Outlook for the public sector 2023
This Collaborative NW Masterclass, led by Richard Stubbs, CEO Yorkshire & Humber AHSN, outlines how we shape the future of care with the government announcing their halving of social care workforce funding & the health service emerging from the most challenging winter of its history.
The Covid19 pandemic, political upheaval, inflation, & industrial action have led to another challenging year on the NHS frontline. In addition to these factors, Saffron Cordery, Deputy Chief Executive, NHS Providers, examines the five fault lines that continue to cripple the NHS.
- Financial: the 2010s saw longest & deepest funding squeeze in NHS history
- Capacity: increasingly mismatched to demand
- Workforce gaps: due to long-term failures of planning
- Social care: awaiting a long-term solution
- A system focused on treatment rather than wellness with enduring health inequalities
Because of this, the NHS is operating under pressure, with activity increasing but performance declining, despite huge efforts by staff. Mental health & elective care services have been some of the most affected, with children’s & young people’s care being “the forgotten group”. Untreated issues with children & young people create a massive backlog in the future as these minor cases become crisis situations down the line.
Some of the biggest challenges facing productivity in the NHS include:
- Care backlogs for elective, mental health, & community services
- Workforce shortages & workforce plan still pending
- Unresolved pay disputes & low staff morale
- High inflation continuing to impact budgets & staff cost of living
- Heightened political expectations ahead of next general election
- Public satisfaction with NHS in decline & narrative of ‘failing service’ more mainstream
However, there are also some significant opportunities!
- Trusts in systems – more collaborative leadership focus & collective ownership of challenges between ICSs & providers
- Foundations are set for a genuine focus on population health, addressing health inequalities & wider determinants of health
- More public debate about sustainability of NHS provides opportunity to show it is a sound investment with social & economic benefits
- Significant gains in elective recovery provide strong start to bring down backlogs at pace… (industrial action dependent)
John Jackson, National Care & Health Improvement Adviser Finance, Partners in Care & Health (PCH), Local Government Association (LGA) & Association of Directors of Adult Social Services (ADASS), answers the question of what adult social care is.
Adult social care, unlike health services, is not free, it is a service making sure that people can live as independently & comfortably as possible. Most older people will need support & care at some point, with most getting this from family or friends, thus most care is provided by unpaid carers. At any moment around 5% of the over 65 population get long term care organised by councils, but over half of that population will be known to social care at some point before they die.
Spending for adult social care in 21/22 came to a gross total of £26.7 billion, funded mostly by local government, the NHS Original Better Care Fund, & other public sector arrangements.
Year on year, spending on older adults has increased quicker than on older people. This reflects older people being supported in ways which do not require long-term care & the increasing complexity of needs of some younger adults. Some observers of our adult social care system question whether we should be spending more on short-term care to prevent, reduce or delay the onset of more acute care needs.
In theory, £13 billion needs to be invested into adult social care to tackle most of their challenges, with an immediate injection of £6 billion to tackle current pressures & limit their immediate & short-term impact, with a further immediate investment of £7 billion to enable adult social care to deliver its range of statutory duties under the Care Act, particularly in terms of helping prevent the onset or escalation of people’s needs, avoid admission to hospital, and – if that is required – to recover quickly & well from that experience.
In practice, Governments say that it has provided extra resources of £2.7 billion which it describes as “the biggest funding increase in history for adult social care in England”. However, it does assume a standard council tax increase of 5%. The extra money will essentially enable adult social care to stand still, but it isn’t an adequate response along the lines set out by the LGA.
The level of vacancies within adult social care is also at an all-time high since records began. This reflects the low pay in the adult social care sector – National Living Wage £10.42/hour whereas Aldi will be paying £11.40/hour from 1st July.
Anita Charlesworth, Director of Research REAL Centre at the Health Foundation, & Honorary Professor in the College of Social Sciences at the Health Services Management Centre, University of Birmingham, demonstrates that people are happier with NHS services at a local level than at a national level, but both have dropped dramatically since 2017. They do not believe that Governments have the right policies in policies in place for the NHS. Two-thirds of people also believe that services will get worse & only 10% think that there will be an improvement.
With an aging population, admission rates & stay times are set to rise dramatically, to keep up with this, we will ideally need an additional 70,000 beds, an additional 23,000 is the minimum amount to keep services going.
The average length of stay on the UK is lower than most OECD countries, & bed occupancy is much higher. Even with 70,000 extra beds we would still be quite far behind most OECD countries.
To keep up with demand, REAL Centre projections show the NHS workforce would need to grow by 262,000 – 314,000 FTE staff under our ‘central’ scenarios. At £9.50 an hour, median care worker earnings in 2021/22 were £1 per hour less than the pay of newly starting healthcare assistants in the NHS, this is a significant inhibitor for expanding the workforce in line with REAL Centre projections.
Watch the full webinar here.
