in the news
The Health and Social Care Committee’s view on the workforce
At the end of July, the House of Commons Health and Social Care committee published a report into the state of the Health and Social Care workforce, entitled Workforce: recruitment, training and retention in health and social care. The report was scathing in its assessment of the government’s handling of the current workforce crisis, stating that it had shown “a marked reluctance to act decisively” in the face of growing demand on the social care sector, which will require an extra 490,000 jobs by the end of the next decade.
Retention in social care
The report found that pay was a key motivating factor behind staff leaving the sector, with evidence from Anchor finding that 44 per cent of those leaving do so because of pay. Social care is having to compete not with the NHS, but with retail and hospitality, where staff can earn more with less responsibility. Responsibility is key, as the report heard evidence from Dr Carolyn Down of Lancaster University that staff felt ‘ill-equipped for their role’ due to a lack of training. Meanwhile, the kind of contract staff are on was cited as having a major impact, with turnover of staff almost 10 per cent higher among those on zero-hours contracts compared to different contracts.
Recruitment in social care
The committee heard, in relation to recruiting staff, that the ongoing cost of living crisis is having a major impact. The poor pay, combined with factors such as lack of affordable housing and public transport in rural locations which need social care workers, is making efforts even more challenging. Providers are also struggling in some cases to recruit international workers on the Health and Care worker visa, as the costs associated with it are too expensive.
“Challenging reading”
With conclusions including raising funds for social care to £7 billion by 2023/24 and publishing a workforce strategy that has been in the offing since the spring, reaction to the report has been strong. Professor Martin Green, CEO of Care England (see this month’s interview) stated that the “lack of government action has had an inevitable consequence… within the sector.” Vic Rayner of the National Care Forum called the report “challenging reading”, saying that “the scale of the challenge clearly requires immediate urgent action.”
Following the Health and Social Care Committee’s report, the Levelling Up and Housing Committee also published a report into the funding of the adult social care sector. It argued that the government needs to provide additional funding to meet the many pressures, including recruitment, faced by the sector. Following this, Clive Betts MP called for the development of a 10 year workforce strategy and work to improve pay and progression. Anita Charlesworth, Director of Research and the REAL Centre at the Health Foundation, stated that the current state of social care showed that “Boris Johnson's stated ambition to fix adult social care simply hasn't been met.”
interview
We spoke to Professor Martin Green OBE, Chief Executive of Care England. He highlights the impact of agency costs on care providers, who providers are having to more frequently turn to in order to ensure provision.
What impact are workforce issues having on the adult social care sector?
The first very tangible impact of these workforce issues is that lots of people are having to go to agencies. Not only are agency costs now astronomical - one of my members recently offered £60 an hour for a nurse and he still couldn’t get one - but many workers in the sector are deciding that they want the higher wages and flexibility that agency work provides. There needs to be some concerted government action to form a cap on agency fees, because they are becoming prohibitive.
Another element is that some care providers are reducing their occupancy levels because they haven’t got the staff to deliver at that agreed occupancy level. That not only reduces system capacity, but it also has a knock-on effect in the NHS and reduces the income level to the care provider at a time when we have seen spiralling costs of living impacting the care sector.
These challenges are compounded by other really serious financial challenges, the key one being the withdrawal of COVID-19 funding, yet providers still having to implement COVID-19 procedures. In some large providers this is amounting to an extra million pounds a month of expenditure.
Given the high rate of zero hours contracts within the sector, are more full-time contracts needed to improve staff retention?
I think that we have now the combination of different contracts to attract different people. At the moment, people who go to agencies are quite happy to go to those roles, which are effectively zero hours contracts, because you only get paid for what you work, and that pay is currently very high.
I think there are a lot of people who would like the zero hours contract if they had proper terms and conditions, and if people pay them what they’re worth. I don’t think it is necessarily the issue of the contract, I think it is a fundamental issue of underfunding and no proper approach to how we train and reward our very dedicated and highly skilled staff.
As long as people in this sector are being paid the minimum wage that is what the problem is, not the contract. If we raised care worker pay to to £40 an hour, there would be a lot of people saying, “I’ll be on a zero hours contract if I was on £40 an hour”.
Should the Care Certificate be re-examined to improve staff retention rates within the sector, given the report raised questions over the impact of how a lack of training has made staff feel underprepared for the job?
What we've got to do first is have a ten year workforce strategy which aligns to the NHS strategy. Then what we’ve got to do is we’ve got to have very clear skills and competency frameworks and a series of portable qualifications where when you get the qualifications throughout your career you are upskilling yourself, but also getting reward commensurate with that.
The way in which the care system works at the moment, some employers are quite happy to accept that a person has done a care certificate if they know their previous employer and are confident that they have delivered care to a high standard. However, if they don’t know they will re-run the care certificate to get the person up to their own standard of quality. What we need is a centralised approach, just as we see in teaching or nursing for example. It doesn’t need to be a degree qualification, but what it does need to be is a portable and recognised qualification.
Has making care workers eligible for the Health and Care visas helped to alleviate labour shortages within the sector?
Undoubtedly they have helped and what we've seen is some of our members have decided to engage in overseas recruitment, mainly because they can’t get particularly specialist staff like nurses in the UK. But there are also quite a lot of senior care roles, for example, where people are recruited from overseas.
We need those in social care to start promoting what they do
Of course, some of the challenges though are again relating to funding. The overseas visa sometimes requires you to pay more to an overseas member of staff than somebody who has been in the organisation for a while who just happens to be a UK member of staff. So it’s not without its problems, but it has made a difference. Increasingly, people are going to look to overseas recruitment if they cannot recruit from a pool of people from home.
What needs to change to improve how social care staff are perceived relative to their health service colleagues?
The real issue is that we are trying to get our status aligned to the NHS. If you align the terms and conditions to the NHS, people will start seeing social care as a valid part of the system.
One of the ways that could happen is if you pay people properly, that will absolutely help improve status. Another way is improving the wider public’s understanding of what the sector does.
Everybody lives with a myth that the NHS will diagnose what is wrong with you, take you to hospital and then cure you and then you go along with your life. On the other hand, social care looks after people with long term conditions who require specialist support, which people don’t like to talk about.
Something I would like to do is to get every single person who works in social care to start championing it. People are delighted to tell you they work for the NHS, no matter their role. But you don’t get the same sort of engagement from people who work in social care, and we need those in social care to start promoting what they do.
OPINION
Kari Gerstheimer, CEO and Founder of Access Social Care, argues that years of neglect by politicians has put parts of the sector on the verge of being unsafe due to not enough staff being available.
Our sector is facing the greatest workforce crisis in its history, with Skills for Care estimating that there are now over 165,000 vacancies in social care. When this is coupled with a vast shortage of nurses and doctors in the NHS, we are no longer just concerned about people having an acceptable quality of life - we are talking about key services being unsafe for use because there simply aren’t enough staff. All the while, demand has never been greater.
In the face of shocking statistics published by the Health and Social Care committee, it is clear that calls for revised funding have fallen on deaf ears. Growing issues with recruitment, training and retention have been foreseeable for years - it is hard to see this other than as wilful neglect. Those of us who have worked in the adult social care sector for a long time have seen similar situations before, but the problems have never been so acute.
Those of us who have worked in the adult social care sector for a long time have seen similar situations before, but the problems have never been so acute
Research published this year from Access Social Care’s annual State of the Nation report shows that calls from carers into helplines have increased by around 100 per cent compared to pre-pandemic times. I am also all too aware that social care providers simply cannot cope. In some cases, they are having to hand back contracts because they are unable to staff their services - we have heard from our member organisations that in some areas, the local authority won’t take back the contract as they are in a similarly desperate situation. The result being people in receipt of social care at risk of harm, an exhausted workforce, and further entrenched struggles with retention.
All of us will need social care at some point, either for ourselves or for a loved one. We are all being failed by the absence of a long-term sustainable workforce strategy that guarantees fair pay and recognition. The workforce plan promised by the Government in the spring has not yet been published and there is no guarantee it will be accurately substantiated by real numbers, which may then come in yet another report later this year.
Failure to address chronic underfunding of social care is a scandalous waste of taxpayer money. We currently sit in a false economy with very little consideration for the power of early intervention. Time and time again cuts are being made that ultimately lead to far costlier state intervention later down the line, and at times unlawful practice. I can’t help but feel our political class is letting us all down.