In recent weeks there has been a great deal of coverage of the shortfalls in Adult Social Care in England. Here in East Anglia the East Anglia Bylines Spotlight team’s exclusive investigation found over 300 care homes across the East of England are below standard. A further 48 are still waiting for their first inspection.
The reality on the ground
Across the region our research showed out of over 1300 care home surveyed, 315 had either not yet been inspected, or were assessed as inadequate or requiring improvement. That’s just over one in five. The regulation of care homes is carried out by the Care Quality Commission (CQC). Their job is to inspect care facilities, including care homes and companies registered to provide home care. Following each inspection, they publish a report about the service and rate the performance on a four-point scale: Outstanding, Good, Requires Improvement or Inadequate.
Norfolk, including the constituency of the Prime Minister, has over 220 care homes. Of those 227 (33%) were rated either ‘Requires Improvement’ or ‘Inadequate’ by the CQC, or it was reported they were still awaiting inspection. Only 13 – less than 1 in 40 of Norfolk’s care homes – were rated ‘Outstanding’.
The Eastern Daily Press reported an example of a care home in the Inadequate category as Dorrington House in Watton, where amongst other issues, Inspectors found there were not enough staff to “keep people safe during the day and overnight”, and they were “unfamiliar with people’s needs”.
Bedfordshire, including Luton
In Bedfordshire, nearly one in three care homes were assessed as ‘Requires Improvement’ or ‘Inadequate’, or they had not yet been inspected.
An example is Agate House in Bedford, which was inspected in July 2022. It was assessed as Inadequate with a number of concerns, including high staff turnover. While the inspectors found “Some staff worked hard to achieve good quality care and good outcomes for people”, other observations nevertheless included: “People did not receive good quality care and support”.
Hertfordshire has over 250 care homes, of which just over one in five have been assessed as ‘Requires Improvement’ or ‘Inadequate’, or they have yet to be inspected.
Inspection scores can change quickly. Some improve and move to ‘Good’ or ‘Outstanding’ while standards fall in others. Such was the case for Crossbrook Care home in Cheshunt in Hertfordshire, which slipped from ‘Good’ to ‘Inadequate’. It was found that “the staff did not support people to have the maximum possible choice and control over their lives and be independent.” There were also concerns over fire safety.
Essex, including Thurrock and Southend on Sea
Essex, with over 400 homes, is the county with the largest number of care homes. However, as in Hertfordshire, just over one in five failed to achieve either ‘Outstanding’ or ‘Good’.
Brenalwood Care Home in Walton-on-the-Naze was rated ‘Inadequate’ earlier this year. In its report the CQC noted, amongst other failings, “Staff did not have the training, knowledge, or support in all areas to ensure people were well cared for.”
Suffolk, including the constituency of the Deputy Prime Minister / Health Secretary, has under 150 care homes. Of those, around a fifth were assessed as ‘Requires Improvement’ or ‘Inadequate’, or had yet to be inspected.
St Georges Care Home in Beccles was rated ‘Inadequate’ for a second time in August 2022. It previously had a reputation for providing a good quality of care, yet “The inspection found that there weren’t enough staff to meet people’s needs and risks to those living at the service weren’t always recognised or mitigated.”
Cambridgeshire performs better than all other East of England counties. It has the lowest number of care homes, with just over 100, of which just over 10% failed to achieve ‘Good’ or ‘Outstanding’. At the time the research was conducted, none of the care homes were deemed to be ‘Inadequate’.
The same cannot be said for Home Care providers which provide care services for clients in their own homes. One, Fen Homecare, was recently rated ‘Inadequate’ in its vetting of staff regarding their qualification and background. There were also concerns about possible food poisoning.
East Anglia Bylines has conducted research into the home-care area of Adult Social Care and will be reporting on this in the coming weeks.
Recently the new Health Minister, Thérèse Coffey, announced a plan to spend £500m to free up 13,000 beds in the NHS by addressing the problem of so-called “bed-blockers”. These are patients who are medically fit and could be cared for in their own homes or in the community, but due to a lack of staff or the need for specialist equipment they have to stay in hospital to receive the care they need.
To be clear, the £500m announced would be allocated to NHS trusts and local authorities, who would then allocate the funding based on local needs. This is in addition to the Social Care precept, which is an increase of up to 3% on Council Tax bills. The precept is set every year by the local authority and the percentage varies from one local authority to another.
The precept and the £500m is welcome, but the sum is insignificant next to the calculation by the Health Foundation in 2021 that over £7bn a year would be needed to stabilise and improve Adult Social Care in England. This also comes at a time when councils are still facing pressure to cut costs.
Staff need better pay
The Levelling Up, Housing and Communities (LUHC) Committee was told earlier this year that competition for staff from the leisure and hospitality industries has led to low levels of recruitment in the care sector. NHS leaders have called for a National Minimum Wage for Social Care to prevent a further exodus.
To place this in context, the current wage per hour for a barista, according to Indeed, is close to £10. But the most up-to-date data, for 2020/2021, shows the average hourly wage of an independent care worker is £9.01. This figure doesn’t include travel time between appointments, and often requires the care worker own a car. According to the Low Incomes Tax Reform Group: “It is not unlawful for care workers to have their travel time between appointments unpaid, so long as their total pay averages out at or above the appropriate minimum wage rate once travel time is factored in.”
The cost-of-living crisis has increased pressure on staff to seek better-paid roles with many leaving the industry, and it is becoming increasingly difficult to recruit qualified staff to replace them. This is not just down to low pay and tough working conditions, but also a record high in general job vacancies. Given the low pay and the post-Brexit exodus of EU workers who until recently made up 12% of those working in the Adult Care sector, it is unsurprising there are over 165,000 staff vacancies currently widely reported.
That in turn affects local authorities. Their financial reserves have been exhausted by austerity and Covid-19, and they have not always focused on the physical and mental wellbeing of the social work staff within their departments dealing with Adult Social Care. Wider concerns and crises persist, such as staff morale and recruitment.
A recent British Medical Association (BMA) report suggests our Adult Social Care system is ‘deeply flawed’ and in need of ‘urgent reform’. Unless the government prioritises significant investment in the care sector, the crisis is likely to deepen, putting lives at risk.