By Mario Kreft MBE, Chair of Care Forum Wales
Social care is the glue that binds our communities together – socially, culturally and economically – but it is being blighted by a triple whammy of chronic underfunding, Dickensian procurement practices and the eye-watering cost of hiring agency nurses.
As a sector, it directly employs 100,000 dedicated and skilled people who support hundreds of thousands of vulnerable adults and children across the land.
It contributes over £3 billion a year to the Welsh economy and underpins our NHS.
Traditionally, social care has been the Cinderella service, with a constant downward pressure on fees with an emphasis on price not value – all of this coinciding with ever escalating costs, some of which are a direct result of extra and often over-bureaucratic regulation and process.
As a result, care homes have closed across Wales because they were not economically viable. Nursing homes are also being forced to shut or de-register their beds at a time when demand is soaring.
One of the major problems affecting the sector is the dire shortage of nursing staff, with providers virtually being held to ransom by the exorbitant cost of agency staff which can exceed £50 and hour.
Around 70 per cent of the weekly income of a care home or nursing home goes straight out in wages. In the case of domiciliary care the figure rises to 80 per cent and that’s before factoring the cost of hiring agency staff.
This is why we’re seeing closures in North Wales, and particularly a reduction in the high-end nursing beds.
That, in turn, is putting more pressure on the NHS, making it less efficient and more costly than it should be.
They, too, are also using huge amounts of agency staff, with millions and millions of pounds a year going into private businesses just to provide agency staff.
What rubs salt in the wound is, that more often than not, these are people who have been trained either by the NHS or the independent sector.
I don’t necessarily blame the nurses themselves but there is something fundamentally flawed with a system that allows this iniquitous practice to happen and we need to take action as a matter of urgency to change the system so we can ethically ensure taxpayers’ money is spent on caring for people rather than on outside interests.
A major step forward was the forward-thinking decision of the Welsh Government to choose social care as one of the four key foundation sectors in the Economic Action Plan for Wales.
As a former Health Minister, our new First Minister, Professor Mark Drakeford, appreciates health and social care are actually one sector.
At Care Forum Wales, we were particularly encouraged by Prof Drakeford’s manifesto pledge to use the power of procurement and public investment to secure quality services in, for example, the care sector by linking that investment to fair pay and career development.
It is extremely frustrating for care providers in fee negotiations when public sector commissioners question providers as to why they would pay staff above the legal minimum wage. This is even the case where those commissioners themselves have committed to paying their own staff the real living wage.
The recently published Welsh Government good practice toolkit on setting fees for care homes for older people, Let’s Agree to Agree, could be used to promote fee setting, based not just on the legal minimum wage and a similar approach could be rolled out to other parts of the sector. We would also like to see a move away from commissioning which encourages piecemeal contracts in domiciliary care and bartering in contracts for care for younger adults.
With Professor Drakeford at the helm, we hope that 2019 heralds a new and fairer beginning for social care.
The demographics don’t lie. With the number of people aged over 85 set to double over next few years, providing social care for an ageing population is the challenge of our age.
We need to value the wonderful people who work in the sector now and make it an attractive career for new recruits. That is about more than kind words. We have to have fair procurement that enables the sector to pay people properly.
Investing in social care will benefit all of us. Social care should not be seen as a burden, it should be recognised as a sector that adds value to our nation.