Written evidence submitted by ARC (Association for Real Change) (RTR0019)


Q: What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?

A: In its 2019 position paper, Adult social care funding and eligibility: our position, the King’s Fund noted that in the past 20 years there have been 12 White Papers, Green Papers and other consultations on social care in England as well as five independent reviews and commissions.

Despite this, no lasting workforce solutions to the problems in social care have been implemented. This is because the model of funding is no longer fit for person centred services we provide.

A top-down / centralised approach from the Treasury with policy implementation from the Department of Health and Social Care leads to inconsistency across 152 Local Authority commissioners. The notion of a one size fits all National recuitment programme via DWP fails to acknowledge the skills, expertise and knowledge that providers have in relation to attracting recruiting and retaining people with the vocational commitment to support people and the individual needs of each person being supported.

If all providers were to receive fee rates that allowed them to deliver high-quality person-centred service on a financially sustainable basis, they will take responsibility themselves for their own staff recruitment and retention approaches and the vast majority would be effective in doing so.

The solution therefore is to offer a consistent funding approach that allows local systems to tackle the root cause of the problem and not the symptoms.

Q: What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?


A: At the Association of Real Change we support members by providing training that develops people’s awareness of rights and entitlements. We believe it is for the leaders and managers of care and support organisations that support people with a learning disability or autism or both to ensure that they have the right mix of staff in terms of skills, experience, attitudes and values.


As delivery models change along with the reform agenda, as and when these require leaders and managers to recruit different people, providers should be responsible for doing this. The issue in terms of staff retention and recruitment in social care is not about the skills, experience, knowledge and abilities of the leaders and managers in the sector. It is more about the low value that society places on social care work which is reflected in the terms and conditions employers are able to offer.



We would welcome central government support in terms of a national workforce plan that ensures the care and support sector is as attractive as the NHS. We must encourage younger people to join us and make a career within social care something they can be proud to talk about within their communities.


Q: What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?


A: The balance must allow us to develop and strengthen our domestic workforce as much as possible. However, providers should be able to attract candidates from the widest possible range of sources. Restricting recruitment from overseas without a clear plan to motivate and upskill the UK citizens who, it is presumed, were expected to fill the roles made vacant by the policy was always going to lead to staff shortages. Long term, we have to develop a workforce plan for both business as usual and managing the seasonal pressures and crises we will face. There is no flexibility within the workforce supply if we do not use all avenues open to us. Furthermore, we should encourage cross-skilling between health and social care staff to ensure we can work across the networks and share professional knowledge for the long term integration plans to succeed.


Q: What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?


A: It is for the provider to determine the skills required for the role and to support and develop candidates who do not initially meet the criteria. If the Care Certificate is to be passportable within the different parts of the sector within the UK, this would reduce the need for candidates from overseas.


Q: What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors?


In particular:


Q: To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?


A: This question focuses on health and not social care


Q: Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?


A: This question focuses on health and not social care


Q: Could the training period for doctors be reduced?


A: This question focuses on health and not social care


Q: Should the cap on the number of medical places offered to international and domestic students be removed?


A: This question focuses on health and not social care


Q: What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?


A: At ARC, our members have shared with us that care workers leave primarily because they and what they do every day is not valued by society. Furthermore the attractiveness of another role, for example within the retail or hospitality sector that pays nearly double the starting salary we can offer for less responsibility, is a welcome change when you have been fire fighting for more than two years on the frontline of the Covid pandemic. The fee rates paid to providers have been severely impacted by a decade of unprecedented cuts in Local Authority budgets and what was already a sector in which people were significantly underpaid (given the levels of responsibility associated with the work) is now very much at the bottom of the pile in terms of desirability.

To address this, we need to fix the fee rates paid to providers as was clearly outlined in Health select committee report: “a funding increase of £7.7bn would increase access to social care, and would have a potentially positive impact on workforce numbers and pay, provider sustainability, and the quality of care.

This is slightly lower than, but broadly comparable to, the estimates put forward both by the Lords Economic Affairs Committee, and by the Local Government Association.


We need to enable the organisations that deliver care and support to operate on a financially sustainable basis so that providers can make sure that their staff feel valued by ensuring that they have an appropriate degree of autonomy in the role, that they are properly trained developed and supported and that the work they do is recognised and valued.


Q: Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?


A: Yes – for example learning disability and autism roles in our communities, registered managers, ultra-rural and major urban conurbations. The gaps are everywhere across our country. Then look for the sectors that are able to attract (sometimes aggressively) people from the social care sector. Historically, these were locations where social care operators were competing with the hospitality and tourism industries. Now, it includes any and all low-pay work such as warehouse / fulfilment operations.



Q: What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?


A: Skills for Care already have a good sense of what the social care workforce needs and we would include integrated training placements in both healthcare and social care settings including hospitals, residential care homes and home care,


Q: To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?

A: ARC would support the improvement of employment conditions in the sector, including reducing the over-reliance on zero hours contracts and improving the provision of sick pay. Also, the market oversight role that the Care Act requires Local Authorities to undertake is often  not being fulfilled. This is a market that is poorly understood by Ministers. Much greater scrutiny and regulation of the market is needed to prevent a continuing race to the bottom.

Q: What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?


A: This will depend on whether these are genuinely a partnership of equals or whether, as they seem to be now and as this survey is presented, this is an NHS-led initiative to which social care is invited to attend but at which it does not enjoy parity of esteem or equality in terms of decision-making, influence and power. There are many care and support staff who have developed clinical skills in their roles akin to healthcare assistants. We need to have a greater number of care and support voices around the table ensuring our staff are recognised for their skill and we can co-produce career development and training pathways to maintain good levels of retention. 




January 2022