NHS leaders warn that social care workforce crisis risks patient safety

• More than 9 in 10 NHS leaders warn of a social care workforce crisis in their area which they expect will get worse this winter
• Nearly all NHS leaders say the lack of capacity in social care is putting the care and safety of patients at risk
• More than four in five warn that the absence of care packages for people to be able to return home or be moved into a care home is the main reason why medically fit patients are stuck in hospital longer than they should be
• Almost all NHS leaders say that the most impactful solution would be better pay for social care staff and want the Government to increase investment in social care as a priority

NHS leaders across England say staffing gaps and a lack of capacity in social care are putting the care and safety of patients in the NHS at risk.

Almost 250 NHS leaders responding to an NHS Confederation survey say that patients are being delayed in hospital much longer than they should, with the knock-on impact resulting in higher demand on A&E departments and longer ambulance response times.

NHS leaders stand in support of their social care colleagues and are urging the Government to increase investment in care services, including by boosting wages for care workers. They say failure to act will leave more and more vulnerable people without the care and support they need, as well as piling further pressure on front-line NHS services.

The stark results from the survey of NHS providers, primary care and integrated care system leaders paint a picture of a social care system struggling to cope with demand and a pressing need for a long-term pay and funding strategy for the sector.

Nine in ten leaders report that the pressure from the fall out of a lack of appropriate and timely social care pathways for people leaving hospital is having the biggest impact in A&E, with almost the same number (86%) saying this is having a huge knock-on effect on ambulance response times. Almost three quarters also say their efforts to bring down waiting lists are being hampered by a lack of social care capacity.

Of the near 250 NHS leaders who responded to the survey, almost all said that the one immediate single change the Government could make now to alleviate the pressure on the social care system would be to increase pay for social care staff.

NHS leaders recently calling on the Government to immediately implement a national care worker minimum wage of £10.50 an hour.

They warned that without an increase above the hourly wage seen across many other industries, including that paid to staff working in supermarkets and across retail, as well as the NHS itself, the social care sector in England will continue to haemorrhage staff.

An acute trust executive director in the South West accused the Government of presiding over a “national scandal.”

“If the social care capacity shortfall was solved then we would not be holding ambulances at all, we would have almost no problems with elective recovery and our emergency departments would not be crowded and unsafe,” they said.

Another acute trust chair in the East of England added: “The result of using nearly 20 per cent of our beds for patients who are medically fit but need packages of care to return home is an overcrowded A&E, twelve-hour trolley waits and much delayed ambulance handover times. The connection is very clear to us…Until we find a solution to social care staffing and funding, the situation can only get worse.”

One acute trust chief executive in the North West said: “In our place, we are experiencing real challenges in social care with retention of staff as lots of people are understandably moving on to lower pressure jobs where they can be paid a similar rate.”

Another ICS director in the Midlands added: “politicians arguing about scrapping the national insurance increase fail to remember that this was an attempt to set aside some further funding for social care in the future so whilst scoring political points, they're jeopardising any attempts to improve this situation in the foreseeable future.”

And the chair of a voluntary sector provider to the NHS in South West said: “People want to be at home, even when they are ill. The lack of care workers in the community means that sick people, even those at end of life, have to stay where the care they get is sufficient for their needs...that is in a hospital bed. The whole system needs to change. Care assistants working in the community need more funding, better pay, more training, and a recognised career path.”

Commenting on the survey results Lord Victor Adebowale, chair of the NHS Confederation, said:

“Decades of delay and inertia have left social care services chronically underfunded and in desperate need of more support.

“NHS leaders stand alongside their sister services in social care in wanting a rescue package for the sector. They are sounding the alarm and sending a clear message to Government that the social care system has not been ‘fixed’.  

“This failure to invest in services and wages for care workers has led to huge vacancies and a lack of capacity. This is contributing to the big problems we are seeing in A&E departments, in terms of longer ambulance handover times, and when it comes to hospitals not being able to discharge medically fit patients when they are ready to go home or into a care home.

“We now urgently need the Government to take decisive action and commit to making it attractive to work in social care and increase the numbers of social care staff.

“The NHS and social care work side by side, when one service is struggling, the other suffers, and the pandemic has served to shine a stark light on how fragile and severely under-resourced the country’s social care system has become.

“Without immediate action, both the NHS and social care could face an endless winter of people being failed by the very systems that should be there to support them at their most vulnerable.”

Nadra Ahmed OBE, chairman of the National Care Association, added:

“Further proof, if needed, that there is a growing crisis in health and social care in relation to staffing challenges which impact service delivery. Social Care services are an essential part of the solutions to ensure that citizens requiring care and support have access to it when they need it.

“It feels inconceivable that the light bulb hasn’t gone on in the hearts and minds of those who can work towards a sustainable resolution to the challenges. Our NHS colleagues need social care to support them in creating a seamless service but without investment in social care and our workforce this feels unattainable.

“This survey lays bare the facts, with NHS leaders calling for investment in social care so that acute beds can be freed up for clinical patients. There is the clear recognition that social care is the backbone that holds up our NHS and care providers are keen to step up and create a pathway to recovery for our NHS. The only challenge we face is that decades of under-investment by successive governments and the pandemic has eroded any resilience in our sector which needs remedial action as a matter of urgency.”

Professor Martin Green OBE, chief executive of Care England, said:

“The NHS Confederation’s social care workforce survey highlights the enormous impact the funding and workforce crisis in social care is having on the NHS. The Government must understand that health and social care are two interdependent systems and social care needs immediate extra funding to improve pay and conditions and then a long-term workforce strategy that aligns with the NHS workforce plan. If the Government fails to focus on the social care workforce, the impact on the NHS will be catastrophic”.

Professor Vic Rayner OBE, chief executive of the National Care Forum, said:

“This survey of NHS leaders comes on top of two Health and Social Care Select Committee reports this week and confirmation of 165,000 vacancies in the adult social care sector by Skills for Care last week.

“The resoundingly stark message from both healthcare and social care leaders is that urgent action is needed now. This survey is clear – the lack of social care capacity is causing huge pressures across the healthcare system and having a very real human impact on people, their families and the entire health and care workforce.

“When healthcare and social care leaders stand side by side to urge the Government to increase investment in care services and boost wages for care workers, then it really is time to listen.  Alongside urgent action on pay, terms and conditions, there is also an urgent need to create a dedicated and fully funded social care workforce plan to enable a long-term approach to workforce development, recruitment and retention, to meet significant demographic change.”

In June the NHS Confederation, on behalf of healthcare leaders, penned a letter to the Prime Minister, warning that their social care counterparts simply do not have “the financial headroom…to respond to the labour market pressures they are facing.”

A decade ago, the average hourly wage for a care worker was 13p more than those working in the sales and retail sector, by last year that had plummeted and an inverse trend in wages saw social care workers paid around 21p less than those working in supermarkets.

England also lags behind other UK nations with both Scotland and Wales having already introduced minimum wages near or well above £10 an hour.

NHS leaders fear that the knock-on effect of a social care sector left with only skeleton staffing will continue to risk patient safety, further exacerbate waiting times, and drive demand for health services ever higher.

They are warning that the social care system is in urgent and radical reform and are urging the next Prime Minister to commit to significant investment in the sector, with the accusation that the social care system is far from ‘fixed’. The Health Foundation projects the Government will need to spend an extra £2.5 billion just to meet future demand and over £9 billion to improve access to care by 2024/25.

They are now calling on the Government to rapidly deliver on its so far unmet manifesto pledge to transform the struggling sector.

1.4 million older people are currently estimated to have an unmet need for social care, yet despite this there have been dramatic falls in spending on social care in England, with figures showing a 12 per cent decrease per person over the decade to 2018/19.

Notes to editors

• Read our full report: System on a cliff edge: addressing challenges in social care capacity

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