Briefing: What is the impact of the social care crisis in Wales?

• Welsh Government priorities

Social care plays a crucial role in supporting the most vulnerable people in our society and is fundamental in ensuring the flow of patients in and out of hospital through aiding their transition to at home care or to a care home. We are at a social care crossroads in Wales as a result of Welsh Government chronic underfunding which has left the sector unable to keep up with increasing demand due to limited resources, workforce challenges and poor working conditions.

Gareth Davies MS has established a Policy Board with experts from the social care sector, exploring five key areas where change is needed to improve the state of the social care sector in Wales. These are:

1. Workforce retention, training and career progression

2. Recruitment

3. Measures to improve working conditions

4. Funding

5. Health and social care interaction

The challenges facing Wales in:

• Workforce retention and recruitment

It is estimated by Daffodil Cymru that the number of people aged 65 and over receiving residential care services is projected to have increased by 82% between 2015 and 2035, and the numbers receiving community-based services by 67%. However, Wales is currently facing a shortage in the social care workforce. The sector is desperately struggling to recruit and retain staff with the right skills and in the right numbers. Welsh Government underfunding has left the social care sector unable to meet the growing demand of people needing care in Wales.

In 2019, the Welsh Government had admitted that 20,000 more social care workers need to be recruited over the next 10 years. However, recruitment remains low, and it was reported that in 2022, just 226 more people had joined the sector. In 2022, 5,323 vacancies were recorded, which makes up 9% of the total workforce, highlighting the high vacancy rate.

Retention in the sector is also low due to lack of investment into training and failure to make carer pathways clear. This has meant social care is unable to be seen as a long-term opportunity. Career progression and training is seen as being better regulated and standardised in the health sector this is part of the reason turnover in social care is high due to those in the workforce seeking employment elsewhere, such as retail as they offer higher pay and better working conditions.

• Working conditions

Poor working conditions had huge consequences for social care staff during the Covid-19 pandemic. The rates of deaths due to Covid for residential and domiciliary care workers were double that for health care workers. Lack and poor-quality PPE, poor statutory sickness pay, casual or zero-hours contracts, and the requirement to give up additional employment, are factors which care workers in Wales identified as putting them at risk during the pandemic. As a result of poor conditions and feeling undervalued, underpaid and poorly supported, a significant number of staff left the sector and sought alternative employment.

The workforce also experiences considerable job insecurity in terms of hours of work, with widespread use of bank or zero hours contracts. Many face difficulty juggling uncertain demands of work with family responsibilities. Workers also receive low pay and do not earn enough for basics, leaving many to rely on additional funding. The lack of sick pay is also a considerable concern, not only do workers who are unable to work due to illness or injury face financial hardships, some work when unwell which poses a risk to both them and those they care for.

• Funding

There is a dire need for more funding across the social care sector. Social care pressures are expected to reach £256million in 2023/24. Significant workforce pressures, including the recruitment and retention of staff, are adding to future financial difficulties to the sector, with local authorities factoring in the need for agency staff which is costly. This has resulted in limited resources, staff shortages and difficulties in providing high quality care. As well as this, funding to improve the skills shortage in social care is inadequate. Social Care Wales funding is largely stagnant, with a decrease of £190,000.

The Social Care and Support Budget is set to fall by 14% compared with funding in 2022/23. The funding goes towards the Improving Lives Programme, which reviews how well people with a learning disability are supported throughout their lives; and support for carers in carrying out their roles as carers whilst maintain their own wellbeing. Whilst the Welsh Government has continued much needed funding to both the Carers Support Fund and the Short Breaks Fund, the Carers Trust highlighted that they have not provided enough in the way of financial support. It is worrying that the Welsh Government doesn’t view financial assistance to unpaid carers as a priority despite the fact they are estimated to provide 96% of the care in Wales.

Whilst the £70million for bringing the national living wage for social care workers to £10.90 per hour is particularly welcome, the 7.9% average in funding support for local authorities is not hypothecated, with the Welsh Government leaving it up to each local council to work out the best way they can use that money. It is regretful that the Welsh Minister is unwilling to take responsibility for the social care sector, particularly as local authorities are considering cuts to social care services.

• Health and social care interaction

Health and social care are inextricably linked and impacted by each other. The shortage in social care workforce directly impacts the health service. The lack of availability of social care has resulted in people unable to access the right support at the right time, adding pressure to an already stretched health system.

A recent Healthcare Inspectorate Wales review found “consistent challenges” caused by poor patient flow through hospital wards. It said that whilst the issues are wide-ranging, it primarily stems from high demand for beds and the complexities involved in discharging medically fit patients. The bottleneck at the point of discharge has a knock-on effect on emergency departments, ambulance response times, inpatient care, planned admissions and overall staff wellbeing. Unnecessarily long stays in hospital due to delayed discharge can also place patients at risk of hospital acquired infections resulting in them seeking further treatment.