Councillors, MPs, academics and trade unions have co-authored a report into the failings of the social care industry, which they will present today (Thursday) as a roadmap to overcome the crisis which currently engulfs the sector.

The report, entitled Who Cares? Reinventing Adult Social Care: Insourcing and Restoring the Public Good will be launched today at 7pm during a webinar.

The report was prepared by a Scrutiny Panel established by the Social Care and Health Select Committee of Liverpool City Council and also includes contributions by the Foundational Economy Group; the Association for Public Service Excellence (APSE); Professor Lydia Hayes- lead researcher for Social Care Regulation at Work and University of Kent; Liverpool MPs Paula Barker and Kim Johnson; plus care workers themselves.

The report examines topics including: the experience of care workers; the financialisation of the sector; the legal framework governing adult social care; challenges and opportunities for insourcing; alternative models of service delivery; the pandemic and social care; the funding of social care and the next steps for the sector.

The report contains specific case studies and statistics relating to Liverpool City Council but the authors’ assessment of the sector and indeed its recommendations could have significant ramifications for councils up and down the country. The report was begun prior to the pandemic but its authors assess the impacts of the ongoing public health crisis on the sector, concluding that the emergency has exposed the fundamental frailty of the fragmented model of service delivery.

Scrutiny Panel Chair, Councillor Steve Munby said: “We recognised early on that the way social care is currently organised and funded was unsustainable. The pandemic has confirmed this. We need to seize the moment and start to change the whole way we deliver social care. This report sets out some of the key steps involved.”

On the topic of the pandemic, the report found stark examples of the reality for care workers and those they care for over recent months. One Liverpool home care worker said: “One of our ladies has died, suspected coronavirus. More than 12 of us have had contact with her. I have had no face mask or hand sanitiser.

I have been asking for weeks but they say I do not need it. I see 15 or 20 (service users) a day – I’m scared stiff that we’ve all got it and we’re spreading it to the clients.”

Whilst worryingly, a Liverpool based residential care worker said: “I usually buy my own hand gel because there’s never enough here but I can’t get any now so we all have to work without it.

“We were told not to wear masks because it would scare the residents but we have now had 11 deaths, which are possible COVID. Everyone is scared and stressed and then the managers are rude to us which doesn’t help.”

The report found that the commissioned model of service provision has been undermining standards of social care provision for many years but that this had been particularly clear and damaging during the pandemic. The authors argue that the fragmented social care model created real barriers to an effective public health response to the outbreak. The report goes as far as to say that: “Social care commissioning has hastened the spread of COVID-19 and resulted in unnecessary deaths of social care service users and workers.”

Whilst in their section of the report, Liverpool MPs Paula Barker and Kim Johnson also discussed the sector’s response to the emergence of the virus. Paula Barker, MP for Liverpool Wavertree said: “In April 2020, I spoke publicly about the ticking time bomb in our care home sector as a result of the pandemic.

“One of the care homes in my constituency had several residents who passed away from COVID-19 very suddenly. It was reported at this early stage that 42 of the 66 residents were exhibiting coronavirus symptoms. The care home was operating with only a quarter of its usual staff numbers and was also struggling to source agency staff.

“Successive Governments have failed to address the issue of social care. This public health crisis has shone a spotlight on a sector that has been neglected by policy makers at all levels and left to develop within the confines of an unregulated private sector.”

Whilst Kim Johnson, MP for Liverpool Riverside said: “It is unlikely that we will ever know the accurate figures for deaths in care homes or those who have died in their own homes or the total number of deaths of frontline staff working in care homes or the domiciliary care sector.

“I have received reports from constituents that domiciliary care workers were particularly badly supported. They had up to 20 visits daily to multiple homes without adequate, if any, PPE. High numbers of staff on zero hour/precarious contracts were forced to continue working when they were vulnerable or should have been shielding to support their families because £95 per week SSP was inadequate, or they were not eligible for SSP.

“There has been a disproportionate impact on Black front-line key workers who have died from COVID-19, with staff putting lives at risk because they have little option to continue working.”

Beyond the examination of the pandemic, the report takes a deep dive into the concerning financial tools utilised by large care companies to the detriment of tax payers, service users and care workers. The report also makes clear that social care was in a state of crisis long before any cases of coronavirus were discovered in the UK. All four of the biggest care-home businesses in the country have been up for sale in the past year and have failed to secure deals. Whilst at a local level, a recent report by the Association of Directors of Social Services reported that almost half of councils have seen the closure of domestic care providers in the past year and a third have seen residential care homes closed.

The report argues that the sector is experiencing market failure on a spectacular scale and that the long-term reliance on low pay and poor working conditions has led to a massive shortage of care workers. The report references an article stating that there are 122,000 current vacancies and the projected need for 580,000 additional social care workers by 2035.

Key findings:

• Insourcing can be as affordable, or even cheaper, than commissioning social care, whilst delivering better standards of employment and service.
• More funding is needed for social care but fundamental reform of the structure of the sector is needed in order to avoid this money being wasted due to the financialised nature of the largest care providers.
• Care workers employed within the private sector face unacceptable working conditions: poor pay (including lack of travel time payments and less than minimum wage sleep-in payments); long hours; casualisation; a lack of training and health and safety issues predominate, leading to a serious labour shortage.
• Care workers employed within the public sector reported better pay, terms and conditions, training and employment practices compared to their private sector counterparts. The evidence suggests a higher level of staff morale, staff retention and superior standards of care within those services directly provided by the council.
• Unacceptable quality of service delivery predominates within the private sector: call cramming; call clipping; lack of continuity of care; lack of accountability- the main home care provider in Liverpool has not been inspected by the CQC since the company’s creation a decade ago.
  
  

Key recommendations:

• Enhanced training and vocational qualifications.
• Creating a new licensing and commissioning framework with private providers building on the work of the Foundational Economy group in Wales and the Preston model.
• Establishing new companies to create a framework for new approaches including a Local Authority Trading Company to act as a service delivery vehicle.
• Direct employment of staff where contracts expire and finance allows.
• Local pilot of increased income tax in order to offer a free and enhanced service to all, putting the care sector on the same footing as the NHS.
• City Council and the Metro Mayor to approach the government to run a pilot exploring new ways of funding social care.

Improved travel for care workers and at least the real Living Wage for all care workers.