Adult social services bosses have given a dire warning that the care sector has never faced such challenges as it does today.
The current situation is ‘unprecedented’, say care chiefs.
There has already been an exodus of care staff to other industries, leaving for better pay and conditions, as well as widespread exhaustion due to an intense 18 months of working with those most vulnerable during a pandemic.
In exactly three weeks, there will be another swathe of workers who will lose their jobs because they are unvaccinated.
The Manchester Evening News revealed that there are more than 1,000 care workers who have not had a first dose against Covid-19 yet in our region.
Staff, residents and the Greater Manchester care sector itself are in the ‘perfect storm’ of troubles, according to leaders, leaving it ‘spinning out of control’ amid fears of how it will get though winter.
‘We’ve never known a situation in care like this’
“The situation we are currently facing is unprecedented. It’s a perfect storm,” Bernie Enright, director of adult social services in Manchester, told a revelatory public meeting of the Greater Manchester Health and Care Board at the beginning of October.
“Recruitment and retention of staff in the sector is a huge challenge, it poses significant risks.
“Even before the pandemic, the GM turnover was almost 27 per cent.
“We’re seeing staff move out of care to retail, hospitality and to our colleagues in the NHS, where terms and conditions are actually better.
“Ultimately, we’ve got nine per cent of staff at the moment currently unvaccinated across GM in the care home sector, and after November 11 we know they won’t be able to work.
“We are ‘working with providers’ to make sure there are business continuity plans in place to ensure residents and patients will be safe.”
It’s a bleak picture as the care sector appears to be spiralling into crisis, seemingly unable to get the staff it needs to run safely.
The director spoke on behalf of all of the adult social services chiefs from across the 10 boroughs, saying: “My director of adult social services colleagues across GM would want me to say at this point – in all of our experience we’ve never known a situation in home care as it is today.
“We have not seen it in as difficult a position as it is at the current time.”
‘Troubles in Manchester’s care sector could also spell disaster for its health system’
The social services problems are also threatening the health system in Greater Manchester, says Ms Enright.
Conversely, the context of pressures on hospitals is also feeding into the care sector. There has been a rise in the complexity of social service users’ needs, and there has been a reduced demand for care in residential homes, in favour of care within people’s own homes.
Altogether, this has resulted in ’25 per cent’ more care being delivered at home by diminishing numbers of staff, according to the Manchester chief.
“We are totally interdependent across health and social care, if we can’t stabilise the social care system it obviously will have a knock on effect on the health system,” adds Ms Enright.
“We’re all seeing increases in demand, waiting lists, people’s needs becoming more complex, home care commissioning, we’re seeing increases, worryingly, in safeguarding and domestic abuse, and the well-publicised demand on our mental health services.”
Touching on services relating to ‘some of the most vulnerable’ in the region, those with learning disabilities and autism, the Manchester chief continued: “Covid has had a huge impact on them. We have seen a big increase in the levels of depression, anxiety and social isolation.
“Day support services were stopped due to the pandemic. Though they have now resumed, the action group for people with learning disabilities and autism has called for action on further day support, as well as loneliness and exhaustion.
“It has never been more important to have a coordinated response to make sure we’re ensuring sufficient equality and sustainability.”
Likewise, carers are another element of the social care arena under strain, with GM chiefs struggling to identify just how many carers there are in the region.
“Carers have been playing a vital role throughout the pandemic and they have been seeing increased pressures,” said Ms Enright.
“The worrying thing about the national figures is that 55 per cent of carers are feeling overwhelmed and close to ‘burnout’.
“The position is the same in GM and we know we need to get better at finding new ways and creative ways of identifying our carers and reaching into all of our localities.
“There is a needed culture change in services in how we support and identify carers, particularly those in BAME communities.”
It’s a ‘cash flow’ problem
The grave concerns highlighted by the adult social service experts are ‘enormously stark’ and pose ‘existential threats’ for the Greater Manchester Health and Social Care Partnership (GMHSCP), said Steven Pleasant, chief executive of Tameside Council and accountable officer for Tameside and Glossop CCG.
The GMHSCP is a body which represents all the major players in the health and wellbeing of people in Greater Manchester, ensuring that different bosses talk to each other about how to improve services.
That includes services like the national and regional NHS organisations, councils, GPs, volunteers, the police and fire services.
The hurdle to answers that might solve the myriad of social services problems has been ‘cash flow’, says the Tameside boss.
“The truth of this is, I think we’ve got a sizable chunk of the answers here already. We just haven’t been able to cash flow our way through it.
“We fundamentally need to be able to fund it and cash flow it through in terms of our investment models. If we do not get onto that page quickly over the next months then actually this system will fall down and it will be more expensive than it currently is.
“Never has this been more important to me that we get this right now. What we’re seeing is a system that is spinning out of control. It’s difficult to see how we’re going to get through the winter with some of the stuff [that Bernie has said].”
‘It will cost millions – but we have to stop paying people disgraceful wages’
The health chiefs ‘have the answers’ in front of them, with some saying it is finally time to start paying up.
“The issue will be recruitment and retention going forward,” continues Ms Enright.
“A quarter of the social care workforce is over 55 – we really need to start attracting younger people to the sector.
“Our workforce has done a fantastic job throughout the pandemic, but they are exhausted.”
Ideas include the creation of an adult social care skills academy, taking low level tasks from district nurses and training home care staff and a North West recruitment campaign.
“But all of this will take time and we know it’s going to take significant funding,” says the Manchester adult social services director.
“We need to make sure the roles are attractive, with a clear career pathway and better rates of pay.”
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Rate of pay is a huge stumbling block to the kind of ‘culture change’ Greater Manchester leaders say is needed.
With ‘care workers earning £2 an hour less than supermarket workers’, wages for those looking after the most vulnerable in society have been branded ‘disgraceful’.
Although it would cost ‘millions’ to implement, one council head says pay rises ‘has to come’, slamming the ‘pittance’ that workers are expected to live off.
Interim chief executive of Oldham Council, Harry Catherall, said: “I think it’s the time now to acknowledge that the crisis in the sector of care home/home care agencies comes back to that workforce issue.
“People are being paid disgraceful wages, we can’t afford to factor into our contracts a genuine commitment to real living wage because we’re into millions per local authority area.
“But if we could and we said we have got to do it, because they deserve it – if we look at society, what we want in the future, and the demographics – it would be a massive shift forwards.
“It’s going to happen sooner or later, and why don’t we as a GM team try and take it on.
“I’m not naïve, I’m a numbers man, what this will cost. But is has got to come.
“We can’t have young kids falling out of sixth form and being expected to be in home care agencies for about six weeks on a pittance of a wage, until they realise ‘actually, I don’t want to do this’.
“We need to professionalise the service right down to that home care agency.”
What happens next?
The Oldham Council chief executive said that the millions needed to give care workers a ‘real living wage’, in order to attract and retain them in the profession, needs to be pushed by Greater Manchester health lead Sir Richard Leese.
The Integrated Care Board will run the NHS in Greater Manchester on a day-to-day basis, as well as all of the planning, and buying health and care services – known as commissioning – and the development of local plans.
“It needs someone like you and your role, Richard, to push this one. It’s going to cost a lot of money but they deserve it,” added Mr Catherall.
The Greater Manchester health lead, Sir Richard, responded that the partnership has put forward proposals which, if granted, would bring the ‘cash flow’ needed.
But, in the face of such ‘bad news’, he admitted there could be a ‘domino effect’ if the adult care system ‘falls over’.
“It’s absolutely a priority for us, if adult care falls over, the whole system will fall over, it will be a domino,” he told the meeting as it came to a close.