in the news
The Adult Social Care sector breathed a sigh of relief on Christmas Eve as the Government chose to add the sector to its shortage occupation list, allowing foreign care workers access to fast-track visa applications in a bid to ease pressure on the sector. However, this, together with the Government’s £462.5 million commitment to support workforce recruitment and retention over the winter period, is a short-term measure. In the medium to long term, there needs to be a greater focus on the deeper issues impacting recruitment into the sector, starting with training routes into the sector.
The view from skills and training
At the end of November, the Campaign for Learning published its report entitled Reforming Adult Social Care: Integrating Funding, Pay, Employment and Skills Policies in England. Bringing together views from across the social care and further education sectors, it assesses how post-16 education and skills policies can help address the wider social care crisis, including its workforce shortages. Jane Hickie, Chief Executive of the Association of Employment and Learning Providers (AELP), sets out data from the 2019 AELP survey of apprenticeship funding rates for the Level 2 and Level 3 Adult Care Worker.
The survey revealed that training providers felt that the prescribed rate of £3000 per learner for Level 2 and 3 qualifications was unviable, and as a result 59 per cent of providers were either reducing the number of apprentice carers being trained or withdrawing their programmes altogether. This could have a major impact, as Susan Pember, Policy Director at HOLEX, feels that the figure of 37 per cent of social care’s current workforce without any formal qualification raises worries regarding the quality of care people will receive.
Social care “needs to sizzle”
Research from the Nuffield Trust showed that in the six months to October, at least 40,000 social care staff left the sector, with that number possibly being as high as 70,000. Chris Hopson, Chief Executive of NHS Providers, feels that work needs to be done to ensure “those who are currently being tempted by large packages in other industries are kept inside the sector.”
Other feel the issues go deeper than simply better pay packages. In a roundtable for Nursing in Practice, several leading figures from the care industry came together to discuss the problems facing the sector, with the general consensus being that the sector has a clear image problem, particularly among the nursing community. Jana Harris, the interim Head of Operations at Wales-based Hafod, says that social care is normally seen as a lesser sibling of hospital care. Because of this, Louise Brady, the Clinical Development Lead at the Royal British Legion, states that “social care needs to sizzle” and the sector needs “to really have a strategic branding and marketing campaign.”
Image and perception of the sector are also as important factors by the Work Foundation in its report Social Care: a guide to attracting and retaining a thriving workforce, published in May last year. The report argues that negative perceptions have always been an issue, but that attitudes are improving, particularly among young people. As such providers and sector bodies need to invest in attracting this demographic into the sector.
interview
To kick off the new year, we spoke to Anne-Marie Perry, Managing Director of CareMatch and Abicare, about the issues surrounding getting more people into the sector. She argues that the short time crisis can be helped by recruiting more foreign workers, but that long term, education and the culture of care is key.
What, in your view, are the key issues the sector faces with regards to recruitment at the moment?
There aren't enough carers to deliver to the client base. The demographics illustrate that the elderly population is growing and the younger population is not growing at the same rate. So it can't be fixed in that respect. There will not be enough people to serve the elderly population as we go forward. So we're going to have to be really creative about what we do and how we do it going forwards – the lack of technology in the industry, for instance, needs to be a big area of focus.
UNISON has said that the staffing emergency "could be ended almost overnight with a simple pay rise." Is pay really the silver bullet to it?
There is no silver bullet, and I think there are several things that we need to consider.
The industry suffers an unfavourable reputation at the moment. It's always in the press as doom and gloom. In the long term, education is the solution. We need to educate the younger generations that they have responsibility to the older generation and their wider communities. They are already very ethical on things like the environment; We need to drive the good that can be achieved from considering their local communities.
The immediate crisis stems from no provision in the community. Social care providers haven’t got the staff because of Brexit, vaccinations and COVID isolation rules, and so they can't move patients out of hospital.
After writing to my MP about the importance of foreign workers in the sector, I got a letter back from the Home Office saying that Europeans were only 7 per cent of the workforce, so it's not going to be much of a challenge. We're 100,000 short already, and we've just lost another 7 per cent.
However, the instigation of flexi-working could really help build a culture of looking after your own.
We need to educate the younger generations that they have responsibility to the older generation and their wider communities
With no commute, it gives people the opportunity to put their heads round the door of their neighbours. In the morning, they can stop in and check they’re ok, and in an evening, do the same and maybe bring a meal round. This is what we’re trying to do with CareMatch, appealing to communities and people’s good will. We had a million volunteers come forward during COVID; if that spirit can be captured, it would be invaluable for the sector.
Raising wages will help, but CareMatch has already given carers the ability to set their own rates, and we’re still challenged in recruiting workers.
The Government pledged £462.5 million before Christmas to help with workforce recruitment and retention over the winter period. Do you feel this figure was enough?
As a provider, I'm benefiting from some of those figures coming through. We are spending it on marketing as well as trying to capture and retain staff.
Whilst the funding will help aspects of the sector it's a very scattergun approach and there's no strategy, which is really frustrating.
We've also got the £5.4 billion that's coming into the care sector from April this year from the new levy. Of course, most of the levy is going to the NHS, so the social care industry doesn't benefit from that. Plus, by raising National Insurance by 1.5 per cent, as an employer in social care it means having to pay more to be able to pay more.
It's not been thought through. The NHS will make use of the social care sector. Improving the efficiency of the way social care is provided, combined with a drive for recruitment in the sector, will help to provide the high-quality care that people need and relieve the pressure faced by the NHS. The response is always reactive rather than proactive, and currently it's trying to just nurse or keep vulnerable adults in hospital because they can’t return home yet.
Given the Government's ambition to transition to what it calls a 'high skill' economy, does this mean the adult social care sector must consider introducing minimum qualification levels to work in care beyond simply having the care certificate?
Martin Green of Care England said we need a workforce that is skilled, valued, and that is listened to. I think those are really important.
Value-based recruitment is essential in care. Someone who has looked after their grandmother since they were 16; that sounds like the ideal person to come into care. Yes, there is risk. The care has significant responsibility when they go out into their community But, I could take an old lady shopping and I don't need a qualification to be able to do that.
The issue is about monitoring and improving delivery, not saying “you need a degree”. We could solve that with a database of carers like they have in Wales, which there seems to be no appetite to achieve in England at this moment in time.
Someone may have a GCSE in Maths or a degree; we don’t necessarily need that. We need somebody who can cook a good meal and actually have a good conversation with our clients.
I've been in the industry for 30 years, and when I started, carers didn't need any training. They had the right values and just wanted to be carers because they wanted to help people - perfect.
What can the care sector do to dispel the negative perceptions it has long had to contend with to attract more people to take up social care training?
Internally, we’ve devised a CareMatch manifesto setting out what we think is really important and looking at how we're going to attract and develop a strong care workforce. A big part of this Manifesto is about transforming the industry, bringing in new technology to change how we deliver care. But the government is also helping us as providers to raise awareness of the shortage of carers.
There are a couple of other things though, that I think the government could do if they wanted to attract carers into the market. They could make driving cheaper for carers or review electric car leases. Give them tax free fuel and free parking so they don’t get given tickets when looking after someone. This is a quick win.
Local authorities should really engage and say, "if you want to be a carer, you get free access to the local gym, your children get free swimming lessons or other solutions offered"
There's so much we can do by looking at what the challenges are for the workforce and saying, "these are the challenges, let's fix that for you."
opinion
January’s opinion comes from Professor Jill Manthorpe, Professor of Social Work at Kings College London and Director of the NIHR Policy Research Unit in Health and Social Care Workforce. She explores the current staffing crisis in the social care sector and how more people can be encouraged to pursue social care training courses and apprenticeships.
There are several ways of thinking about the adult social care workforce. The first is to get an impression of it when compared to the NHS. It is larger in numbers (having 1.65 million jobs) than the NHS workforce, but very different in pay, terms and conditions. Many more people work part-time and most are women.
In contrast to the NHS most people employed in adult social care work in quite small organisations, the average care home employs about 35 people and the average home care agency about 40 per location. And the smaller numbers of people working in adult social care – such as directly employed care workers (Personal Assistants) are largely on their own.
The staffing crisis in social care is a matter of high levels of vacancies, and high turnover. This is evident in the number of adverts seeking employees and in some wage increases to retain the existing workforce as much as to attract new applicants.
Covid-19 has exacerbated these problems since the stresses of working in this sector have been amplified – stresses such as worries about outbreaks of the virus on service users and lack of Personal Protective Equipment (PPE) are being replaced by tiredness, depression and anxiety, and fewer positive feelings about their jobs.
The staffing crisis in social care is a matter of high levels of vacancies, and high turnover
Amid this gloom what is being done? First, government is running recruitment campaigns in the form of advertising the inherent human rewards of social care work – that people can make a difference, and funding some extra Covid-related costs; second, many councils are supporting more local initiatives such as Proud to Care; and lastly employers are using every form of social media to advertise, with incentives such as rewards for recruiting a friend.
Beyond these immediate responses, the White Paper ‘People at the Heart of Care’ proposed a new universal career structure, a skills passport, and a Knowledge and Skills Framework and more training opportunities, and promised at least £500 million over the coming three years to start to transform support for the care workforce.
Other developments are role specific, such as recruiting more nurses to work in adult social care by highlighting the opportunities for professional development in this sector and not just the NHS. And making use of wider skills investments such as apprenticeships to become a Nursing Assistant in social care are underway, if developing slowly.
All these initiatives reveal no shortage of ideas of what can be done and needs to be done to support this workforce who were and are on the ‘frontline’ of care during these testing times.