The social care sector is facing a crisis in staffing, with an estimated 105,000 vacancies, according to the 2021 State of the Adult Social Care Sector and Workforce report by Skills for Care, and with the possibility of this rising sharply as the requirement to be double vaccinated to work in a care home comes into place in early November.

The staffing crisis means care homes are having to refuse to take new arrivals discharged from hospital and companies that provide care within the home are handing back contracts as they no longer have sufficient staff.

The knock-on effect of this is that the NHS will really struggle to make any inroads on the record 5.74 million waiting list, particularly as winter bites with its associated increase in patients. 

The Guardian reported that Britain’s largest not-for-profit care home provider, MHA, has already had to close one in 10 of its homes to admissions from hospitals.

Around 78% of providers of home care who responded to a survey carried out by ITV and the UK Homecare Association in September 2021, said recruiting carers is the hardest it has ever been. Many described the situation as being at “breaking point”.

The shortage of staff means that around 30% of the 843 providers surveyed were handing back some, or all, of their care to local authorities because they can no longer fulfil their contracts, and 95% said they are unable to take on all the new clients in need of their help.

Other surveys in the past few months by the National Care Forum and the Institute of Health and Social Care Management also highlight the staffing crisis, with eight out of ten operators saying levels of service are under threat, with some capping resident numbers and companies declining care requests due to lack of staff.

What this means at the grass-roots level is that vulnerable patients are going without the care they need to live at home, basic help with getting up, dressed and fed, families are waiting months for care packages to be put in place, and patients that no longer need hospital care can not leave but are stuck taking up bed space that could be used by one of the 5.74 million on the waiting list for surgery.

What this means for the staff still working is that many are having to regularly work 60 hours a week, or more if they are required to be on-call. Such long hours are not sustainable, but as the shortage of care workers increases, they are going to become more and more widespread, with the resulting increased loss of staff.

Staffing was an issue before the pandemic, with an estimated 100,000 vacancies, but Brexit and the pandemic has turned the staffing issue into a crisis.

Burnout during the pandemic has led care workers to reassess their lives, aggressive recruitment from other sectors, such as Amazon and the hospitality sector, where care workers are able to earn much more, and the change in immigration rules as a result of Brexit – have all led to the current crisis and continue to fuel the loss in staff and the difficulty in recruiting new people.

In addition, the deadline in early November for mandatory double vaccination for all care workers to be able to work in care homes is looming and there are still many workers that have not been double vaccinated. There are reports that many have already left because of this requirement and if the remainder are not double vaccinated then they will have to be deployed out of the care homes to the home care sector.

A recent NHS England figure was that 88% of staff in care homes for older adults had been vaccinated by 14th October, leaving 12% or 55,600 workers needing either the second dose or both doses. Unless they are vaccinated soon they will either leave the care sector or have to be redeployed to a care at home service.

Back in early September, a care home manager told the Guardian that Amazon’s new warehouse in Nottinghamshire was luring staff with 30% more pay. The retailer is also offering a £1,000 joining bonus.

An evening housekeeper at the care home on £9.30 an hour left to take a job picking orders in the Amazon warehouse on £13.50 an hour. 

The care home had also lost six to better-paid jobs in the NHS and four who left due to the introduction of the vaccine as mandatory. 

Pay has been an issue in the care sector for many years, now as vacancies rise in other sectors, why would you stay in the care sector when in many cases workers are being paid below the Real Living Wage (RLW). In July 2021 an investigation by ITV, the Bureau of Investigative Journalism (TBIJ) and the Mirror found that many home care workers are still paid below the RLW, even though dozens of councils have pledged to pay at least that rate.

The investigation found 60% of all home care jobs advertised in the previous six months offered a wage which would not be enough to live on. This was more than 7,000 advertised jobs offering less than the RLW of £9.50 an hour in the UK and £10.85 in London. In Wales, the investigation found 75% of care work ads offering below the RLW.

The Skills for Care report shows that Brexit and new immigration rules have compounded the workforce shortage with a fall in foreign staff coming to fill vacancies. Less than 2% of new starters in the first quarter of this year arrived from abroad, compared with more than 8% in 2019, a  drop of about 20,000 people.

The new immigration rules from 1 January 2021 mean that it is almost impossible to recruit from abroad. The salary of a ‘care worker’ does not meet the required threshold. The only way to recruit would be if ‘care worker’ is added to the Shortage Occupation List (SOL), an official list of roles for which the domestic labour market cannot meet the demand to fill vacant posts. 

Back in March 2021, the government u-turned and agreed to add ‘senior care worker’ to the SOL, after initially refusing to add the job, but it has consistently refused to add any other care worker job titles despite lobbying by the industry. 

Care England, which represents the largest private care home chains, said ministers should cut the qualifying salary level for overseas recruitment of social care staff from £25,600 and add all care workers to the shortage occupation list used to grant visas. However, even if ‘care worker’ is added to the list, changes in the way other countries in Europe manage social care means better pay and conditions are available to workers.

And on top of all of this the increase in National Insurance announced by the government back in September will place an additional strain on recruitment, according Pete Calveley, CEO of Barchester, the UK’s second-largest private care home operator. He said the tax rise will cost his 17,000 staff about £6m a year and his company around the same amount. He told the Guardian:

“At a time when it is very difficult to recruit staff into social care we have less money to increase their salaries. It is just utter madness and I can’t believe this is what they have done.”

So what is the government doing to address the issue? Well when it is asked to comment the Department of Health and Social Care talks of running regular recruitment campaigns, encouraging staff to get vaccinated, and wanting employers to make long-term investments in staff rather than recruit from abroad, plus of course that £500m to support the care workforce (this amount is generally agreed to be a tiny fraction of what is needed). And that is it!

NHS England meanwhile has told hospitals to stabilise the number of patients waiting for hospital treatment, keep people waiting over a year for surgery at current levels, and eliminate two-year waits by March 2022. However it’s clear that NHS England can set whatever targets it likes, but it will be impossible to achieve them if patients cannot be discharged to social care services and therefore the crisis in social care staffing needs to be addressed with some urgency. If this doesn’t happen, then waiting lists will rise and more and more vulnerable people will not get the care they should.

See also: The privatisation of Social Care

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