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Select committee: Health and Social Care Committee

Social care: funding and workforce

Closed Opened 10 Mar 2020 Closed 26 Oct 2021 20 recommendations 1 conclusion

Health and Social Care Committee Inquiry on parliament.uk ↗

Inquiry scope (the committee's words)
The reopened Social care: funding and workforce inquiry seeks to establish how much extra money would need to be spent by government in each of the next five years to counteract the impact of a shortage of care on the NHS. Shortages in the social care workforce and what solutions need to be found to address changes in the years ahead will also be considered. The inquiry was paused in March to allow the committee to focus its efforts on the crisis posed by the outbreak of the coronavirus. In addition to the previously announced Terms of Reference, the inquiry will also consider what further reforms are needed to the long-term social care funding system. Terms of reference: What impact is the current social care funding situation having on the NHS and on people who need social care? What level of funding is required in each of the next five years to address this? What is the extent of current workforce shortages in social care, how will they change over the next five years, and how do they need to be addressed? What further reforms are needed to the social care funding system in the long term?

Where it stands

The inquiry is closed, opened 10 March 2020.

The committee has published 1 report, most recently Third Report - Social care: funding and workforce on 22 October 2020.

The government's response

Published 17 February 2021. The deadline was 22 December 2020.

Read the government's response ↗ Report an error

Recommendations and conclusions

All 21 recommendations and conclusions

Reports

All reports

Evidence

  • 4 oral evidence sessionsLatest 8 September 2020
  • 88 written submissions
  • 22 witnesses
All evidence

Recent activity

Recommendations and conclusions 21 shown

Recommendation 1

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The case for making a sustained investment in social care has never been stronger– the toll the pandemic has taken on this sector means that social care is no longer a hidden problem, but one that the country as a whole understands. We urge the Government to now address this crisis as a matter of urgency.

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Recommendation 2

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
It is clear from the evidence we have heard that funding shortfalls are having a serious negative impact on the lives of those who use the social care system, as well impacting the pay levels of the workforce and threatening the sustainability of the care market. An immediate funding increase is needed to avoid the risk of market collapse caused by providers withdrawing from offering services to council-funded clients and focusing exclusively on the self-pay market.

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Recommendation 3

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The crisis in social care funding has been brought into sharp focus by the COVID-19 pandemic, and this must now be addressed by Government as a matter of the utmost urgency. The funding increase we are calling for is significant at a time when public finances are likely to be stretched, but the pandemic has made it clear that doing nothing is no longer an option. Providing adequate funding for social care will also help the NHS, and may itself have positive economic and long-term social impacts, given that social care is an important part of the economy.

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Recommendation 4

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
We believe the starting point must be an increase in annual funding of £3.9 bn by 2023–24 to meet demographic changes and planned increases in the National Living Wage. However such an increase alone will not address shortfalls in the quality of care currently provided, reverse the decline in access or stop the market retreating to providing only for self-payers. Further funding to address these issues is therefore also required as a matter of urgency.

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Recommendation 5

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
Alongside such a long term funding settlement we strongly believe the government should publish a 10 year plan for the social care sector as it has done for the NHS. The two systems are increasingly linked and it makes no sense to put in place long term plans for one without the other. Failure to do so is also likely to inhibit reform and lead to higher costs as workforce shortages become more pronounced with higher dependency on agency staff. Reducing the 30% turnover rates typical in the sector will also require a long term, strategic approach to social care pay and conditions.

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Recommendation 6

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
It is vital that the supply of PPE to social care providers is protected in the event of any future surges of coronavirus so that providers can be confident in their access to PPE.

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Recommendation 7

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government must ensure that standards for weekly testing for care home staff are maintained including rapid turnaround times and that regular data is published on the number of tests delivered to social care staff and residents. In addition, the Government should consider extending routine testing beyond care homes to other care settings, particularly domiciliary care and consider including a named key relative in routine testing.

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Recommendation 8

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
Improving the level of recognition afforded to social care workers must be a key focus for the Government to safeguard the future of the social care workforce. Not to do so would be to fail the many thousands of care workers who have worked so tirelessly during the coronavirus pandemic. Building on initial steps such as the CARE badge and recruitment campaigns for social care, there are a number of practical changes which the Government must make to improve the level of recognition felt by social care professionals and to support the future sustainability of the workforce. These are detailed below and in our recommendations.

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Recommendation 9

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
We welcome the Government’s commitment to bringing forward a long-term solution to low pay in social care. It is essential that this solution provides a sustainable basis for continued rises in pay above and beyond increases to the National Minimum Wage and in line with increases given to NHS staff. Evidence from the Health Foundation and others demonstrates that this must be supported by investment: the Health Foundation estimates that to increase the average pay in social care to just 5% above the National Living Wage, while meeting future demand, would cost an extra £3.9bn per year by 2023–24.

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Recommendation 10

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government must use the forthcoming Spending Review to ensure that there is a sustainable funding settlement to provide for competitive pay for social care workers which ensures parity with NHS staff and is reflective of the skilled nature of social care work. Parity could be achieved by linking social care pay to equivalent bands of the NHS Agenda for Change contract and introducing meaningful pay progression.

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Recommendation 11

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
Inadequate employment conditions undermine the sustainability of the social care workforce and have been brought into sharp relief by the coronavirus pandemic. As well as addressing issues of pay within the social care sector, we recommend that the Government bring forward proposals to support the improvement of employment conditions in the sector, including reducing the over-reliance on zero hours contracts and improving the provision of sick pay.

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Recommendation 12

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Secretary of State has committed to increasing the alignment between the training of NHS and social care staff and his stated ambition being to make it easier for a registered nurse, for example, to move between the NHS and social care is an important one. We await more detail about how this increased alignment will be achieved. It is important that this increase in alignment of training is not focused solely on nurses and other social care workers with a registered qualification, or allowing care staff to more easily move to higher paying roles in the NHS. Establishing a clear career path with substantial training opportunities, more effectively aligned with the NHS is vital for all entrants to the social care workforce.

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Recommendation 13

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
As part of its long-term proposals for the future of social care, we recommend that the Government work with Skills for Care and the social care sector to bring forward a plan to streamline the training of social care workers in order to improve routes of entry to the profession and improve career progression for existing social care workers. The plan should include proposals to improve alignment with training for NHS staff and to improve the professional recognition of social care staff. We further recommend that the workforce development fund be expanded to implement the plan, ensuring that all staff are able to access funding for training and career development.

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Recommendation 14

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Government must ensure that transitional arrangements are in place to ensure that social care workers can continue to be recruited from overseas for as long as it takes to build sufficient resilience in the domestic supply of social care workers. We agree with the Migration Advisory Committee (MAC) that building this resilience will depend on improving pay and other workforce issues in social care.

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Recommendation 15

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
We are concerned that lower qualified social care workers and those without qualifications at all are not eligible for the new NHS visa, not least because it undermines parity of esteem between the health and social care sectors. The Government should accept the MAC’s recent recommendation to add senior social care workers to the shortage occupation list. We welcome the MAC’s plans to conduct further research on the social care workforce: this research should consider the impact of new immigration rules on the ability of care providers to recruit to less senior roles.

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Recommendation 16

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The current system is unfair, confusing, demeaning, and frightening for the most vulnerable people in our society, and their families. It is therefore essential that the Government tackle the problems in the care sector as a priority. The success of the reforms in Japan has demonstrated that it is possible for a Government to grasp the nettle and take decisions on social care which, though they may be initially difficult, lead to positive and lasting change which is widely accepted by society.

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Recommendation 17

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The Lords Economic Affairs Committee’s report makes a persuasive case for the introduction of free personal care. This would cost around £5bn per year, which is only a small fraction of what is currently spent on NHS care. It would also simplify the current confusing arrangements for people who need care, and would put social care on a more equal footing with the NHS by ensuring that all basic care needs are met free at the point of need. Free personal care was also recommended by a joint report of the Health and Social Care Committee and Housing, Communities and Local Government Committee in 2018.

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Recommendation 18

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
We also strongly endorse a lifetime cap on care costs which could be implemented swiftly under the provisions of the Care Act 2014. Such a change would focuses resources on the most severely affected people, protecting those with very high care needs–and remove the injustice which sees the NHS cover certain types of extreme care costs but the social care system not cover others, including those with dementia, motor neurone disease or many other neurological conditions. Any reform package must therefore introduce a cap on care costs to protect people Social care: funding and workforce 37 against catastrophic costs. We believe this should be set at the level specified in Sir Andrew Dilnot’s original report, namely £46,000 which will cost around £3.1bn by 2023–24.

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Recommendation 19

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
The COVID-19 pandemic has had devastating consequences both for vulnerable people using social care, and for the committed professional workforce that provide that care. These challenges have been exacerbated by long-standing funding and workforce issues which need to be recognised by the government in a social care reform package that must be brought forward before the end of this financial year.

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Recommendation 20

Recommendation · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Recommended (the committee's words)
We believe that the starting point for the social care funding increase must be an additional £7bn per year by 2023–24 to cover demographic changes, uplift staff pay in line with the National Minimum Wage and to protect people who face catastrophic social care costs. This represents a 34% increase from the 2023–24 £20.4bn adult social care baseline projected budget at today’s prices. In this report we have not examined how such an increase could be funded but we recognise the challenges involved and the need for innovative thinking to address them.

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Conclusion 21

Conclusion · Third Report - Social care: funding and workforce · Addressed to Department of Health and Social Care

Concluded (the committee's words)
But we are clear that this is only a starting point. It will not provide any improvement in access to care, which is urgently needed and would be improved through introducing free personal care as recommended by previous select committee reports from both the Lords and the Commons, which we continue to endorse as worthy of consideration. The full cost of adequately funding social care is therefore likely to be substantially higher than £7bn, potentially running to tens of billions of pounds. We recognise these are substantial increases at a time of severe financial pressure but the evidence we have heard both from those who use social care, and frontline social care workers suggests that the gravity of the crisis now facing the social care sector requires a bold response if we are to recognise the sacrifices made recently by the social care workforce and—most importantly—look after vulnerable people in our society with the dignity and respect they deserve.

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Reports

1 report

Oral evidence sessions

4 sessions

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Date Session and witnesses Source
8 Sep 2020
Oral evidence session
James Bullion · Association of Directors of Adult Social Services, Rt Hon Matt Hancock · Department of Health and Social Care, Sarah Pickup · Local Government Association 		View ↗
14 Jul 2020
Oral evidence session
Deborah Gray, care user, Kevin Caulfield · Hammersmith and Fulham Borough Council, Pamela King, former carer, Sir Andrew Dilnot · Commission on Funding of Care and Support, The Rt Hon. the Lord Forsyth of Drumlean · Economic Affairs Select Committee (HL), Yasuhisa Shiozaki, former Minister for Health, Labour and Welfare of Japan 		View ↗
23 Jun 2020
Oral evidence session
Jane Townson · UK Homecare Association, Marlene Kelly · Auburn Mere Care Home, Mel Cairnduff · Agincare, Oonagh Smyth · Skills for Care, Professor Martin Green · Care England, Raina Summerson · Agincare, Sue Ann Balcombe · Priscilla Wakefield House Nursing Home 		View ↗
9 Jun 2020
Social care: funding and workforce
Anita Charlesworth · Health Foundation, Anna Severwright, Daphne Havercroft, former carer and attorney for a social care user, George Stoye · Institute for Fiscal Studies, Paul Little · Suffolk County Council & East Suffolk and North Essex Foundation Trust, Professor Tine Rosgaard, Roskilde University, Denmark 		View ↗

Written evidence

88 submissions recorded

Submission metadata is shown here; use the source links to read the evidence on Parliament’s website.

Showing the latest 50 of 88 recorded submissions. Written evidence in the activity timeline uses this same preview. Browse the inquiry on Parliament.

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ReferenceDateSubmitter
SCF0039 21 Oct 2020 Ms Leah Miller, The British Medical Association
SCF0107 19 Oct 2020 United Kingdom Homecare Association
SCF0113 6 Oct 2020 The Health Foundation
SCF0112 8 Sep 2020 Transcripts of interviews with care home managers
SCF0106 8 Sep 2020 Carers UK
SCF0105 8 Sep 2020 Agincare Group
SCF0104 8 Sep 2020 Association of British Insurers
SCF0103
Full text not held
 8 Sep 2020 Dan Dennis, University of Oxford
SCF0102 8 Sep 2020 Carers Trust
SCF0101 8 Sep 2020 Hampshire Care Association
SCF0100 8 Sep 2020 Motor Neurone Disease (MND) Association
SCF0099 8 Sep 2020 ADASS
SCF0098 8 Sep 2020 SeeAbility
SCF0097 8 Sep 2020 London Councils
SCF0094 8 Sep 2020 WinVisible (women with visible & invisible disabilities)
SCF0093 8 Sep 2020 The Guinness Partnership
SCF0092 8 Sep 2020 UK Women's Budget Group
SCF0090 8 Sep 2020 North East Lincolnshire Council
SCF0089 8 Sep 2020 Inclusion London
SCF0088 8 Sep 2020 British Association of Social Workers
SCF0087 8 Sep 2020 Mrs Marion Wale
SCF0081 8 Sep 2020 Mrs Maxine Hall
SCF0080 8 Sep 2020 Women Against State Pension Inequality (WASPI) Campaign
SCF0078 8 Sep 2020 Lesley Bell
SCF0077 8 Sep 2020 CHRISTIAN CARE HOMES REGISTERED CHARITY 299522
SCF0111 2 Sep 2020 David Hinchcliffe, David Hinchcliffe
SCF0110 2 Sep 2020 Annabel Sykes, Annabel Sykes
SCF0075 21 Jul 2020 National Care Forum
SCF0074 21 Jul 2020 Mrs Anthea Sanders
SCF0072 21 Jul 2020 Trades Union Congress
SCF0071 21 Jul 2020 Professor Peter Beresford, Co-Chair of Shaping Our Lives
SCF0070 21 Jul 2020 The Health Foundation
SCF0069 21 Jul 2020 Department of Health and Social Care
SCF0067 23 Jun 2020 Mr Paul clarke, Skills for Care
SCF0066 23 Jun 2020 Rachael Truswell, Royal College of Nursing
SCF0065 23 Jun 2020 Mr Niall Dickson CBE, NHS Confederation
SCF0064 23 Jun 2020 Harry Dayantis, The King's Fund
SCF0063 23 Jun 2020 Miss Ayesha Carmouche, Care Quality Commission
SCF0062 23 Jun 2020 Mr James Floyd, Anchor Hanover
SCF0061 23 Jun 2020 Mr Sam Dalton, ARCO (Associated Retirement Community Operators)
SCF0060 23 Jun 2020 Miss Rachel Harrison, GMB
SCF0059 23 Jun 2020 Joanna Clason, Shelford Group
SCF0058 23 Jun 2020 Mr Peter Hand, The Working Group of the APPG on Adult Social Care
SCF0057 23 Jun 2020 Ms Pavan Dhaliwal, MHA
SCF0056 23 Jun 2020 Mark Dayan, Nuffield Trust
SCF0015 16 Jun 2020 Head of Policy Neil Border, South East Strategic Leaders
SCF0014 16 Jun 2020 Mr Robert Kilgour
SCF0010 16 Jun 2020 Mrs. Maureen Hallam
SCF0009 16 Jun 2020 Emeritus Professor BEN FINE
SCF0007
Full text not held
 16 Jun 2020 Dr Simon Duffy, Centre for Welfare Reform

Who gave evidence

22 witnesses

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WitnessOrganisationSessions
Anita Charlesworth · Senior Economic Adviser Health Foundation 1
Anna Severwright Not recorded 1
Daphne Havercroft, former carer and attorney for a social care user Not recorded 1
Deborah Gray, care user Not recorded 1
George Stoye · Associate Director Institute for Fiscal Studies 1
James Bullion · President Association of Directors of Adult Social Services 1
Jane Townson · Chief Executive Officer UK Homecare Association 1
Kevin Caulfield · Disabled person and strategic lead for co-production Hammersmith and Fulham Borough Council 1
Marlene Kelly · Registered Manager Auburn Mere Care Home 1
Mel Cairnduff · Social Care Worker Agincare 1
Oonagh Smyth · Chief Executive Officer Skills for Care 1
Pamela King, former carer Not recorded 1
Paul Little · Director for Integrated Health and Care Suffolk County Council & East Suffolk and North Essex Foundation Trust 1
Professor Martin Green · Chief Executive Care England 1
Professor Tine Rosgaard, Roskilde University, Denmark Not recorded 1
Raina Summerson · Chief Executive Agincare 1
Rt Hon Matt Hancock · Secretary of State Department of Health and Social Care 1
Sarah Pickup · Deputy Chief Executive Local Government Association 1
Sir Andrew Dilnot · former Chair Commission on Funding of Care and Support 1
Sue Ann Balcombe · Registered Manager Priscilla Wakefield House Nursing Home 1
The Rt Hon. the Lord Forsyth of Drumlean · Chair Economic Affairs Select Committee (HL) 1
Yasuhisa Shiozaki, former Minister for Health, Labour and Welfare of Japan Not recorded 1

Correspondence

2 letters

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PublishedDirectionLetter
17 Feb 2021 From committee Letter to the Minister of State for Care on Social care: funding and workforce
10 Nov 2020 To committee Letter from the Secretary of State for Health and Social Care on SignHealth