More funding from a new Prime Minister won't fix adult social care on its own. Local authorities need to rethink how they commission care, says Alice Semark, Senior Researcher at think tank Re:State.

With a new Prime Minister there comes a new promise: more money for social care. Much more money, in fact, since Burnham seems to be leaning toward a system that is genuinely free at the point of use. Plus, a Fair Pay Agreement is on the (somewhat distant) horizon.

There is no detail at all yet on what Burnham’s plans would mean in practice. But with all this, there is a risk that one simple reality is being forgotten: more money alone cannot fix the adult social care system. More money will not be a silver bullet and will not, alone, resolve the sector’s permacrisis.

Social care workforce crisis

First and foremost, not enough people want to work in care, resulting in high vacancy rates and high turnover. This means gaps in care availability; more demand on NHS services, particularly hospitals; and deep differences in care quality. It is also a huge risk to the future availability of adult social care services.

Workforce shortages are indeed partly the result of inadequate funding, which leads to low pay, unfavourable terms of employment, and poor opportunities for career progression. But shortages are also driven by how local authorities commission care.

Commissioning care

Local authorities often purchase social care services at the lowest possible price, in a sporadic and short-term way, from a large number of providers – known as ‘spot commissioning’. This is damaging for providers, the care workforce, and local authorities. It prevents providers delivering care in an efficient way and often creates financial instability. This is passed on to care workers through zero-hours contracts, last-minute notice of shifts and shift cancellations, unpaid travel time, and frustratingly inefficient shifts. For example, it is estimated that frontline homecare workers spend on average 20% of their shifts driving between visits.

It is entirely understandable, even inevitable, that these day-to-day realities make care an unappealing career for many. Why would someone want to work in care, a difficult and demanding job with a high workload and long hours, when they could earn the same (or more) with better working conditions as a delivery driver or a shop assistant?

For future-fit social care, care work must become more appealing. To this end, local authority spot commissioning and poor provider practices cannot continue. Instead, local authorities should commission care strategically, working with fewer providers on longer-term contracts.

Our latest research, Care to stay, highlights that this is already possible, in this funding reality. This is demonstrated in places like Wigan and Southwark, where local authorities have introduced cross-cutting approaches to improve care quality and workforce outcomes. In these places, strategic commissioning is a fundamental part of their approach. As a result, Southwark’s turnover and vacancy rates are markedly lower than the national or regional averages. And Wigan achieved £25m of savings in adult social care, while outcomes improved.

As well as creating greater certainty and stability for providers, enabling better working conditions for staff, strategic commissioning would enable local authorities to influence how providers deliver care.

The delivery of care is plagued by vast inefficiency. Frontline care workers spend up to 70% of their working hours on admin tasks. Meanwhile, 20% of health and social care managers spend up to 8 hours a day on admin. Not only inefficient, this is incredibly unrewarding work, contributing to poor staff wellbeing and turnover.

Technology as a transformative solution

Technology offers a transformative solution. From AI-enabled transcription tools to automated medication dispensers, new technologies are able to complete many tasks to the same or a higher standard and save hours of staff time.

Local authorities can, as an example, require providers to deliver care in a tech-enabled way in order to win local authority contracts, as seen in Wigan Council. This is a win-win-win, delivering cost savings for providers, wellbeing benefits for the workforce, and higher quality care for those drawing on services. Commissioners should see their role as influencing care delivery in this way, rather than just about purchasing services at the lowest possible price. But this is only realistic when councils are working with fewer providers.

Chronic underfunding

Of course, addressing the sector’s chronic underfunding is a matter of urgency. And if the new PM is successful in doing so, it will be transformational. But this is not the beginning and end of addressing the problems facing the adult social care sector. Workforce shortages are another ‘life-threatening’ problem for care, related to, but not entirely the result of, underfunding.

Local authorities should not wait for Westminster to fix adult social care (and, if they do, it won’t work). They must take action today to make a career in care more appealing by better enabling and supporting the workforce.