The future of social care

06 June 2016

Article by Amy Clifton, National Assembly for Wales Research Service

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Social services are undergoing a period of transformation in Wales, but what will this mean for access to services, paying for care, and the social care workforce?

There are many challenges facing social services in a period of budget constraints and increasing demand. Three issues are likely to be particularly high on the agenda in the Fifth Assembly: access to services, paying for care, and the social care workforce.

Access to services

The Social Services and Well-being (Wales) Act 2014 went ‘live’ in April 2016, and attention has focused on what this will mean for an individual’s ability to access the services they need under the new national eligibility criteria. The criteria determine whether an individual has an enforceable right to care and support provided or arranged by the local authority.

The Fourth Assembly’s Health and Social Care Committee heard concerns that the ‘can and can only’ test could present barriers and delays for individuals attempting to access services. Service user organisations were worried that some people could be wrongly denied services, and unpaid carers could be pressured to take on further responsibilities.

The legislation places greater reliance on community resources, but some stakeholders questioned whether communities are sufficiently equipped to deal with this, particularly at a time of local authority budget cuts.

Unlike the English Care Act 2014, the Welsh Act does not contain an appeals process, but individuals can request a review or re-assessment of eligibility decisions in certain circumstances.

The Health and Social Care Committee highlighted the need to closely monitor how the Act is implemented. Mark Drakeford, the then Minister for Health and Social Services, committed to evaluate the Act in the Fifth Assembly, focusing on assessment and eligibility to determine whether the objectives are being met.

New national eligibility criteria

An assessment decides whether an individual’s needs and wellbeing outcomes ‘can and can only’ be met by the delivery of a care and support plan, provided or arranged by the local authority. If the needs and outcomes could be met by the person themselves, by anyone else, by community services, or by any other means, it is unlikely they would be eligible for personalised statutory care and support.

Paying for residential care

It has long been recognised that the way individuals pay for residential care in England and Wales needs reforming. The current system is seen as complex, unfair and unsustainable, given the

demands of an ageing population. Finding a solution is difficult and potentially costly, but the issue will not go away.

There has been much debate and consultation about the right approach, but both the UK and Welsh Governments have delayed action on reforms. Ahead of the 2016 Assembly elections, a number of Welsh political parties made manifesto pledges promising to change the current system.

One option, supported by the Welsh Government’s Stakeholder Advisory Group, is to raise the threshold at which individuals pay the full cost of their care. The group reported that raising the capital limit to £100,000 would reduce the number of people required to fully self-fund their residential care and enable residents to retain a higher proportion of their capital. It has been estimated this would initially cost the Welsh Government an additional £30 million a year.

The charging system in Wales

Anyone with capital of their own above £24,000 (including savings, assets and property) is expected to meet the full cost of their care until their capital falls below the threshold. Below this limit the person is only expected to contribute to the costs from their day-to-day income (such as their pension).

The social care workforce

The quality and sustainability of the social care workforce is currently under the spotlight and there are questions about its capacity to meet the increasing demands being placed on care services. There are concerns about registration, terms and conditions and remuneration.

Adult residential care workers and domiciliary (home) care workers are not currently registered and regulated in the same way as other social care staff. During scrutiny of the Regulation and Inspection of Social Care (Wales) Act 2016, Mark Drakeford, the then Minister committed to registering all domiciliary care workers from 2020, and adult residential care workers in 2022.

The Health and Social Care Committee reported in 2015 that poor terms and conditions for care workers can lead to high staff turnover and lower standards of care.

The Minister commissioned research into how domiciliary care workers are recruited and retained. This identified factors that have a negative impact on the quality of care. They include zero hours contracts, low wages, non-payment for travelling time, heavy workloads, 15 minute care visits and poor training.

The new legislation places restrictions on care visits of less than 30 minutes, and the previous Welsh Government consulted on proposals for further reforms. These included restricting the use of zero hour contracts and ensuring employers pay domiciliary care workers the national minimum wage (including travelling time). The new Welsh Government may therefore take action on this.

Social care providers in both England and Wales have expressed concern that the new higher National Living Wage (which replaced the National Minimum Wage from April 2016) will place the sector under increased financial pressure and could result in cuts to services. The Association of Directors of Social Services Cymru and the National Provider Forum (Wales) warned that the care sector in Wales will be particularly hard hit because the vast majority of care is paid for by the public sector, which is itself under financial pressure.

Domiciliary staff turnover

The Welsh Government estimates the domiciliary care sector has a turnover of around 32% and a vacancy rate of 6%.

Key sources