A 15 year workforce strategy is to be developed for social care by Skills for Care, the workforce development body, in an effort to address the ongoing crisis in the workforce. The plan, which will be similar to that unveiled for the NHS in June 2023, will be developed in collaboration with several other organisations, including the King’s Fund, but NOT with the Department of Health and Social Care (DHSC), which has ignored repeated calls for such a plan.
The aims of the plan are to improve reward, progression and recognition for staff, and enhance workforce planning, so the sector has sufficient workers with the right skills to meet future needs and enable better integration with the NHS. Projections from Skills for Care show that England will need 25% more posts (440,000) by 2035 if the number of adult social care posts grows proportionally to the projected number of people aged 65 and over in the population.
The announcement coincided with the publication of the annual Skills for Care State of the adult social care sector and workforce in England study, which looks in depth at the situation with staffing in social care across England and Wales.
And comes hot on the heels of the report – Carenomics – published by the Future Care Coalition, a cross-party pressure group that includes former ministers, unions, charities, and employer organisations, which focused on the economic positives that a properly funded social care system could provide.
The Skills for Care report, covering the year from April 2022 to March 2023, had some positive news on vacancy rate, down to 9.9% from 10.6% the previous year. However this is still around 152,000 vacancies on any given day. Furthermore, it was clear that the increase in workforce was largely driven by an increase in international recruitment, in particular from non-EU countries.
A change in immigration rules, after intense lobbying by the industry, led to the inclusion on the Shortage Occupation List and Health and Care worker visa route of senior care worker roles in April 2021, then after further lobbying, in February 2022 care workers were added to the list and visa route.
Between March 2022 and March 2023, Skills for Care estimated that 70,000 people started direct care providing roles in the independent sector having arrived in the UK during that period. This is a substantial increase in international recruitment on previous years (20,000 in 2021/22 and 10,000 in 2020/21).
International recruitment has not only boosted the workforce, but helped with retention as data shows these recruits have half the turnover rate of people recruited from within the UK. Despite this trend social care continues to suffer high levels of staff turnover; in 2022/23 turnover was 28.3%, with around 390,000 people leaving their jobs. Around a third of them left the sector altogether.
The Skills for Care chief executive Oonagh Smyth said the 2022/23 state of care report showed some “green shoots”, with the fall in vacancy rate. But, warned that the sector’s workforce challenges continue:
“In particular, the fact that 390,000 people left their jobs in 2022-23 and around a third of them left the sector altogether shows that we have a leaky bucket that we urgently need to repair. We can’t simply recruit our way out of our retention challenges. So, we need a comprehensive workforce strategy to ensure we can both attract and keep enough people with the right skills to support everyone who draws on care and support – and all of us who will draw on care and support in the future.”
This year an analysis of the data collected by Skills for Care has given an insight of how to improve staff retention, with five main factors: being paid more than the minimum wage; not being on a zero-hours contract; being able to work full-time; being able to access training; and having a relevant qualification. The report found that real term median hourly pay in the independent sector in March 2023 was just £10.11, down 35p on March 2022, so it is not surprising that care workers leave when retail jobs often begin at £12.00 or more an hour.
Where none of these five factors apply, care workers are more than twice as likely to leave their jobs than when all five factors apply – a 48.7% turnover rate compared with 20.6%.
Despite the increase in workforce, the sector continues to have a workforce crisis and this translates into too many people going without the care they need and the lack of social care capacity causing significant and growing problems for the NHS.
ADASS (the Association of Directors of Adult Social Services) has found that any increases in care delivered are not keeping pace with increased needs. Care waiting lists remain too high and most councils are not confident they can offer the minimum social care support in their communities as required by law.
Moves by the NHS to speed up hospital discharge means that council social care teams are having to support more people coming out of hospital with complex health and support needs.
Whilst the workforce plan has been welcomed by providers and other organisations, a plan without long-term sustainable funding will be insufficient to solve the workforce issues.
NHS Providers’ director of policy and strategy, Miriam Deakin noted:
“A plan alone will not be enough unless it is accompanied by sustainable government investment and support to ensure the sector can not only recruit but keep much-needed staff.”
Funding and reform of social care has been a major political hot potato for many years. With politicians averse to the subject probably related to how previous plans have been treated and branded by the media. In 2010, Labour’s plans for funding social care were branded a “death tax” by the Tories and in 2017 Theresa May’s Conservative campaign suffered damage due to accusations she was planning a “dementia tax”.
The Carenomics report, which has a focus on the economic positives of investing in social care, takes the view that spending on social care should be “viewed as an investment rather than a mere cost.”
Adult social care is of major importance to the country’s economy – adding £55.7 billion per annum to the economy in England in 2022/23 (up 8.5% from 2021/22). This is more than the accommodation and food service industries.
Increased investment in the sector could boost the economy, by enabling people to stay in the workforce for longer, improve employment opportunities for disabled people, reduce the pressure on the NHS, and reduce costs for employers
Whatsmore the economic contribution of the social care sector is also notably higher in areas that need levelling up, like the North East, so social care investment will boost local economies that need it most.
The Conservative party have previously committed to introducing a new cap on care costs and making the means tests more generous, but have delayed implementation until after the next election. Back in April 2023, funding changes to workforce initiatives prompted Stuart Hoddinott, a senior researcher at the Institute for Government, to write that “the government has given up on its manifesto commitment to implement social care reform that “stands the test of time”.”
Two white papers in late 2021 by Boris Johnson’s government had given some hope that a government was finally serious about tackling social care reform.
The Labour Party has been involved with the discussions of a National Care Service. Back in June 2023,The Fabian Society report Support Guaranteed: The roadmap to a national care service,which was requested by the shadow health secretary Wes Streeting, and commissioned by the trade union Unison, called for a complete overhaul of the current system. This being the only way to produce a system in which everyone receives the care they need, when they need it, provided by staff that are paid adequately and trained well, given opportunities for advancement, and treated with respect.
The report noted that the creation of a National Care Service would be a ‘reset’ moment for social care. Instead of the current system of ‘sticking plaster’ solutions, with isolated public policy changes and occasional increases in funding, the creation of an NCS would be an ambitious project to position social care as a comprehensive and shared public service.
More recently, however the Observer reported that the Labour Party is preparing to omit a detailed plan of how to fund a reformed social care system from its next election manifesto, because of its potential to be used against them in an election campaign.
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