Working in adult social care in Birmingham: a factsheet

Adult social care is one of the largest sectors of the Birmingham workforce and the city council’s largest area of expenditure. [Note 1]. Labour is now promoting the insourcing of council services currently provided by the private sector. [1] BATC commented on it in a recent article. [2] In this factsheet we provide some of the background facts and figures for Birmingham and England which policies to end or reduce outsourcing of Adult Social Care in Birmingham would need to take into account.

The size of the Adult Social Care workforce

According to the Skills for Care Workforce Intelligence report ‘The state of the adult social care sector and workforce in England’, October 2019, there are 1,620,000 jobs in Adult Social Care in England. If the adult social care workforce grows proportionally to the projected number of people aged 65 and over in the population then the number of adult social care jobs will increase by 36% (580,000 jobs) to around 2.2 million jobs by 2035. [3] ‘The total direct, indirect and induced contribution of adult social care sector activity in the West Midlands to the English economy was estimated to be between £3.8 billion to £4.1 billion.’ (pp2-4)

Adult social care is one of the largest sectors of the Birmingham workforce, with 29,000 jobs out of a total Birmingham workforce of 520,000 – 5.6%. That compares with 19,500 in construction – 3.8% – and is not that far short of the number of jobs in manufacturing, 38,000 – 7.3%. Adult social care makes up 17.8% – about I in 6 – of the 163,000 public sector jobs in the city. [4]

Where they work

The vast majority of jobs are in the Independent sector – 1,265,000 of the 1,620,000 jobs in England. 112,200 are local authority jobs, 145,000 are Direct Payment Recipients and 96,000 are in the NHS. [5] According to Skills for Care, [6]

…over three quarters (78%) of jobs in adult social care were with independent employers. Jobs in local authorities accounted for 7% of all jobs and adult social care jobs in the NHS accounted for 6% of the total.

The workforce employed by direct payment recipients accounted for 9% of all jobs. This estimate should be treated with some caution… (p25)

The independent sector: for-profit businesses and voluntary organisations

The independent sector mainly comprises for-profit businesses but there are also voluntary organisations. There is no data available for Birmingham but according to Skills for Care the national picture is that while ‘Jobs working for independent employers could not be accurately split into ‘private’ and ‘voluntary’ they estimate that approximately 75% of the jobs working for independent employers were in private establishments and 25% were in voluntary establishments. (pp25-6) [7]

Where they work – residential homes and domiciliary care

Most Jobs in adult social care are either in residential homes or in domiciliary care. This includes jobs in both the local authority and independent sectors as well as jobs supporting direct payment recipients. In Birmingham 12,000 work in care homes and 11,500 provide care in clients’ homes. In addition 2,700 work in community care and 850 in day care. [8]

Birmingham City Council has contracts with a total of 700 providers, comprising 434 Care Homes, 196 Supported Living, 34 Home Support (Specialist – Sensory) and 41 Home Support (Specialist – Approved Premises) (totalling 705). [9) There are 548 establishments in Birmingham regulated by the Care Quality Commission. [10]

There is a shift nationally from residential to domiciliary provision. According to the Care Quality Commission ‘the number of residential and nursing home beds has been falling steadily in all regions over the last five years, which reflects a national and local ambition to support people to remain at home for as long as possible.’ (p35). ‘As the amount of care home provision has reduced across the country, the number of domiciliary care agencies has continued to increase – by 23% in the last five years.’ (p37). [11]

Care homes

The King’s Fund reports that in England ‘for-profit providers account for 83 per cent of care home beds and the voluntary sector accounts for a further 13 per cent. The remaining 4 per cent of care home beds are run by local government or the NHS.’ (p15). [12] The report notes that

  • the largest 30 care home providers supply 30 per cent of the overall capacity, and the 80 per cent of providers running one home supply 29 per cent of care home beds
  • care homes have 40 beds on average. The average size of a care home has been gradually increasing, with the optimum size in terms of operational effectiveness considered to be around 60–70 beds (though this contrasts with the CQC finding that smaller care homes are of higher quality…).(p15)

How is adult social care in care homes funded?

The recent Which? report ‘Local authority funding for a care home’ explains the threshold for local authority support in England. [13]

Self-funders – if your savings and assets exceed the upper limit [£23,250], you will be a self-funder; in other words, you’ll have to pay for all of your own care.

Partial support – this may be available if your savings and assets fall between the lower and upper thresholds [£14,250 – £23,250]

Maximum support – the local authority may cover the full cost of care for those whose total savings and assets are below the lower threshold [£14,250 or less]

Types of funding in care homes in the West Midlands in 2019:

  • Fully self funded 21%;
  • Partly self funded 14%;
  • Fully local authority funded 48%;
  • Partly local authority and/or NHS and/or charity funded 9%;
  • Fully NHS funded 9%. [14]

According to Which? the average amount self-funders pay for a residential care home in the area of Birmingham City Council is likely to be around £702 per week, or £36,504 per year. [15]

Unpaid care

We need to remember that a great deal of adult social care is provided by unpaid carers, often family members.

Unpaid carers play a major role in adult social care but are not usually included in employment statistics and are therefore not included in the workforce estimates in this report. Latest figures, as at 2017, found there were an estimated 7 million carers in the UK and this figure is projected, by Carers UK, to increase by 3.4 million (a 60% increase) by 203012. (p24) [16]

Age UK estimates that 1.4 million older people – nearly one in seven – do not have access to all the care and support they need from either formal or informal sources, and are therefore living with an unmet need. [17]

Workforce contracts

Here are the national figures from Skills for Care: [18]

Overview of employment information of the adult social care workforce, as at 2018/19

■ The majority (91%) of the adult social care workforce were employed on permanent contracts.

■ Approximately half of the workforce (48%) worked on a full-time basis, 40% were part-time and the remaining 12% had no fixed hours.

■ Around a quarter of the workforce (24%) were on a zero-hours contract (370,000 jobs).

■ More than two in five (43%) of those working in domiciliary care services were on zero-hours contracts.

■ The proportion of zero-hours contracts is highest amongst care workers (35%).

The workforce in Birmingham

Data about Birmingham from Skills for Care Workforce Intelligence, ‘The state of the adult social care sector and workforce in England’, October 2019: [18]

  • 80% of workers are female, 20% male.
  • 53% are White, 47% BAME.
  • 81% have British nationality, 6% EU, 13% non-EU.
  • 59% had a qualification relevant to social care.
  • The average hourly rate for jobs in the local authority sector in September 2017 was £14.13, compared to £8.75 in the independent sector in March 2018.
  • On average, pay in the local authority was £6.63 higher than the National Living Wage (£7.50).
  • On average, pay in the independent sector was £1.25 higher than the National Living Wage.
  • 49% of jobs were full-time, 37% part-time, neither 14%.
  • 26% of workers were employed on zero-hours contracts (or 7,100 jobs)
  • The turnover rate in 2017/18 was 34.8% (or 8,700 leavers).
  • The vacancy rate in 2017/18 was 5.7% (or 1,500 jobs).
  • Around 63% of leavers remained within the sector.

The CQC report speaks of concerns about

care homes being inadequately staffed to safely support and care for the people living in them. Care workers have told us they were working chaotic and unorganised shift patterns, at times without breaks, causing many to feel dissatisfied, stressed and undervalued in their caring role. A similar picture has been given in domiciliary care services, with feedback about managers taking on new care packages at times when care workers’ existing rotas were already too challenging for them to manage safely. We have heard of situations being made worse when care workers have decided to leave and were not replaced, or were replaced by inexperienced or unskilled staff. [19]

David Brindle, the Guardian’s public services editor, reports that ‘Homecare agencies are at breaking point. Reform is long overdue’:

Care agencies say they cannot improve workers’ pay and conditions, and improve turnover, because most councils do not pay them enough to do so. The UK Homecare Association (UKHA), which represents the sector, says only one in seven councils pays care providers a contract price that is enough to run a sustainable business and meet minimum wage obligations: a price it puts at £18.93 an hour, allowing for 55p profit. [20]

He reports that Walsall Council has started paying for home care by the minute.

The quality of provision

The Care Quality Commission rates the quality of adult social care by region. [21]  Provision in the West Midlands is rated Good 80%, Requires improvement 16%. However, David Brindle points out that

Although the Care Quality Commission rates 82% of agencies in England as “good”, and a further 4% “outstanding”, there is widespread anecdotal evidence of rushed or missed visits and a constant churn of care workers. According to official estimates, 50% of the domiciliary workforce is on zero-hours contracts and annual staff turnover is 44%, with one in 10 jobs unfilled at any one time. [22]

The crisis of funding in Adult Social Care

All the reports on Adult Social Care Funding highlight the devastating effects of the funding crisis caused by cuts in government and local authority funding, exacerbated by the increase in demand. This analysis by the Care Quality Commission is typical:

In last year’s State of Care report, we highlighted issues with funding in adult social care, saying that “a sustainable financial plan for adult social care will be an important element of the forthcoming social care green paper”. The green paper has still not been published and pressures caused by funding and workforce issues are affecting people’s ability to access services. (p20)

An Institute for Fiscal Studies report found that overall spending by local authorities on adult social care fell by 5% from 2009/10 to 2017/18.32 The government’s response to funding pressures was to give local authorities access to around £10 billion dedicated to adult social care over the period 2017/18 to 2019/20, with further funding announced in the 2019 Spending Round. The 2017-20 funding was welcomed, but the Local Government Association described it as a short term measure for tackling issues, such as easing winter pressures on the NHS. Analysis by the Health Foundation forecasts that, without additional funding, the money available for adult social care will rise at an annual average rate of 1.4% a year from 2017/18 to 2023/24.34 They point out that this is lower than the 3.4% a year the government has committed to the NHS and the rising demand of 3.6% a year. (p39-40)  [23]

Richard Hatcher

Birmingham Against the Cuts

29 October 2019

All comments, corrections and additions welcome. Contact: Richard Hatcher@bcu.ac.uk

Note 1

Birmingham Council spending on Adult Social Care

Social care is the Council’s biggest expenditure. According to the minutes of the Health and Social Care Overview and Scrutiny Committee meeting on 20 November 2018 the Report of the Cabinet Member for Health & Social Care states that:

The total budget in 2018/19 for the portfolio is £336.1m. […]

  • 59% of the net total budget is allocated to external packages of care.
  • 9% is spent on specialist care services.
  • 11% is spent on assessment and support planning (Social Work).
  • 7% of the budget is spent on Supporting People.
  • 14% is spent on commissioning and other services.

So 59% of the net total budget for the portfolio is allocated to ‘external packages of care’. That is about £200m – not far short of a quarter of the whole controllable Council budget of £855m. What are these ‘external packages of care’? The Cabinet member’s report doesn’t say. But what is being referred to here is what the Council spends in the local social care market. This may also include some, perhaps most, of the other 41% of the total budget. It can be assumed that the large majority, if not all, of the ‘external packages of care’ refers to contracts with providers of care homes and supported living. [24}

References

  1. The Labour Party (2019) Democratising Local Public Services: A Plan for Twenty-First Century Insourcing. http://labour.org.uk/wp-content/uploads/2019/07/Democratising-Local-Public-Services.pdf .
  2. ‘What Labour’s new policy document on insourcing public services should say about social care and participatory democracy’, Birmingham Against the Cuts, 4 September 2019. https://birminghamagainstthecuts.wordpress.com/2019/09/04/what-labours-new-policy-document-on-insourcing-public-services-should-say-about-social-care-and-participatory-democracy/
  3. Skills for Care Workforce Intelligence. ‘The state of the adult social care sector and workforce in England’, October 2019. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/The-size-and-structure-of-the-adult-social-care-sector-and-workforce-in-England.aspx
  4. Birmingham City Council. ‘Workplace Employment in Birmingham and its Constituencies 2018’. https://www.birmingham.gov.uk/downloads/file/2863/workplace_employment_2018
  5. Skills for Care Workforce Intelligence. ‘The state of the adult social care sector and workforce in England’, October 2019.
  6. Skills for Care. ‘The size and structure of the adult social care sector and workforce in England’, 2019. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/Size-of-the-adult-social-care-sector/Size-and-Structure-2019.pdf
  7. Skills for Care. ‘The size and structure of the adult social care sector and workforce in England’, 2019.
  8. Skills for Care Workforce Intelligence. https://public.tableau.com/profile/skills.for.care.workforce.intelligence#!/vizhome/MyLocalAuthorityarea/Homepage
  9. Birmingham City Council website ‘Care Homes and Supported Living 2018’. https://www.birmingham.gov.uk/directory/55/care_homes_home_support_and_supported_living/category/1069. See also ‘Birmingham Care Services Directory 2019’. https://www.carechoices.co.uk/publication/birmingham-care-services-directory/
  10. Skills for Care Workforce Intelligence. https://public.tableau.com/profile/skills.for.care.workforce.intelligence#!/vizhome/MyLocalAuthorityarea/Homepage
  11. Care Quality Commission. ‘The state of health care and adult social care in England 2018/19’ October 2019. https://www.cqc.org.uk/sites/default/files/20191015b_stateofcare1819_fullreport.pdf
  12. The King’s Fund. ‘Key challenges facing the adult social care sector in England., September 2018.
  13. Which?. ‘Local authority funding for a care home’. https://www.which.co.uk/later-life-care/financing-care/care-home-finance/local-authority-funding-for-a-care-home-arxsk9l8qzzr
  14. Care Quality Commission. ‘The state of health care and adult social care in England 2018/19’, p36.
  15. Which? https://www.which.co.uk/later-life-care/financing-care/cost-of-care-and-eligibility-checker/
  16. Skills for Care Workforce Intelligence. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/Workforce-estimates.aspx
  17. Age UK. ‘Briefing: Health and Care of Older People in England 2019’. https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health–wellbeing/age_uk_briefing_state_of_health_and_care_of_older_people_july2019.pdf
  18. Skills for Care Workforce Intelligence. ‘The state of the adult social care sector and workforce in England’, October 2019.
  19. Care Quality Commission. ‘The state of health care and adult social care in England 2018/19’, p40.
  20. David Brindle, Guardian 22 October 2019. https://www.theguardian.com/society/2019/oct/22/homecare-agencies-breaking-point-reform-fix-care-system
  21. Care Quality Commission. ‘The state of health care and adult social care in England 2018/19’,
  22. Care Quality Commission. ‘The state of health care and adult social care in England 2018/19’. See also The King’s Fund, ‘Key challenges facing the adult social care sector in England’. September 2018. https://www.kingsfund.org.uk/sites/default/files/2018-12/Key-challenges-facing-the-adult-social-care-sector-in-England.pdf
  23. From ‘What Labour’s new policy document on insourcing public services should say about social care and participatory democracy’, Birmingham Against the Cuts, 4 September 2019.
  24. ‘What Labour’s new policy document on insourcing public services should say about social care and participatory democracy’, Birmingham Against the Cuts, 4 September 2019.
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