Failure to reform the social care sector in Wales risks persisting with a fragmented system based on relatively low pay according to a new report from Cardiff University’s Wales Governance Centre.
The Wales Fiscal Analysis report identifies four key issues with which future policy in Wales must grapple; namely the level of resourcing required to deliver effective care services, the currently fragmented nature of service provision, low pay and high staff turnover, and the difficulty in projecting and meeting future demand.
According to the analysis, informal care provided by friends and relatives is by far the largest source of adult care provision. Its replacement cost (the cost of purchasing this care at market price) is estimated at £8 billion – a similar order of magnitude to the annual NHS Wales budget.
The delivery of formal care services is highly fragmented, particularly in residential care, with over 1,000 providers operating across Wales. Local authority run care homes account for only 9% of care home places, and three local authorities (Torfaen, Powys and Cardiff) are wholly reliant on the private sector for care home provision.
The report also reveals the extent of low pay within the sector. Fewer than half the personal care workforce in Wales are paid the Real Living Wage, and workers have faced a decade of no relative improvement in pay.
Forthcoming research is expected to shine a light on the implications for public finances of moving partly or fully towards free personal social care, as policymakers look towards the next Welsh Parliament term.
Cian Siôn, one of the authors of the report, said: “Few areas have been hit as hard by Covid-19 as social care. Not only has the pandemic highlighted the importance of the sector, it has also exposed its vulnerabilities.
“Levels of public resourcing have seen little growth in more than a decade, and there are questions about whether the current fee structure can attract new investment into a supply that is predominantly private. Any plans for reforming older adult care must address whether the current mixed economy is the way forward.
“They must also address the current extent of low pay within the sector. Given that 4 out of 5 residential care workers are women, we know that the current pay arrangements have a decidedly unequal impact. Moreover, the UK appears to be an outlier in its relative remuneration of care workers compared to other developed countries.
“It seems inevitable that Wales will have to spend more on social care over the next decade. A national conversation about what the future mix of care provision might be, and who will meet this cost is long overdue.”