Care sector faces fast-deepening workforce crisis

Care sector commentator David Brindle discusses the care sector’s workforce crisis.

This week(September 6-10) is Professional Care Workers’ Week, a welcome opportunity to showcase and celebrate excellent practice in adult social care.

But the occasion is being overshadowed by the sector’s fast-deepening workforce crisis which is now indisputably putting people with care and support needs at risk.

In many respects, a workforce crisis is always with us. According to the sector skills agency, Skills for Care, social care in England went into the Covid emergency with 112,000 vacancies and a turnover rate exceeding 30%.

Heroically, the sector managed to hold things together, just, through the pandemic’s darkest days. Now, however, a combination of exhaustion, Brexit and better-paid job options in a reviving economy is taking its toll and the plates that have somehow been kept spinning are crashing to the ground.

A survey by the UK Homecare Association for ITV news last week exposed the impact. A shocking 95% of 843 home care providers who responded said they were unable to take on all the new clients referred to them, 78% said recruitment was the hardest they had ever known it and almost 30% said they were handing back full or part-contracts they could no longer fulfil. ITV’s UK editor Paul Brand said: ‘Carers we spoke to are broken. Every single staff member we interviewed burst into tears.’

And it’s about to get a whole lot worse. On the government’s own mid-range estimate, 40,000 workers in care homes will leave or lose their jobs on or before November 11 because they will not have had the stipulated two doses of the Covid vaccine.

A consultation on extending the mandatory requirement to other care workers is promised imminently and is prompting grim foreboding in-home care, where nationally almost 20% of workers have yet to receive the first dose. In some areas, the unvaccinated rate is at least half as much again.

If compulsion is pursued in all care settings, and it would be something very hard to defend if it stopped at care homes, it will surely push the sector over the brink, if it is not already over it and in freefall. But at least that would force the government to act.

Everyone with a stake in social care has been clamouring for a national workforce plan, mapping society’s growing needs for care and support and setting out clear career paths, comprehensive training programmes and a staged series of improvements in pay and conditions.

If Covid has taught us one lesson, it is that the sector must move away from paying minimum wage. Yet the Westminster government has not even ‘followed the administrations in Wales, Scotland and Northern Ireland in funding a pandemic ‘thank you’ bonus.

In the continuing absence of a national plan, the Department of Health and Social Care has said that local authorities should be monitoring workforce pressures in their areas and, where necessary, developing local plans. Some are doing so: Plymouth, for example, is launching a dedicated programme to attract people into home care work, helping them with interview tips, in-work benefits advice, entry-level skills and financial support for work clothing and initial travel costs.

Other councils and providers are meanwhile exploring the potential for new technology to reduce the need for quite so many pairs of hands. Dorset is working with Lilli, a UK machine learning developer, to cut routine home visits through constant monitoring of householders’ vital signs and activity.

Results of a pilot study across five care teams suggest that labour savings equivalent to £4,000 per person per year could be realised, not to mention the far more significant outcome of keeping people living independently and out of residential care for longer.

Cera, a home care provider aiming to ‘revolutionise’ services through technology, has recently announced it will extend its offer to include telehealth nursing care for people living at home with complex conditions. Attracting nurses to work in social care has been one of the sector’s biggest workforce challenges.  

But welcome as such initiatives are, they are no substitute for a national strategy. Amid feverish speculation that a funding announcement for some sort of social care reform is due any day, the hope is that the emerging scale of the workforce crisis will shock ministers to include a dedicated plan in any reform package.

Such a focused blueprint would be a first: when the government published a draft joint health and care plan in 2017, social care merited just five pages out of 140 and its section was illustrated with a photo of an ambulance.

The evidence of crisis on the ground is stark. As Richard Webb, director of health and adult services for North Yorkshire told his local resilience forum a couple of weeks ago, there were 1,000 unfilled social care jobs in the county and providers were reporting a 70% drop in applications.

Pressures were ‘probably the most significant I have seen in a quarter of a century working in social care and the NHS’. He will have spoken for many.

David Brindle is a care sector commentator and former public services editor of the Guardian. He is chair of Ambient Support.

Photo Credit – Mulyadi