Workforce Pressures

The social care sector and social care workforce are facing increasing challenges. This page provides information from the latest National Care Forum survey results, NCF commentary on the workforce crisis, the Skills for Care State of the Adult Social Care Sector and Workforce in England 2021 Report and Experimental data from the Government about self-funders to highlight some of the key challenges facing the sector.

Why does this all matter?

It matters because of the essential role that social care plays, both in the lives of the people and their families who need it and in the wider functioning of the health system.

If social care providers cannot help with new requests for care at home or offer places to people who need to move into a care home then those people and their families face impossible circumstances.

It matters because people are not being discharged from hospital when their acute healthcare needs have been met, or they and their families are struggling at home, in need of care and support.

It also matters because it means that care providers sometimes do not have enough staff to support new request for care and support from people with high or complex needs.

Some immediate things that will help now to respond to the social care workforce crisis include:

  • the urgent need for action to support the social care workforce with a retention bonus like all the other countries in the UK
  • a pay increase for social care staff – given that between 60% and 70% of all care is commissioned and paid for by the state, via local authority and health commissioners, it is absolutely clear that the ability of social care providers as employers to increase the amount they pay their staff is hugely dependent on the income they generate from the services they provide. If the price that the state pays remains significantly below the true cost of providing those care and support services, this inevitably constrains care home providers’ ability to offer better pay to their staff.
  • It is clear that the social care sector is competing with other sectors for staff, especially the healthcare sector as well as the hospitality and retail sector, both in terms of keeping the staff they have and recruiting new staff.  As a temporary solution, the government should add care workers to the Shortage Occupation List now for a defined period, to enable more workers from overseas to work in UK care homes with Skilled Worker visas. This will help now with the immediate workforce pressures.

NCF Survey Statistics

NCF Members Survey on Vaccination as a Condition of Deployment in Care Homes (November 2021)

The key findings from the National Care Forum’s Survey on Vaccination as a Condition of Deployment in Care Homes were:

  • Care home providers fear they will lose around 8% of their care home staff as a direct result of this policy
  • An enormous amount of time has gone into implementation of this policy
    • 91% of respondents said that they had required additional HR time 93% said they had to run additional one-to-one sessions for staff to talk them through the policy and its implications
    • 74% providing whole team briefings for their workforce
    • 53% of respondents incurring additional costs for specialist legal advice on how to implement this policy
  • There is a loss of goodwill between employee/employer relationship with 58% of respondents running disciplinary hearings and 40% managing appeals
NCF & TOM Managers’ Survey (October 2021)

The National Care Forum together with The Outstanding Managers Network surveyed registered managers of care services to ascertain the full extent of the challenges faced by care providers and registered managers on the ground in the wake of the significant staff shortages experienced in the sector.

The key findings from this survey were:

  • Average staff vacancy rate of 17%
  • 67% have either limited or stopped admissions of any new people into care homes or refused to take on any new requests for domiciliary care
  • 33% limited or stopped admissions from hospital
  • 5,000 people turned away from care
  • Management covering care roles
  • Shrinking sector due to a closure of services and failure to open planned services
NCF Snapshot Survey of Workforce Challenges (August 2021)

The key findings from the National Care Forum’s Snapshot of Workforce Challenges survey carried out in August 2021 were:

  • Increase in staff exits
  • Reasons for leaving stress features highly
  • Competition for staff from other sectors
  • Front line care staff and nursing roles are particularly hard to fill
  • All providers are concerned about winter
  • Nearly 74% have seen the rate of exit increase since April 2021
  • 46% of staff who are leaving are leaving the sector altogether – go to health or hospitality for better wages and terms and conditions
  • For 38% of staff the reason for leaving is due to rejecting the vaccine
NCF Snapshot Survey of Workforce Challenges (July 2021)

The key findings from the National Care Forum’s Snapshot of Workforce Challenges survey carried out in July 2021 were:

  • Increase in staff exits
  • Reasons for leaving stress features highly
  • Competition for staff from other sectors
  • Front line care staff roles are particularly hard to fill
  • It is most difficult to recruit in rural areas
  • Providers were concerned about problems after October 2021 – foresee moderate – high staffing level issues later in the year
  • Nearly 60% have seen the rate of exit increase since April 2021
  • 41% of staff who are leaving are leaving the sector altogether – go to health or hospitality for better wages and terms and conditions
  • For 15% of staff the reason for leaving is due to rejecting the vaccine

NCF Commentary on the Workforce Crisis

Unison and NCF Letter to Sajid Javid

UNISON and the National Care Forum (NCF) have written jointly to Sajid Javid calling for urgent action over the staffing crisis engulfing the care sector. Further information about the letter can be accessed here.

British Geriatrics Society – Timely Discharge Series Blog

Policy Director, Liz Jones has published a blog in the British Geriatrics Society Timely Discharge Series: Time to act now! The blog contains the NCFs warnings of a staffing crisis in social care and highlights some immediate things that will help now to respond to the social care workforce crisis.

Skills for Care Workforce Pressures

The Skills for Care State of the Adult Social Care Sector and Workforce in England 2021 Report highlights the challenges faced by the adult social care sector and adult social care workforce. In the short term, there are more vacancies than there were pre-pandemic and there is also high turnover. In the longer term, there is an ageing workforce who retire soon. The report estimates that the workforce is continuing to grow (by 20,000 since last year) and is predicted to grow by almost half a million additional jobs by 2035.

Some of the main challenges highlighted in the report include:

  • Approximately 1.54 million were working in adult social care (ASC) in 2020-21.
  • Since March 2021, there has been a 1.8% decrease in jobs (filled posts).
  • Since 2012-13 domiciliary care jobs have increased by 22%, while jobs filled in residential services have only increased by 4%.
  • There are currently 104,000 vacancies.

The report also featured useful information about contracts, staff sickness and staff turnover. More information about this is presented below.

Contracts

89% of the ASC workforce are employed on a permanent contract (3% are temporary, 6% bank or pool, 2% agency and 1% other). Half work full-time hours and half work part-time hours.  Care workers (who make up 53% of jobs and workforce) only had 49% of staff who were on full-time hours. Most registered managers (92%), senior managers (87%), senior care workers (72%) worked full-time.

Nearly one-quarter of the ASC workforce is on a zero-hour contract. 35% of care workers were estimated to be on zero-hour contracts (310,000). For all job roles in the domiciliary care workforce, 42% of the workforce are on zero-hour contracts. When looking only at domiciliary care workers, 55% are on a zero-hour contract.

Staff Sickness

Staff sickness nearly doubled last year (average 9.5 days lost to sickness 20/21 compared to 5.1 days before the pandemic). This includes workers being ill, self-isolating or being unable to work due to other issues including childcare. Overall, last year, there were 6 million extra days lost to sickness than the year before.

Turnover

In 2020-21, the turnover rates of directly employed staff was 28.5%, representing 410,000 staff leaving their jobs over the course of the year. Most, however, do not leave the sector, with 63% recruited from roles within the sector. Care workers were the group that had the highest turnover rate of direct care-providing roles, at 34.4%; almost twice that of senior care workers (17.4%).

Factors that influence turnover

Skills for Care have predicted that care workers are less likely to leave their role if they have:

  • Higher pay
  • Are not on zero-hour contracts
  • More experience
  • Better retention and staff training
  • A higher number of contracted hours
  • Fewer sickness days
  • Social care qualifications

Government Experimental Statistics – Care homes and estimating the self-funding population in England

A new dataset has been published to provide more data on self-funders – this has been noted as an area on which the government does not have enough data (see accompanying blog).

The data is derived from CQC Provider Information Return (PIR) forms between August 2019 and February 2020 – so the estimates provide a pre-pandemic baseline.

Definitions:
  • A self-funder pays for their own care in a care home privately, this could be arranged by:
    • Themselves
    • Via Local Authority
    • Provided by a charity
    • Funded by NHS-funded nursing care
  • State-funded people are funded in full or partly by the Local Authority
    • Paying user charges
    • Funded by NHS Continuing Care
    • Personal budget through LA
    • Third party top up.
  • A care home is anywhere that personal care and accommodation are provided together.

The sample of PIRs from CQC was from 6,009 providers of older adult and working age people’s care homes.  Included with and without nursing care.

The data have been modelled and weighted to provide a representative picture for England.

The next steps for the ONS are to look at the other UK nations in a similar way, and to use data linkage with Census 2021 to look at characteristics of self-funders.

Key data:
  • There was 84.7% occupancy of care home beds just before the pandemic (391,927 beds occupied out of 462,460 – from the 6,009 PIRs)
  • 36.7% were self-funders, 63.3% were State-funded
  • The South East has the highest proportion of self-funders (45.4% – nearly a half of people living in care homes) and North East the lowest – 24.6 (approx. a quarter). This probably reflects wealth / poverty geographical spread.
  • Not surprisingly, self-funding shows a clear pattern by IMD (of the care home).
  • Care homes for older people (older people and dementia care combined – 40.9%) have a much higher proportion of self-funding than those for younger adults (14.4% for all other types).
  • Smaller care homes tend to have much lower proportions of self-funders – as do small providers running one care home.
  • Larger proportions of self-funders in homes with higher CQC ratings.
  • UTLAs with the 10 highest proportions of self-funders (NB sample sizes were very low in some areas and no data were available for 23 areas)