The return of a national service

Provision of domiciliary care (or homecare) in Wales has been challenging for Local Authorities over the last ten years and the pandemic has made things even harder.

Low salaries, weak role status, and few career opportunities all contribute to a feeling that a career in care being the poor cousin of working in the health service in Wales. Most of the domiciliary care in Wales is commissioned by Local Authorities and provided by private care agencies.

There have been valiant efforts nationally and locally to change the situation. Social Care Wales have driven the professionalisation agenda with care workers now a registered professional group. The Welsh Government has recently supported better salaries with the Real Living Wage being paid to all registered care staff in Wales from April 2022. And locally rural Local Authorities have supported innovative initiatives to improve terms and conditions for care staff, such as the Powys Pledge and in the organisation of care provision, such as the Home Care Project in Gwynedd.

Care services across Wales are not currently sustainable.

However, the demand for care and support at home continues to increase, especially with more and more people awaiting planned health interventions, mostly delayed because of the pandemic’s impact upon the health service. Despite the best efforts of the Welsh Government, national care institutions and Local Authorities, it is proving to be increasingly challenging to retain care staff and to recruit new care staff. At a time of low unemployment and increasing costs, people who may historically have worked in the care sector are often choosing to work in retail or leisure sectors. This is resulting in hundreds of frail and vulnerable individuals across Wales having to live without the support they need, and their unpaid carers (mostly next of kins) bearing the brunt of supplying personal care in difficult circumstances. Those unpaid carers often provide significant levels of care and this can have a detrimental effect on both their well-being and relationship with their loved one, as well as on their income.

The reality in rural counties, like Powys, is that the rapidly increasing number of older people through natural demographic growth and in-migration, is not matched by care service availability. Younger people of a working age are often choosing to move out of Powys (the county is experiencing a loss of approximately 600 people of a working age annually) or are unable to afford to live in such a rural setting. 

Perhaps the re-introduction of an optional national service for care would be a win-win for all.

The result of this is that care services across Wales are not currently sustainable.

But there may be a solution hiding in some European countries who have held on to their tradition of a military national service, albeit a voluntary national service in most instances now. In Germany, for instance, all young adults have the option to undertake a voluntary national service, which is no longer mandatory, but which enticed 37,400 young adults to participate in 2021/22. While this may summon pictures of young people dressed in military uniforms learning how to drill and march, in fact it is a hugely different concept. This ‘national service’ in Germany allows young people to opt to do other community tasks such as…. providing care for frail and vulnerable people. Historically, this type of national service has enabled Germany to supply care to its older population and supported younger adults to gain valuable practical and social experiences, at the beginning of their career and life journeys.

While it is unlikely that the Welsh Government would ever opt to enforce a mandatory national service on the youth of Wales (especially for a non-devolved military), there may be incentives available to entice young adults to work as care staff for a year or two at the start of their careers. The main incentive available could include paying off student loans while doing care work at an apprentice’s salary.

University students in Wales regularly start their working life with student loans of approximately £50K. But it is an accepted fact that most individuals never pay off their student loan.

If it were a possibility for graduates to work for two years on an apprentice’s salary to pay off the student loan, it would be interesting to see how many would opt for such an opportunity. Could this, in fact, solve the care provision challenge in Wales? The benefits would be for those in need of care, the care providers, the national service care staff, and for future employers who would see the experiences as positives on CVs. It is anecdotally acknowledged that the apprenticeship model generates a significantly better trained workforce, with a social conscience aligned to the values of the people of Wales.

There would be equity of opportunity issues to consider, requiring the development of similar options for non-graduates working in the care sector. This could possibly include recognition of other forms of debt or incentivising lower interest rates for mortgages, for example. There could also be schemes which allow for the student fees part of the loan to be paid off after one year’s care work, with the second year paying off the rest of the loan.

Could such a scheme be funded jointly by care providers and the government? This could be considered to be dreamland by some, and the administration of such a scheme could negatively impact. But when we realise that similar systems already exist in some countries that are not so far away…

Perhaps the re-introduction of an optional national service for care would be a win-win for all.

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