In the News
As 2023 draws to a close, so too does another punishing year for the care sector, which has been marked by escalating costs exacerbated by high inflation. Meanwhile, demographic shifts have resulted in increased demand, while workforce shortages have made recruitment even harder. These factors have further strained local councils' ability to provide adult social care effectively to those who need it. For example, Bolton Council's recent decision to trim £4 million from the city's social care budget in 2024/5 points to the pressures that current budgetary crises are applying to local governments' capacity to deliver care.
Looking ahead to 2024, we talked to three leading experts: Jon Glasby, Professor of Health and Social Care at the University of Birmingham; Richard Humphries, Senior Policy Advisor at the Health Foundation; and Martin Knapp, Professor of Health and Social Care Policy at the London School of Economics. Together, we examined the likely developments to existing challenges for the sector, as well as the effects of key events, including the much-anticipated general election.
Financial strain on local authorities
Despite falling inflation rates, all three were pessimistic about the financial outlook for the sector in 2024. Widening budgets gaps, coupled with financial mismanagement, and increasing demand for public services mean that local authority budgets are under unprecedented strain.
Glasby accepted that local councils across the country are "under pressure across all areas", but particularly in social care and children's services, which in most cases absorb the majority of council funding.
Humphries echoed these sentiments. He questioned how councils could be expected to "keep their heads above the water financially" given both the lack of long-term planning for the sector and the current cost of living crisis.
The risk of council overspending has been made all too clear recently. Both Nottingham City and Birmingham City Councils' decision to issue section 114 notices and, in effect, declare themselves bankrupt hint at an anticipated trend for 2024.
Interestingly, in Birmingham's case, provisional financial reports identified the rising demands and complexity of adult social care provision as one of the 'underlying forces' behind local council overspending both in Birmingham and across the country.
Even when councils are able to budget for the protection of adult social care, Glasby acknowledged that such decisions often come at the expense of other local investment, such as in roads, housing, libraries and community safety. Knapp pointed out that some councils have already exhausted options in trimming non-essential service budgets, and thus face "real problems" next year.
Future projections are equally sobering for the sector. A Local Government Association report anticipates a funding deficit of £8 billion for local councils by 2024, and Office of National Statistics' data has projected a 1.3 million increase in the population of over-65s by 2028. The prospect of significant supply and demand imbalances paints a concerning picture for the future of adult social care in 2024 and beyond. Glasby noted that "as well as adult social care being underfunded, it is also under-imagined."
Policymakers will always priorities funding for the NHS, especially as we approach a general election, as it garners more public interest. Consequently, as we approach a new year of election campaigning the sector will receive less attention and funding due to lower public pressure on policymakers.
Workforce challenges and the general election
Recent statistics have reinforced the importance of care visas in providing staff for the adult social care sector. In the year-ending September 2023, almost 100,000 work visas were granted to those entering direct employment in care, compromising close to one-third of all work visas granted across the period. Almost one-in-five care workers across the country are of non-British origin.
All three of the experts collectively acknowledged the importance of immigration in buttressing the UK's care workforce. But there was also agreement that much of the reliance on migrant workers in the sector was a result of an unappealing and unrewarding care home structure, that fails to attract domestic employees. Humphries argued that the country needs a sector that is "capable of attracting people form wherever" into "an attractive and fulfilling job" that offers career advancement, quality leadership and training opportunities.
Glasby also stressed the importance of how the sector is framed in the public psyche, arguing that adult social care's often negative perception was proving a hindrance in tackling the workforce crisis. While acknowledging the nature of the challenges, he argued that "being positive and energised " about the opportunities of improvement that the sector offers could go some way towards drawing more individuals into care work.
However, with the general election on the horizon, there is political appetite among policymakers to appear tough on immigration. Recently, reports have surfaced that government ministers have been considering cutting the number of care worker dependent that can arrive in the UK alongside intended employees.
Knapp warned that making work migration more difficult would be detrimental to social care provision given the value of immigration to the health care system across the country. He emphasised the importance not just of those who migrate solely to work as care assistants, but also those who enter with other valuable qualifications, such as in nursing or management that could prove an "advantage" to the care sector.
The future for adult social care in 2024
Glasby and Humphries both conceded that, thus far, many policy decisions regarding the adult social care sector have been "piecemeal", or "sticking plaster" promises.
Glasby argued for policy change on a national scale, first aimed at "propping up" the current sector, but more importantly to enable it to develop a "funding settlement with a proper plan and strategy for the long term." However, he also accepted that a longer-term solution might depend on being able to move away from a "crisis-focused, deficit-based approach" to one that builds on people's strengths, relationships and communities - boosting the natural supports that help all of us live the kind of lives we want to lead.
Humphries agreed on the same premise, suggesting that a "stabilising" injection of funding could precede specific future reform objectives.
For Kanpp, effective reform would take "brave" plans for effective social care financing, despite the theoretical unpopularity of decisions that either draw on increased taxation or the diversion of resources from elsewhere.
All three of those interviewed agreed that a long-term reform plan for adult social care must be the priority of the next government, whatever it might be, to ensure that care provision remains accessible, affordable and adapted to the needs of those who rely upon it.