Over winter, it has been widely reported that the NHS was in crisis, with pressure from winter flu, long delays accessing Accident and Emergency, and staff striking over pay and conditions. Nationally there are shortages of GPs and district nurses. And the social care system, where people are supported at home or in the community, is also buckling.
Last year an exclusive investigation by the East Anglia Bylines Spotlight team found that over 400 care agencies that provide home care, close to one in three, either had not been inspected yet, or were described as Requires Improvement or Inadequate. We also highlighted the pressures on those providing ‘domiciliary care’ – care in the home.
The coming storm
The Levelling Up, Housing and Communities (LUHC) Committee was told in 2022 that competition for staff from the leisure and hospitality sector has led to a lack of recruitment, and NHS leaders called for a National Minimum Wage for Social Care to prevent an exodus.
The threat of a staff exodus dramatises the fact that there are already 165,000 staff vacancies in Adult Social Care. The BBC reported in May 2022 that over half a million people, both in the community and in hospital, were waiting to be assessed by Adult Social Care.
In July 2022, the Association of Directors of Adult Social Services (ADASS) reported that an average of six hundred people are added to the waiting list for care every day. In addition to chronic staffing shortages, it cites funding as a key issue.
“Contrary to claims,” said ADASS chief executive Cathie Williams at the time, “social care is not being fixed and we need decisive action and funding now to get us through the months ahead and to start to build the foundations of the reformed system that we all want to see.”
Austerity, funding and failings
At the same time as East Anglia Bylines was carrying out its research, the Government announced funding to address the issues in Social Care. The additional funds generated through the Council Tax Precept, the £200m to speed up hospital discharge by buying care home beds announced on 9 January, and the previously announced £500m Discharge fund, are all useful. However, estimates show that close to ten times those sums are needed to stabilise and improve Adult Social Care in England.
Equally, the proposal to free up 13000 beds will assist, but does not alter the fact that 25,000 beds have been lost from hospitals since 2010/11.
Yet despite the warnings from Parliamentary Committee, as well as data from the Care Quality Commission (CQC), the reality on the ground continues to be the same.
In Essex, two care homes were found to be Inadequate. When visiting the homes, Alexander House Private Nursing Home and Ravensmere Rest Home, both in Westcliff on Sea, the inspectors found that the standard of care had actually deteriorated. In Hertfordshire, a newly opened care home in Broxbourne was also found to be inadequate, while one in St Albans has even had to make the decision to close.
Staffing levels and training are a common theme throughout all of the inspections. There is pressure to recruit and then rush staff out, sometimes without adequate checks on the applicant’s background or skills. These actions put the wellbeing of vulnerable people at risk, as evident in the case of Impact Healthcare in Basildon, who were found to be Inadequate late last year.
The governments plan to buy care home spaces to reduce pressure on the NHS may seem relatively straightforward, but in response the Association of Directors of Adult Social Services (ADASS) did point out that there was a risk of “poor or possibly illegal” practice, if people are moved into care homes as a default, and not into their own home. They also pointed out that the funding has come “very late”.
The ADASS statement said:
“ADASS survey findings underline the need to focus equally on investment in home and community-based support, that is, the social care workforce and support for family carers, and not just in care homes. People are deteriorating in the community and falling into crisis because of lack of community support.”
Large announcements of funding are always a good way to grab headlines, but until those funds are allocated, and have an impact on those in hospital – whether staff or patients – then those announcements are just words.
Research by J. J. Jackson and Wendy Boother and the East Anglia Bylines Spotlight team