National Care Association (NCA) executive chair Nadra Ahmed OBE tackles the sector’s big issues, including Brexit, funding, recruitment and health and social care integration
These are uncertain times for the social care sector with a General Election today and Brexit looking increasingly likely to follow at the end of January.
Through her role at the NCA, Nadra has played a key part in the sector’s Brexit preparations. Talks with the government began in January when the UK was initially preparing to leave the EU at the end of March.
“We put checklists out to our members in January about being Brexit ready, contacting their suppliers and ensuring they had dried foods, and servicing for things such as lifts, chair lifts and washing machine and laundry services,” Nadra told CHP.
“Our members need to be aware where their supplies and parts are sourced. We also advised them to have conversations with their GP and pharmacists about medicines supplies and to talk to their fresh food suppliers.”
Since January, Nadra has remained in close contact with the Department of Health and Social Care (DHSC) as Brexit has been repeatedly postponed.
“We spoke about the necessity to have a strong communications strategy that would filter into every provider,” Nadra said.
Communicating with the sector as a whole has been complicated, however, by the fact that up to half of providers are not affiliated to an association.
“I am worried about the other 50% who are not with a network,” Nadra said.
“How are local authorities communicating with them?”
Talks with the government have focused on ensuring that care home providers have adequate supplies of medicines and medical products in the event of no-deal.
While welcoming moves to stockpile, Nadra said she remained concerned about how stocks would be replenished.
“We are in a situation with Brexit where the provider is on the front line so God forbid there isn’t a specific medication for residents because it will be the provider who will be facing the resident and being blamed,” Nadra said.
“We are way down the chain on this. We are not the manufacturers of drugs or the people transporting them into the country or the people prescribing them and we are not the people dispensing them.”
While Brexit’s future remains in doubt ahead of today’s General Election, Nadra said the sector was as ready as it could be for any outcome.
“I have to say there have been really constructive discussions with the DHSC,” she noted.
“They have shown considerable willingness to listen. In a county like Kent ‘no deal’ would be a massive challenge. If we have motorways at a standstill, we are going to have a real issue with people in rural areas who are reliant on domiciliary care.”
While the risks are real, Nadra said the important thing was to not alarm people, however, and to focus on finding solutions.
As well as medicines and medical products supplies, recruitment is another key area where the sector could, and to some extent already is, being impacted by Brexit.
“Providers have gone down the route of recruiting from Europe after the government closed down ways to recruit from the subcontinent and the tiering system started, even though it’s been a much harder route because initially they didn’t have English as a first language,” Nadra noted.
“Post the Brexit vote, the migrant workforce has felt they aren’t wanted.”
The NCA executive said restricting entry visas above the £30,000 level had been a cause of “major unease” for migrants, many of whom had already left the country as a result.
She said Brexit had compounded the recruitment challenges already being experienced by the sector because of its poor image and the complexities of the vote.
“We need to dispel the argument that social care is poorly paid because the introduction of the National Living Wage has equalised that argument,” Nadra said.
“You have got to be passionate about care and money isn’t the primary driver. Very often being appreciated for what you do is just as important, if not more.
“The media image of the role is so poor that we forget the value of the service our people are
“We are one of the most regulated of all the sectors with high levels of training and education and innovation and then it’s all washed away by the talk of low pay and unskilled staff.”
Nadra said inadequate local authority funding was the primary cause of the sector’s low wage culture.
“We have got to start the conversation on funding,” Nadra told CHP. “I don’t think there is a Parliamentarian at the moment who has any gumption to bring this forward because it’s such as big subject.
“Providers are getting less than £500 a week for somebody with high levels of dementia care, you are talking about less than £4 an hour.
“If LAs are ok with that then how is a provider able to move forward, how do we innovate and deliver innovation?”
Nadra was dismissive of the commonly held belief that private fee payers were cross-subsidising local authority residents.
“It’s the provider that creates the subsidy through choosing to take lower than cost fees from LAs,” she argued.
“We know there is an issue around the long term funding of social care. The people who are receiving care and support deserve to be cared for and looked after properly and the people delivering it should be treated with respect. Everything else has to follow on from that.”
The NCA chair said it was “right and proper” that care home providers had shifted towards the private market as a result of low LA fees, adding: “It is the only way to survive but the consequence is a two-tier offer, which does not feel right.
“When people get poor care, it’s generally because they can’t get the level of staffing in with the right level of training.
“We want to have a service that is first class but we are not prepared to fund it. Leaders in the services need to have the tools to create sustainable cultures.”
Nadra said adult social care would see little of the £1.5bn recently announced by the government. She pointed out that a third of this figure would come from the social care precept, which had always been the case, adding childcare services would account for the majority of the remaining £1bn.
She added that very few providers had seen a tangible benefit from the Better Care Fund.
The care leader was also downbeat about the prospects of the government reaching a long term funding solution in the foreseeable future.
“I don’t know where they are getting information about how to make social care sustainable for the future,” she said. “It’s about having a conversation that is grown up and honest and one wonders who is leading those conversations?”
Nadra highlighted that care home providers were operating essentially as healthcare providers without the government support given to the NHS due to the ageing demographic of residents and their increasingly acute care needs.
“We need to redefine the term social care because the general public think it’s a cream tea society,” she stressed.
“The reality is our customers have acute complex healthcare needs. When I started my care home business in the 1990s, we had the cream tea society. Now we have people coming in by ambulances, on drips, having had strokes. They were people who used to be looked after in long stay, geriatric wards and the NHS was funded to look after them. We are not funded to do any of that. The people we used to look after are now in sheltered housing. The shift has occurred but the money hasn’t come with it.”
The NCA boss said she was also wary of the drive towards health and social care integration.
“Integration is not going to benefit social care,” she observed. “If it was going to happen, it would have happened long before now. The problem is you are trying to bring together a service that has one master – the Secretary State of Health – with 28,000 independent providers. How is that going to work?
“If you are talking about a service that is led by the NHS that is looking to social care to deliver part of it – that’s not integration. It’s about a new way of working and that might work but if you mean bringing the two services together, I am not sure how that could happen.”
Nadra was more positive about calls to share staff resources between the NHS and social care, however.
“Workforce is one of the easiest areas to integrate,” she noted. “Training and education should be cross border with the NHS. I never understand why the NHS doesn’t offer training to social care because that would offer consistency of understanding and practice.
“We have talked in the past about people having a passport showing they have completed training in a cross border setting but we can’t even do that. That would be a fantastic first move towards consistency of service and integration.”
The NCA chief also welcomed the government’s National Recruitment Campaign which entered its second phase this year.
“I am glad to see the campaign because I think Caroline Dinenage does have a commitment towards this,” she said. “She wants to make a difference. It’s a good campaign. If younger people are starting to look at social care that’s no mean feat.”
Main picture credit: LAURENCE CAWLEY BBC