Cath Bowen argues that services which carers rely on need to be put on a sustainable footing
We are proud of the services provided across the Carers Trust Wales Network and their impact on carers and those that work with them. However, in order for carers services to have the most impact they need to be funded in sustainable ways that fully appreciate both the importance of innovation and the importance of funding long-term mainstream services. There is a clear and growing need for additional investment in social care across Wales with local authorities having felt the pressure of reducing budgets over many years.
Carers deserve and need care and support in their own right to enable them to live healthy and fulfilling lives alongside their caring role. This is a right given to them under the ground-breaking Social Services and Wellbeing (Wales) Act 2014 and one that won’t be fully realised if local carers services are not given sufficient funding.
Within our Network, we have had examples of closures, mergers and the cessation of services as a result of the increasing financial pressures locally. The particular challenges that have been faced are often as a result of commissioning processes that don’t sufficiently prioritise achieving the wellbeing outcomes of those they are designed to support. Whilst Regional Partnership Boards and the Social Value Fora that sit alongside them are, in theory, well placed to ensure that support needs are identified and met in innovative and creative ways – the reality is that there is still significant work to be done to make this aspiration a reality.
As employers, all of our Network Partners have seen rising salary costs in line with rises to the National Living Wage. Whilst fair and appropriate remuneration is of course important, this alongside the costs associated with training and developing the workforce has made the cost of delivering services, substantially higher. This increase in cost has not been recognised by all commissioners with many service providers themselves often facing real-terms cuts year on year.
As providers, Network Partners have experienced a range of challenges to being commissioned in a way that enables them to continue to deliver a high-quality service for carers and those they care for in a way that is sustainable.
To develop appropriate and impactful services, it is important that when service specifications are developed the third sector are engaged as equal partners in determining what support is needed and how this can best be delivered to the individual. Many of the additional benefits that can be gained as a result of providing care within the home, such as signposting to other services, providing assurance and support to the family and delivering appropriate and compassionate care are often curtailed by seemingly arbitrary limits on call times.
Within our Network we have had examples where Partners have been commissioned by Local Authorities to deliver domiciliary care at a rate that is below what it costs to deliver the service. This has resulted in some Network Partners handing contracts back with others facing significant financial difficulty as a result.
Other examples, in terms of financial disincentives to providing domiciliary care, include the cost of travel between calls in rural areas. This cost is both the pay for the care worker and the actual cost of travel which can be prohibitive in some rural areas. We have numerous examples from within our Network where Partners have had to cease providing care to those in rural or remote areas because it is not financial viable to do so under the current system.
Local authorities can and have changed their method and timing of payments, sometimes moving from in advance to in arrears. One of our Network Partners reports that if they had not had sufficient reserves to withstand a short-term shortfall because of a change in payment methods and process they would have risked closure.
As more people are choosing to live at home with increasingly complex needs, the skills required to deliver this type of care are growing. Upskilling the workforce presents challenges, both the time and cost implications of doing so, and the challenge of retaining them within the social care sector once they have been trained. Training and recruitment costs, can be significant for care providers and are often not accounted for in commissioning processes.
The regulations under the Regulation and Inspection of Social Care (Wales) Act 2016 are a welcome move towards the creation of a recognised and highly-skilled registered workforce. While our Network supports the professionalisation of the workforce, we are concerned by the potential to add pressure to the ability to recruit and retain the workforce on current terms and conditions. These measures will undoubtedly create additional costs for the sector in terms of training, administration and registration fees.
The challenges facing unpaid carers in Wales today are significant and have growing potential to impact on our public services if they are not robustly addressed. The demand on health and social care services is growing and projected to grow further still. If just a small percentage of carers stopped caring, health and social care services could easily become unsustainable.
Supporting our unpaid carers is the definition of a preventative integrated health and social care service:
- Carers provide 96% of care in the communities of Wales
- Unpaid carers contribute £8.1 billion to the Welsh economy each year (this is calculated at the cost of an hour of unpaid care being paid at the minimum wage).
Failing to address the pressures currently facing carers will undoubtedly have economic consequences. Additionally, failure to change will risk the health, wellbeing, financial security and life chances of a whole generation of carers.
We believe that for health and social care services to survive, the services carers rely on must be placed on a sustainable footing and given the tools to thrive.
This series of articles to mark Carers Week have been guest edited by Kate Cubbage.
All articles published on Click on Wales are subject to IWA’s disclaimer.