• 18 May 2021
  • 10 min read

The 6 Key Factors Impacting Social Care In 2021

  • Liam Palmer
    Registered Home Manager
    • Mat Martin
    • Aubrey Hollebon
    • Richard Gill
  • 1
  • 569
"The rise of home care, nervousness around care homes, lack of central gov funding, ever-growing demand - major issues impacting social care provision in the UK..."

The nation is now more aware of the great work carried out by the 1.5m people who work in social care. The challenge is how we organise it better. Here are the 6 key factors that need to be addressed.

Topics Covered In This Article

The Ever Increasing Demand For Social Care

The Rise Of Supported Living

Covid Has Accelerated The Home Care Sector

Funding From The Private Sector Underpins UK Social Care

Social Care Is Fragmented Which Impacts Quality

Compliance Varies Between Home Care And Residential Care

The Ever Increasing Demand For Social Care

In addition to the obvious constraints with the pandemic which has been especially tough on care providers, there are a series of other factors that have been conspiring against the social care sector for some years. Not least of which is the increasing demand.

In the last 20 years, many of those entering long-term care are more fragile, older and with far more complex needs than before.

The distinction between nursing care (high need / more expensive) and residential care (lower need / less expensive) has blurred.

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Those considered for nursing care ten to fifteen years ago are now considered suitable for residential care instead.

As people live longer, the prevalence of dementia (most common in those 85+) has greatly increased. And with it, the need for nursing care.

The Rise Of Supported Living

There is now a large market of smaller care homes for adults with learning difficulties or more complex needs.

Within this part of residential care, the trend is often for smaller homes or, where possible, independent living.

The lines tend to blur a little.

Supported living (housing schemes) are an expanding alternative to traditional residential (non-nursing) care homes.

Supported living helps those experiencing social isolation (little family or neighbour support) by having a shared dwelling with some communal facilities and / or a warden for example.

These properties are currently not regulated by the CQC.

Only clients who have a care need currently come under the oversight of the CQC.

The supported living concept is extended further with the rise of “Retirement Villages”, where a lifestyle and more facilities are incorporated into a building complex.

Retirement villages is a concept imported from the U.S.

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The largest UK provider is Extracare Charitable Trust which now has 16 retirement villages of between 150 – 200 apartments each.

This is a growing concept but still for a relatively small number of people.

Retirement villages and many housing schemes involving purchase are partially funded through the appreciation in property value being retained by the scheme.

This scheme offers an attractive alternative to the higher monthly service charges of care homes and seems to be a practical model to fund the extra services these communities enjoy.

Where supported living and social care overlap is a moot point and one that may need to be addressed in the coming years.

Covid Has Accelerated The Home Care Sector

Without doubt, domiciliary care (home care) is one of the fastest-growing areas of social care needing Registered Managers and Regional Managers.

Home care has become even more popular in 2020 - 2021 due to the Covid 19 pandemic.

Fears around moving to care homes has dramatically impacted occupancy rates (in some cases down from 80% to 60%).

The profile of care homes has been further undermined of course by the temporary ban on families visiting their love ones in care homes.

However, we expect care homes to bounce back.

Funding From The Private Sector Underpins UK Social Care

The cost of residential care for older people in the UK is divided between local authority (LA) and private finance.

LA funded care is available for people who have no (or very partial) means to contribute.

Often, some homes will have residents funded from either option living side by side – some who pay £1,000 per week using the proceeds of their home to pay for the best care while the bed in the adjoining room is paid for by the local authority.

However, the contribution from the LA may be around £500 per week - for the same bed.

This discrepancy is primarily due to under-funding from the government with fee increases that haven’t kept up with cost increases.

Social care spending in the UK steadily rose from the late 1970s up to 2005.

Since then spending has risen only a little, sometimes none at all and, following the financial crash, it fell.

Of course, at the same time, the population grew and the demand increased.

The squeeze on local authorities’ budgets and ability to pay for elderly care has become greater.

Oftentimes, LAs have tried to prioritise elderly care at the expense of other services.

Social care spending takes up 55% of a council’s budget.

For those owning and running care homes, including Registered Managers and Regional Managers, the requirement to become more commercially focussed has increased.

For a residential service to remain financially viable, it has required a proportion of private funders to balance the finances.

The sector doesn’t differentiate the offering that residents receive.

The only difference may be with the finish of the room for example.

Private care homes attract investment from pension funds and bring much needed capital to the long-term care sector.

In return for that capital, the services need to be financially viable.

Some industry experts are expressing concern that we may reach a point where privately run care homes simply cannot afford to take non-private service receivers unless local authorities are given more support to pay for them from central Government.

Social Care Is Fragmented Which Impacts Quality

According to Skillsforcare data, in 2020, there were 1.6m jobs in social care and 1.52m employees.

The NHS employs 1.3m – 1.7m depending on where you look, making the NHS the 11th biggest employer in the world.

Though the workforce of social care is a comparable size to the NHS it is less well understood than the NHS as it is not state owned or funded, nor a single entity.

Instead, it is a mixture of charity-run and privately-run organizations.

Around 15% of the social care sector belongs to large groups, while around 50% is operated by smaller groups, and the balance is made up of companies with just 1 or 2 care homes.

As a result, social care is very fragmented and this impacts consistency and quality.

Here are some stats which highlight this fragmentation:

Number of care homes In The UK = 15,675

According to the CQC website (30.1.21) this is broken down into:

11,292 Residential Homes

4,383 nursing Homes

These homes are rated as:

6.4% “outstanding” (656 homes)

73.8% “good” (11,564 homes)

15% “requires improvement” (2,348 homes)

1.2% “inadequate” (190 homes)

Number Of Home Care Agencies In The UK = 11,650

According to the CQC website (30.1.21) there were 8,512 Home Care agencies inspected and 3,138 not inspected. Of the services rated:

5.4.% “outstanding” (656 services)

82.2% “good” (11,564 services)

11.7% “requires improvement” (2,348 services)

0.7% “inadequate” (190 services)

(We have more stats and facts about social care in the UK here.)

Compliance Varies Between Home Care And Residential Care

The CQC regulatory and compliance framework relates to 5 key lines of enquiry (called K.L.O.E’s).

They are: “is the service safe, caring, effective, well led, responsive?”

This has been in place since 2015.

Prior to this an inspection would inspect one area out of 5, now it is 5 of 5.

Of late, it is the view of many care providers that what would previously be considered a minor issue by the CQC are being seen as serious issues that lead to a downgrading of their overall CQC rating.

In other words, though the rating hasn’t changed, the way it is being interpreted and applied has.

This can add a lot of pressure to the job of running a care service, especially for smaller providers without a quality assurance team or other management support.

In some instances where a home is downgraded, the provider will remove the deputy or Home Manager (for right or wrong).

Smaller homes are often given better ratings than larger nursing homes with far more clients and far more complexity and risk.

These small homes - say 10 beds for a group of adults with learning difficulties - are naturally run on a more homely basis.

The staff and residents work together to cook, do things together as near to a “home like” atmosphere as possible.

This comes out well under the CQC framework.

Clearly larger and more complex care homes with 120 staff and many residents who are not mobile and with very different needs are of necessity run quite differently.

It is possible for those larger homes to achieve strong ratings.

Arguably tougher of course but it can be done through sound management and leadership, good communication, a sense of teamwork, strong quality assurance and an overriding focus on the resident experience, with a sense of kindness.

However, with home care, it is interesting to note that there are over 3,000 services that were not yet inspected.

Whether it is possible for this to be addressed is a matter for discussion.

Of course the task of inspection – visiting a person’s individual home versus visiting a care home is quite different.

After all, how can an inspector access, say, 50 people’s homes for 1 inspection?

How do they choose which home to inspect? It is all possible but arguably far more complex.

For example, an inspector visiting an individual may not mark down the untidiness of their home overall whereas in a care home, they likely would.

The care home is professionally managed with a staff team whereas an individual’s home is not.

The care delivery context is slightly different. As social care in the UK changes, however, this may be a question that needs to be addressed.

Conclusion

There are many calls for the UK to focus more attention on social care. Covid 19 has thrown a spotlight on the sector - how hard its workforce works.

If we are to take on the challenge of matching social care services to those available in healthcare then the issues outlined above will need to be addressed.

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What are your thoughts about social care in 2021?

Leave your comments below

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 3 books on raising quality standards in care homes through developing leadership skills. In Oct 2020, he published a guide to the Home Manager role called "So You Want To Be A Care Home Manager?". Liam has been fortunate to work as a Senior Manager across many healthcare brands including a private hospital, a retirement village and medium to large Care Homes in the private sector and 3rd sector. He hosts a podcast "Care Quality - meet the leaders and innovators”.

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  • Liam Palmer
    Registered Home Manager

About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 3 books on raising quality standards in care homes through developing leadership skills. In Oct 2020, he published a guide to the Home Manager role called "So You Want To Be A Care Home Manager?". Liam has been fortunate to work as a Senior Manager across many healthcare brands including a private hospital, a retirement village and medium to large Care Homes in the private sector and 3rd sector. He hosts a podcast "Care Quality - meet the leaders and innovators”.

  • 1 Comments
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    • Sue Hester 2 months ago
      Sue Hester
    • Sue Hester
      2 months ago

      Not just as a retired nurse but as a carer for my husband withPD the last thing either of us ... read more

      • Dear Sue, Thank you for sharing your experience - I am so sorry to hear of your mother's experience in a care home, that is shocking and upsetting. No excuse for that poor care. You are so right, your... read more

        Dear Sue, Thank you for sharing your experience - I am so sorry to hear of your mother's experience in a care home, that is shocking and upsetting. No excuse for that poor care. You are so right, your husband is really fortunate to have your help as an ex nurse who ensures he gets the right type of care and support . Agreed there are issues around public funding and process and a perceived reluctance with some stakeholders to provide the real support needed. It is something that the key figures in social care Professor Martin Green, Vic Rayner and Mike Pagham continuously write to the government - about to get a fair deal for social care. Providing care and support for an dependent individual can be exhausting - care homes often do an amazing job but they do vary, same with homecare. There are so many people that need that help inevitably there are those who don't have a good experience. It is someone that as a registered manager, I am continuously aware of - to take the very best care of all in my service - everyone matters, every person has value and we need to strive to make care services safe and welcoming for all. Thank you again for your comment.
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        Replied by: Liam Palmer