguarding children from abuse or neglect. Historically, councils had to send Business Rate revenue to the government, while the government provided a large grant to councils based on need. Under the Cameron Ministry, the Business rate system was changed, so that councils keep 50% of the revenue; the central government grant was correspondingly reduced, and hypothecated streams merged into the general grant. The central grant has continued to fall, and shortly councils will retain 100% of Business Rate revenue. The grant has also fallen due to school funding being transferred directly to new Academy schools, and Housing Benefit (paid via the council) being replaced by centrally paid Universal Credit.
The government has steadily cut funding for child social care. There is less money for children with disabilities, there is also less for children at risk of abuse or neglect. According to an inquiry into child social care in England nearly 90% of directors of children’s services say they now find fulfilling their legal duties to children in need of support increasingly hard. That involves keeping a child developing, healthy and safe. The National Children’s Bureau, which did the inquiry stated, “They’re being asked to do more with less. Something has to give.” Parents of sick children who need respite care now get less. Some children are not getting protection against being abused or neglected. Welfare cuts and increased poverty have increased the numbers of children in need while resources are falling. Early intervention services have been cut because the government is not providing funding for this. Families on the breadline can get less help feeding their children and evicted families can get less help being passed to homeless charities. Maintained nurseries are being shut and youth mental health services are being cut. Councils facing 20% cuts to funding must focus resources on children who are already suffering and there is less for preventative measures like spotting domestic violence in a family. When authorities eventually are involved the situation may need the child being taken into care. Children taken into care have increased by 17%. This is considered inhuman and is also a false economy as the cost of keeping a teenager in care is far higher than the cost of mentoring the family so the youngster can stay with its family. Due to this money spent on the average child in need has increased over the years. Children taken into care are too frequently placed far from where they live, away from family and friends and vulnerable to paedophiles, drug gangs and other criminals grooming them. Children's care homes too frequently call the police over minor offenses and the children are criminalised despite government guidelines that this should not happen. This happens especially in privatised care homes because the private companies give staff little training.
Meanwhile, migration from the EU has drastically increased the number of young families. The National Children’s Bureau, stated, that nearly 90% of directors of children's services in England say they now find fulfilling their legal obligations increasingly hard, and complained that “They’re being asked to do more with less. Something has to give.”
Many Sure Start centres have been closed. However, councils continue to provide their statutory obligations which were delivered at Sure Start centres, but do so elsewhere; the rental and maintenance costs of modern, well-located, spacious, buildings in which the Sure Start services are located is one of the main reason cited for choosing to close such centres. Preventative measures - like spotting domestic violence in a family - continue to be undertaken by Health Visitors, and there is an increasing number of them; Health Visitors now spend more time visiting, than they did historically, rather than get visited.
Nevertheless, the loss of Sure Start centres is not without significant political criticism. Alison Michalska of the 'Association of Directors of Children’s Services' said, “We cannot go on as we are. Local authorities know that a strong local early-intervention offer can reduce the need for more intrusive and costly interventions in the lives of children and families once problems have worsened and reached crisis point, yet councils have been left with no choice but to reduce these services in order to cope with rising demand. Local authorities have worked hard to make savings, but we are running out of options.”
Children with life-threatening and life limiting conditions sometimes need to access support at any time of day or night but cannot get that support. Parents who are not expert clinicians have to deal with complex medical conditions themselves or call A&E.
The social care workforce broadly encompasses those who work in public services that are provided, directly or commissioned, by local councils to discharge their personal social services (PSS) responsibilities.
In England, the social care workforce comprises over one and half million people. An estimated two thirds of the workforce work for some 25,000 employers in the private and voluntary sectors. The remaining third work in the statutory sector, largely for 150 local councils with personal social services responsibilities. Data on the social care workforce is collected and analysed by Skills for Care, the national workforce organization for adult social care in England. Data is collected on the social care workforce through Skills for Care's National Minimum Data Set (NMDS-SC). A survey by Skills for Care in April 2019 showed that the average care worker was 59p (8%) better off, in real terms, in February 2019 than they were in September 2012, with a greater increase for those at the bottom of the pay scale. Pay was higher in the South of England than in the North, but in the South East the average take home pay was lower than the cost of living.
These two areas broadly break down into the responsibilities of "provision" and "assessment and commissioning" on behalf of local public finance for people felt to be in need according to eligibility criteria.
The range of work settings includes the community, hospitals, health centres, education and advice centres and people’s homes. Social care practitioners frequently work in partnership with staff from other professions, including health, housing, education, advice and advocacy services and the law.
Providers are under pressure, find it hard to keep staff, preserve quality of care and stay in business. Local authorities are forced to make cuts, while discharging patients from hospital is delayed due to lack of support in the community. Over 900 carers leave the profession daily and staff shortages mean vulnerable people get a lower standard of care. This applies to people receiving care in their own homes and to care home residents. High staff turnover prevents those who receive care getting to know their carers. Care workers are paid on average £7.69 per hour. The number of people over 75 years old is projected to double by 2040, according to the Office for National Statistics. Social care providers say without far-reaching change, there will be too few people to care for the aging English population. Mike Padgham of the UK Homecare Association wrote, "My biggest fear is that we will soon run out of capacity to provide care to those who cannot fund themselves. I agree wholeheartedly with Age UK's warning that the social care system will begin to collapse this year, but I would go further and say that the system has already begun to collapse." Staff turnover is high, 6.6% of posts are unfilled, 1 in 11 nursing posts and 1 in 9 management posts are vacant. Caroline Abrahams of Age UK said frail older people went without care they needed.
Most care recipients are satisfied with their care, however a minority have serious problems. Some care workers do not know how to do basic tasks like making a bed, others have insufficient time to shower their carer recipient so showers happen rarely and care workers must go over their time to give showers. Other care workers do not arrive at scheduled times so diabetic medicine is administered at the wrong times.
In a worst-case scenario if care workers migrating from elsewhere in the European Economic Area stop coming after BREXIT the shortage of care workers could become so acute people (mostly women) will be forced to give up paid work and care for dependent relatives.
The Care Standards Act 2000, as well as establishing regulations covering service provision, brought greater recognition for the profession of social work with the introduction of a social work degree and social workers’ register. To become a social worker in the UK and use the title, students need to complete an Honours degree or postgraduate MA in Social Work. There are access courses for mature students, trainee schemes and employment based routes to gaining the qualification. Qualified social workers are currently required to register with the Health and Care Professions Council (HCPC) before commencing practice. Social workers are also required to ensure that they keep their training and knowledge up-to-date with current developments in the field.
Occupational Therapy is another important profession working in health and social care settings, contributing to the promotion of people's independence through advice and provision of equipment, and enhancing the suitability of housing through Adaptations.
There are many other social care roles for which other qualifications, experience and training may be necessary.
Examples of the range of professions within this field include policy makers, researchers, academics, project workers, support workers, employed care staff (in residential or domiciliary care settings sometimes confusingly referred to as "carers") and personal assistants.
Social workers' hierarchy in England and Wales
Although there is no formal or national hierarchy (rank) of social workers, many local authorities in England and Wales adopt a similar pattern of seniority of social workers. This is mainly for the purpose of case work allocation, supervision, leadership and management. As an example, below is an example of three role structure for an adults, childcare and mental health social work team. To compare, there are also links to the PCF levels of practitioner.
|Newly Qualified Social Worker (for 1 year)||Newly Qualified Social Worker (for 1 year)||Newly Qualified Mental Health Social Worker (for 1 year) (Band 5)||PCF - NQSW Social Worker|
|Social Worker / Qualified Care Manager / Social Work Practitioner / Level 1 or Level 2 Social Worker||Social Worker / Social Work Practitioner / Level 1 or Level 2 Social Worker||Mental Health Social Worker / Mental Health Practitioner (Band 5)||PCF - Social Worker|
|Senior Social Worker / Higher Grade Social Worker / Level 3 Social Worker||Senior Social Worker / Social Worker (Child Care Practitioner status) / Level 3 Social Worker||Senior Mental Health Social Worker / Approved Mental Health Professional (Band 6)||PCF - Experienced Social Worker|
|Senior Practitioner / Assistant Team Manager||Senior Practitioner / Assistant Team Manager||Senior Practitioner / Team Leader (Band 7) (inc AMHP)||PCF - Advanced Social Worker|
|Team Manager||Team Manager / Practice Manager||Team Manager / Clinical Manager (Band 7 or 8a) (inc AMHP)||PCF - Advanced Social Worker|
|Service Manager||Service Manager||Service Manager (Band 8a, sometimes 8b) (inc AMHP)||PCF - Strategic Social Worker|
|Area Director / Operational Manager||Area Manager / Area Director||Senior Manager / Operational Manager (Band 8b, sometimes 8c)||PCF - Strategic Social Worker|
|Assistant Director / Deputy Director of Adult Services||Assistant Director / Deputy Director of Child Care Services||Assistant Director / Deputy Director of Adult Social Care (Mental Health) (Band 8b or 8c, rarely 8d)||PCF - Strategic Social Worker|
|Director of Adult Services||Director of Children Services||Director of Social Care (Band 8b, 8c or 8d)||PCF - Strategic Social Worker|
Social care organisations
UK Social workers are currently registered with the Health Professions Council which sets codes of conduct and practice. Through the work of the Munro Review, the Social Work Reform Board and the piloting of social work practices, Government aims to give greater autonomy to social workers. The Reform Board recommended the development of a professional college. The College of Social Work has been set up with the aim of improving and supporting social work by leading the development of the profession and representing it in discussions with organisations that regulate, train, work with, and are affected by social work. Social care services are regulated by the Care Quality Commission.
Other social care organisations include the Social Care Institute for Excellence - an independent charity that identifies and transfers knowledge about good practice, and Skills for Care, the national lead agency for policy and strategy related to workforce development and the adult social care workforce.
The National Skills Academy for Social Care, launched in 2009, provides learning support and training practice for social care workers and employers in England with a specific remit on leadership development.
The Association of Directors of Adult Social Services is the official voice of senior social care managers in England.
There are many other voluntary and independent organisations that exist to support the delivery of social care. These exist to support both the social care workforce and people who use services, and include user-led organisations.
421 care home businesses have gone out of business from 2010 to 2017. This covers nursing homes, homes for the elderly, residential care activities for learning disabilities, mental health, and substance abuse. FRP Advisory claims care homes were the only UK industry that suffered rising insolvencies over the time period. There is pressure on care homes because councils have contributed less while costs, notably staff overheads rose. Martin Green of Care England said, “My view is that if you ask me who is to blame, it is the government. The government should be delivering a very clear vision for what social care is, they should be giving clear expectations to citizens about what they should expect from the system and what they should expect to pay for. None of that is happening.” Chris Stevens of FRP said, “The fall in sterling against the euro will exacerbate pre-existing pressure on staffing costs in a sector reliant on overseas workers to fill frontline staff vacancies, and where margins have come under increasing pressure from the rise in the minimum wage, pension costs and cuts in local authority funding. The care home sector is beleaguered due to all local authorities facing overall double-digit budget cuts for this current financial year under way and beyond.”
Local authority spending on adult social care is a demand on the local tax revenue and for this reason and associated costs to the NHS from hospital admissions, Social care is high on the UK government’s agenda, with an aim of integration of health, social care and education to reflect the overlap between these areas.
The Coalition Government's plans for adult social care services were set out in 'A vision for adult social care: capable communities and active citizens', which was published in November 2010. The aim was to make services more personalised, more preventative and more focused on delivering the best outcomes for the people who used them. The Government wanted people eligible for services to be advised of the public money to be allocated to their needs (their "Personal care budget") and to encourage care and support to be accessed from a partnership between individuals, communities, the voluntary sector, the NHS and councils. The rollout of personal budgets will be extended, and councils and NHS organisations will be expected to work together in an integrated way to commission services. The Health and Social Care Bill published in January 2011 outlined these changes in more detail.
Dementia care is an area that has received increasing attention, following the launch of the National Dementia Strategy in February 2009. This strategy focuses on ‘living well’ with dementia and aims to provide those living with dementia and their carers information and support that maintains dignity and increases choice. With rises in life expectancy leading to increase in people affected by dementia, The Coalition Government has indicated that dementia remains a priority. Age UK estimated in 2014 that 900,000 people in England between the age of 65 and 89 had unmet social care needs, and said in 2015 that the figure was increasing because 40% cuts to government funding for local councils, which provide the bulk of social care, had had a devastating impact.
In children’s services, Government will focus on helping the poorest and most vulnerable families, through targeted and early intervention. Ministers across Government have made a commitment to end child poverty by 2020. The establishment of the Centre for Excellence and Outcomes in Children’s and Young People’s Services is intended to support this agenda in England.
Developing the skills of the social care workforce is a continuous priority, specifically in response to changes in the social care sector and media coverage of social care issues. Following the recommendations of the Social Work Taskforce (2009), The College of Social Work has been set up. The College will represent and support social workers and help maintain standards for the profession. Skills for Care is the lead national body for strategy and policy in relation to workforce development and the social care workforce.
Robots are being developed which it is hoped will be able to help with some social care. The Social Market Foundation has suggested that the adoption of technology should be 'properly handled' so that it complements human interaction rather than replacing it.
Between April 2014 and October 2019 the number of domiciliary care services in England increased by 23% to 9,528. However the residential care sector is declining, and the Care Quality Commission has warned that the domiciliary sector is not growing fast enough to meet the increasing demand and does not match the falling number of nursing and residential home beds. Nursing homes fell 6% and residential homes 11% in the same period. They said effective domiciliary care needed innovative providers who could bring together nurses, occupational therapists, physiotherapists and other carers.
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