Our care system should be enabling people to live fulfilling lives, but each week brings new evidence that Britain’s social care system is unable to deliver this.
Huge numbers of people are struggling to access support. The majority of people who deal with care services are unsatisfied with them. And the number of vacant posts in adult social care is the highest since records began in 2012-13, with about 165,000 vacancies in England on any given day.
Many had hoped that the pandemic would become a positive turning point for care, as its importance was more widely recognised and government boosted funding. What went wrong?
New research sheds light on how much extra money went into care homes during the pandemic, and how it was spent. The government scrambled to pump money into the sector, but to a large extent, staff often kept the services going at a cost to their own wellbeing and without extra financial reward. The research also reveals that workers fared differently in for-profit care companies compared with not-for-profit organisations. These insights hold important lessons for the future of care.
Care homes for older people in the UK received extra public support worth £2.1bn in the first year of the pandemic – about £5,900 for every individual care home place. Services needed support to help cover the huge costs of Covid-19. They received free PPE, money to cover sick pay for staff required to isolate, and subsidies for empty rooms as residents died and new admissions were suspended during outbreaks.
This emergency funding did succeed in propping up care home revenues in the early phase of the pandemic. Remarkably, revenues actually rose in the majority of homes in the first year of Covid, even though the sector was caring for fewer people. In private care homes, our analysis shows that profits increased by £117m.
But alongside the extra funding, care homes were also sustained by the efforts of their workforce: they kept services going amid extreme pressures and hazards. Amid all the clapping for carers, this could have been the moment to raise wages and improve conditions for one of the economy’s lowest-paid sectors.
However, only a small proportion of the emergency funding was spent on directly supporting care staff. The government funded full sick pay for Covid across the UK and, for some of the care home workforce, “recognition payments” of a few hundred pounds. These were important but modest improvements. Yet in our survey of more than 600 staff, two-thirds said extra funding for their employer did not benefit them. Most reported working much harder without an increase in pay, and often doing unpaid overtime.
And, disturbingly, more than 40% reported that they had experienced personal financial problems linked to working in care during the pandemic. There was a range of reasons. Some had their hours cut if their home had fewer residents. When care staff caught Covid, employers didn’t always offer full sick pay, despite government support for the cost. They also lost earnings if they had to take time off to care for family members with the virus. In contrast, there was an unexpected jump in pay-outs to investors in the first year of the pandemic. Dividends from 122 care companies rose by 11%.
To date, the UK government hasn’t been interested in the business models of care homes. But there is mounting evidence that ownership matters. Staff in for-profit care homes reported greater increases in their workload and working hours during the pandemic. They were less satisfied with their sick pay and the support available to them. These differences could be because some companies are paying out significant portions of their revenue to investors, landlords and creditors, rather than reinvesting in the service. And although there are many committed managers in private care homes, not-for-profits were less likely to cut spending on staff during the pandemic. This suggests they may be offering more secure contracts and pursuing different priorities.
With pandemic funding now withdrawn, care homes are struggling to recover amid labour shortages and high energy costs. When more public money is injected to cope with these challenges, a future pandemic or other economic shock, it must go to the right uses. To make sure that happens, the government needs to get a grip on the finances of care homes.
That means greater transparency on how companies split their income between staffing, facilities, rent, debt repayments and profit. Decision makers should seek to promote forms of provision that offer both good quality care and good quality jobs, and take account of the evidence that shows varying outcomes by ownership type. All of this could guide a new framework for emergency public support for private care home companies, so that individual residents and the public purse aren’t left subsidising extraordinary returns to investors. Bailing out companies, without protecting care staff from burnout, is no way to care for the sector.
Amy Horton is a lecturer at University College London and researcher for Financial Impacts of Covid on Care Homes