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Articles by Simon Bottery
'Social care buy-in for fair pay plan at risk after Budget tax hike'
By Simon Bottery, King’s Fund On the day before the Budget, I held a round table with social care leaders on the government’s ambition for a ‘fair pay agreement’ to raise care worker pay. This would involve creating a negotiating body, bringing together care providers and unions, to agree higher wages and better terms and conditions for care staff. “Will the plans happen?”, I asked. The sector leaders were largely positive that they would.
Simon Bottery: Don’t look at social care workforce through lens of immigration
A broader package of reforms is needed to give us the social system we need, writes the senior fellow, social care, at the King’s Fund. The recent report from The Centre for Policy Studies was clear and unequivocal: care workers need a pay rise. However, the subject of the report was not in fact social care but immigration: the pay rise was needed, it said, to prevent the need to recruit staff from overseas.
Is a ‘National Care Service’ what we can expect from the next Labour government?
There are good reasons why we should take seriously the new report from The Fabian Society on reform of adult social care. Firstly, it was commissioned by Wes Streeting, who – if polls are taken at face value – stands a good chance of being the next secretary of state for health and social care. Second, it comes at a time when there is a market for new social care ideas, given repeated failures to get reforms focused around the introduction of a cap on care costs over the line.
Immigration will not fix social care’s workforce crisis
Immigration is helping alleviate the recruitment crisis in adult social care but the government needs to find a longer-term solution, writes Simon Bottery, senior fellow, social care, at the King’s Fund. Last week’s figures showing an increase in net migration to the UK helped shine a light on how the government has turned to immigration to solve the recruitment crisis in adult social care. In 2021-22, adult social care saw its , with 165,000 vacancies.
Making independent living a reality for disabled people
I first found myself in need of support (care) in 1984 when my partner of 20 years left me. The local authority, despite being informed of my needs, rang two days before he left to tell me they had no idea how to support me. Initially, I received two 20-minute visits from a home help and in the evening a friend help me into bed. After about six months my friend’s support ended, so a home carer came in the morning to get me up and a district nurse in the evening.
Reflecting on 75 years of social care
Report The rise and decline of the NHS in England 2000–20: How political failure led to the crisis in the NHS and social care Multi-year funding increases and reforms led to improvements in NHS performance between 2000 and 2010, but performance has declined since 2010 as a result of much lower funding increases, limited funds for capital investment, and neglect of workforce planning.
Odds stacked against it: how social care struggles to compete with supermarkets on pay
What, though, is the extent of that competition? To find out, we looked at the minimum rates paid to their staff by the 10 biggest supermarkets in June 2022 and compared them to the rate paid to care workers in the independent sector (which employs the vast majority of care workers, around 790,000 in total). The results are chastening, if not surprising. For social care, the minimum rate for staff over the age of 23 in June 2022 was £9.50 – the statutory minimum set by the national living wage.
Reform of adult social care: some progress, but nowhere near enough
Overall, the government has gone further than previous administrations with its reform of the means test and introduction of a cap on social care costs. However, the small print behind the cap leaves a bitter taste in the mouth. Elsewhere reforms are either smaller scale or it is too early to judge their impact. Finally, there is almost total failure to address the twin issues of wider unmet need and the workforce, problems identified by the public in the recent British Social Attitudes survey.
Simon Bottery: New data shows adult social care not ‘fixed’
An analysis of key trends in adult social care confirms wider reform of the sector remains an urgent priority, writes a senior fellow at The King’s Fund. Analysis of local authority social care data from 2020-21 – covering both the first and second waves of Covid-19 – reveals two puzzles, as well as illustrating yet again the range and scale of the problems facing the sector.
Key facts and figures about adult social care
What is social care? How many people deliver social care? How much does social care cost individuals and the state? Our press and public affairs team, library service and policy experts deal with hundreds of enquiries every year. Below are our answers to some key questions that have been frequently or recently posed to us. If you’ve got a question, get in touch with us. What...? What is adult social care?
Will COVID be the catalyst for change?
By Simon Bottery | 30 March 2021 There was a brief moment in early March when the Government seemed to have delayed still further its plans for social care reform. In two separate documents it talked about bringing forward plans ‘next year’ rather than ‘this year’, as it had promised. But it was cock-up rather than conspiracy: the documents were drafted in 2020, ‘next year’ meant ‘this year’, and we can still – it seems – expect reform proposals in 2021.
How Covid-19 has magnified some of social care’s key problems
Last year we listed the key problems as: means testing: social care is not free at point of use like the NHS catastrophic costs: some people end up paying large amounts and even selling their homes to pay for care unmet need: many people go without the care and support they need quality of care: a wide spectrum of concerns, from 15-minute care visits to neglect and lack of choice and control workforce pay and conditions: staff are underpaid, leading to high vacancy rates and turnover market...
Simon Bottery: Why social care needs to give knee-jerk reactions the elbow
In a week that has seen strong reaction to reports the government wants the NHS to take over social care, a senior fellow at the King’s Fund writes that compromises will be needed to solve the sector’s problems.
Tackling the Covid-19 outbreak in care homes
Staff working in care homes have played a key role in the response to Covid-19. Care homes have opened their doors to rapid admissions from both the community and hospitals, and staff have worked hard to understand residents’ wishes and to ensure that care plans respect these. Staff have gone above and beyond in caring for residents and have, in many instances, learned new competencies and skills to do so.
Social care can’t cope alone with the cost of the living wage
Staff costs are the single largest outgoing cost for care businesses. The UK Home Care Association estimates that gross care worker pay accounts for just over half of the cost of running a viable homecare business. Pension, National Insurance and other wage-dependent costs add a further 14 per cent, bringing the total linked to basic pay to around two thirds of total costs.
We can't go on like this
The government's 'big care debate' on how we pay for an ageing population – in part designed to wean us off an uncritical reliance on general taxation as the solution to all funding problems – concluded in 2009. As the parliamentary passage of the Personal Care at Home Bill draws to a close, it seems likely that from next October those with the highest needs should get their care at home (but not in care homes) for free.
Looking ahead to 2020
The early months of the year will see some important stakes in the ground. First, it’s hard to understate the importance of the long-awaited People Plan, key as it is to confronting the current workforce crisis in health (but not social care, unfortunately). The same timeframe will see whether we keep Matt Hancock as Secretary of State for Health and Social Care in the upcoming reshuffle.
Quality in social care
Inevitably, it is not quite that simple. As we have noted previously, carers report less satisfaction with the services received by themselves and the person they care for (38.6 per cent were extremely or very satisfied in 2018/19) and in 2019, the Local Government Ombudsman said that, while the number of complaints about social care was level, the type of complaints were ‘ever more serious’.
Why are we still waiting for solutions to the problems of social care?
Five years later, there has been no adequate government response to these issues, and no real debate about entitlements and funding. In late 2017, when I was asked to become a member of an advisory group for a Green Paper on social care, my hopes were briefly high that, at last, there would be serious efforts to tackle this difficult problem. But now it’s late 2019 and no Green Paper has appeared, despite extensive and useful discussions.
International recruitment in adult social care
Blog Party conference season: the key announcements on health and social care As this year’s party conference season comes to a close, what have we learned about the main parties’ priorities for health and social care? Richard Murray weighs up the key commitments, from funding and the NHS workforce to social care reform. By Richard Murray - 4 October 2019
Average pay for care workers
Each year Skills for Care publishes a report on The state of the adult social care sector and workforce in England, in which the scale of the recruitment and retention challenges are laid out. The report also tells us about care worker pay, which, with the introduction of the national living wage, has seen noticeable improvement over the past seven years: from an average of £6.78 an hour in September 2012 to £7.89 in March 2018. However, this increase hides a less cheerful picture.
Adult social care funding and eligibility
Unlike most of the NHS, publicly funded adult social care is not free at the point of use. Instead access is restricted to those with the highest needs and lowest assets. Complicated rules to determine eligibility for publicly funded services create a complex system that is difficult to understand. Social care also differs from the NHS in that it is run by local authorities, who typically commission private sector companies or voluntary sector organisations to provide services.
Social care funding reform:
So you might think that I would be delighted to see the new Prime Minister commit to ‘fixing the social care crisis’, and at breakneck speed, with a White Paper ‘within weeks’. But quite the opposite, I fear that racing out of the starting blocks will mean the policy is destined to fail.
Is personalisation within adult social care stalling?
Photo: airdone/Fotolia By Simon Bottery What has been the biggest success story for local government during nearly 10 years of austerity? If we take the figures in the King’s Fund’s Social Care 360 report released at the end of April at face value, a candidate might be the continuing high levels of satisfaction expressed by users of adult social care services.
The King's Fund responds to the announcement that Four Seasons Health Care has gone in to administration
Commenting on the announcement that one of Britain’s largest care home groups, Four Seasons Health Care, has gone in to administration, Simon Bottery, Senior Fellow at The King’s Fund, said: ‘Today’s announcement will be worrying for the 17,000 Four Seasons residents and their families, though it is important to recognise there is no immediate threat to the operation of Four Seasons’ care homes.
Social care 360
Key social care trends in England in 2021/22 showed signs of a return to the situation before Covid-19. Most importantly, the number of new requests to local authorities for support (indicator 1, requests for support) increased, but the number of people receiving publicly funded care fell (indicator 2, service delivery). This had been the case until 2020/21 but then, due to Covid-19, the number of new requests from older people fell sharply. Requests have now returned to pre-Covid levels.
More people asking for social care support but fewer getting it as demand leaves social care system at crisis point
Rising disability among working-age adults and a growth in the number of people over 65 is putting rising pressure on the adult social care system in England, with more people requesting care but fewer people receiving it. New analysis from The King’s Fund shows that the proportion of working-age adults approaching local authorities for support has risen by 4 per cent – over 23,000 people – since 2015/16.
The longer-term solution to home care's problems requires more than money
By Simon Bottery | 21 December 2018 The decline and fall of Allied Healthcare has not been the disaster that some feared. Councils moved quickly to transfer services and, at time of writing, there have been few reported problems in finding new providers. Some have gone to a reborn Allied (under new ownership), some to other providers and some may be taken in house. Optimists will see that as triumph of the market’s ability to swallow weak companies and emerge stronger.
The King's Fund responds to new figures from NHS Digital on adult social care
Responding to new figures from NHS Digital on adult social care in England, Simon Bottery, Senior Fellow at The King’s Fund, said: 'These figures show a social care system struggling to cope with the increased pressures placed upon it, as councils battle with increasing need from older people and people with disabilities and inadequate levels of funding. 'More people are asking for help but fewer people are getting it.
A potential red herring in the social care Green Paper
The idea of an opt-out is a classic ‘nudge’ approach and its nearest model is pension auto-enrolment, which has been a significant success since its introduction in 2012. Hancock is keen for the idea to be included in the forthcoming Green Paper on social care, due sometime this autumn, and you can see why it appears attractive: if it worked, it would bring new private funding into social care and reduce the need for extra government money.
Solving the puzzle of social care: the time for action is now
The nature of the puzzle can be described simply. The costs of social care are often unexpected and sometimes catastrophic. The private insurance market has failed to offer products to enable people to protect themselves from these costs and successive governments have chosen not to tackle this market failure. The complexity of current arrangements and different entitlements to health and social care also create confusion for people requiring support.
A fork in the road
Current funding pressures There has been concern about the system of publicly funded social care in England for more than 20 years. The report finds that additional revenue will need to be raised for adult social care services even without a major change in the model of delivery. Social care is facing high growth in demand, which is projected to rise by around £12 billion by 2030/31, growing at an average rate of 3.7 per cent a year.
Reforming social care is about more than funding
Let’s take a look at those areas. Demand management, although not mentioned by the Secretary of State, is critical. The Green Paper should recognise that while need for social care is growing, there is an opportunity to influence the size of that need and the extent to which it leads to demand for formal social care services. There are at least two critical questions the Green Paper needs to answer: Market sustainability relates to whether the current, market-based, system can meet future demand.
Why implementation is a barrier to care funding reforms
In our new report with the Health Foundation, we consider five key approaches often raised in discussions about funding social care – improving the current system, the 2017 General Election Conservative proposals, a single budget for health and care, free personal care (as in Scotland) and a hypothecated tax. We consider all five against a range of attributes from equity and fairness to, perhaps unusually, the challenge of implementing any change.
Approaches to social care funding
It is widely accepted that the system for funding social care is in urgent need of reform. Faced with shrinking budgets, local authorities are struggling to meet the growing demand for care, linked to increasing complexity in need and an ageing population. As a result, the number of older people receiving publicly funded social care has declined.
The road ahead for the social care consultation
Inevitably the answer is: it depends. There are risks around process, content and implementation. These risks are not insurmountable but neither can they be ignored. In terms of process, there is a risk that the momentum that had been building behind the green paper – slow though it was – will be lost. The last thing that is needed is a further delay. It will also be important to keep together the nucleus of the experienced team that had originally been assembled to produce the green paper.
Andrew Burns: Hammond must devolve business rates
Will the chancellor’s Budget on 22 November contain any positive news for the public finances and local government? Whilst much rhetoric is suggesting austerity is over (or rather, the public is tired of that narrative) the chancellor will no doubt emphasise that we will still need to live within our means and a growing economy is needed to generate the tax revenues to fund public services.
Mapped: council performance against DTOC targets
In July this year councils were set targets to significantly reduce delayed transfers of care attributable to social care in their area by September, against a February baseline. Failure to meet these targets could result in councils losing control over some of their better care fund cash. DTOC performance data was published by NHS England last week. Using analysis of the data by Impower, LGC has mapped council performance (hover over council area for full details).
Andrew Burns: Hammond could solve short-term finance woes with business rates move
Will the chancellor’s Budget on 22 November contain any positive news for the public finances and local government? Whilst much rhetoric is suggesting austerity is over (or rather, the public is tired of that narrative) the chancellor will no doubt emphasise that we will still need to live within our means and a growing economy is needed to generate the tax revenues to fund public services.
Simon Bottery: Hammond must create an ‘OBR for health and care’
Paul Tilsley (Lib Dem), the former deputy leader of Birmingham City Council, has a saying: “There are three types of people in the world: those born in Birmingham, those that moved here and those with no ambition at all.”
Simon Bottery: Bullying and stoking fights will not help to cut DTOCs
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Age-related dependency needs policy and long-term planning
This is positive news, and while we should avoid the ageist language of catastrophe – ‘grey tsunami’, ‘ticking demographic time bomb’, etc – we mustn’t duck the reality of planning future health provision and services to meet the needs of this ageing population. If we live long enough, most of us will need care and support in some form. A rapid rise in the overall numbers living with dementia and frailty – when people live with lower reserve and resilience – is inevitable.
What is social care and how does it work?
Data visualisation Social care in a nutshell Currently, unlike NHS services, social care is not free at the point of use. Find out who is eligible for publicly funded social care, how many people have requested support, and how many people's needs are not being met.
Older people
Blog Improving hospital discharge and intermediate care for older people Healthwatch England's recent report, Safely home, described in harrowing detail the personal stories of patients who felt that their discharge from hospital was unsupported. It also described patients marooned in acute beds unable to move on. So how can older people's care be improved?
Overcoming the challenges to improve health and wellbeing in care homes
Currently there are more than 400,000 people living in care homes in the United Kingdom. That’s around three times the number of hospital beds. The umbrella term ‘care homes’ covers a very diverse range of places, including those classified as nursing or residential, whether specially designed and staffed for people with dementia, mental health needs or complex physical or learning disabilities.
Social care for older people
I really find it difficult to start my response: firstly we all pay National Insurance, based on our earning, those not in employment have their State Pension protected, however their are many 'working poor' who cannot survive' without visiting 'food banks' and 'handouts' from friends and family: to actually have a further 'compulsory' deduction from your already low wage, will have serious consequences.
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