Written evidence submitted by Skills for Care [ASC 060]
Skills for Care is the employer-led leadership and workforce development charity for adult social care in England. We work with employers across England to create a confident, caring, skilled and well-led workforce with the right values to provide high quality, person-centred care and support, valued by those who receive it.
Skills for Care’s role is to work closely across the whole system to understand the key drivers of workforce change in social care and the characteristics and skills that will be needed to meet needs now and in the future. We do that through workforce planning, defining good practice standards for skills, knowledge, competencies and behaviours in social care, developing the learning market and supporting employers with workforce development.
Our submission draws on data from our Adult Social Care – Workforce Data Set (ASC-WDS) which is funded by the Department of Health and Social Care (DHSC). More than 20,000 employers contribute data from around 700,000 worker records to the dataset. When not otherwise stated, the data used in the submission below is the data collected over the course of April 2019 to March 2020. The data we have collected through ASC-WDS over the last decade allow us to not only understand what is happening in adult social care, but also make projections for the future.
How has COVID-19 changed the landscape for long-term reform of the adult social care sector?
1. COVID-19 has highlighted many of the issues facing adult social care including the sector’s workforce recruitment and retention challenges.
2. The extent of the impact of pandemic on the adult social care workforce will become clearer when we publish our annual ‘The state of the adult social care sector and workforce in England’ report in Autumn this year. Ahead of this publication, we have been analysing ASC-WDS data supplied by employers on a monthly basis to monitor the impact of COVID-19[i].
3. The overall vacancy rate for providers in February 2021 was 6.9% - compared to the pre-COVID rate of 8.2%
4. The vacancy rate for registered nurses in February 2021 was 11% - compared to the pre-COVID rate of 15.3%
5. The percentage of days lost to sickness in February 2021 was 5.9% - compared to 2.8% pre-COVID-19, which is an increase of 114%. Sickness days will include those self-isolating and shielding, as well as those who were unwell (including COVID-19 and non-COVID-19 related illness).
6. Between March and August 2020, the occupancy rate had fallen from 87% to 79% in care homes with nursing and from 87% to 82% in care homes without nursing.
7. Over the same period, there was no evidence of the number of staff employed falling overall. It could be the case that the fall in the occupancy has served to reduce the shortfall in workforce supply rather than impacting staffing numbers. Our market intelligence from employers also found that some care homes were maintaining staff levels to cover sickness as well as to carry out new work now associated with running a safe service.
8. The turnover rate of directly employed staff working in the adult social care sector was 30.4% in 2019/20. This equates to approximately 430,000 people leaving jobs over the year. Most of these people don’t leave the sector, however, as 66% of recruitment in social care is from other roles within the sector. Turnover rates have increased steadily, by a total of 10.2 percentage points, between 2012/13 and 2019/20.
9. The continued high levels of pre and post pandemic turnover and churn indicates that employers will still struggle to find, recruit and retain suitable people to the sector.
10. We know that around 21% of adult social care workers identified as being of an ethnicity that was black, Asian, mixed, or minority ethnic (BAME). A literature review carried out by the Black, Asian and minority ethnic (BAME) Communities Advisory Group indicates that BAME health and care professionals have experienced disproportionate mortality relative to their white counterparts[ii]. For instance, two-thirds of health workers who have died from contracting COVID-19 have been from the BAME population.
11. In December 2020, we published the findings of a survey of over 500 social care workers from BAME backgrounds about the impact of COVID-19. The survey found significant concerns about racism, inequality, equality, progression, representation, and health. Respondents were anxious about the increased risks faced by BAME staff in relation to COVID-19, and often felt that they were not being sufficiently protected at work. Mental health issues were also a concern, linked to the frustration and resentment of experiencing racism and anxiety about the COVID-19 risk. Long-term reform of the sector must address the issues faced by BAME leaders and workers, so that employers have inclusive and positive cultures and are led by diverse and compassionate leaders.
12. One of the traditional key drivers of poor retention and recruitment of social care workers is the poor perception of the job by the public. People either do not understand it, see it as low-skilled (which in our view is incorrect), or as a poor alternative to working in healthcare. This has a significant impact on the status and profile of the sector and careers in it, hampering employer’s efforts to recruit and retain a values-based workforce. The pandemic has increased the profile of care homes to the public, with ‘Clap for Carers’ and increased media scrutiny. However, we do need to do more promote a positive image of social care as a rewarding, fulfilling job and we should learn from international examples, such as Every Australian Counts[iii], on how to improve public understanding and perception.
13. COVID-19 has made it even clearer that sustainable long-term reform and the future stability of adult social care will only be successful if it understands and then addresses workforce issues.
How can the adult social care market be stabilised?
Workforce planning, underpinned by a workforce strategy, will support the market
14. To stabilise the market, we need a consistent approach workforce planning which is joined up by a national workforce strategy. This strategy must ensure we have the right staff now, and are planning for more staff, with the right skills to meet future need. We must address the recruitment and retention challenges to stabilise the market:
15. We have calculated that if the adult social care workforce grows at the same rate as the projected number of people aged 65 and over in the population, then the number of adult social care jobs in England will increase by 32% (or by 520,000 jobs) to around 2.17 million jobs by 2035. The cost of paying for those new workers and the costs of their career long learning and development opportunities will need to be factored into the cost of any future reforms of adult social care.
16. To attract new staff and retain current staff we need to promote a positive image of social care as a rewarding and fulfilling career; improve the pay and conditions of staff and improve career development opportunities.
17. Central to understanding future demand is the ability to plan to meet the needs of local populations with a skilled workforce with the required skills and knowledge. With a more stable workforce, employers will be able to focus on quality. To achieve this, we need to proactively address the well-known workforce challenges of vacancy and turnover, as well as forward plan to meet the projected demographic shift which will see an increase in the number of people often with complex needs accessing social care services.
Focus on the growth of future skills and increasing qualifications
18. We know that demographic changes will mean more people with more complex care needs. Our ASC-WDS data indicates that in 2019/20 around half the direct care providing workforce held a relevant social care qualification (50%), while 50% had no relevant social care qualifications recorded in ASC-WDS. Our analysis has shown that those with a relevant qualification are less likely to leave their post.
19. A focus on career long learning and development opportunities is needed to ensure peoples more complex needs can be met. This will also support our growing workforce to work across traditional organisational and boundaries related sectors, like health or housing, and to grow confidence in digital skills to make the most of technology developments such as monitoring and assistive technologies, which will play a crucial part in stabilising the post pandemic adult social care sector.
Support the growth of diverse and strong leaders
20. Our sector’s 22,000 registered managers will be a key role in helping stabile the market. There is a vacancy rate of 12.0% associated with this key leadership role and a turnover rate of 25.4%. Registered Managers that have worked in the sector for 20 years or more had a lower turnover rate (14.7%) than those new to the sector (40.8% for those with less than one year of experience).
21. Registered managers are a group who were already facing significant pressures pre-COVID-19. The role was associated with complexity and change; vacancy and turnover rates were high; reports of professional isolation were common; professional recognition was limited compared to regulated professions, like nurses or social workers, with a similar level of responsibility
22. Despite the challenges, they frequently report viewing the role as a vocation, and often express how much they personally get out of it. When managers were surveyed about the impact of registered manager networks supported by Skills for Care 70% agreed or strongly agreed that they felt less isolated as a result of attending network meetings; 69% agreed or strongly agreed that they felt more positive about their current position as a result of attending a network meeting.
23. Skills for Care will continue to support and expand those registered managers networks post pandemic to support and retain this key group of workers.
Embrace the economic opportunity presented by social care
24. It is vital that we think and talk about adult social care as an economic opportunity rather an economic cost. We calculated that the sector contributes £40.5 billion per annum to the economy in England. Investing in our workforce, through funding training and improving pay and conditions will attract people to work in the sector, fill existing vacancies and ultimately benefit local economies.
How can the adult social care market be incentivised to compete on quality and/or innovation?
Market Shaping and outcome-based commissioning
25. Under the Care Act 2014, local authorities are required to develop a market that delivers a wide range of sustainable high-quality care and support services that will be available to their communities, this is known as market shaping. Commissioning care and support services that are both high quality and safe requires consideration of both capacity and capability. A guiding principle should be that when you commission a service, you’re also commissioning the workforce that implements it.
26. Atkinson et al (2018) found that outsourcing care often “leads, particularly in the independent sector, to cost-based commissioning that mitigates against robust employment practice”, and it has been found that local authorities pay lower fees than self-funders who cross-subsidise the cost of care[iv]. Whilst cost is naturally a factor in commissioning the focus needs to shift towards commissioning for outcomes and quality, to encourage competition and improvements in this area.
27. We have developed best practice guidance to support local authority commissioners in this area, for example our Practical guide to workforce shaping and commissioning for better outcomes[v]. This best practice must be implemented consistently, and we hope the Government’s plans for CQC assurance of local authorities will include a focus on this role.
28. It is essential that commissioners are trained in how to commission well. We want to see wider uptake of the Level 5 qualification for commissioners[vi] (currently around 300 people have completed this). This qualification was developed to support current and aspiring commissioners in achieving a rich, diverse and sustainable market of provision as well as ensuring that personalised support and care is available where, how and when it is needed.
Innovation and alternative delivery models
29. It is essential that we do not forget the workforce when we are innovating and developing new delivery models.
30. We need to think about, and commission, the workforce needed to deliver both existing and new models of care and support. Sometimes, the workforce needs to be actively shaped and supported to deliver new models which really achieve person-centred care and enable people to live the lives that they choose. For example, expanding and promoting opportunities for personal assistants (we currently have 135,000 job roles), or rethinking how to provide traditional care models.
31. We also need to support the existing workforce with new and changing skills. One example of new skills needed to support innovation is around the pandemic’s acceleration of the development and adoption of digital technology, which has been vital in supporting staff and services and transforming business models. For example, in our research on the Digital Readiness of the sector, we found a seismic shift in the use of video meeting platforms between 2019 and 2020 increasing by 65% in that period. However, across the range of possible digital ways of working there were more modest increases – e.g. the use of secure email up by 12%.
32. One of the barriers to digital readiness is a lack of consistent or clear understanding about what digital skills are and what digital leadership mean in adult social care. Digital leadership is not a well-defined concept or a specific job role and through research in 2020 we found that many leaders aren’t confident in their own knowledge, and more support is needed to develop their digital skills. So, while we found an upward trend in some areas, skills development and leadership are key to maximising the benefits of any change and innovation.
33. We will support the sector by building the workforce’s digital understanding, enabling greater confidence of digital working via peer networks and building new formal learning opportunities.
34. In order to deal with these challenges of recruitment, retention and development, the NAO report recognises the need for a workforce strategy for adult social care. Our ASC-WDS data provides insights into the challenges that need to be addressed through this strategy, and will help measure progress.
35. Any future reforms must be underpinned by a consistent approach to workforce planning which is joined up by a national workforce strategy/people plan, but one that is flexible to local needs.