The focus is on the NHS, but London’s social care workforce too is playing a vital role during the pandemic. For example, with over 200 staff at my local hospital trust currently off sick due to Covid at our local hospital trust, my borough, Greenwich, has deployed 30 home care workers onto the wards, working side by side with doctors, nurses and hospital teams to keep the show on the road.
But as well as the immediate priority of responding to Covid, the social care sector is grappling with enormous long-term challenges. Some might assume that London’s relatively youthful population means its adult care services face fewer pressures than other parts of the country. This couldn’t be more wrong.
The number of Londoners aged 65 and older is expected to increase by 71 per cent by 2039 – a faster rate than any other region in England. It is also a misconception to think social care is only about older people. Around half of adult social care expenditure in the capital is on care and support for working-age Londoners.
We have a higher than average number of residents with disabilities requiring care, and these figures are also rising. The population of working-age Londoners with a learning disability is predicted to increase by eight per cent by 2035 and those with impaired mobility by 14 per cent.
These demographic trends are taking place in the context of a system that has been chronically underfunded for many years, and London boroughs are massively concerned. Local authorities play a pivotal role in assessing residents’ care needs and arranging their care. It’s a responsibility we take extremely seriously.
Against a backdrop of dramatically reduced government funding for councils over the past decade, we’ve protected spending on social care for the 150,000 Londoners receiving support – even though this has meant other services, such as planning and highways, have had to bear the brunt of austerity.
Unfortunately, prioritising investment in social care isn’t enough. Demand outstrips the resources available for provision. Our most recent estimate is that London boroughs face an adult social care funding shortfall of £400 million over the next three years due to demographics and inflation – and that’s not taking into account the continuing impact of Covid-19.
The continual stretching of social care resources makes it harder and harder to keep providing the high-quality services residents deserve. This problem of maintaining the workforce is particularly acute.
Social care is very much about people – individuals being supported by others to live their life as fully as possible. However, the combination of low pay, growing instability in the care market and the high cost of living in the capital means London is struggling to recruit and retain care workers. At London Councils we estimate 10 per cent of posts in London’s adult social care services are vacant. Around 42 per cent of social care jobs in the capital are zero-hour contracts.
It is impossible for the situation to improve without better funding for adult social care, by which I mean more investment going into the system to stabilise services, bolster the workforce, and bring about better results for those receiving care.
London boroughs needed the government’s recent social care white paper to address the fundamental issue of money. We hoped for both an immediate investment boost to support frontline services through the coming winter months and for a long-term solution – as we’ve been promised countless times – to the question of how to fund these services adequately in the future.
But the white paper was yet another disappointment. There was some extra funding for housing adaptations, greater use of technology, and workforce training, all of which was welcome, but it was frankly piecemeal considering the overall challenge we face.
Boroughs have been left with zero idea of the government’s future funding plans. It seems that social care will continue to languish in a state of permanent financial crisis, reliant on an irregular flow of emergency funding injections from the government to stop wholesale collapse.
This is incredibly frustrating. For one thing, it’s a false economy. The longer the workforce problems are allowed to build up, the longer they’ll take to resolve. An under-resourced social care sector also undermines NHS performance. And most importantly, of course, we know there can be hugely detrimental impacts on the health and wellbeing of Londoners, exacerbating inequalities.
No one could realistically expect the white paper to “solve” adult social care in one fell swoop. Reforming it is an ongoing journey, and at least ministers acknowledge things cannot continue as they are. However, we need far more momentum. I hope 2022 is the year the government faces up to the key issue of long-term funding increases, giving councils the financial commitments we require for sustaining local services and reassuring Londoners that the system will provide the care they need.
Danny Thorpe is cross-party body London Councils’ executive member for health and care. Follow Danny on Twitter. Image from GLA.
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