Experienced care workers were earning just 4p per hour more on average than newcomers to the sector as of December 2024, according to new Skills for Care data.

This is the smallest pay gap between independent sector care workers with five or more years’ experience and those with those less than a year’s service yet recorded in a data series dating back to 2016.

Then, experienced care workers earned 33p per hour (4.4%) more on average than newcomers, but the gap has fallen significantly since, dropping from 10p to 4p per hour from March to December 2024.

Shrinking pay gap between senior care workers and junior colleagues

Skills for Care’s latest report on independent sector pay also showed that the differential between care worker and senior care worker salaries had reached its lowest level yet recorded – 6%, down from 8% in March 2024 and a high of 11% in March 2017.

Median pay for senior care workers stood at £12.75 per hour in December 2024, compared with £12.00 per hour for care workers, said the report.

The squeeze in pay progression appears to have been driven by the impact of growth in the national living wage (NLW), now the wage floor for those aged 21 and over, on a low-paying sector such as adult social care. Since the NLW’s introduction in 2016, real-terms median pay has grown by 26.2% among the bottom tenth of independent sector earners and by just 14.1% among the top tenth.

Providers’ challenge in meeting living wage rises

The NLW has increased sharply over the past two years, from £9.50 to £10.42 per hour in April 2023, a rise of 9.7%, and then to £11.44 last April (9.8%). This has meant that independent care workers have received average real-terms pay rises of 5.4% and 7%, respectively, in each of the past two years, said Skills for Care.

However, it added that some employers had reported that keeping up with changes in the NLW had been challenging, alongside their other business costs.

This is likely to become more challenging still next month, when the NLW grows by a further 6.7%, to £12.21 per hour, and employers must also meet the costs of significant increases to their national insurance contributions (NICs).

Skills for Care found that 58% of independent sector adult social care workers – about 780,000 staff – were earning less than the forthcoming NLW (£12.21 per hour) as of December 2024 – meaning they would benefit from next month’s rise. This includes about 575,000 care workers.

Much of the rest of the workforce is likely to receive a pay rise too because of the need to maintain pay differentials as far as possible.

Costs of NLW and national insurance hikes

Think-tank the Nuffield Trust has calculated that the rises in the NLW and NICs combined will cost independent sector providers an additional £2.8bn in 2025-26, with councils expected to fund £2bn of this to cover the services that they commission.

However, dedicated adult social care funding for councils in England is due to rise by approximately £1.2bn in 2025-26.

“Many councils cannot cover the rise in employment costs and we are worried this will increase the risk of non-compliance with the minimum wage,” said Homecare Association chief executive Jane Townson, in response to the Skills for Care figures.

Townson criticised the government’s decision last week to overturn a House of Lords vote to exempt adult social care providers from the NICs rise.

‘A direct threat to the quality of care’

For Care England, which represents independent sector providers, chief executive Martin Green said: “Care providers are caught between rising wage costs and insufficient money to fund them. Many are already struggling to recruit and retain staff, and with further financial pressures, the situation is only going to worsen.

“This is not just a problem for the providers themselves – it is a direct threat to the quality of care that millions rely on”.

Staff vacancy numbers in adult social care services fell last year, early data suggests.

As of December 2024, 7% of roles in independent sector adult social care providers in England lay vacant, down from 7.6% in April 2024, according to the Skills for Care (SfC’s) figures.

The data only covers those providers that have submitted figures to SfC’s adult social care workforce data set (ASC-WDS) for the relevant time period so is not representative of the sector as a whole.

SfC’s last sector-wide assessment measured the independent sector vacancy rate at 8.1% as of March 2024, down from 9.9% in 2023 and 10.7% in 2022.

Rapid fall in level of overseas recruitment

These falls were largely driven by the recruitment of staff from abroad. However, levels of international recruitment have fallen since March 2024, when the government banned adult social care staff on new or extended health and care visas from bringing partners or children to the UK.

According to SfC’s estimates, independent providers recruited 18,000 international staff from April to September 2024, compared with 105,000 in the year to March 2024, a fall of roughly two-thirds in the quarterly average.

Nevertheless, SfC data showed that the number of filled posts in independent providers rose from 575,000 to 585,000 from April to December 2024, alongside the apparent fall in vacancies.

Possible contributors to the trends include the 9.8% rise in the national living wage (NLW), from £10.42 to £11.44 an hour, in April 2024, which will have driven up pay across hundreds of thousands of care worker roles.

Concerns over potential care and job cuts

The NLW is due to rise again in April, by 6.7%, to £12.21 an hour. However, there is widespread sector concern that the measure, in combination with the planned increase in employer national insurance contributions, will lead to cuts to both levels of care and employment.

Almost two-thirds (64%) of organisations said they would need to make staff redundant, while 57% said they would have to hand care contracts back to councils and NHS commissioners on the back of the measures, according to a survey carried out last November by the Care Provider Alliance.

Think-tank the Nuffield Trust has estimated that the measures will cost providers in England £2.8bn in 2025-26, £2bn of which would need to be met by local authorities. Separately, the Association of Directors of Adult Social Services (ADASS) has calculated that councils face £1.8bn in increased costs in adult social care in 2025-26 due to the two measures, and wider inflation.

The government has said that it is making available an extra £3.7bn for local authorities with adult social care responsibilities in 2025-26. However, only about £1.2bn of this is dedicated funding for the sector.

Many thousands of care workers will get a 6.7% pay rise next April after the government announced the 2025 increase in the national living wage (NLW).

The wage floor for UK workers aged 21 and over will increase from £11.44 to £12.21 per hour, while there will be a steeper rise in the national minimum wage for those aged 18-20, from £8.60 to £10.00 an hour, a 16.3% boost.

The increase was recommended by the Low Pay Commission (LPC), based on its remit, set by ministers, to ensure the NLW does not fall below two-thirds of median hourly earnings and that any increase takes account of expected inflation up to March 2026.

The LPC said it expected the increase to amount to a real-terms pay rise for those currently on the NLW, with the Bank of England predicting inflation to be about 2% during this period.

Thousands of care workers set to benefit 

The beneficiaries will include the many thousands of care workers who currently earn on or just above the NLW.

Before the last rise in the NLW, in April 2024, 18% of the then 875,000 independent sector care workers in England – about 150,000 people – earned on or just under the then wage floor of £10.42 per hour (source: Skills for Care).

Most of this group would have likely seen their pay rise to the current NLW, £11.44, in April 2024, and are likely to also benefit from the full 6.7% rise in the wage floor next year.

However, because of the need for care providers to maintain pay differentials in their workforces, the many care workers earning just above the NLW will also likely benefit from the 2025 increase.

Increased fees for councils

To cover the rise, providers will need to increase the fees they charge councils, NHS commissioners and self-funders.

This year’s 9.8% increase in the NLW translated into increases in the fees paid by councils of between 6% and 6.6% across different adult social care service areas in England.

Councils’ ability to cover the 2025 rise will depend on the local government funding settlement they receive for 2025-26 from chancellor Rachel Reeves in tomorrow’s Budget.

However, provider leaders have long warned that councils do not pay them enough to cover the NLW for their staff, given their other costs.

Claim of £1bn shortfall in home care fees

The Homecare Association has calculated that there is a £1bn shortfall in the home care fees paid by councils and the NHS in 2024-25 compared with what providers in England need to pay staff the NLW, meet other costs and make a 5% profit.

In a post on X in response to the latest NLW increase, the association’s chief executive, Jane Townson, said: “Most councils and [NHS integrated care boards] are not paying enough to cover this year’s [NLW] of £11.44. Some have not increased fee rates since 2023. Allowing unethical purchase of care by public bodies is scandalous.”

Plan to create adult social care pay-setting body

The news comes with the government legislating to create a negotiating body to set adult social care pay and conditions in England. Its agreements, when ratified with ministers, would be binding on providers, who would need to reflect them in care workers’ contracts.

The measure, included in the Employment Rights Bill, is designed to raise terms and conditions in the sector and thereby boost recruitment and retention, reducing labour shortages.

However, the government has admitted that it would likely raise costs for councils because providers would not be able to absorb the impact through boosting productivity, narrowing pay differentials between workers or squeezing profits.

The planned fair pay agreement for adult social care is likely to increase costs to councils, as well as those funding their own care, the government has said.

Providers have limited scope to absorb the expected boosts to staff pay and conditions by improving productivity, narrowing salary differentials or squeezing profits, according to an impact assessment of the proposal contained in the government’s Employment Rights Bill.

As a result, the pay increases are likely to have to be reflected in increases to the fees paid to providers by self-funders and councils, with the latter potentially translating into increased costs for central government, said the Department for Business and Trade (DBT) assessment.

However, the assessment did not put a figure on the overall costs of the measure or the amount that would fall on councils.

It was published as MPs backed the Employment Rights Bill by 386 votes to 105, following its second reading in the House of Commons on 21 October 2024.

Body to set pay and conditions for adult care staff

The bill would allow the government to make regulations creating an Adult Social Care Negotiating Body, with a remit to make agreements about the pay, terms and conditions of adult social care workers in England.

The body would have to have representation from unions representing social care staff and sector employers, though may have other members, while the government would determine how it would operate and reach decisions.

Under the bill, the government would also be able to ask the negotiating body to reconsider proposed agreements.

Enforcing social care pay agreements

Where ministers were in agreement with the body’s proposals, the bill provides for them to make further regulations ratifying them, meaning the agreements would be binding on adult social care employers in England and would need to be reflected in workers’ contracts.

This would be enforceable in the same way as minimum wage legislation is, with such enforcement being the function of a new Fair Work Agency.

The objective of the agreements would be to raise pay, terms and conditions in the sector.

Poor pay and terms and conditions

As of December 2023, median pay for care workers in the independent sector was £11 per hour, against a then national living wage of £10.42, according to Skills for Care’s annual report on the workforce for 2023-24.

The sector continues to lag behind most parts of the economy, with 80% of workers in the UK earning at least £11.54 as of November 2023, according to Office for National Statistics (ONS) figures.

Besides receiving low pay, care workers’ terms and conditions tended to be the minimum required by law, said the impact assessment.

At the same time, the vacancy rate in adult social care in England (8.3%) is three times that of the wider economy (2.7%). While the turnover rate in the independent and local authority sectors fell from 29.1% in 2022-23 to 24.8% in 2023-24, this was substantially driven by international staff, the supply of whom has fallen due to immigration restrictions brought in this year.

Also, Skills for Care analysis has found that staff paid more are less likely to leave their roles.

Low pay ‘affecting domestic recruitment and retention’

In its impact assessment, the DBT said that the evidence it had accumulated showed that “that low pay and poor terms and conditions are key factors affecting domestic recruitment and retention, alongside factors such as limited career progression and limited access to learning and development”.

However, while in a normally functioning market, wages would rise in response to labour shortages, provider pay was “highly constrained” by local authority fee rates, in a context where 77% of community care users and 63% of care home residents received state-funded care as of 2022-23.

The assessment said this could not be addressed simply by raising funding for local authorities as councils may not pass these rises on to providers and, if they did, employers may not pass the increased fees on to staff.

It said creating a fair pay agreement for adult social care “provides a means to negotiate for better pay and conditions”, along with “levers to ensure the negotiated outcome is honoured”.

Positive impact for workers, negative impact for providers

The assessment said the agreement would improve the living standards, health and wellbeing of care workers. However, the impact on providers would be negative, due to increased labour costs, which would be partially offset by cost savings from improved retention.

The DBT said that providers had limited scope to raise productivity in order to absorb these costs because of the labour intensiveness of social care. If they were unable to raise their fees to compensate, due to local authority budget constraints, this would squeeze profits, threatening the viability of some providers, particularly smaller businesses.

The department said it would expect the costs of the fair pay agreement would “likely lead to higher costs for local authorities’ commissioning services and for self-funders”, with the higher council costs potentially requiring more funding from central government.

However, it was not able to quantify the costs because these would be dependent on negotiations between employers and unions through the Adult Social Care Negotiating Body.

Mixed impact on people needing care and carers

The impact on people needing care and unpaid carers was mixed, based on the impact assessment.

It added that people with care and support needs may benefit “both from the additional supply [of workers] to meet demand and from more productive carers who are retained for longer, with greater experience and skills, and more motivation and effort in their work”. This may reduce the burden on unpaid carers by reducing unmet need.

However, it said the increased costs faced by self-funders may increase unmet need and pressures on unpaid carers as a result of people buying less care.

After passing its second reading in the Commons, the bill will now be scrutinised by a committee of MPs, whose deliberations will conclude on 21 January 2025.

The government will create a body to set pay and conditions for adult social care staff in England should its Employment Rights Bill become law.

The bill, published yesterday, would allow the government to make regulations creating an Adult Social Care Negotiating Body, to make agreements about the pay, terms and conditions of adult social care workers in England.

The body would have to have representation from unions representing social care staff and sector employers, though may have other members, while the government would determine how it would operate and reach decisions.

Under the bill, the government would also be able to ask the negotiating body to reconsider proposed agreements.

Enforcing social care pay agreements

Where ministers were in agreement with the body’s proposals, the bill provides for them to make further regulations ratifying them, meaning the agreements would be binding on adult social care employers in England and would need to be reflected in social care workers’ contracts.

This would be enforceable in the same way as minimum wage legislation is, with such enforcement being the function of a new Fair Work Agency.

Tackling ‘exploitative’ zero-hours contracts

Alongside the negotiating body, the bill also provides for an end to “exploitative” zero-hours contracts by introducing rights for workers to:

• a reasonable notice of shifts and payment for shift cancellation and curtailment at short notice, for those on zero- and low-hours contracts, and
• a guaranteed hours contract that reflects the hours they regularly work over a reference period.

According to Skills for Care’s latest report on the adult social care workforce, also published yesterday, 21% of all adult social care posts (about 340,000 roles), 29% of care worker posts and 43% of home care worker posts were employed on zero-hours contracts in 2023-24.

The bill would also abolish the lower earnings limit – currently £123 per week – for eligibility for statutory sick pay (SSP), while SSP would also be payable from the first day of a person’s absence, not the fourth, as is currently the case.

Question marks over funding

The government has not yet set out how the measures affecting social care would be resourced, in the context of most services being funded by the state, prompting concerns from provider leaders.

Homecare Association chief executive Jane Townson said it  fully supported “measures to enhance workers’ rights and improve job security”.

However, she said that, by the association’s calculations, current council and NHS fees were significantly below that required by providers to cover costs and make a 5% profit or surplus.

Providers ‘may be pushed to the brink’

“Introducing day-one rights for sick pay, for example, could add at least 10p per hour to the cost of delivering homecare. While beneficial for workers, this will add financial burdens to care providers who already operate on tight margins,” she added.

“If local authorities and the NHS don’t provide more funding, these new regulations could push many providers to the brink.”

She said the association backed establishing a national contract, requiring public bodies to pay a minimum price for care services.

“We call on the government to work closely with the care sector to find solutions that balance the laudable aims of the Employment Rights Bill with the need to maintain a viable and robust care system,” Townson said. “We must address these challenges to protect and support both care workers and those they help.”

‘A major step towards giving social care due priority’

Think-tank the Nuffield Trust said the bill was a “major step towards giving adult social care the visibility and priority it has been lacking for far too long”.

“The provisions on pay and conditions massively strengthen the secretary of state’s powers and responsibilities for social care staffing, making them clearly accountable in a way that has previously been lacking,” said its deputy director of policy, Natasha Curry.

“However, the new rights and any changes to pay will need to be implemented carefully because social care is in such a precarious state after decades of neglect,” she added. “Many employers are so financially squeezed that suddenly requiring guaranteed hours and additional rights without support could push some into bankruptcy.”

The legislation was strongly welcomed by UNISON, whose general secretary, Christina McAnea, said: “The means to create a fair pay agreement to increase wages for care workers in England is game-changing. It’s an historic first step towards transforming a sector that’s been neglected and ignored for far too long.”

Other employment reforms

The bill would also remove the two-year qualifying period for protection from unfair dismissal, meaning that employers would only be able to dismiss staff for a fair reason that falls under any of five categories (conduct, capability, redundancy, statutory restriction, or some other substantial reason) from the start of their employment. However, employers would have more flexibility to dismiss during an initial probationary period set by regulations, which is likely to be nine months, though will be subject to consultation.

Other measures include:

• reducing employers’ scope to reject flexible working requests only to cases where accepting the request were not reasonably feasible;
• removing the 26-week qualifying period for people to take paternity or parental leave, enabling them to do from day one of their employment;
• requiring employers to protect their staff from harassment from third parties;
• enabling ministers to require employers delivering outsourced public services to equalise terms and conditions between staff transferred from the public sector and other employees;
• making it easier for trades unions to gain recognition from employers to collectively bargain on behalf of staff.

Announcing the bill in a parliamentary statement, business and trade secretary Jonathan Reynolds said it represented “the biggest upgrade in employment rights for a generation” and would “raise living standards across the country and provide better support for those businesses who are engaged in good practices”.

The number of overseas recruits to the social care sector has plummeted as a report highlights how reliant the sector has become on international staff.

From April to June this year, an estimated 8,000 international recruits joined the adult social care workforce in England, down from a quarterly average of 26,000 in 2023-24, according to data from Skills for Care.

The sharp drop started in the month after a ban came into place on overseas care staff bringing dependants with them when taking jobs on health and care worker visas.

How overseas care staff have improved workforce indicators

Skills for Care shared the figures today as its annual State of the Adult Social Care Sector and Workforce in England report for 2023-24 demonstrated that overseas staff had been largely responsible for reducing vacancy rates and cutting turnover to its lowest level in almost a decade.

In addition, international care staff were more likely to have achieved the entry level care certificate standards than domestic recruits, while they had also helped increase the proportion of men – a target group for recruitment – in the workforce.

However, despite the contribution of overseas staff, the adult social care vacancy rate (8.3%) was almost three times the economy-wide average, while just two in five care workers (41%) had a relevant qualification at level 2, a figure that has been stuck since 2020-21.

Average pay rises but social care still lags other sectors

Following a real-terms fall in average pay for staff in 2022-23 – as a result of high rates of inflation – median pay for independent sector care workers grew from £10.11 to £11.00 per hour as of March 2024, a rise worth 8.8% in cash terms and 5.7% in real terms. This was driven by a 9.7% cash increase in the national living wage (NLW), from £9.50 to £10.42 per hour, in April 2023.

However, the sector continued to lag behind most parts of the economy, with 80% of workers in the UK earning at least £11.54 as of November 2023, according to Office for National Statistics (ONS) figures.

The news came as the government unveiled its Employment Rights Bill, which includes provisions to set up an adult social care negotiating body to determine pay and conditions in the sector, with a view to raising salaries.

A growing and more stable workforce with fewer vacancies

The number of filled adult social care posts, which fell for the first time in 2021-22, grew for the second consecutive year, from 1.635m in 2022-23 to 1.705m in 2023-24, a rise of 70,000 (4.2%).

This was driven by growing numbers of home care (42,000) and NHS roles (8,200), though there was a fall of 7,200 in the number of personal assistants, who are employed by direct payment recipients.

At the same time, the vacancy rate, which hit a peak of 10.6% in 2021-22 before falling to 9.9% in 2022-23, dipped again to 8.3% in 2023-24, equivalent to 131,000 roles.

As in previous years, the rate was considerably higher in domiciliary care (11.5%) and for direct payment recipients (11%), than in community care (6.2%), residential care (5.2%) or day care (4.9%).

The vacancy rate fell across all roles, with the highest percentage point fall being among care workers, where it dropped from 11.8% to 9.9%.

The workforce was also more stable, with the turnover rate across the independent and local authority sectors – who collectively employ 86% of the workforce – dropping from 29.1% in 2022-23 to 24.8% in 2023-24, the lowest level since 2014-15.

Positive trends driven by overseas staff 

Skills for Care said that these trends had largely been driven by overseas staff, on the back of the Conservative government’s decision to allow employers to recruit care workers from abroad via the health and care visa from February 2022.

From 2021-22 to 2023-24, the number of posts filled by staff who were from outside the EU rose by 160,000 (from 140,000 to 300,000), meaning their share of the workforce increased from 9% to 19%. Over the same period, the number of posts held by British nationals fell by 70,000, from 1,260,000 (84% of the workforce) to 1,190,000 (75%).

Employers who employed at least one non-British worker who arrived in the UK from April 2022 to March 2024 saw their turnover rate fall by 8.1 percentage points (from 41.5% to 33.4%) from 2021-22 to 2023-24. While employers who did not recruit internationally had a lower turnover rate to start with – 31.6% in 2021-22 – this only fell by 2.9 percentage points over the period (to 28.7%).

Similarly, employers who recruited internationally saw their vacancy rate fall from 12.8% to 8.5% over the two-year period – a drop of 4.3 percentage points – while the rate for other employers fell by only 1.2 percentage points, from 8.1% to 6.9%.

Qualifications and sickness absence gaps

Skills for Care also found significant gaps between international and British staff recruited in 2023-24 in relation to qualifications and levels of sickness absence.

While international recruits took an average of 2.5 days’ sickness absence during the year, domestic recruits took 9 days. Also, while 55% of those international recruits had completed the care certificate standards, which set basic expectations of care workers, by March 2024, this was true of 37% of British recruits.

International recruits also drove the rise in the proportion of men in the workforce, from 19% in 2022-23 to 21% in 2023-24, the highest level yet recorded. Men made up 29% of international recruits in 2023-24, but just 15% of domestic recruits.

Warning over ‘rapid’ decline in number of international recruits

Skills for Care chief executive Oonagh Smyth (photo from Skills for Care)

“On the face of it, the headline statistics paint a positive picture,” said Skills for Care chief executive Oonagh Smyth. “The workforce grew for the second consecutive year and we’ve seen the lowest turnover in a decade.”

“[But] the improvements in this year’s report are largely driven by international recruitment…and there is early evidence that the number of international recruits is rapidly falling.

“And it’s clear that social care is struggling to compete for staff in local labour markets so longstanding domestic recruitment and retention challenges exist.”

She added: “So we need to stem the tide of British care workers who are leaving their jobs and we can only do that by improving the quality of care roles so the sector can be more competitive in local job markets.”

Adult social care workforce strategy

In the summer, Skills for Care published a 15-year strategy for the workforce, designed to improve recruitment and retention in order to fill current gaps and meet the sector’s future needs, in the context of an ageing population.

The strategy, conceived by sector leaders, urged action to boost pay and qualification levels in the sector, along with measures to attract currently underrepresented groups, such as men and young people, into the workforce.

Skills for Care has set up an implementation unit to support adoption of the strategy’s recommendations. However, half of the recommendations are for government, either alone or in partnership with others.

No funding plan for pay improvements

While the Employment Rights Bill is designed to boost pay and conditions for adult social care staff, the government has not set out how it will fund local authority and NHS commissioners to pass on the required increases in fees to enable providers to deliver on these improvements.

This is the context of providers already warning that they are significantly under-resourced to deliver services. For example, the Homecare Association has calculated that there there is a £1bn gap between the home care fees paid by commissioners and the amount required by providers in England to pay staff the NLW.

Meanwhile, in relation to training and qualifications, the Labour administration has cut funding levels for 2024-25 by £115m relative to its Conservative predecessor’s plans.

The new Labour government has pledged to legislate to strengthen the child protection system in its first King’s Speech.

The long-awaited reform of the Mental Health Act 1983 and action to deliver “fair pay” for staff in adult social care are also included in its first legislative programme since taking office.

Strengthening child protection

A Children’s Wellbeing Bill would keep children “safe, happy and rooted in their communities and schools by strengthening multi-agency child protection and safeguarding arrangements”, the government said.

It added that the legislation would deliver on Labour’s manifesto commitment on children’s social care “to ensure that all children can thrive in safe, loving homes”.

Labour offered little detail on its children’s social care plans in its manifesto and its King’s Speech background document is similarly unclear on what these reforms will involve.

The government has also not confirmed how much it will retain of its predecessor’s Stable Homes, Built on Love agenda. That aimed to reform children’s social care by, among other things, investing more in family support and kinship care to reduce the need for statutory interventions.

Registers of children not in school to be introduced

Labour also said that the bill would place a duty on councils to have and maintain registers of children not in school, something its predecessor had planned to do but did not achieve.

Councils would also need to provide support to home-educating parents. The bill follows a rise in the number of home-educated children in England, from 80,900 to 92,000, in the year to autumn 2023.

A Child Safeguarding Practice Review Panel analysis of reviews of serious cases involving home-educated children, published in May, found there were “potential risks of harm for some children when they are not visible to public agencies and cannot access the potential benefits of school as a protective factor”.

The panel said the evidence it had seen “[reinforced] the need for a statutory register so that relevant statutory organisations know which children are being home educated” and to enable safeguarding agencies to have better knowledge of them.

‘Fewer children will slip under radar’

The government said its bill would “ensure fewer children slip under the radar when they are not in school and more children reach their full potential through suitable education”.

It was welcomed by the Association of Directors of Children’s Services (ADCS), whose president, Andy Smith, said: For too long we have had no way of assuring ourselves of whether a growing number of children are receiving a suitable education or that they are safe.

“While a register in and of itself will not keep children safe it will help to establish how many children are being educated other than in school and to identify children who may be vulnerable to harm.”

‘Fair pay’ for adult social care staff

As trailed in the manifesto, the King’s Speech also included provisions to introduce a fair pay agreement for adult social care staff, which will form part of an Employment Rights Bill.

The Labour manifesto said this would set fair pay, terms and conditions, along with training standards, for care staff, and would be based on consultation with trade unions and providers.

However, the party did not set out any funding plans for the agreement, despite any policy that raises pay in social care requiring a significant funding boost to councils to enable providers to meet the increased costs.

UNISON welcomed the plan, with general secretary Christina McAnea saying: “After years of government neglect, the fair pay agreement is the first sign things are set to change [for social care]…Once the new pay agreement is in place, wages in care will rise across England, easing the sector’s staffing nightmare and relieving pressure on the NHS.”

The move was also welcomed by think-tank the King’s Fund but its chief executive, Sarah Woolnough, stressed the importance of the agreement being funded.

“The government’s plan to increase adult social care pay is good news for care workers, and we hope it will come with a commensurate rise in local government budgets to avoid the pay boost being funded by cuts elsewhere,” she said.

Ban on ‘exploitative zero-hour contracts’

The employment bill would also ban “exploitative zero-hour contracts”. This would provide workers with a contract that “reflects the number of hours they regularly work” and ensure they get reasonable notice of shift changes and are compensated for cancelled or curtailed shifts.

This will have significant implications for the home care sector, with a recent Homecare Association survey finding that two-thirds of providers offer zero-hour contracts to their staff.

The association, which represents domiciliary care organisations, said zero-hour contracts were the result of council and NHS commissioning practices that did not guarantee providers a set number of hours.

“For employers to stop or reduce use of zero-hour contracts and improve pay, public bodies need to change how they commission and purchase home care,” it said in the report on its survey.

This should include commissioning based on outcomes – rather than time and task – and paying providers for planned hours in advance, the association added.

Risk of ‘unintended consequences’

Following the King’s Speech, the association’s chief executive, Jane Towson, said: “Care employers need higher fees and secure contracts from councils and the NHS to provide better pay and working conditions. This requires government investment.

“Focusing on employment practices without also improving funding and commissioning risks unintended consequences.”

There was a similar warning from think-tank the Nuffield Trust, whose director of policy, Natasha Curry, said: “The hard reality is that adult social care has become reliant on zero hours contracts and some workers value the flexibility, and so there needs to be a careful, cautious, approach here that seeks to improve terms and conditions without suddenly destabilising the sector.”

Long-awaited Mental Health Act reform

The King’s Speech also included long-awaited legislation to reform the Mental Health Act 1983. This was promised by the Conservatives in their 2019 election manifesto, but not delivered during their subsequent five years in power, despite the party producing draft legislation in 2022.

Labour said its planned legislation would ensure “patients have greater choice, autonomy, rights and support, and make sure all patients are treated with dignity and respect throughout their treatment”.

Specific measures set out in the King’s Speech background briefing appear very similar to the Conservatives’ planned reforms. These include:

• Revising the detention criteria to ensure that people can only be detained if they pose a risk of serious harm either to themselves or to others, and where there is a reasonable prospect that treatment would have a therapeutic benefit.
• Shortening the period that a patient may be kept in detention for treatment, which is currently an initial six months, and providing faster and more frequent reviews and appeals in relation to both detentions and treatment.
• Further limiting the extent to which people with a learning disability and/or autistic people can be detained and treated under the Mental Health Act and supporting such individuals to live fulfilling lives in their community, including by ensuring an adequate supply of community services to prevent inappropriate detentions.
• Replacing the role of nearest relative – a family member with key rights and responsibilities in relation to patients but whom the patient has no role in appointing – with that of nominated person, who would generally chosen by the patient.
• Extending access to independent mental health advocates to informal patients and introduc an opt-out system for formal patients.
• Removing police stations and prisons as places of safety under the MHA to ensure people experiencing a mental health crisis are supported in the most appropriate setting.
• Adding statutory weight to patients’ rights to be involved with planning for their care and to make choices and refusals regarding the treatment they receive.
• Supporting offenders with severe mental health problems to access the care they need as quickly and early as possible, and improving the management of those patients subject to a restriction order (for the purposes of public protection).

‘Once-in-a-generation opportunity’

“Reforming the Mental Health Act is a once-in-a-generation opportunity,” said Sarah Hughes, chief executive of mental health charity Mind.

“This bill is a chance to strengthen people’s rights, choice, and control when they’re being treated in a mental health hospital. It’s a chance that must be taken to address the shameful racial disparities the law currently enables, particularly for Black people who are nearly four times more likely to be detained.

“And it’s a chance to ditch community treatment orders, which are meant to give people supervised treatment in the community but are too often intrusive, restrictive and fail to reduce readmissions as they were intended.”

For the Centre for Mental Health, chief executive Andy Bell said: “We hope the bill that is delivered will be sufficiently comprehensive to update legislation that does not provide enough safeguards and that leaves people spending months in prison waiting for an urgent hospital bed.”

However, in outlining its plans for the bill, the government  said its impact would be years in the making.

“These reforms will take a number of years to implement, as we will need to recruit and train more clinical and judicial staff,” it said. “We plan to introduce these reforms in phases as resources allow, and we will not commence new powers unless we have sufficient staff in place that means it is safe to do so.”

Labour’s return to power last week was greeted with a chorus of welcomes from adult social care organisations in England – along with a chorus of demands of the new government.

Broadly, these were for significant investment in, and reform to, the sector to address issues including unmet need, workforce shortages and inadequate care.

For many, these challenges are the legacy of the Conservatives’ 14-year period in office.

The ‘austerity’ decade

This began with the decade of “austerity” in the 2010s, during which councils’ available budgets fell by 29% in real-terms (source: National Audit Office [NAO]).

While authorities strove to protect adult social care from these cuts, their spending on the service was only marginally higher 2019-20 than 2010-11, after taking account of inflation.

Image: treety/Adobe Stock

According to the Association of Directors of Adult Social Services (ADASS), authorities had to make £7.7bn in adult social care savings during the decade to manage increasing demand and cost pressures without extra resource.

One result was a significant fall in the number of people who received long-term care, from 872,520 in 2015-16 to 838,530 in 2019-20 (source: NHS Digital).

These pressures were driven by the expected – an ageing population and growing numbers of people with multiple and complex needs – and the unexpected.

For example, the Supreme Court’s landmark Cheshire West judgment, by widening the definition of a deprivation of liberty, triggered a tenfold increase in councils’ Deprivation of Liberty Safeguards (DoLS) caseloads, from 13,700 in 2013-14 to 137,540 in 2014-15.

Modernising the law

The middle of the decade saw the implementation of the Care Act 2014, unifying and modernising the previous panoply of social care legislation into one statute that made promoting wellbeing and preventing, reducing or delaying need the service’s central missions.

Alongside this, it created rights to support for carers and rights to advocacy for those who would otherwise struggle to participate in key processes, placed councils under a statutory duty to investigate adult safeguarding concerns and sought to improve the transitions process for young people.

Photo: Gary Brigden

However, the legislation’s vision soon ran into the realities of the fiscal constraints and pressures on the service.

To take one example, a study published in 2021 found that assessments of, support for, and spending on carers fell in the years following the act’s implementation – contrary to its intent – because of funding pressures.

Care Act deemed a ‘failure’

Key aspects of the act were not implemented, including rights of appeal against council decisions and the so-called ‘Dilnot’ charging reforms, which were designed to make the means-testing system more generous and cap people’s liabilities for their personal care.

The latter were originally due to be implemented in 2016 and were then delayed until 2020 before being scrapped under Theresa May’s government in 2017 – though not for good (see below).

In its 2021 white paper, People at the Heart of Care, the government concluded that the full spirit of the Care Act had not been realised. A 2022 report by a House of Lords committee went further and declared the legislation a failure.

“Far from ensuring individuals’ wellbeing, care services tend to be reduced to a minimum and designed to enable people to survive, rather than to live and thrive,” it said.

The tragic impact of Covid

The austerity years were followed by the tragedy of Covid-19. This would have always hit social care hard given that people who used the service – older people and those with multiple health conditions – were at particular risk from the disease.

But the impact was compounded in the early stages by government policies to free up 15,000 hospital beds in March 2020 and for care homes to make their full capacity available. This led to many people with asymptomatic Covid being discharged into residential care.

Photo: thodonal/Adobe Stock

From March 2020 to April 2021, there were 27,179 more deaths than expected among care home residents, while there were 9,571 excess deaths reported among home care users over a similar timeframe (source: the Health Foundation).

In addition, over 900 care workers lost their lives to Covid up to May 2021, while the workforce was worst hit of all occupational groups by long Covid.

At the same time, many people were left at home without a service, and adult safeguarding concerns were delayed, during lockdowns, worsening unmet need, risks of harm and the strain on unpaid carers.

The devastating impact of the pandemic on adult social care triggered an increased focus on the sector – and apparent recognition of its value – from the Conservative government.

The Tories’ reform agenda

Its first response was the People at the Heart of Care white paper, published in late 2021, which allocated £3.6bn to reviving the Dilnot charging reforms, and a further £1.7bn to assorted other changes designed to improve services, from 2022-25.

These included raising qualification levels and the status of the workforce (£500m); expanding specialist housing for people with care needs (£300m); promoting the digitisation of the sector to improve productivity (£150m); enhancing commissioning (£70m), and supporting carers (£25m).

However, much of this reform agenda subsequently unravelled in the face of the severity of day-to-day pressures on services.

Severe pressures remain

The number of staff vacancies increased by 50% to 164,000 in the year to March 2022, while the number of people on waiting lists for assessments, reviews and care packages grew by 37%, to 542,000, from November 2021 to April 2022.

Meanwhile, there was a 57% rise, to over 13,000, in the number of hospital beds occupied by someone fit for discharge, in the two years to December 2022 (source: the Health Foundation), in part because of social care shortages.

Amid such pressures, council bodies argued that it was all but impossible for them to implement the Dilnot reforms in line with the planned start date of October 2023, given the scale of the changes required. These included:

• Recruiting sufficient practitioners and overhauling systems in order to be able to assess and review many thousands of self-funders coming forward to take advantage of the more generous means-test or be considered for the cap on care costs.
• Upgrading their case management systems in line with revised financial assessment procedures and to track people’s progress towards the cap.

Reforms delayed or shelved

In response, the government pushed the start date of the reforms back by two years, ploughing most of the allocated £3.6bn into shoring up day-to-day social care services, including for children. 

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This was accompanied by giving authorities permission to raise council tax by 3% and the adult social care precept – which is ring-fenced for the sector – by 2% per year, along with additional grant funding, from 2023-25.

Then in July 2023, it shifted £600m of the remaining reform funding into core services, having already halved its investment in workforce development.

The Conservatives also shelved their plan to replace the DoLS, and the use of Court of Protection orders to authorise deprivations of liberty in the community, with a more streamlined system, the Liberty Protection Safeguards (LPS).

This was despite DoLS caseloads having continued to mount, topping 300,000 in 2022-23, with the average case taking 156 days, leaving many thousands of people unlawfully deprived of their liberty.

Impact of increased funding

The resulting increase in government funding for adult social care from 2023-25 has had a definite impact.

Councils budgeted to increase spending on the service by 10% in real terms (£2bn) in 2023-24 and have planned to raise expenditure by 9.2% in real terms (£2.1bn) this year.

This has helped fund two consecutive 10% increases in the national living wage, benefiting tens of thousands of care workers, chiefly in the independent sector.

Along with increased international recruitment, which was promoted by the Conservative government, at least until late last year, this appears to have had an impact on workforce sufficiency.

Skills for Care figures show that the sector vacancy rate fell from 9.9% in March 2023 to 8% in April 2024.

No let up in challenges

However, the extra funding clearly did not solve the challenges facing the sector. At 8%, its vacancy rate was more than double the economy-wide average (3.0% as of autumn 2023, according to the Office for National Statistics).

Waiting lists not only remained high but grew, by 8% to 470,576, from March to August 2023, reported ADASS. And the number of people awaiting discharge from hospital has remained stubbornly around the 13,000 mark, shows NHS England data.

Photo: IQoncept/Adobe Stock

Meanwhile, the Local Government Association (LGA) has calculated that councils would need an additional £5.1bn in 2026-27 compared with 2023-24 to maintain services at existing levels, because of funding pressures.

Lack of certainty over funding and reform

Unsurprisingly, this has prompted calls for further funding for adult social care. However, the Conservatives also faced criticism for how they resourced the sector, particularly through their reliance on short-term grants, sometimes provided with little notice.

“There are concerns that short-term funding does not support value-for-money decision-making,” said the NAO, in a report on adult social care reform published in November last year. “It can lead to a lack of time to review savings options to make good rather than quick decisions.”

The same NAO report also raised significant concerns about whether the Dilnot charging reforms were deliverable by the revised target date of October 2025.

This was not just because of the amount of work this would involve, but also because the Department of Health and Social Care (DHSC) had disbanded the programme board responsible for overseeing the changes.

Unfunded commitments to charging reform

Both the Conservatives – in their manifesto – and Labour – in media interviews – committed to implementing the charging reforms by October 2025 during the election campaign.

But, as think-tank the Institute for Fiscal Studies (IFS) has pointed out, the outgoing government left no funding to implement the changes, meaning fresh resource would need to be found by the new Labour administration.

This is in addition to all the preparatory work that would need to be carried out by civil servants, councils, IT firms who supply case management systems and care providers.

Unsurprisingly, ADASS concluded the chances of the reforms being implemented in October 2025 were “quite low”.

Labour’s offer on adult social care

The party’s election manifesto was not short of pledges on adult social care. These comprised:

• A programme of reform to create a national care service, underpinned by national standards, delivering consistency of care across the country, ensuring high-quality care and ongoing sustainability, and ensuring providers behave responsibly.
• A principle of ‘home first’ that supports people to live independently for as long as possible.
• Local partnership working between the NHS and social care on hospital discharge.
• An agreement setting fair pay, terms and conditions, and training standards for adult social care workers, following widespread consultation.
• Guaranteeing the rights of care home residents to see their families.
• Asking regulators to assess the role social care workers can play in basic health treatment and monitoring.
• Providing councils with multi-year funding settlements.

Is more austerity on the cards? 

However, while councils will no doubt welcome the predictability of multi-year funding settlements – something also pledged by the Tories – they will have noted, with alarm, the lack of commitment to increase their funding.

This is particularly so in the context of Labour’s pledges not to increase income tax rates, national insurance or VAT and limit borrowing so that public debt is on course to fall as a share of national income over the medium-term.

Based on these pledges, the current state of the public finances and likely increases in the NHS, overseas aid, defence and childcare budgets, the IFS has sketched out possible trajectories for local government funding over the coming years.

Under these, council spending would rise by between 0.4% and 2.5% per year in real terms up to 2028-29, with the even the latter falling well short of what the LGA has calculated that authorities need to stand still over the coming years.

This has led to accusations of authorities facing a further round of austerity – albeit less stringent than that of the 2010s – something that Labour has vigorously rejected.

No funding for fair pay agreement

The party also did not pledge any resource to implement its fair pay agreement for the sector, placing significant question marks against its impact.

The IFS has calculated that, if this involved setting a sector minimum wage that was £1 an hour above the national living wage (NLW), it could cost the public sector about £200m-£360m a year; a £2-an-hour boost could cost £750m-£1.2bn a year.

The party’s other pledges on social care, meanwhile, remain open to significant interpretation.

Questions for Wes Streeting and Stephen Kinnock

For example, what does “a principle of “home first” mean in practice, what will the party do differently to speed up hospital discharge and what will its proposed national standards to drive up care quality amount to?

Health and social care secretary Wes Streeting (credit: Labour Party)

Most significantly of all, what is a national care service?

The new health and social care secretary, Wes Streeting, and minister for care Stephen Kinnock will be expected to provide answers to these questions and address the lack of funding in their plans for adult social care over the coming weeks and months.

It will be through their answers that we will know how different a Labour government will be to its Conservative predecessors.

Increasing qualifications levels for the adult social care workforce – linked to higher pay – is among the ideas under consideration by the group developing a 15-year strategy for the adult social care workforce.

Other potential proposals include providing registered managers with a supported year in which to develop, developing a graduate training scheme for that role or making it a degree-level position.

The ideas were shared last week by David Pearson, co-chair of the steering group developing the strategy, in a session at the Association of Directors of Adult Social Services spring seminar.

The strategy is being developed by the group, which Pearson co-chairs with Oonagh Smyth, chief executive of Skills for Care, the organisation responsible for the plan.

Though the Department of Health and Social Care is not directing the strategy, it has representation on the group, alongside ADASS, the British Association of Social Workers, Social Work England, the Care Quality Commission (CQC) and provider umbrella body the Care Provider Alliance, among others.

‘No important thing for sector than workforce strategy’

Pearson, a former director and ADASS president, said he thought there was “no more important thing for adult social care at this time, given the stats and the pressures” than the workforce strategy.

He cited the sector’s 9.9% vacancy rate, as of March 2023 (source: Skills for Care) – compared to an economy-wide average of 3% (Office for National Statistics) – and the fact that 28% of staff (about 390,000) left their jobs each year (Skills for Care). The turnover rate was far higher among young people, at 53.7%.

“We’ve got a bit of a leaky bucket,” said Pearson. “A lot of people leave. We need to be equipping people to develop their careers.”

Pay and development key to retention

Pearson said there was evidence of what worked in promoting retention.

He cited Skills for Care analysis showing that turnover among independent sector care staff was more than twice as high when a worker lacked all of five elements – being paid more than the minimum wage, having access to training, having a qualification, being able to work full-time and not being on a zero-hours contract – compared to having all five.

Photo: Yurii Kibalnik/Adobe Stock

“This shows that there are a number of things that are in the gift of the sector if we choose to do it,” he added.

Pearson said the steering group was looking at how to enhance training and development among adult social care staff. One idea under consideration was to set a requirement or expectation for staff to be at least level 3 qualified (equivalent to A level) within three years of joining the sector, with such progression linked to higher pay.

Current qualification levels

Making social care a level 3 sector would be a significant step up from the current situation, in which just an estimated quarter of the workforce (excluding regulated professionals, who require a degree) held at least this tier of qualification as of March 2023 (Skills for Care).

It also exceeds the DHSC’s aim to make adult social care a level 2 sector (equivalent to a good GCSE), by rolling out its new care certificate qualification.

Even this is ambitious, with an estimated 43% of the non-regulated workforce holding at least a level 2 qualification as of March 2023 (Skills for Care).

As well as tying the suggested level 3 qualification to enhanced pay, the steering group is considering proposing that pay differentials more generally are tied to a worker’s development.

This would also mark a significant shift from the status quo, with Skills for Care data showing that an independent sector care worker with five years’ experience or more earned just 6p per hour more than one with less than a year’s time on the job.

Enhancing registered manager role

Another possible recommendation in the strategy would be enhancing the role of providers’ registered managers, either by making it a degree-level job, creating a graduate trainee scheme for the position or introducing a supported year of development for new recruits.

According to Skills for Care, services without a registered manager in post at the time of an inspection were less likely to receive a outstanding or good rating from the CQC during 2022-23. However,  the vacancy rate for registered manager roles was 10.6% as of March 2023, while the role had a turnover rate of 23.2% in 2022-23, said the workforce development body.

Currently, the CQC requires that registered managers have “the necessary qualifications, competence, skills and experience to manage the regulated activity”, but does not specify a qualification level.

Skills for Care recommends that they take the level 5 (degree level) diploma in leadership and management in adult social care, however, as of March 2023, an estimated 44% of registered managers did not have at least this level of qualification.

Strategy ‘will require extra investment’

Pearson acknowledged that the strategy, due to be published in July, would require extra investment in adult social care but said that the steering group’s intention was that it would be “fully costed”.

Photo: chrupka/Adobe Stock

“It’s our intention to come up with something that is robust, credible, evidence-based and has the right costings associated with it and an understanding that this cannot be provided unless the extra money is there,” he added.

With an election due by January 2024, Pearson said the steering group was engaging with the major political parties to understand their thinking on the adult social care workforce.

While the government has allocated £250m from 2023-25 to develop the adult social care workforce, this is a cut from its original plan of providing £500m from 2022-25.

Funding pressures

And though care workers have seen their wages rise in real terms over the past two years, due to consecutive 10% increases in the national living wage (NLW), councils are struggling to cover the costs in the fees they pay providers.

As providers must ensure staff receive at least the NLW (now £11.44 an hour) by law, this means they will struggle to maintain current pay differentials, let alone increase them to reward experience and qualifications.

In addition, with public sector net debt worth about 98% of national income as of March this year (source: Office for National Statistics) and taxation levels set to hit a post-war high in 2028-29 (source: Office for Budget Responsibility), the next government is likely to be wary of raising spending outside of priority areas such as the NHS and defence.

Pearson said that the steering group was looking to craft a message that enabled the next government to start implementing the strategy without being deterred by the costs.

“There’s something nuanced here that we enable progress to be made without saying in the first three weeks there’s a billion pound bill that no government can afford,” he said. “It’s better to come up with something we can start on, as well as a sector and with any government, rather than something that people say is too difficult.”

Over four in ten adult social care providers closed parts of their organisation or handed back contracts last year because of cost pressures, driven in particular by staffing shortages, a survey has found.

Almost one in five said they were providing care to fewer people, while a similar proportion said they made redundancies in 2023, due to cost constraints, found the annual Pulse Check survey commissioned by learning disability provider Hft and representative body Care England.

Also, just under four in five reported that local authority fee increases were insufficient to cover last year’s 9.7% increase in the national living wage (NLW), amid widespread concerns that the same will be true of the 9.8% rise in the salary floor due in April 2024.

Increased funding for adult social care

The research was a test of the impact on providers of a 10% real-terms budgeted increase in adult social care spending by councils in 2023-24, on the back of significant extra government funding.

Several chunks of this funding, either in whole or in part, were focused on increasing the fees councils pay providers, including:

• The £562m market sustainability and improvement fund (MSIF), £162m of which was designed to help councils pay providers ‘a fair cost of care’ with the remainder earmarked for fee increases, bolstering workforce capacity or cutting waiting lists for care or assessments.
• The £365m market sustainability and improvement fund – workforce fund, which is for the same purpose as the MSIF but is particularly designed to bolster the workforce.

‘No impact’ from government cash boosts

However, most respondents (84%) reported that recent government funding rises, such as the MSIF workforce fund, had had no impact on their financial sustainability, with two-thirds saying the same about the fair cost of care work.

Providers reported that they struggled to meet funding conditions that differed between authorities and also said that, in some areas, domiciliary care was prioritised over residential services for resourcing.

The Pulse Check report also criticised the “short-term, sporadic nature of these government funding measures”, which only delivered “temporary relief”, rather than helping providers address financial challenges “root and branch”.

Service closures

As a result of these pressures, 43% either closed parts of their organisation or handed back contracts to commissioners, 18% provided care to fewer people and 19% made redundancies.

Workforce-related costs were, by far, the largest pressure on providers (cited by 81% of respondents) followed by utility bills (59%) and unrealistic expectations from commissioners, such as unfunded service costs (38%).

The most significant staffing pressure, reported by 87% of providers, was the need to increase pay in line with rises in the statutory national living wage (NLW) or the voluntary real living wage or London living wage.

The NLW rose from £9.50 to £10.42 per hour last year, a 9.7% rise that was the highest percentage increase in the salary floor since its introduction in 2016. However, 79% of respondents to the Pulse Check said increases in council fees were not sufficient to cover the rise.

Providers struggling to offer competitive pay

The report said this appeared to have had an impact on providers’ ability to offer competitive pay, with gap between the average wage respondents offered care workers (excluding senior care workers) and the NLW having narrowed from £1.02 per hour in 2022 to 77p in 2023.

Correspondingly, 86% of providers cited pay as their biggest recruitment and retention challenge, up from 75% in the 2022 study.

The NLW is due to go up by an even greater amount next year – by 9.8%, from £10.42 to £11.44 an hour – and council leaders have warned that the government has not funded them to deliver this increase.

“Unfortunately, as pay for care workers shifts closer to the NLW it is likely that recruitment will become ever more challenging as potential staff chose careers offering a more attractive salary,” the Pulse Check report warned.

Reliance on international recruitment

National data showed a small overall reduction in adult social care vacancies from 2022-23, from 164,000 to 152,000, driven by the government relaxing immigration rules to enable more recruitment from abroad.

However, while most respondents to the Pulse Check reported an increase in international recruitment (57%) in the previous 12 months, this was not true for domestic recruitment. For this, 43% of providers saw an increase in activity, but almost as many (36%) saw a reduction.

The study also found international recruitment was not viable for some organisations, with a quarter saying it was “not applicable” to them. It also warned that the government’s impending ban on allowing overseas care workers to bring family members over when taking up jobs in the UK would make the recruitment situation worse for providers.

Recommendations

On the back of the research, Hft and Care England called on the government to make international recruitment more accessible by measures including reducing visa fees and providing more support to guide providers through the process.

Other recommendations from the report included introducing national standards for commissioning – backed by statutory guidance – to reduce costs and complexity for providers and improve consistency, including in how councils allocated the funding they received.

They also called for changes to VAT rules to reduce providers’ tax liabilities.

Extra funding ‘not cutting through’

“For years, adult social care providers have absorbed increased costs and inflationary pressures without corresponding funding,” said Care England chief executive Martin Green.

“When money is made available it simply isn’t cutting through. Recent changes to immigration rules and an insufficient local government finance settlement this year further suggest a government that is heading in the wrong direction.”

The Association of Directors of Adult Social Services (ADASS), which welcomed the Pulse Check’s “practical recommendations to ease pressure on the sector”, issued a similar message on funding.

Investment ‘not keeping pace with need’

“The government has invested more, but it’s not keeping pace with increased levels and complexity of need, inflationary pressures including wages, and broader pressures on local government budgets,” said ADASS joint chief executive Anna Hemmings.

“We welcomed the increase in the living wage announced last autumn, but with no new money to pay care workers that increase, there can only be one result: fewer jobs and cuts in care.”

In response to the report, a Department of Health and Social Care spokesperson said: “To address the issues facing the care sector, we’re investing up to £8.1bn* to put the adult social care system on a stronger footing, enabling local authorities to buy more care packages, help people leave hospital on time, and reduce waiting times.”

Breakdown of extra government cash

Not all of the £8.1bn, allocated for 2023-25, will be spent on adult social care, with some destined for children’s services and another chunk dependent on council tax increases. It consists of:

• £3.2bn extra through the existing social care grant, with 60% expected to be spent on adults’ services and 40% on children’s services.
• £1.6bn to tackle delayed discharges, with the funding split between councils and NHS integrated care boards.
• £1.6bn through increasing the adult social care council tax precept by 2% and raising standard council tax by 3% in each year.
• £1.08bn through the market sustainability and improvement fund, designed to help councils increase provider fees, tackle waiting lists and boost recruitment and retention.
• £570m through a separate market sustainability and improvement fund – workforce fund, which has the same objectives but is particularly focused on tackling staff shortages.

New career pathway

With the Pulse Check having identified poor perceptions of social care as a career as providers’ second biggest recruitment and retention challenge, behind pay, the DHSC spokesperson also cited its announcement last week of funding for a new qualification, alongside the establishment of a career pathway, for care staff.

“Last week, we also announced a major boost to the care workforce through the creation of a new accredited qualification meaning for the first time, there will be a national care career structure, giving the profession the recognition it deserves,” they said.

However, sector bodies have warned that the pathway would not succeed without extra investment to enable providers to reward progression with additional pay.