IntoWork 2016
Understanding the health and care sectors: a guide for employability people
Debbie Sorkin
National Director of Systems Leadership
The Leadership Centre
11th July 2016ICC, Birmingham
Context: some facts and figures
o Almost 1 in 5 people in the UK has a disability
o Disabled people are less likely to be in employment
o By Jan 2016, UK employment rate amongst working age disabled people = 46.5%. Equivalent rate amongst non-disabled people = 84%
o >44% of working age disabled people are economically inactive – nearly 4x rate for non-disabled people
o At same time disabled young people more likely to participate in higher education at age 19
o At all levels of qualification, proportion of disabled people who don’t have, but want, paid work is much greater than for their non-disabled peers
o Key barriers = lack of appropriate job opportunities (modified hours/days) and transport
Source: Papworth Trust, Disability in the United Kingdom 2016
Progress, but the gap is still a chasm(Source: The Resolution Foundation, June 2016)
Hence the government’s ambition to halve the employment gap between disabled and non-disabled people by 2020.
BUT: ‘Events, dear boy, events’
So what is likely to help, and what is likely to hinder?1. Brexit
o Fall in value of sterling possibly leading to higher prices, especially for goods bought in £ but priced in $, e.g. many basic commodities and drugs (likely to have disproportionate effect on disabled people: disabled people’s day-to-day living costs on ave 25% higher than those of non-disabled)
o Potential lack of access to single market could lead to drop in investment (and potentially fewer, or fewer high-quality, jobs)
o Risk of economic downturn and return to recession
o Not helped by continuing uncertainty if negotiations are played out over years
o And there are specific issues: >85,000 disabled people currently access the European Social Fund to support their engagement with the labour market and could be particularly affected by UK exit from EU
o European Disability Strategy viewed very positively as reinforcing and reaffirming rights of disabled people over and above protection offered by existing UK legislation
o May see reduction in/ending of European Regional Funding to support particular geographical areas (with concomitant effect on regional employment)
So what is likely to help, and what is likely to hinder?2. Social Care
The lie of the land
o Bigger sector than NHS: workforce c. 1.5m, supporting >1.75m people (cf NHS workforce c. 1.3m)
o Demand for services rising: partly due to demographic changes (ONS forecasts no of over-85s to rise from 1.3m in 2008 to 3.3m in 2033), partly because of better lives and changing expectations
o Sector often highly innovative/familiar with complexity
o But underfunded (est £2.5bn shortfall after last Comprehensive Spending Review); undervalued: traditionally low-status, low qualification sector; and invisible
o And imperfectly understood:o not free at point of useo highly fragmented provision: c. 28,000 services, 17,000 providerso large private sector component – large and small
o Key trends:o personalisation, independence and living at homeo rise of self-funderso reliance on unpaid carers (1.4m in UK, delivering > £22bn’s worth of care per year)o wanting to provide quality (and c. 60% of services do) but commissioners and providers
increasingly hamstrung and under pressure, esp in home care/nursing homes
So what is likely to help, and what is likely to hinder?2. Social Care
Potential implications
o Sector already under huge financial pressure due to ongoing reductions in local authority funding
o Unlikely to stop: local government currently set to lose >£6bn in central government grant by 2020
o According to ADASS, between 2010 – 2016, c. 500,000 people have had their eligibility for adult social care removed
o Implications re: unmet need and statutory responsibilities, e.g. in relation to the Care Act 2014
o Implications – linked to Brexit – for social care workforce
o Already significant issues with shortages and churn: nurse vacancy rates c. 20% for domiciliary care, 11% for residential care, with steady migration to NHS/agency work. Ave churn rate c. 30%
o EU staff currently make up 6% or 80,000 of the existing workforce – can’t afford to lose them
o If we do have a recession or funding for public services reduces further, what happens to funding for the National Living Wage?
o Does what is already a Cinderella sector fade further from view as the needs of the NHS take ever-greater precedence?
So what is likely to help, and what is likely to hinder?3. The NHS and broader health/wellbeing issues
The lie of the land
o Caught between Danny Boyle and David Nicholson
o Culture in England for past c. 15 years about marketisation and competition, e.g. rise of Foundation Trusts: now painfully trying to move towards collaborative approaches and distributed leadership
o Annual budget c. £116bn: £8bn additional funding; NHS is amongst world’s most efficient but funding not (and never) enough and funding has been reducing in real terms over past 6 years
o Most European states spend c. 9% GDP on health services: UK is currently at c. 7% GDP
o Strain is showing: o A&E waiting time targets missed consistently for past two years; DETOCS significant issueo Staff shortages and reliance on locums/agency staff: one report in Apr that NHS had
underestimated workforce by c. 70,000; morale issues, esp for junior doctors
o The Department for Putting Things on Top of Other Things:o Health and Social Care Act 2012 (Lansley reforms) – CCGs replace PCTs; NHS Englando Health and Social Care Integration Pioneers, CQC/A Fresh Start 2013o Five Year Forward View 2014o New Models of Care Vanguards 2015o Sustainability and Transformation Plans, NHS Improvement 2016
o
So what is likely to help, and what is likely to hinder?3. The NHS and broader health/wellbeing issues
Potential implications
o In England, NHS moving towards longer-term view, prevention rather than cure and population-based approach: Five Year Forward View and Sustainability and Transformation Plans (STPs); moves towards Accountable Care Organisations
o Lots of good – and sustainable – innovation going on, e.g. via Vanguards and Pioneers
o But focus still mostly on NHS; good intentions lost to financial exigencies and chronic underfunding
o NHS Hospital Trusts £2.45bn in deficit for 2015/16 (vs plan of £1.8bn deficit); supposed to be back in balance in this financial year but NHS Improvement already forecasting £500m deficit
o So additional financial squeeze being put on hospitals – STPs to include back-office and service mergers to reduce deficit to £250m; “re-set” (= more cuts) coming later this month
o Will play out in de facto rationing, continuing staff shortages (National Audit Office has estimated overall shortage of c. 50,000, including 23,000 nurses)
o NHS also uniquely (in Europe) vulnerable to EU exit because of reliance on staff from EU – make up 10% of doctors, 4% of nurses
o £350m a week for the NHS? Er…..
So what is likely to help, and what is likely to hinder?4. Welfare and housing issues
Continuing pressure
o Even if Brexit were not a thing, disabled people would be particularly affected by welfare reforms
o Welfare Reform and Work Act now law: will further reduce Housing Benefit along with lowering limit for benefit cap
o Main benefits to be frozen for next four years alongside cuts in Employment and Support Allowance
o Plans for cuts to Personal Independence Payments abandoned following budget backlash, even though PIP has not delivered savings expected compared with Disability Living Allowance
o Although revisions to tax credits defeated in House of Lords in 2015, they may come in through the back door via cuts in Universal Credit and limiting of tax credits to two children
o Severe shortage of affordable and suitable housing: implications of Housing and Planning Act still unclear but many housing associations have curtailed social housing development plans, away from housing for rent and towards forms of shared ownership
o NB Context for this is that disabled people are more likely to live in low income households than their peers: disabled adults aged from 25 to retirement are twice as likely as non-disabled counterparts to live in low-income households (31% vs 16%)
So what is likely to help, and what is likely to hinder?5. Devolution
Some devo deals (below) already secured; others are in the pipeline
o Cornwall
o East Anglia
o Greater Lincolnshire
o Greater Manchester
o Liverpool City Region
o London
o North East Combined Authority
o Sheffield City Region
o Tees Valley
o West of England
o West Midlands Combined Authority
o West Yorkshire Combined Authority
Different in different areas
Alongside devolved powers, many of the deals unlock additional central funding: e.g. £15m for Greater Lincs; £36m a year for 30 years for the West Midlands Investment Fund
Input into new Work and Health Programme
Joint commissioning arrangements with DWP re: Work Programmes
Ability to retain higher % of business rates growth
Skills funding and provision
Funding for innovation – e.g. Sheffield City Region Advanced Manufacturing Innovation District
Joint strategic planning re workforce
So what do you do?
o Don’t panic!
o Take a systems-wide view: Myron Roger’s Maximso People own what they createo Real change takes place in real worko The people who do the work make the changeo Start anywhere and follow it everywhereo Keep connecting the system to itself
o Disabled people at the centre and from the start
o Engage with devo areas – they may well redouble their plans in the light of events
o Engage with STP footprints and leads - they are going to need to implement their plans after September 2016
o Act as connectors between different parts of the system
o Don’t wait to ask permission or to know definitively what’s happening – people won’t know
o The Revolution will be Improvised
Understanding the health and care sectors: a guide for employability people
Thank you.
Questions and discussion
[email protected]@DebbieSorkin2
