Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at the Policy Institute at King’s. (1,593 words)

A new report from the Centre for Workforce Intelligence: Forecasting the Adult Social Care Workforce to 2035 was launched at an event on the 27 July. This report asks some key questions and offers some possible answers. What will social care look like in 2035? Who will be doing the work?  How many people will be needed to keep care and support services going? Social care seems to like such forecasts, a previous report by Skills for Care in 2011 estimated that the number of jobs in the adult social care sector would need to grow from around 1.6 million in 2010, to 2.8 million in 2025 in order to meet projected demand for social care support. Only last year the Centre for Workforce Intelligence (2015) forecasted a 33 per cent growth in demand by 2030.

The report updates this prediction through an analysis of more recent data collected by the Office for National Statistics (ONS). While last year’s report (CfWI 2015) took us up to 2030; this report goes further to the year 2035. Again it takes a systems approach to help with its estimates, this time focusing on the impact of four possible scenarios on demand for social care and the workforce.

The launch event on 27/07/2016 included an overview of findings from the report. It has both assessed the current shape of the adult social care workforce and attempts to forecast future demand and supply requirements for the next 20 years (ie until 2035). Taking into account population estimates alone, the report predicts an annual growth of 1.6% demand for all kinds of adult social care services.

CWfI asked experts to estimate future requirements, taking into account people’s health, changes in social vulnerability, and policy developments, as well as predictions about population growth. By combining the estimates from population changes and the expert estimates, the report predicts a 2.6% annual increase in demand for adult social care services. This is broadly in line with estimates of demand increase for the period 2005-2013 given by Fernandéz and his colleagues in 2013. The experts were also asked to consider the impact of four scenarios, all of which were felt potentially to reduce the increase in demand:

• Integration (of health and social care)
• Self-care technology
• Funding
• Prevention and community involvement.

Supply

On the face of it, data on demand seems more robust than data on workforce supply but supply data is good. Skills for Care’s evidence is that the workforce has been growing substantially recently, by 3.4% annually between 2009 and 2014. If this trend continues, the report suggests that supply will be able to meet demand. However, there was a strong ‘health warning’ on this forecast.

Recruitment  and retention a policy perspective

In addition to the report findings, the launch event provided a policy perspective, focusing on recruitment and retention, as well as wider topics. The government’s Spending Review was acknowledged to be ‘tough’ although possibly a slight relief in the later parts of the Review (ie 2019-20) was suggested. Care homes with nursing, in particular, have overall been receiving poorer quality ratings from the Care Quality Commission than other providers, highlighting inadequate staffing levels, and poor medicines management. Shortages and overall quality of the managers’ of care homes with nursing, and shortages of registered nurses working there seem to contribute to these quality ratings. However, it is home care services that have the highest levels of vacancies.

No news was given on whether the postponed changes from the Care Act 2014, in relation to funding adult social care, would be implemented. With a new Prime Minister and new ministers (including a new Parliamentary Under Secretary of State for Community Health and Care, David Mowat MP), it is hard to predict future decisions. However, DH investment in workforce initiatives includes:

• Funding of the sector skills council, Skills for Care, which provides information and tools for social care organisations to recruit and develop a skilled workforce.
• Work on developing nursing in social care (Nurses being on the Shortage Occupation List to enable international recruitment; new ‘Nurse Associate’ role in social care as well as the NHS; and ‘teaching’ care homes, and the piloting of ‘Return to Practice’ support for nurses working in adult social care).

More work is planned, in respect of children’s social work, registered care home managers; and the rates for NHS funded nursing care. The complications of BREXIT are also being considered. This will affect different parts of the country differently. In the South East and London, for example, 10% of all care workers and 15% of professionals working in social care come from other EU countries. Consequently, even if there are no changes to the current status of EU citizens already in the UK, BREXIT may create uncertainty and a climate that will induce some to leave, potentially creating staffing shortages.

Social Care Mapping and discussion

The rest of the morning was taken up with two exercises. The first involved supplementing a ‘social care map’, a work in progress, developed using Systems Theory. Delegates were given a print out of the draft social care map, which identified variables of relevance to levels of social care needs, demand for social care and demand for the social care workforce. Causal links and the direction of influence are represented on the map by arrows and ‘+’ or ‘-‘ symbols. For example, ‘population size’ influences ‘care and support needs’: increases in population size generates more care and support needs.

In the second exercise, we were asked to use the variables and linkages suggested in the care maps to help answer following questions:

1. What will have the biggest impact on
   1. The projected demand for social care?
   2. Ensuring a sustainable workforce?
2. For each area identified in 1., we were asked to identify:
   1. The current barriers to change in those areas?
   2. What actions can be taken to remove the barrier?
3. What work is being undertaking that would contribute to workforce analysis?

The themes emerging from the feedback session from both exercises are summarised below:

Impacts on demand for social care services

Increases demand	Decreases demand
Ageing population (although ameliorated somewhat by an increase in the birth rate)	Increasing birth rate
More people living alone
Greater  geographic distance between family members
People working until an older age (and therefore being less available to undertake informal care)	Enlightened employers allowing more flexibility for workers with caring responsibilities
Reduced preventive intervention (because of reductions to local authority budgets)
Socio-economic changes can increase demand, in some areas, which suffer more in economic downturn – link with increased need for social care

 

Impacts on creating a sustainable workforce

Acts against a sustainable workforce	How to Promote a sustainable workforce
Low status of social care. This was linked to the gendered nature of the work (ie being female dominated, which still has a low status). Low pay, poor working conditions and very limited career progression.	Increase availability of training and social care qualifications –e.g. ‘return to practice’ programmes in care homesPromote care work as possible career choice for young people in schools
Poor image of social care presented in the media	Campaign for more positive image in the media
Stigma surrounding use of social care (contributes to low status of social care)
	More flexibility and better working conditions for staff
	Recruitment of and valuing of older workers – e.g. older people who have cared for older relatives with dementia
	Collaboration not competition

 

Concluding remarks

The morning highlighted the complexity of forecasting the social care workforce. For example, demographic changes have been predicted to lead to an imbalance in the ratios between older and working age people, potentially creating shortages. However, increases in EU immigration, which have been associated with an increase in the birth rate, may have an ameliorating effect on this imbalance. The UK leaving the EU creates a further complexity, given the current uncertainties about the impact on immigration, which has a particular significance for the social care workforce.

It is interesting to note that social care is one quite small part of the list of responsibilities held by David Mowat (the new care minister). The placement of social care within a multitude of other responsibilities will be a challenge.

A concern about the status of social care was another strong theme. Low pay, even with the Living Wage, and impressions of poor conditions of work and uncertainties in the social care market were all cited as contributing to this. Such factors have been exacerbated by reductions in public funding of social care over the last six years. However, the importance of public attitudes towards care work and also to the people who require social care was also highlighted. Changes in public attitudes may be slow to develop and will require investment and concerted action.

Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at the Policy Institute at King’s.

References

Centre for Workforce Intelligence (2015) Forecasting the adult social care workforce

A summary report of workforce intelligence, London, CfWI. Available from http://www.cfwi.org.uk/publications/forecasting-the-adult-social-care-workforce-workforce-intelligence-report

Centre for Workforce Intelligence (2016) Forecasting the Adult Social Care Workforce to 2035, London, CfWI. Available from (http://www.cfwi.org.uk/publications/forecasting-the-adult-social-care-workforce-to-2035-workforce-intelligence-report)

Fernandéz ,J-L., Snell, T. and Wistow, G. (2013) Changes in the patterns of social care provision in England: 2005/6 to 2012/13. London: Personal Social Services Research Unit. Available from http://eprints.lse.ac.uk/56111/ (Accessed 27/07/2016)

Skills for Care (2011) The size and structure of the adult social care sector and workforce in England 2011, Leeds, Skills for Care, August 2011.