What has happened since the last MPS?
The Covid pandemic increased the pressure and stresses on all elements of the health and social care system. The Care Quality Commission (CQC) State of Care Report 2019/20 noted:
“As the pandemic gathered pace, health and care staff across all roles and services showed huge resilience in the face of unprecedented pressures and adapted quickly to work in different ways to keep people safe.
It took a substantial emotional toll on care staff, concerned as they were not only for the wellbeing of their patients and residents but also for their own families and loved ones, as they worked to understand the nature of the disease and protect people to the best of their ability.”
The emotional legacy of Covid has been the depletion of people prepared to work in the industry. The difficulties faced saw many leave the profession and recruitment and retention of staff has become a major concern ever since.
Workforce availability is increasingly the dominating factor for the provision of any care services and demography determines that this will continue to be the case. In Gloucestershire whilst the older population is growing rapidly the working age population growth rate is much slower. This means that demand is increasing but the number of potential staff available to meet it is not. Added to that the experience of Covid for staff working in health and care was extremely challenging and, in some instances, traumatic. The industry has lost staff who might have stayed in the profession for longer at a time.
There is a need to replace them and a restricted amount of people willing to step forward. The NIHR Policy research unit conducted six online surveys with health and social care workforce from 2020 to 2023 and found that, of the social care worker respondents 44.2% considered changing their occupation during the pandemic and
53.7% were “overwhelmed by increased pressures”. (Analysis: Health and Social Care Workforce Research Study).
During Covid financial pressures for the independent provider market increased:
• Care homes felt an economic impact as they lost residents and admissions stopped for a period causing a loss in earnings.
• Workforce pressures were felt across the system with rising staff sickness and the need for people to isolate challenging capacity. The cost of staffing increased rapidly fuelled by soaring agency costs and wage rises to match other sectors such as retail.
• The cost of providing personal protective equipment (PPE) before national funding and supply became available was an unexpected burden, particularly as supply issues saw prices escalate.
Since then, the cost of living has significantly increased, and providers reported the impact of this in response to the “Cost of Care” exercise undertaken in 2022. Locally the cost of care identified by bed-based care providers was higher than the average price paid by the local authority, domiciliary care saw less difference In 2023 Home Farm Trust (HFT) and Care England (CE) reported that, nationally, on average, providers saw energy costs rise by 72% but some saw increases of up to 350%. (Hft Sector Pulse Check 2023 - Digital Singles).
Local Authorities and the NHS are equally impacted by the cost of living increases and despite Government investment, such as the Market Sustainability and Improvement Fund (MSIF) demand for services continues to grow more rapidly than budgets meaning the overall impact of these funds on wages for instance are minimal. HFT and CE report that, nationally, 84% of adult social care providers said that government funding initiatives implemented over the past year have had no impact upon their financial sustainability.
The impact of the increased cost of living is also felt by citizens. We know that the conditions in which we are born, grow, live, work and age can impact our health and wellbeing. These “wider determinants of health” mean that people living in deprived areas are more susceptible to ill health and more likely to use social care services than those in wealthier circumstances. It is likely that the rise in the cost of living will have increased demand.
The biggest expenditure, and therefore the biggest economic concern, for providers continues to be the workforce. In Gloucestershire the provider representative organisation has highlighted this and the HFT and CE report indicates that 81% of providers flag workforce as the most significant pressure.
The cost of care exercise undertaken in 2022 revealed that in Gloucestershire care homes there are a large proportion of people funding their own care. People who fund their own care only do so until their capital drops below the threshold over which they are fully chargeable. After this point providers turn to the local authority to pick up the cost at the but with an increase in the older population putting maximum strain on council budgets councils are unlikely to pay anything above their usual rates. If social care reforms are implemented, and the threshold for local authority funded care is lowered, less people will be self-funding in the first instance and those providers whose business models rely on higher private fees will feel a significant impact.
Engagement with providers for the MPS reflected many of the same concerns and issues identified by commissioners and other system partners, namely:
1. Workforce
2. Cross-sector collaboration and engagement
3. Training
4. Increasing complexities
5. Mental health service users
6. Funding and rates
7. Diversification of roles and services
8. Estate and housing
9. Telecare/Digital
10. Out of county placements
Engagement responses on these topics are woven into the “addressing our system challenges” section where appropriate but are also described in an additional section titled “what we heard from Gloucestershire’s adult social care providers” for ease of reference.
Last reviewed: