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After COVID: the future of care

The coronavirus crisis has highlighted the importance of care and extra-care housing. But once the pandemic ends, what will the future hold for the under-valued sector? Sian Norris finds out

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Care workers have continued with home visits during the pandemic (Picture: Getty)
Care workers have continued with home visits during the pandemic (Picture: Getty)
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The coronavirus crisis has highlighted the importance of care and extra-care housing. But once the pandemic ends, what will the future hold for the under-valued sector? #ukhousing

Politicians have been fond of using war metaphors to describe the ‘battle’ against COVID-19 this year. The bombast of some of these statements may not always have been helpful, but if the pandemic has been a war, there is no doubt that the care sector has been right on the frontline.

At the time of writing, the first doses of vaccines were about to be distributed, with care staff and residents at the top of the priority list. However, while the sector is very much in the thick of fighting coronavirus, it has already started looking ahead to what comes next and how care can survive the pressures that have been put on it. Inside Housing spoke to housing providers with care arms to find out what their thinking is.

The real challenges facing care providers during the coronavirus crisis and afterwards can be summed up in two words: ‘funding’ and ‘staffing’.

The pandemic has been expensive for providers of care and extra-care housing. A combination of lost revenue from suspended lettings, beds and apartments standing empty and the need for personal protective equipment (PPE) have led to costs adding up.

In Wales, Edward Hughes, executive director of care and support at ClwydAlyn, says the past nine months have seen his housing association’s care arm “incurring quite a few additional costs in order to keep residents and staff safe”.

“Additionally, admissions into the homes have been delayed due to COVID-19, which have added greater pressures. We have carried more void beds than normal. If you are carrying a void bed for three or four months, that’s thousands of pounds in lost income,” he says.


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Mr Hughes believes the pandemic highlighted “what a great job the care sector does, but also that it has been undervalued for some time”.

“The government needs to be funding the care sector properly and better,” he adds. “The funding you get from local authority-funded placements within care is not enough to cover the costs of the service. You are reliant on trying to top that up with private payers. It does make it very difficult.”

Local authorities provide different levels of funding for care, resulting in a postcode lottery that disregards the actual costs of running a service.

Mr Hughes says: “There’s a really big disparity in some local authorities’ fee rates.”

Mr Hughes is confident that the demand for extra-care housing will continue in the future. “Extra care has increased in popularity in recent times,” he explains. “You have the independence of your own home, with the security of on-site care should you need it.”

He is more concerned that the care arm of ClwydAlyn and the wider sector will suffer due to a combination of increasing costs and not knowing how long the impact of COVID-19 will last.

The future of funding, particularly for staff costs, is also a cause for concern for Mark Carter, director of care and support at Hightown, which provides support for vulnerable adults across 7,000 homes.

Advert for homecare staff outside an Essex employment agency during the pandemic (Picture: Alamy)
Advert for homecare staff outside an Essex employment agency during the pandemic (Picture: Alamy)

Like much of the care sector, Hightown had a large number of staff vacancies before the pandemic. According to analysis from The King’s Fund, there were 122,000 unfilled vacancies across social care before March 2020. Hightown has been able to attract more staff as people were made redundant from struggling sectors, such as hospitality. As Mr Carter explains, the care sector offers stability, because “come what may, it’s evident that you’ve still got to care for people”.

But a combination of low pay and a real-terms decrease in local authority funding means it is uncertain whether those staffing levels will continue. There is concern that, should the economy restabilise in 2021, with people returning to better paid jobs in hospitality or retail, the care sector “might lose a lot of people again and that would be upsetting to see”, says Mr Carter.

While ever more people need care and support, employment growth in the sector has stalled since 2014, with care workers’ pay increasing at a slower rate than for workers in other industries.

Mr Carter says: “Pandemic aside, there’s been a long-running scaling back of budgets and finances over the past seven years or so. The money available to commissioners, county councils and local authorities for housing providers with a care arm has not kept pace in any way with the national minimum wage.”

This is causing a squeeze: the need for care has increased, the number of vacancies has increased, but wages and available funding have failed to match this.

“It’s very hard to recruit at the level of funding we have,” Mr Carter says. “We did have high vacancies until the pandemic hit and we could easily go back to that.”

Mr Carter recognises and is grateful for additional funding made available by the Treasury to help Hightown and other care providers through the pandemic. But the future remains uncertain.

He says: “There’s no confidence whatsoever that there is going to be that money next year. We are going to get really squeezed if the national minimum wage increases but care funding doesn’t.”

Rebranding extra care

As well as the financial pressures facing care, the pandemic has prompted soul searching on a deeper level about what care offers and what it should be called. Paul Mullane, director of development and growth at Halton Housing, recently sparked debate by arguing for scrapping the term ‘extra care’ in an opinion piece for Inside Housing.

Mr Mullane argues that the term, which describes housing for older or vulnerable people who live independently with access to on-site care, should be replaced with ‘independent living’, claiming residents no longer liked the word ‘care’ as a result of the pandemic.

But people’s responses to extra-care housing during the pandemic have been “the complete opposite”, says Mr Peach at Housing 21.

Since lettings reopened after the first lockdown, Housing 21 has seen more demand for extra care as “an alternative to residential care”, says Mr Peach. Rather than the pandemic turning people away from extra-care housing, Mr Peach believes the crisis has shown that “care has never been more important. If anything, coronavirus has probably strengthened the importance of extra-care housing”.

“We have people living in our extra-care facilities that have care needs, and that’s important to them,” Mr Peach explains. “It’s important for people to see that we can respond to their care needs too, as well as the housing offer.”

Care is not a word “we should shy away from”, he adds.

The concerns about funding for care reflect, according to Kris Peach, executive director of extra care at Housing 21, how “social care was seen as slightly second class to health”. It is a sentiment Mr Carter agrees with. He argues that it is a question of “how we value the skills and empathy required for social care work”.

“Most of us look at what care assistants do and say we couldn’t do it ourselves, but as a society we need to be willing to back that up financially.”

Graeme Hall, director of rented housing at Anchor Hanover, echoes Mr Peach’s comments, arguing that “the pandemic has demonstrated more forcefully than ever the huge benefits of specialist retirement housing”.

Mr Peach is optimistic, however, that COVID-19 will prove to be a turning point. He hopes it will mean the care his and other housing associations provide is better valued – and that includes extra-care housing.

“The importance of care has shone through in this pandemic and it’s shown we can’t live without care,” he says. “It’s such an important part of people’s lives. There will always be people who can’t afford to pay for their own care, so we have to make sure we get behind the sector and fund it properly.”

Mr Hall shares Mr Peach’s optimism. “It is encouraging to see a stronger focus from central government on the pivotal role that care and housing have played and will continue to play in supporting older people in their later years.”

Like all those Inside Housing has spoken to, however, he says funding continues to be an issue – with an ageing society and the changing needs of older people.

Mr Hall says: “It’s crucial that a long-term funding solution is put in place so the needs of those in later life continue to be met.”

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