Social care funding gap makes sector less appealing to nurses

Poor pay and conditions for nurses and other working in social care in England are a major threat to the quality of care and future sustainability of the sector, said the Health Foundation in a report.

“It is hard to see how social care providers can recruit and retain staff at current pay rates”

Health Foundation report

More than 40,000 nurses work in adult social care but almost a third are estimated to have left their role within the past 12 months, it noted.

A key reason for problems with recruitment and retention was the fact wages are low and below equivalent salaries in the NHS, said the analysis.

According to the think tank’s document – titled The real cost of a fair adult social care system – there is a 7% gap between the pay rates for adult social care nurses and the rates available for nurses in the NHS.

“Over the next few years, this will rise further with basic pay for NHS nurses starting in 2017-18 increasing by up to 22%, including pay progression,” said the analysis.

For care workers the average full-time equivalent pay in 2017-18 was £16,000. However, a similar support role in the NHS would a fifth higher at £19,300, said the document.

The loss of nurses is “unlikely to be sustainable” said the analysis, which suggested funding for social care would need to increase by around £1.8bn to match NHS pay rates.

“This would mean that the gap between cost and demand pressures, and local authority spending power, would be £4.4bn by 2023-24,” said the report.

“While this is a significant additional cost, it is hard to see how social care providers can recruit and retain staff at current pay rates when salaries will be higher in competitor labour markets,” it said.

“If reform remains unaddressed, social care’s inadequacies will continue to undermine the NHS”

Anita Charlesworth

The analysis suggested that funding for social care was lagging way behind investment in the health service.

Without extra funding, the money available for adult social care will rise at an annual average rate of 1.4% a year, said the analysis.

This is much lower than then 3.4% a year the government has committed to the NHS. Meanwhile, demand for services is rising at a rate of 3.6% per year with increasing numbers of elderly people and young adults with social care needs.

The Health Foundation’s analysis also suggested England spends considerably less on publicly-funded social care per person that Scotland and Wales.

Government spending on adult social care in England fell from £345 per person in 2010-11 to £310 in 2016-17, said the report.

In Wales the average spend per person in 2016-17 was £414 – a third more than in England – and in Scotland it was 43% higher at £445.

While variation in spending between UK countries could – to some extent – be explained by differences in their populations and care needs, gaps in spending on health are far less pronounced and have narrowed in recent years, said the report.

Anita Charlesworth, director of economics and research at the Health Foundation, said adult social care was in need of urgent reform and staffing was key to both quality and cost.

Anita charlesworth 3x2

Anita charlesworth 3×2

Anita Charlesworth

“With around two-thirds of staff at the minimum wage and a quarter on zero hours contracts, it is perhaps unsurprising that adult social care providers are struggling to attract and retain workers,” she said.

Uncertainty around international recruitment – exacerbated by Brexit – would also hit the sector hard give its reliance on staff recruited from overseas.

“Rising demand and competition for the same pool of workers from other sectors, including the NHS, will compound these problems,” she added.

Ms Charlesworth called for “decisive political action” and an appropriate funding settlement.

“Successive governments have ducked the challenge and the tragedy is that vulnerable people and their families are suffering as a result,” she said.

“If reform remains unaddressed, social care’s inadequacies will continue to undermine the NHS and people in need of care will continue to fall through the cracks,” she added.