Written evidence submitted by the Norfolk Care Association (RTR0004)
We are currently facing a sustained and worrying crisis in both staff retention and recruitment. Currently, the sector is seeing sustained losses in staff with The National Care Forum saying providers are running at 17% average staff vacancy rates as well as struggling to fill the positions. In a survey we carried out among local providers, we found that over a 3-month period of those surveyed 73% of roles were unfilled. From this it is easy to see how the unmet needs list locally has reached as high as approx. 650 weekly, in homecare alone. We ran a survey on providers in terms of what they have found successful in terms of recruitment and strikingly 59% stated that nothing they have tried had had a positive impact on their recruitment. In terms of retention of staff, with the ongoing issues around staffing levels, we have heard providers talk about how difficult it is to release staff to any CPD offers or provide flexibility within working patterns.
Currently for care providers to recruit overseas there are considerable restrictions regarding what roles can be recruited overseas and payrates, coupled with an incredibly complex process, overseas recruitment is something many are not finding easy. From our recent local survey, 16% of those surveyed identified that relaxing, and supporting overseas recruitment would support them in their staffing concerns. This is echoed in findings from other organisations such as the BBC finding in areas of ageing populations, massive staff shortages are occurring in the wake of Brexit, with about 6,500 jobs in care just in North Somerset alone.: Somerset care home boss blames Brexit for staff shortage - BBC News.
In terms of initial support for the sector, organisations such as National Care Forum suggesting a rise in wages in line with the national average of £15 per hour, this would need considerable investment from local authorities to enable these pay rates. We also want the UK Government to change the VAT status from exempt to zero-rated to allow providers to reclaim the VAT on expenses goods and services offered by care operators are currently exempt from VAT, so providers do not charge VAT on their services. Also identified by us is changes within the NI contributions. The NHS will likely be compensated its Employer National Insurance Contributions. See the Health and Care Plan, pg. 29: ‘Finally, the estimated public sector employer contributions to the Levy are subtracted, as the Government intends to compensate departments and other public sector employers in England at the Spending Review for the increased cost of the Levy and provide Barnett consequential on this funding to the devolved administrations. If the Government did not take this step then the spending power of public services, including the NHS, would be reduced. This adjustment reduces the amount that is available from the Levy to spend on health and social care by around £1.8 billion per year, bringing the total funding available to around £11.4 billion per year’ Why is it not possible to consider social care providers to be in scope for this as well as public services and the NHS? https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1015736/Build_Back_Better-_Our_Plan_for_Health_and_Social_Care.pdf
Currently there is a large number of opportunities for further training, with programmes locally like the ESF projects as well as the successful TNA programme, the issue is care workers are unable to attend these sessions due to the staffing pressures. We see the only way to increase uptake in training is to alleviate working pressures. This encompasses one of the main areas of concern that is driving staff from the sector, recently a programme of wellbeing events locally provided by Norfolk and Suffolk Care Support saw over 700 care workers take up much needed resources and support in regards to wellbeing. Areas such as Hertfordshire and Surrey have also experienced issues in regards to staff losses due to the mandating of the COVID-19 vaccine, with many at breaking point choosing to leave the service.
Within our region, recruitment is uniquely affected, which in turn is having a knock-on effect in regards to CQC ratings and safety for those within care. Due to the makeup of our local region, with rural isolated areas and, difficulties with transport links; an aging population, most local providers are experiencing some form of staffing shortages. Currently, we are the lowest performing location in our family group in regards to CQC numbers with 23.7% of settings showing as required improvement and 4.2% showing as inadequate. Many of the common themes within these reports are issues around unsafe staffing levels and not enough staff being on shift. It’s clear to see in Norfolk we are struggling with recruitment and retention to the extent that it is having an effect on safety.
Immediate action is needed to support the sector and it cannot wait a further 2-5 years for the levy to enact real change, something needs to be done now. We suggest this can be in the form of bonuses, wage increases in line with parity of esteem with health, as well as adding social care to the shortage occupation list and supporting providers though the overseas recruitment process. We are currently working on a Care Worker Pay Framework, with the aim to suggest a standardised pay scale in line with the NHS, we believe, if implemented, this will increase recruitment potential across the sector.
Many local homecare contracts are based off a zero-rated model, this is primarily due to the way that homecare is commissioned locally in Norfolk, on hourly rates. Zero-hour contracts represent 17% of jobs within social care in Norfolk (Skills for Care). This in turn leads to a lack of full-time contractual arrangements on offer for staff. Without an agreed volume, either by minimum guarantee or otherwise, providers find it difficult to plan for their businesses, varriations in hours, packages, etc can put pressure on staffing levels and can equally mean staff are left with unreliable incomes. This also has a knock-on effect in regards to providing and arranging training and development opportunities. This was recently highlighted in the below Guardian article:
“Looking across the sector as a whole, the atomised system of providers and agencies pitted against one another for contracts leads to a race to the bottom, with bad employers driving down pay and conditions for staff and standards of care across the board”. When it comes to commissioning care and providing contracts of packages, the lowest price is still considered the best price in many areas of commissioning. Until this is changed, both quality of care as well as staff retention will continue to suffer.
The Integrated Care System, currently, suffers from issues around disparity in pay and incentives. Initiatives, such as the sector-based work academy programme, are therefore not run on an even playing field, leading to recruitment difficulties within social care. Skills for Care’s report, The state of the adult social care sector and workforce in England showed that in 2020/2021 on average 105,000 vacancies were being advertised within social care each day. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx
Within Norfolk, Skills for Care found that the turnover rate of staff was 33.9%, equating to 7,800 leavers from the industry. This has risen from 31.2% in 2019/2020. Within education in the sector, 36% were found to hold a qualification relevant to social care, which is 9% lower that the average across the UK. With 61% of those working in care locally having not started a qualification. It can be inferred from this data that training, retention and recruitment remain a significant issue locally.