Drivers of change in care, work and education
We have reviewed the trends in the provision of adult social care in recent years and set out some assumptions here. They look at three essential elements of a workforce strategy – the shape of care, the shape of work and the shape of education.
As part of the strategy development, a sub-group of the Steering Group explored service assumptions for the next 15 years, supported by The King's Fund. The full summary of this thinking can be found in the Service assumptions report.
The shape of care
Given changing needs, we would expect integration between health and social care and the ambitions of the Care Act to remain important. This means that we will need an integrated workforce that focuses on personalisation, prevention and wellbeing.
Prevention and hospital avoidance were priorities for everyone we spoke to, and particularly for people with experience drawing on care and support. People working in social care have a key role in prevention, including avoiding people going into hospital. If policy makers do not focus on primary prevention and public health, it is likely that the need for the social care workforce will grow as needs increase and independence reduces. This is likely to mean that people working in social care will need the skills and time to support people before their needs escalate and we will need new skills, roles and ways of working.
Integration: The aim of integrated care is to join up health and care services for individuals and carers and to deliver care that meets people’s personal needs. From a workforce perspective, this is likely to mean we need more people in particular roles (registered nurses, nursing associates and occupational therapists, for example), joint training, integrated teams, developing more clinical skills in social care and rewarding those skills and career development pathways between health and social care. It will mean building cultures where people working in social care are valued for their unique strengths, where we promote collaboration over competition and our leaders champion integration and collaboration.
We might need different roles and skills to support people with their mental health. We are seeing a growth in the number of people with mental ill-health and a call for legislative reform which would lead to changes in statutory responsibilities for health and social care organisations. This needs to be factored into workforce development as we might need new roles, more roles or different skills.
We are likely to need different roles and skills in technology. Demand for social care is increasing, with a projected need for an extra 540,000 posts by 2040. Advancements like AI-powered care are re-shaping care. We need to adapt to developments (including technology-enabled care and AI) which is likely to mean new skills and new roles.
We will need new and different roles and skills as needs change. In 2016, 18% of the population was over 65, and this is projected to reach 26% by 2066 (an increase of 8.6 million people, roughly the equivalent of London today). People over 85 will double to 4% by 2041 (just after the end of this Strategy) and treble by 2066.1 Two-thirds of over-65s will have multiple health conditions and a third will have mental health needs.2 The number of people with dementia is expected to rise by 43% by 2040 (from 982,000 today to 1.4 million by 2040).3 The population of adults with a learning disability in England is 956,0004 today and that is projected to grow.5 It is estimated that 30% of people with Down’s Syndrome over 50 will develop dementia, increasing the need for social care. All of this is likely to mean an increasing need for bespoke skills.
We can expect a greater proportion of future need to be met in the community. Since 2015-16, more people are being supported at home and local authorities are spending more on community services as a proportion of their social care spend. There has been a decline in nursing beds and successive policy positions by Association of Directors of Adult Social Services (ADASS) suggest that, while there may or may not be a continued decline in the use of care home beds, it is reasonable to assume that a greater proportion of future additional need will be met in the community.
We will need more personal assistants. Despite personal budgets being in existence since 1997 and encouragement in the Care Act for increased choice and control, personal budgets are levelling off and the use of personal assistants has not grown, despite a growth in the overall workforce. We might anticipate that the expectation of people having choice and control will continue and the need for personal assistants will continue. Many actions which will impact on the number of personal assistants sit outside the scope of this Strategy (encouraging uptake of personal budgets, supporting commissioners and others to understand direct payments better, showcasing the use of direct payments and their impacts) but will be important if we are to see more personal assistants enter the workforce.
We might need more people working in social care if charging reform goes ahead. If charging reform changes the balance of responsibility in paying for care and leads to more state-funded social care, we will need more staff (such as social workers) to undertake the growth in complex care and finance assessments that will be needed as part of the Care Act requirements. The impact of this on the workforce will depend on how the reforms are implemented.
The system depends on unpaid carers. There are around 4.7 million unpaid carers in England6 - around 9% of the population (although many estimate this to be higher). Although unpaid carers are outside of the scope of this Strategy, they are vital in supporting the care system. If unpaid carers were not supporting their family and friends, it would have significant personal, economic and workforce implications.
The shape of work
Expectations of work are changing. People providing social care support want more time to care, build relationships, learn and live. In the next few years, we will see a spike in the number of 18 year-olds in England that will not be seen again for decades.7 They will be the most racially and ethnically diverse generation in history - motivated by purpose, passion and pride and with salary and work/life balance being seen as equally important. While attracting and keeping a highly engaged workforce is getting harder, social care can meet these needs, offering a huge opportunity for the sector.
The shape of education
We are seeing some trends in education that we must be ready for, including:
- Tech infusion: technology will become a bigger part of teaching and learning.8 Online learning is likely to continue to grow. Artificial intelligence might personalise learning experiences, show student strengths and weaknesses and even provide targeted support.
- Focus on soft skills: while core subjects are still important, more emphasis is being placed on developing critical thinking, communication and teamwork skills.9
- Microlearning: bite-sized learning chunks are gaining traction.10
- Lifelong learning on the rise: the need to constantly adapt and learn new skills is becoming a reality. We would expect to see more opportunities for ongoing education throughout a person’s life.11