Care and support workers sit at the heart of the Social Care system. The moment-by-moment interaction between support worker and recipient is where the magic happens. This is where the truly remarkable and highly skilled Social Care workforce transforms lives.
But as a society we have undervalued and neglected our Social Care workforce for many years, and we are now paying the price.
For providers, the shortage of care and support workers is their most pressing issue. They apply maximum creativity and innovation to attract and retain staff, but without the funding to reward people fairly and competitively, most will ultimately fail, services will come under strain and the sector will be driven to an even-more precarious state.
Our challenge is to ensure that the preconditions exist for highly skilled people to be attracted to work in the Social Care sector and to enable them to build a worthwhile career for life.
Current Issues & Problems
The Social Care workforce is a complex group comprising over 1.5 million individuals. Employees are spread across tens of thousands of employers, most of whom have different terms and conditions of employment.
The long term underfunding of Social Care, mixed with the unchecked market power wielded by government commissioners in this disparate market, has led to pay and conditions with the majority of employers being less attractive than those on offer from other sectors.
Key workforce statistics
Number of workers. Skills for Care predicts growth of 30,000 jobs per year in the Social Care sector. Since 2012, providers have been adding about 18,000 jobs each year, but have only succeeded in recruiting about 10,000 workers to the workforce. If nothing is done to change the current situation, then each year we will be 20,000 workers short of where we need to be.
Vacancy rates. The number of empty jobs increases every year and in Summer 2021 was reported at around 120,000 jobs (8.2%). Ongoing staff shortages driven by funding, Brexit and mandatory vaccination redundancies have pushed this up over recent months, with NCF reporting vacancy rates of 17%.
Retention. Last year our sector recruited 440,000 individuals, just to increase the total number employed by 10,000 people. Unless retention can be improved this represents a huge investment in management time and effort, often just to stay still.
Care work pay. The Social Care sector is essentially a minimum wage payer. Care workers make up almost two third of the workforce. In 2020 the average pay for a care worker was 68p above the national minimum wage. By 2021 this differential had dropped to 29p. This means that pay differentials for those with more experience/length of service have not risen in line with increases to those on the statutory minimum.
Comparing social work pay. In 2013, Care workers earned more on average than those working comparative jobs in retail and cleaning and domestic work. By 2021 these sectors have overtaken and are now paid more. As a society we now pay more for those serving us at checkouts and cleaning our houses than we do for those looking after our grandparents.
Key workforce issues
We have simplified the complex workforce question into seven top issues which need to be addressed.
Increasing demand. The Social Care faces an ever increasing demand for services as our population continues to age. Skills for Care estimates that the Social Care workforce will need to grow by an estimated 30,000 jobs per year to meet increased demand.
Inadequate supply. Not enough people want to work in social care. “Natural” growth is 5 x lower than required growth.
Poor pay. Real terms pay has been driven down year after year, and is now close to minimum wage. On average, only kitchen porters and laundry workers are paid less.
Poor sector image. “Bum wiping” is still the pub definition of our industry.
Poor retention. The Social Care workforce is transient. Each year 28.5% of the workforce, equating to 410,000 people, leave their Social Care jobs. Of these, 152,000 leave to work in other sectors. This means that each year providers have to employer 152,000 new entrants to the sector, just to stand still. Most of provider recruitment resource goes to replace people who have not been in their job for long.
Quality of applicants. Quality (and number) of staff directly affects quality of care. Low numbers of applicants means that lower quality applicants are more likely to get jobs. Poor referencing practice within the UK exacerbates the issue.
Training. There is a large gap between education provided by sector bodies and training wanted by employers. There is also almost no portability of training qualifications between providers.
We propose a number of changes to improve the quantity and quality of the Social Care workforce.
Where industries have introduced a body to register and represent a workforce, this has usually led to improved pay levels and better recognition and respect for that workforce over time. The major positives of registration are:
- A body elected by workers could set out skills and training required to do the role well, rather than this being imposed by academics or employers. This would hopefully move training away from teaching people to do tasks and towards giving them portable skills.
- The body would be able to lobby for increased funding without the ethical issues that are often encountered by for-profit providers.
- A professional body could create a system to report/ weed out those not suitable for care. With the weakening of referencing over the past decade these individuals currently job hop and move from provider to provider.
- A body could be tasked to promote the registered professions and improve their image within society. They could also develop and highlight a career structure and pathway.
- These types of body often offer peer support by creating connections between registrants.
There are, however, some drawbacks to professional bodies which we must work to mitigate. We must ensure that the professional body is not hijacked by politicians or unions wanting to impose their view on our sector. In an industry where retention is a major burden creating further antagonism between employees and employers could do irreparable damage.
We must also ensure that registration is not time consuming or onerous. Otherwise the requirement to register with a professional body could become a further barrier to recruitment.
There will be a requirement for the professional body to be well-funded and operated. There is a debate to be had about where these funds will come from, and how governance would be structured.
More attractive pay
The last ten years have shown that it is extremely difficult to attract and retain workers at the minimum wage. If we are to recruit in the UK then carer wages should be increased well above the national minimum wage. This is both a prerequisite for recruitment, and the right thing to do. People should be rewarded at a level commensurate with the skilled and challenging role they fulfil.
To increase all wages in our sector by £1 per hour it would cost Social Care providers between £2.5 and £2.8 billion per year. Whilst this is a large number, to put it into context the recent 1.25% increase in National Insurance to fund Social Care would fund a 25% pay increase if all of the money was given to Social Care staff.
Recruitment from overseas
In the UK it became more challenging to recruit from outside Europe when part of the EU, and Brexit has now erected a barrier to recruitment from Europe too. We have shot ourselves in the foot.
Social Care providers must be permitted to recruit from overseas at all pay grades. For decades this has been how our society has filled shortages in the Health and Social Care workforce.
One way to achieve this is to add care workers to the shortage occupation list. If this was done then employers would have multiple applicants for all vacant jobs in care. This would require lots of support and investment from employers, not least in navigating the dangerous swamp that is the UK sponsorship system. It would however require no additional monetary funding from British taxpayers.
Becoming better employers
Problems with retention are not all down to pay – remember that 66% of movement is between settings. Whist there are some great examples, there is some way for others to become excellent employers who truly value their staff. This means developing a culture of appreciation, having better employee engagement, using values based recruitment and more. aIn general being better employers would help Adult Social Care to stem some of the retention problems.
This is not a simple ask however. As an industry there is no current kitemark to distinguish good from bad. There is also very little research looking at the causes of poor retention. In order start on this journey the sector will need:
- Training. Leaders in our sector need to be supported so that they know how to lead better. We need excellent leadership and management training for all people in leadership positions.
- Recognition. Currently a mediocre employer is just as likely to get an outstanding CQC rating as a good one. A kite mark or similar recognition for excellence staff management and support systems is needed. If this helped providers to get an outstanding rating with CQC then huge portions of the market would invest in this.
- Career development. Most managers have enjoyed a career in care. When asked, they will say “I started as X 10 years ago and look at me now”. What is lacking is structured and planned training and support along the journey. Most managers start with little to no knowledge on day 1 and learn on the job as they go on.
- Occupational Health support for staff – What we do is physically damaging and emotionally draining. Due to the disparate nature of employers it is unlikely that employer led occupational health could function. A centrally provided system (state/ social partnership/ charitable/controlled private market) would enable better support and access to appropriate health care for staff.
Significant sums are invested by the UK government in Social Care training each year. Most of this training is either aimed at “putting on a course” and offering this free to providers or putting staff through NVQ type qualifications. Training planning is particularly hampered by the lack of a cogent workforce development plan for the social care sector, meaning that training happens in isolation and does not form part of a cohesive plan for our workforce.
Training needs to be provider led. In many successful industries it is the sector trade association/body that sets standards and produces training courses. These organisations are headed and directed by providers. In our industry however, Skills for Care, SCIE, NICE are all arms length government bodies set up and populated by government. This has led to a situation where large sums of money are being spent but most providers feeling they are unsupported.
The levels of investment are probably correct, and we believe that with restructuring, all training wanted by the sector could be provided free of charge for providers, with some recompense for back-fill (an area that is currently completely unfunded).
There also needs to be more research and emphasis on new starter training. Current practice is to put new entrants to the sector through a set of theoretical workbooks and then expect a good outcome. The Care Certificate in its current guise is not fit for purpose as a mechanism to introduce workers to our sector without an employer putting in place considerable additional support for that individual. We believe that this lack of initial support is why each year those in their first few months of work with an employer are almost three times more likely to leave than those with more than 6 months service.
Commentary on ‘People At The Heart Of Care’: The Adult Social Care Reform White Paper (published 01/12/21)
Best Practice Share
Our Key Takeaways