By Deborah Rozansky, Social Care Institute for Excellence (SCIE)

Reablement services play a critical role in maintaining people’s independence and quality of life. Most frequently used to support people’s recovery after a hospital stay, reablement can also be preventive, reducing the need for hospital admissions or long-term residential care.

However, our research has shown that reablement is misunderstood, potentially preventing people from fully benefiting from it. Inconsistent staff training, varying levels of family support and limited access to appropriate services and equipment also play a role.

Last year, we published evidence-based and practical recommendations for reablement commissioners and providers, developed by researchers from the University of York, to tackle these barriers and ensure more people receive the high-quality support they need and deserve.

Boosting staff training and morale

A significant barrier the researchers identified relates to the training of reablement staff, who include assessors, support workers and, in some cases, occupational therapists or physiotherapists.

Reablement is not just about assisting with daily tasks, but also involves understanding what motivates each individual and tailoring support accordingly, to achieve the person’s goals.

To do this well, staff need comprehensive training in the core principles of reablement – specifically promoting independence, motivational interviewing and working within multi-disciplinary teams.

Proper investment is needed for staff training to achieve the culture of care that supports reablement. Regular check-ins and open communication channels that help staff problem-solve, share best practice and build confidence are also important.

Another significant barrier to success is low staff morale. While some sources of low morale are beyond the control of managers, there are steps services can take. These include involving staff in review processes, acknowledging their expertise in supervision meetings and keeping them updated on service performance, thereby helping them feel supported and valued, which in turn can lead to better outcomes for those receiving care.

Setting goals

When staff fail to involve individuals in setting their own goals, or when goals are unrealistic or too vague, their engagement with the reablement process suffers.

A two-step approach to assessment and personal goal-setting can help individuals feel more engaged in the process.

The initial assessment should introduce broad goals that align with the core principles of reablement, such as improving mobility or rebuilding confidence in daily tasks. A follow-up assessment should then refine these into more focused, personalised objectives that reflect the individual’s specific needs and priorities – being able to make a cup of tea or climb the stairs, for example.

Progress should be documented clearly – ideally being displayed in the home where individuals and their families can see it – and reviews should be structured around it to ensure goals remain meaningful and individuals stay motivated.

Engaging families

Lack of family support is another significant barrier. Family members may not always fully understand their role in the reablement process or may be reluctant to support it due to safety concerns around increasing independence.

First and foremost, staff should have open conversations with families to address any concerns, clarify relatives’ roles and ensure they feel confident in supporting the reablement process.

Involving them directly – encouraging them to celebrate progress and reinforce goals, for example – can make a real difference, where it is appropriate to do so.

If safety is a key concern, staff can also provide reassurance by signposting family members to fall alarms and other digital tools that offer extra security and peace of mind.

The right equipment

Sometimes, the smallest adjustments make the biggest impact. Something as simple as adapted cutlery can produce immediate results, boosting motivation.

Conversely, lack of access to appropriate equipment can hinder progress and therefore knock an individual’s confidence, discouraging engagement in the reablement process.

Occupational therapists (OTs) are often responsible for assessing and recommending equipment that supports a person’s independence. However, the availability of OT support can vary.

Given this, reablement services must equip non-OT qualified staff – who often have limited knowledge of the options available – with the information they need, to empower them to identify and provide the right equipment in a timely manner.

Resources such as the NHS’s ‘Care services, equipment and care homes’ and Scope’s ‘How to get disability equipment and assistive technology’ can be invaluable. Services could also consider providing staff with a small budget to purchase non-prescribed equipment.

Promoting companionship and connections

For many people, visits from reablement staff aren’t just about practical support – they also provide much-needed companionship.

With reablement services often limited to six weeks, the prospect of losing support can sometimes lead to individuals disengaging from the process.

To prevent this, reablement services should assess individuals’ community networks early on and ensure they have opportunities to reconnect with activities and relationships that enhance their wellbeing.

Involving family members, friends and community contacts can also be invaluable in ensuring loss of companionship doesn’t impact motivation and engagement.

An increasingly vital service

As our population continues to age and care needs become more complex, the role of reablement services in supporting individuals to restore their independence, maintain their wellbeing and enhance their quality of life will becomes increasingly vital.

It’s essential, therefore, that we continuously refine reablement practices and seek opportunities to improve outcomes at every stage.

The work already done by practitioners, researchers and organisations like SCIE provides a strong foundation; now, we must focus on translating this knowledge into practical, everyday actions.

Deborah Rozansky is director of policy, research and information at SCIE

Providers say they will have to cut jobs and reduce the amount of care they deliver because of the increased costs imposed by the Budget, a survey has found.

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, reported the Care Provider Alliance (CPA).

The CPA – an umbrella body for organisations representing providers – surveyed 1,180 organisations about the impact of the increases to the national living wage (NLW) and employers’ national insurance contributions (NICs) announced in last month’s Budget.

Tax and wage increases

From next April, employers will have to pay NICs at 15% – up from 13.8% – on staff earnings above £5,000 a year, down from £9,100, while the NLW will rise from £11.44 to £12.21.

Think-tank the Nuffield Trust has calculated that the two measures will cost England’s almost 18,000 independent care providers an additional £2.8bn in 2025-26, about £2bn of which would need to be found by councils.

This dwarfs the £600m in additional grant authorities have been promised for social care in 2025-26, which is expected to be available for both children’s and adults’ services.

Providers predict cuts to care and jobs

The CPA found that, without further government assistance:

• 73% would have to refuse new care packages from local authorities or the NHS.
• 57% would hand back existing contracts to local authorities or the NHS.
• 77% would have to draw on reserves.
• 64% would have to make staff redundant.
• 76% of providers would have to cut training and resources for staff.
• 86% would not be able to maintain wage differentials between staff.
• 22% indicated they would have to close their businesses entirely.

Among the 479 home care respondents, 42.9% planned to shorten care visits.

Most (77.6%) of the 628 care home providers who responded said they were planning to reduce or stop planned maintenance, while 79.7% said they would have to halt capital investment.

‘People’s lives will deteriorate’

“Without adequate support, we now know for certain that services will close, care providers will stop delivering public services, and care workers will lose their jobs,” said CPA chair Vic Rayner, who is also the chief executive of the National Care Forum.

“Critically, a huge number of people who rely on care and support will go without or see their lives deteriorate.”

Sixty per cent of community social care services in England have no or an ‘outdated’ performance rating, an analysis of Care Quality Commission (CQC) data has found.

Almost a quarter of home care, extra care, shared lives or supported living services (23%) had never been rated by the CQC as of June 2024, despite more than half of these having been registered with the regulator for more than 18 months at that point.

A further 37% of services had ratings that were four to eight years old, found the analysis by the Homecare Association, the representative body for domiciliary providers.

The association also found that 49.5% of residential services had a rating that was four to eight years old, though only 3.6% of these were unrated. It is possible that some of the findings are due to providers re-registering an existing service as a new location, making them appear as having not been inspected despite having received a relatively recent visit from the CQC.

However, the Homecare Association said its findings showed that the CQC was not inspecting enough services to ensure the quality and safety of social care.

CQC found ‘not fit for purpose’

The study echoes the damning findings of the interim report of a government-commissioned review of the regulator, published in July.

Dr Penny Dash found that an estimated one in five of the services CQC had the power to inspect had never received a rating and the average age of ratings was 3.7 years, while also criticising a lack of specialist inspection regime and the effectiveness of the regulator’s IT systems.

Her findings led health and social care secretary Wes Streeting to conclude that the regulator was “not fit for purpose”.

The Homecare Association’s analysis provides more detail than Dash’s interim report on the lack of inspections of social care services and the reasons behind this.

Huge increase in number of services

The association found there had been a 5.5-fold increase in the number of regulated community social care services from 2013 to 2024, from 2,303 to to 12,574.

However, over the same period, annual CQC expenditure only rose by a third, from £175m to £231.2m. As a result, its expenditure per registered location fell from about £7,700 in 2013-2014 to £4,400 in 2023-2024, while its number of staff per service dropped from 0.10 to 0.06.

The CQC operates a risk-based model of regulation, in which inspections are focused on those where there are greatest concerns about safety and quality.

The association found the regulator was identifying a greater number of under-performing providers, with the proportion of community social care providers rated requires improvement (the second lowest of the four ratings) increasing from 0.5% in 2017 to 26.3% in 2024.

However, it added: “A risk-based approach to regulation is fine, provided there is enough resource to reassess all providers. As the data show, 60% of all community care providers have no recent rating or no rating at all. Market intelligence suggests there are still too many poor quality providers operating undetected.”

Councils criticised for proliferation of services

But while the report was heavily critical of the regulator, the Homecare Association also took aim at councils for promoting a proliferation of home care services in their areas, making it harder for the CQC to effectively regulate the market.

It said authorities were spreading the home care hours they commissioned among multiple providers, with some contracting with about 200 organisations.

“By their own admission, they do not have the resources to monitor the quality of 200 providers in one local authority area. Neither does CQC. Spreading the hours across so many providers makes efficient deployment of the workforce difficult. It also makes it difficult for providers to be
financially efficient and sustainable since they cannot benefit from economies of scale.”

Among its recommendations, the association called on the government to commission “a realistic review of CQC’s resourcing needs” and to address the impact of local authority commissioning practices on care quality and market stability.

CQC ‘committed to increasing inspection numbers’

The study comes ahead of the final report from Dash’s review, due this autumn.

In a statement, the CQC’s interim chief executive, Kate Terroni, said: “We accept in full the findings and recommendations in the Penny Dash interim review, which identifies clear areas where improvement is urgently needed.

“Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong. We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.

“We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement. Alongside this we are working to improve how we’re using our new regulatory approach.

“We’re increasing the number of people working in registration and working to improve on current IT systems with involvement from providers and colleagues, so we can improve waiting times and deliver better outcomes for everyone.”

There is a £1bn shortfall in home care fees paid and the amount required by providers in England to pay staff the statutory minimum wage, meet other costs and make a “small” profit.

That was among the findings of the Homecare Association’s latest report on how the fees paid by commissioners across the UK measured up against its assessment of the minimum price for home care for 2024-25. The study was based on contract data supplied by the association’s members.

On average, councils and health and social care trusts in Northern Ireland paid providers £23.26 per hour for care in their regular contracts for services, up 7.5% on the year before.

However, in all parts of the UK, average fees were well short of the association’s calculation of the minimum price, which just 1% of contracts complied with.

The association’s price is based on providers paying staff the relevant minimum wage for the country, including for travel time, meeting other worker and business costs, such as mileage, management and administration, and turning a 5% profit or surplus.

Fee rises lagging behind national living wage increase

In England, employers are required to pay staff aged 21 and over the national living wage (NLW), which rose by 9.8%, from £10.42 to £11.44 an hour, in April this year.

With many home care workers in England earning just above the NLW and direct staff costs making up about 70% of the overall price of home care, this was reflected in a 9.9% rise in the minimum price for the country, from £25.95 to £28.53 per hour.

However, the Homecare Association found that average council fees had only risen by 7.4% over the past year.

£1bn shortfall

When contracts with the NHS were also taken into account, the association identified a £1.08bn shortfall in the amount commissioners paid providers and the funding required to deliver the minimum price.

“It’s shocking that 99% of contracts fail to meet even the minimum price required for sustainable, quality care,” said the association’s chief executive, Jane Towson.

“Without urgent government action to increase funding and mandate fair fee rates, we risk destabilising the home care sector, compromising care quality, and exacerbating the already critical workforce shortage.”

Labour’s plan for fair pay agreement

The findings come with the new Labour government committed to legislating to create a fair pay agreement for care staff in England, in order to raise pay, terms and conditions.

However, it is yet to allocate any resource to this, despite such an agreement requiring significant increases in commissioners’ payments to providers.

The Homecare Association also reiterated its longstanding position that commissioning practices needed to shift from being based around time and task to being founded on outcomes for the person receiving care. It also said councils needed to manage their provider market to ensure there wasn’t too few or too many providers.

Many thousands of care workers in England will get a 10% pay rise next April after the government decided to increase its national living wage (NLW) from £10.42 to £11.44 an hour.

The NLW will also be applied to staff aged 21 and 22, raising their wage floor from the national minimum wage (NMW), which is currently worth £10.18 an hour.

As of March 2023, about 140,000 care workers in the independent sector in England (17% of the total) earned the then NLW of £9.50, according to Skills for Care’s latest report on the workforce.

10% pay boost for thousands of staff

This suggests a similar number of care staff will receive the full 10% increase next April, which is well above the current annual inflation rate of 4.6% and will be worth £1,800 a year in cash terms for full-time workers.

Many more care staff, earning between £10.42 and £11.43 will also receive a significant pay rise on the back of next year’s NLW increase.

Skills for Care’s data showed that about 400,000 care workers in England (47% of the total) earned between £9.50 and £10.41 as of March 2023, meaning they would have received a pay rise when the NLW rose to £10.42 earlier this year.

Two years of real-terms pay cuts for care staff

The prospect of an inflation-busting pay rise will be welcome for care staff after two years of real-terms wage cuts.

Average real pay fell from £10.66 to £10.08 an hour for care home staff, and from £11.11 to £10.50 an hour for domiciliary care staff in the two years to March 2023, according to Skills for Care’s data.

The erosion of care worker pay has exacerbated workforce instability, with adult social care vacancies rising by 52% in 2021-22 before falling slightly in 2022-23, on the back of increased overseas recruitment.

However, there are significant questions about whether councils and NHS commissioners will be able to fund providers sufficiently to meet the new NLW, alongside meeting their other employment and operating costs.

Provider body Care England’s chief executive, Martin Green said: “While the rise in national living wage has an undeniably positive impact on those working within adult social care, due consideration must be lent to care providers who will need to grapple with increased workforce costs again, against a backdrop of local authority funding struggling to keep pace.”

£900m deficit in provider fees estimated

In a report last week, the Homecare Association estimated there was a gap of £893.4m between the amount English commissioners paid domiciliary care providers and the fees required to pay staff the current NLW of £10.42.

The finding was based on comparing data from 99% of councils and 52% of NHS integrated care boards (ICBs) against the association’s the minimum price for home care, which was £25.95 an hour in England in 2023-24.

This is based on providers paying the NLW, meeting other statutory employment obligations, funding workers’ travel time and mileage costs, financing operating costs and making a 4% profit.

The association found that just 5% of commissioners in England paid the minimum price, with commissioners paying an average of £21.59 an hour, weighted for the different volumes of care purchased by different bodies.

Commissioning practices criticised

The association also raised concerns about the ongoing practice of commissioners purchasing care by the minute, which it said risked people’s visits being cut short, and staff not being paid for their travel time.

Regulations require that staff pay rates cannot be pushed below the NLW or NMW, as appropriate, once travel time is taken into account.

While being critical of commissioners, the association said the root cause of the issues was inadequate government funding.

“Inadequate central government funding for home care has led to poor practices in the commissioning and purchasing by public organisations,” the report concluded. “In turn, this has led to poor pay and terms and conditions for the workforce, which is a root cause of insufficient workforce capacity to meet need.”

DHSC defends record on funding

In response, the Department of Health and Social Care defended its record on funding social care, citing the up to £8.1bn it had made available to authorities from 2023-25 to meet current pressures, though not all of it is for adults’ services. The funding comprises

• £3.2bn extra through the existing social care grant, though this is for both adults’ and children’s services, with an expected 40% due to be spent on the latter.
• £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.

“We are grateful for all the work that homecare providers and their staff do, as part of our wider social care sector,” said a DHSC spokesperson.

“The market sustainability and improvement fund (MSIF) and the MSIF workforce fund – backed by nearly £2 billion – include a focus on workforce pay and will allow local authorities to make improvements to adult social care services.

Extra resource welcome but insufficient – ADASS

However, the Association of Directors of Adult Social Services said the extra resource, while welcome, was insufficient.

Joint chief executive Cathie Williams said: “Extra funding from the government this year to help recruit and retain social care staff has been welcome, but as a result of high levels of inflation and increasing need, this report shows it’s not enough to solve the fundamental problem that we don’t have the resources in adult social care to provide competitive pay and conditions to the 1.5 million people working in care in England, supporting older and disabled people stay independent and do things that matter to them.

“And that means it’s difficult to recruit and retain staff, with 152,000 job vacancies in care, over half a million hours of homecare were not able to be delivered to older and disabled people last year due to not having enough staff.”

Higher pay in Scotland, Wales and Northern Ireland

Care workers in Scotland, Wales and Northern Ireland in publicly commissioned services are currently paid a minimum of £10.90 an hour, in line with what was, until recently, the UK real living wage (RLW).

This is set by campaign group the Living Wage Foundation, is voluntary and is based on the cost of living.

Last month, the foundation increased the UK RLW to £12 an hour.

The Scottish Government has pledged that care staff in commissioned services in will receive at least this wage from next April, with Wales and Northern Ireland likely to follow suit.

Most home care providers have seen a fall in the number of hours of care councils have commissioned from them, research has found.

Half of agencies (48%) reported a fall of 25% in the number of hours of care available to them to deliver, with a further 32% reporting decreases of less than this, found the Homecare Association.

The sector umbrella body surveyed members in July and August 2023, receiving responses from 225 agencies which, between them, provided care to almost 43,000 people and had 23,282 care workers on their books.

Loss of care staff

Agencies said the drop in the number of commissioned hours was leading to them losing valued staff because they could not give them the number of hours’ work that they needed.

Others raised concerns about their future viability, including some who had recruited from abroad in the anticipation of having increased work that they could not now provide to overseas staff.

Providers gave mixed responses as to what was driving the trend.

A third of those who responded to this question said it was down to councils commissioning less care due to squeezed budgets, while one-fifth cited delays in councils carrying out care assessments.

Increased provider competition

However, 41% said it was down to councils opening up their commissioning portals to more providers, while 27% attributed the trend to there being a rising number of providers in the local market.

Others referred to factors including councils providing more care in-house or assigning packages to the cheapest bidder, including at rates below the cost of care.

The findings come with the government urging councils to boost home care capacity in their areas to deal with what are anticipated to be severe pressures on the health and social care systems this winter.

The Homecare Association said agencies appeared to be doing better in areas where councils commissioned a limited number of lead providers to deliver care in specific localities.

Late payments

The survey also found eight in ten providers had experienced late payments from council or NHS commissioners, with a third saying that most of their local authority payments were late and almost half (47%) saying the same about most of those from the health service.

Public bodies are expected to pay invoices within 30 days. However, 57% of providers said their average payment time from councils was more than this, while 65% said this was the case for NHS commissioners.

The Homecare Association’s chief executive, Jane Townson, said that late payments were a “serious issue, threatening the financial viability of many home care providers”.

“Some are having to spend months fighting for thousands of pounds owed for care delivered, being pushed from pillar to post without resolution,” she added.

Home care ‘highly sensitive to volumes of care’

Townson warned that home care businesses were “highly sensitive to the volume of hours delivered”, both because of the costs of overheads, such as employing a registered manager, training and office rent, but also because of the impacts on care workers’ salaries.

“When the number of hours delivered are spread across a greater number of providers, it can mean that individual care workers are more likely to have gaps in their rotas reducing the amount of pay they receive each day,” said the association’s chief executive, Jane Townson. “This risks even more home care workers choosing to leave the sector.”

She added that, “without proper change we will not be able to meet the growing demand for care, take pressure off the NHS and reduce costs for the health and social care system.”

Need for ‘long-term plan for social care’

The Association of Directors of Adult Social Services (ADASS) attributed the findings to the lack of “a long-term sustainable funding plan for adult social care”, which had “hampered [councils’] ability to plan over the long-term, improve quality of care and deliver the care we want and need”.

“The impact is clear, with 66% of directors reporting providers closing or handing back contracts last year,” said ADASS’s joint chief executive, Sheila Norris.

“To create the right conditions to improve care and support in England, we need a long-term and fully-funded plan with long-term increases in funding.

“This investment and support will not only benefit those of us needing care, it will also reduce the number of hospital stays and residential care admissions, help grow our economy and boost jobs.”

Social Work Recap is a weekly series where we present key news, events, conversations, tweets and campaigns around social work from the preceding week.

From a ruling over who’s responsible for unaccompanied migrant children living in hotels to the exploitation of overseas staff recruited to work for a social care provider, here’s what you might have missed this week in social work:

Councils responsible for unaccompanied children, judge rules

Photo posed by model (Jan H Andersen/Adobe Stock)

Local authorities are responsible for unaccompanied asylum-seeking children in hotels run by the Home Office, a family court judge has ruled (source: CYPNow).

In a ruling, published last week, Mrs Justice Lieven stated that young people who arrived in the UK without a parent or carer and were housed in hotels were entitled to protection under the Children Act 1989 on the same basis as other children.

This was on the back of children’s rights charity Article 39 issuing a wardship application for 76 children who had been reported missing from a Home Office-run hotel in Brighton and Hove earlier this year.

The charity had warned that it was not clear whether the children were the responsibility of the Home Office or relevant local authority, risking them going without statutory support. If successful, the wardship application would have brought them under the protection of the court, but the judge ruled that there was no gap in the law.

“This judgment has brought vital clarity to a wholly unacceptable situation where extremely vulnerable children have been treated as being in ‘legal limbo’, outside the protection of the Children Act 1989,” said Carolyne Willow, director of Article 39.

“The Home Office has no power to house children outside the care system, and government should be properly funding and supporting local authorities to meet their comprehensive duties.”

In response to the ruling, a Department for Education spokesperson said: “The wellbeing of children and minors in our care is an absolute priority. Robust safeguarding and welfare measures are in place at all temporary hotels to ensure children are safe, secure and supported as we urgently seek placements with a local authority.”

Migrant staff at care provider left in debt – investigation

Photo by AdobeStock/Proxima Studio

Migrant nurses hired by one of England’s biggest children’s care chains have been left without income for months and stuck in debt, an investigation by The Observer has found.

The nurses, hired through agencies to help fill 400 vacancies at Cambian children’s services, were paid lower wages than initially agreed and, in some cases, were also given ‘false promises’ about accommodation and employment terms, reported the paper.

The group consisted mostly of women from India, who had spent as much as £18,000 on relocation costs, training charges and other fees.

Despite being promised financial support from their 11th day in the UK, they were told, on arrival, that they would only be paid after shifts started. However, some were left waiting up to four months to start working, with their visa preventing them from finding another job.

One nurse, hired from India, said she had been waiting for three months without pay and paying 20 times as much for rent as she had back in India.

“Our family is dependent on us. We came here to work for them,” she said, adding that the nurses were now asking for help from those same relatives to “eat and pay the bills”.

Cambian has denied suggestions that it was in any way responsible for “shortcomings” in the recruitment process, including fee arrangements between agencies and workers. The company added that agency partners were responsible for accommodation, arranging English lessons and for setting expectations of what working in the UK would be like.

It added that it had gone beyond its contractual obligations to support recruits by offering interest-free loans and hiring a transition officer.

Share your experience of social work

Photo by AdobeStock/chrupka

Social Work England is looking for practitioners or people with lived experience of social work to join its national advisory forum.

The forum’s role is to act as a “critical friend” to the regulator, with its members providing feedback on Social Work England’s work from the perspective of practitioners and those who had been involved with social work services.

“The National Advisory Forum makes sure that Social Work England takes the views of real experience of social work into account,” said Sally Parker, member of the forum since 2020.

“We have co-produced over 50 pieces of work this year and we been involved at all stages from planning to implementation and then evaluation. The group is dynamic, and we bring together diverse knowledge and perspectives, whilst maintaining a culture that is open and supportive.”

The deadline to sign up is 29 June, and anyone who has had social workers in their lives, social workers and social work educators can apply.

Majority of home care staff not paid for travel, finds survey

Photo: dglimages/Adobe Stock

Three-quarters of home care staff in England are not being paid for the time they spend travelling between visits, a survey has found.

The results, published by UNISON this week, showed that 18% of the 310 staff surveyed reported been provided with pay slips accurately detailing their time spent travelling and what they had been paid for this.

According to data from the Homecare Association, home care workers spend one-fifth of their working day (19%) travelling between appointments.

One worker who responded to the survey said they had completed a 12-hour day, including travelling, but had only been paid for nine hours.

“I’m only paid for the time spent in someone’s home,” said Sandra, who works in Yorkshire. “I’m out working eight hours minimum but get paid for six This dramatically reduces my hourly wage. I’ve thought long and hard about going into a different sector to get a fairer wage,”

For UNISON general secretary Christina McAnea, this was a matter affecting both care workers and those they looked after.

“Vulnerable people suffer when their already rationed care visits are cut short or delayed,” she added.

“These appalling working practices must be tackled urgently if more people are to be encouraged to work in a sector desperately short of staff.”

Tweet of the week: social work and AI

“While social work and AI may appear an impossible alliance, the impact they can have on services when combined is profound”

Fantastic presentation from @BarmanAdhikari on how we can harness the potential of AI to transform social services for the better #ESSC2023 pic.twitter.com/aGPJlHytA5

— Calum Campbell (@sw_calum) June 16, 2023

Fears about artificial intelligence’s impact on humanity have been rife recently, but could it potentially have a positive impact on social work? That was the suggestion from a presentation this week from US-based social work academic Anamika Barman Adhikari, at the European Social Services Conference.

For more information, check out this TED Talk she did on how social workers can use AI to assess risks to homeless young people and thereby improve support for them.

For a sceptical take on the technology, check out this piece for Professional Social Work magazine from UK academic Christian Kerr.

Do you want to share your views and reflections on social work with fellow practitioners by writing for us? Check out our guidelines page for information on how to share your ideas.

The social care workforce has been boosted by 58,000 overseas staff over the past year, revealed government immigration figures published today.

But while care homes have made a dent in record vacancy levels experienced in 2022, staffing gaps have remained stubbornly high in domiciliary care, according to separate data issued by Skills for Care.

The rise in overseas staff joining the workforce came on the back of the government’s decision to add ‘care workers’ and ‘home carers’ to its shortage occupation list for skilled workers in February 2022, enabling providers to directly recruit from abroad to these roles for the first time.

Immigration figures

This resulted in a rise from 113 to 40,416 in the number of these staff issued with health and care visas from 2021-22 to 2022-23. Over the same period, the number of senior care workers recruited in the same way rose from 6,763 to 17,250, meaning 50,790 more staff joined the workforce through the health and care visa in 2022-23 than 2021-22.

Social care staff accounted for 57% of health and care visas in 2022-23, up from 19% in 2021-22. Over half of health and care visas were granted to staff from India (29,726), Nigeria (17,596) or Zimbabwe (17,421), with all three nations seeing rapid growth in the number of their citizens moving to the UK to work in health and social care.

Photo: Zerbor/Adobe Stock

The rise in the overseas workforce follows a 52% rise in adult social care vacancies in 2021-22, attributed to factors including a loss of competitiveness in pay to retail and hospitality, a drop in the number of migrant staff from Europe due to Brexit and post-Covid burnout among the workforce.

Falling care home vacancies

Vacancies appear to have fallen – and employment increased – since then in the care home sector. Preliminary Skills for Care data showed that, from March 2022 to April 2023:

• There was a 3.8% rise in the number of filled care worker posts in residential and nursing homes from March 2022 to April 2023.
• The nursing home vacancy rate, for all roles, fell from 8.8% to 7.9%.
• The residential home vacancy rate dropped from 7.7% to 6.8%.

However, in domiciliary care, the vacancy rate for all roles fell only slightly over this time, from 13.2% to 13%, while the number of filled care worker posts fell by 1.2%.

Umbrella body the Homecare Association has cited the sharp rise in fuel costs during 2022 as among factors forcing staff to leave their roles.

The extent of the pressures on home care workforce were revealed in the results of Homecare Association research with providers carried out in January and February 2023.

This found that 66% of providers felt recruitment was harder, while 43% said that more care workers were leaving,  than six months previously.

Care England, which represents independent care providers, said the rise in the number of overseas staff could not address the chronic workforce pressures the sector faced, driven by low pay.

£15 minimum wage urged

“Whilst increases in net migration may help to fill vacancies within the sector, ultimately, the workforce crisis will never be truly addressed until the government provides the sector with the funding it needs to adequately reward the workforce with the pay and recognition they deserve,” said its chief executive, Martin Green.

Care England CEO Martin Green

As of last month, the national living wage (NLW) – the hourly pay floor for staff aged 23 and over – rose from £9.50 to £10.42, while the national minimum wage (NMW) for 21- and 22-year-olds increased from £9.18 to £10.18.

This will have boosted the pay of the many care workers who earn around the NLW or NMW.

However, Green added: “Care England has long called for a care wage that sits above the NLW and supports the Trade Union Congress’ call to implement a £15 minimum wage for individuals in care worker roles, fully funded by central government and ring-fenced for this purpose. This would not only improve the workforce crisis in adult social care, but give the English economy a much needed multi-billion pound boost.”

Councils underfunded home care and older people’s care home services in England by just under £2.9bn in 2021-22, according to an analysis by provider bodies.

The figure is based on an examination of cost of care exercises that councils carried out recently to determine sustainable fee rates for these services and identify how far they were from paying them.

The exercises used data supplied by providers concerning their costs, broken down into areas such as staffing, premises, services and supplies and appropriate levels of profit, as of 2021.

As reported last month, the Association of Directors of Adult Social Services warned that the exercises – which the Department of Health and Social Care (DHSC) required authorities to carry out – revealed a significant shortfall.

Shortfall of almost £3bn

Provider bodies have now attempted to quantified this and identified a £2.88bn shortfall in home care and older people’s care home services, said umbrella organisation the Care Provider Alliance (CPA) in an open letter to care minister Helen Whately.

CPA member Care England said its analysis of the figures for older people’s care homes revealed a shortfall of over £2bn in this sector alone, with council residential care fees £218 a week below the calculated fair cost on average, and nursing home fees short by £231 per week.

It identified particular concerns in certain regions, with residential fees needing to rise by 32%, and nursing fees by 25%, in the South East, while in the North East, councils would have to improve their residential rates by 18% and their nursing rates by 24% to meet the assessed fair cost.

However, both Care England and the CPA said the figures were underestimates because of the impact of inflation on care providers’ bottom lines in the past two years.

“These figures do not reflect subsequent increases in the minimum wage and skyrocketing rates of inflation and energy costs,” wrote CPA chair Nadra Ahmed in her letter to Whately. “Nor do the figures account for the urgent need for improved pay, terms and conditions of employment for care workers.”

Care market ‘in untenable position’

She pointed out that the exercise also excluded care home provision for younger adults, which also faced significant pressures.

“It [is] deeply disappointing, but not surprising, that the care market is showing an untenable operating position, which impacts on people that draw on services across our country, their relatives and carers,” she added.

The exercises were carried out as part of a DHSC policy to encourage councils to move towards paying providers a “fair cost of care”, which was originally due to be backed by £600m in funding in each of the next two years.

However, this has now been cut to £162m per year, the same as in 2022-23, with the rest of funding reallocated to help councils meet a broader range of pressures, including delayed discharges from hospital, waiting times for care assessments and packages and care worker shortages.

This was as part of a funding settlement ministers have said would provide councils with up to £2.8bn in 2023-24 and £4.7bn in 2024-25 for social care.

Councils have questioned these figures since some of the money is designed to be spent on children’s social care and another chunk is dependent on authorities raising the maximum permissible amount from council tax in each year, though a County Councils Network analysis published last month found most were planning to do so.

Funding ‘does not scratch the surface’

Care England chief executive Martin Green said the overall package would “not scratch the surface in tackling the inherent issue of local authorities underfunding care packages and the rising gap between fees paid and the cost of care caused by inflation”.

He said the situation led to the ongoing issue of self-funders cross-subsidising council-funded residents by paying higher fees, and depressed the wages of care staff in homes where local authority placements predominated.

“The core purpose of the fair cost of exercise, an initiative led by the government, was aimed at increasing the care fees paid by local authorities to ensure the care sector’s sustainability,” Green added. “This reality must now be realised.”

For ADASS, joint chief executive Cathie Williams agreed with Green and Ahmed that the funding gap was an underestimate because it was based on April 2021 figures and did not include the full range of social care services.

She added: “Now the government has a better understanding of provider care costs they should provide the long-term sustainable funding to deliver the ambition set out in the [2021] adult social care white paper for people to be able to access outstanding quality and tailored care and support.”

However, a DHSC spokesperson said: “We are making available up to £7.5bn in additional funding over two years to support adult social care and discharge which will help local authorities address waiting lists, low fee rates, and workforce pressures in the sector.

“This historic funding boost will mean local authorities can go beyond dealing with immediate pressures, to deliver long lasting tangible improvements to their adult social care services so people who draw on care can know they’re getting the best possible care for their needs.”

Sustainability plans due

The next stage of the fair cost process is for councils to publish market sustainability plans by 27 March 2023. These should set out:

• Councils’ assessments of the sustainability of their home care and older people’s care home markets, covering the sufficiency, diversity and quality of provision, the adequacy of average fee rates and the state of the workforce.
• Their evaluation of the expected impact of market changes over the next three years, including the expected introduction, in October 2025, of the right of self-funders to request their council arranges their care home placement, enabling them to take advantage of local authority fee rates.
• Their plans to address the sustainability issues identified.

The minimum price commissioners should pay home care providers will rise by 11.8% next year due to increases in the national living wage and the impact of inflation on services’ costs.

That was the message from the Homecare Association as it announced that the minimum for 2023-24 would be £25.95, up from £23.20 currently.

The umbrella body’s annual calculation is based on the cost of complying with minimum wage legislation, while also paying for care workers’ travel time, mileage costs, other wage-related costs and providers’ operating costs and allowing for a 4% profit.

The association said next year’s rise was driven by a 9.7% rise in the national living wage – the pay floor for those aged 23 and over – and inflation in providers’ operating costs, including “sky-high fuel prices and rising rent, rates and utilities”. The living wage is due to rise from £9.50 to £10.42 per hour.

Councils paying ‘far below true cost of care’

However, the association warned that “too many” councils and NHS commissioners were procuring services at rates “far below the true cost of delivering care”.

Chief executive Jane Townson said: “Persistently underestimating providers’ costs risks diminishing the availability of services, the experience of the workforce, and providers’ ability to comply with the legal requirements placed on them.”

She said low fee rates were led directly to staff receiving “poor pay and terms and conditions of employment” and shortages of workers, as evidenced by the 13% vacancy rate in the sector as of March 2022, above the social care average of 11.7%. Vacancies across adult social care rose by more than half (52%) in the year to March 2022.

At the same time, 94% of directors reported that they did not have sufficient care staff in their areas to deliver services this winter, in response to an Association of Directors of Adult Social Services survey carried out in October and November.

Pay care staff ‘much more than national living wage’ 

In response to the Homecare Association’s minimum price, ADASS chief executive Cathie Williams and its president, Sarah McClinton, said: “This report by the Homecare Association should be a powerful reminder of the human impact that poorly paid social care has on both workers and those drawing on support.

“Care work is highly skilled and all care workers should be paid more than the national living wage. If this were to be the case, we could make some inroads in maintaining the essential workforce needed so that older and disabled people can continue to access support and live life fully.”

However, they warned that the current situation left councils in “the invidious position of having to make decisions about paying providers more to retain staff at the same time as being very aware of the numbers of people waiting for or having insufficient care and support”.

While the government has provided councils and NHS leaders with £500m over the winter months to help speed up hospital discharges – including by funding home care – Williams and McClinton said it was not targeted at “the sustainable care and support that could prevent people from being hospitalised in the first place”.

Migration advisers ‘disappointed’ with government

Meanwhile, the government’s migration advisers have expressed their disappointment at the Department of Health and Social Care’s (DHSC) failure to respond to their call for a minimum rate of pay for adult social care, set at £1 above the national living wage (NLW).

The Migration Advisory Committee made this call in April in a report on adult social care post-Brexit, in which it said that low pay was behind the significant recruitment and retention problems the sector faced.

In its annual report, published this week, the MAC said: “We are very disappointed that the government has not responded to any of our recommendations in the 8 months since receiving the report it commissioned from us. The conditions now faced by the social care sector are unsustainable. Persistent underfunding by successive governments underlies almost all the workforce problems in the sector.

“Higher pay at a premium to the NLW, which the government is instrumental in setting, is a prerequisite to attracting and retaining workers.”

In response to the MAC report, a DHSC spokesperson said: “All care workers were added to the shortage occupation list in February 2022 [making it easier for employers to recruit from abroad], and Skills for Care estimate that, since February, up to 15,000 migrant workers have moved to the UK to take up care worker roles. On top of this, we are also investing £15m to further boost international recruitment opportunities.

“Most paid carers are employed by private sector providers who set their pay and conditions independently, but the government is raising the national living wage by 9.7% to £10.42 an hour for workers aged 23 and over from April 2023, and is working to reduce vacancies.

“The government is still carefully considering the recommendations made by the Migrant Advisory Committee in their review of adult social care and will respond in due course.”