Written evidence submitted by Skills for Care (RTR0034)

Skills for Care is the workforce development charity for adult social care in England. We work with employers across the country to create a confident, caring, skilled and well-led workforce with the right values to provide high quality, person-centred care and support for people who draw on it. 

Our submission draws on multiple evidence sources, including the Adult Social Care Workforce Data Set (ASC-WDS) and qualitative market insight from our networks of over 6,500 registered managers and other frontline staff.

The pandemic has been a challenging time for social care and staff have continued to work incredibly hard to support people and their families. We need to build on the increased awareness of the fundamental role social care plays in our society, while also enacting the changes needed to ensure that people who work in social care are valued, developed, and rewarded.

1.0   Recruitment solutions

1.1 The Skills for Care Adult Social Care Workforce Data Set (ASC-WDS) collects data from around 8,000 organisations and holds approximately 650,000 individual worker records. We use this to create workforce models that allow us to produce estimates of the whole adult social care workforce.

1.2 The recruitment and retention challenges are both short and long term. We estimate that the adult social care workforce in England employs 1.54 million people with 17,700 organisations providing care. The current vacancy rate is running at 6.8%, or 105,000 jobs, on average. Our projections show that by 2035 the sector will need to find and retain an additional 490,000 jobs to meet demand.

1.3 Our monthly tracking data shows that filled posts have fallen by 3.7% since March 2021 whilst vacancy rates have risen to 9.4%.[1] This is the first time on record that the number of jobs (filled posts) has fallen. Concurrently, vacancy rates are increasing to pre-pandemic levels which indicates that providers are struggling with recruitment and retention.

1.4 Recruitment solutions could include:

1.4.1 Short term:

• Removing barriers to rapid recruitment, including quicker (and free) DBS checks, and uptake of rapid induction training provided by Skills for Care
• Innovative and collaborative recruitment between health and social care[2] to  reduce competition for the same people, and promote equal opportunities
• Continue to develop and evaluate existing initiatives including awareness campaigns that address common misconceptions about careers in care
• Encourage and support values-based approaches to recruitment[3]
• Rollout of incentivisation schemes where care staff ‘refer a friend’ to join the workforce
• Support the Government’s workforce recruitment and retention funds to be passed efficiently to providers for targeted use

1.4.2 Medium-term:

• Provide more support to the sector on key topics including international recruitment, better use of digital platforms and developing closer relationships with local Department of Work and Pensions (DWP) offices to promote social care employment opportunities
• Ambassador schemes offering the frontline perspective such as ‘I Care Ambassadors’ should be utilised to their full potential[4]
• A national workforce plan that sets the direction and priorities for workforce capacity and capabilities. National planning must be sufficiently flexible to adapt to local needs whilst providing an overarching vision encouraging integration and innovation
• Sector-wide, government backed agreement on how to improve terms and conditions:
• Low pay is commonly identified as a major factor influencing employers’ ability to recruit and retain workers.[5] Once care workers are paid significantly above the NLW, an improvement in turnover rates can be identified
• Our data shows that turnover rates were up to 11.1% higher for care workers with zero contracted hours per week, compared to those with 16-45 contracted hours per week. Turnover rates were lowest amongst workers with more than 35 contracted hours per week (21.3%)
• Social care currently struggles to match the terms and conditions available in the health sector (including pensions, annual leave entitlements and sick pay) which can mean that when there is competition between the two sectors, individuals will choose to work in health

1.4.3 Long-term:

• Help to engage other professionals to better understand and promote social care as a positive career option, including education providers, DWP staff, housing associations and school career advisors
• There should be a particular focus on positive engagement with young people; to incorporate a better understanding of social care into the national curriculum and encouraging young people to see care as a positive career choice

• Better recognise the professionalism of social care and promote the opportunities to progress in social care, including through specialisation

2.0   Balancing international and domestic recruitment

2.1 In economic terms, adult social care recruitment is ‘counter cyclical’: as the number of people being registered as unemployed goes up, adult social care vacancies go down[6]. The ONS is reporting that job vacancies in the UK have reached a record high of 1.2 million[7] which impacts the ability of providers to recruit from the domestic market, particularly when sectors with traditionally lower (or similar) levels of pay are now offering higher salaries or sign-on bonuses. The average salary for sales and retail assistants is £9.22 compared to £9.01 for a care worker.

2.2 There is wide regional variation in the number of social care workers of a British nationality ranging from 96% in the North East to 63% in London.[8]

Chart 1: Estimated proportions of the adult social are workforce by nationality and region, 2020/21 (independent and local authority sectors only).

Source: Skills for Care estimates

2.3 Since the new immigration rules came into place post Brexit, there has been no evidence of the existing non-British workforce leaving at an increased rate. We are yet to fully see the impact on non-British entrants to the workforce.

2.4 We welcome the decision made in December 2021, following the Migration Advisory Committee’s (MAC) recommendation, that social care workers will be placed on the shortage occupation list, joining senior care workers and some regulated professional roles. However, care workers will only be able to apply for a one-year visa, and the minimum threshold salary of £20,480 (higher than the average social care worker salary) will prevent some providers from being able to afford to employ staff via this route.

3.0   Changes to training to increase capacity

3.1 As a society, we value and prioritise the training of key professionals in health, education and other public services. This recognition should extend to the adult social care workforce, who carry out skilled work to provide care and support for people with increasingly complex care needs. While the majority of those working in adult social care work in the independent sector, we don’t see this as a barrier to publicly funding training for the likes of opticians, dentists, GPs and teachers who then go on to work in the private sector.

3.2 Training is essential to meeting the needs and aspirations of people who draw on care and support in a personalised way. Learning and development opportunities should be accessible at every stage and level within the social care sector. Our analysis shows that where employers invest in the skills and knowledge of their workforce they have lower turnover rates, as it contributes to employees’ sense of being valued and recognised.[9]

3.4 We want to achieve our vision for social care that enables people to live in a place they call home with the people and things that they love, which requires ensuring those training for regulated professional roles gain experience in the full breadth of health and care settings. Government and specialist organisation should work with universities and training providers to increase capacity for training placements in community settings. For the non-regulated workforce, embedding training and ensuring relevance and consistency of the offer, especially for new starters, could positively impact retention rates.

3.5 The white paper indicated an intention to explore validation for Care Certificate (CC) which we believe is key. A validated CC could ensure high-quality, relevant training as well as address the current issue of staff having to repeat the training if they change employer. Realistically these aspirations can only be realised if the CC is an accredited qualification or is subject to a formal external assessment process (as with apprenticeships) and to achieve consistency across the workforce it would need to be mandatory. However, the diversity of the sector will need to be carefully considered to ensure the content is relevant.

3.6 There are barriers to employers and staff accessing learning and development opportunities:

• Smaller providers can struggle to pay for training. The sector needs to continue to be supported by funding that providers can access directly such as the Workforce Development Fund (WDF)
• Providers also tell us they struggle to release staff for training as they cannot backfill them and it is also reported to us that there is a paucity of experienced staff to help support training and development. Longer-term investment from government, would enable providers to deliver training more sustainably through multi-year development plans
• Training could be incentivised through making elements of the Knowledge and Skills Framework (KSF) mandatory. Careful implementation would be necessary to avoid imposing a ‘one size fits all’ training structure

3.7 The government announced £500 million for adult social care workforce development and proposed a series of policy initiatives around training. To use the new funding effectively the sector needs:

• Support for professionalising and developing the workforce. All the different White Paper proposals, including the Skills Hub and the KSF, should be joined-up to provide clear and coherent career pathways
• Clarity on the learning and development offer linked to the KSF including how it will relate to existing offers such as the WDF; how additional training will be delivered and how employers going to be able to release people for training
• Inclusive training offers that are sufficiently flexible to meet the needs of the workforce. This includes supporting the progression of minority groups and growing competencies in new ways of working

4.0   Staff turnover: causes and solutions

4.1 Our analysis details some of the key factors influencing care workers leaving their roles:

• Age: For 2020/21, the turnover rate amongst those under 20 years old was 41.6%, much higher than the rate of 22.2% for those aged 60 and above
• Experience: the average turnover rate for those with less than one year of experience in sector was 39.9%. This decreased to just 19.6% for those with 20 years or more experience
• Workers are more likely to leave if they’re on zero-hours contracts (32.1% turnover rate), compared to if they’re not (22.6%) 
• Employers that received a favourable CQC inspection were found to have lower vacancy rates, higher levels of staff undertaking learning and development, as well as a longer serving registered managers[10]

4.2 Pay remains an issue for recruitment and retention as differentials between social care and other low paying occupations (defined by the Low Pay Commission) have been decreasing. Notably, sales and retail assistants earned 13 pence per hour less than care workers in 2012/13, but in 2020/21, on average, they earned 21 pence per hour more.[11] Further, maintaining pay differentials with more senior roles and rewarding experience has become increasingly challenging for employers. On average, care workers with five years’ (or more) experience in the sector are paid just 6 pence (1%) more per hour than care workers with less than one year of experience.

Chart 2: Difference between the median independent sector hourly care worker pay in adult social care and selected jobs with low pay across the whole economy.

Source: Skills for Care estimates and ONS Annual Survey of Hours and Earning

4.3 We have also heard from providers that the impact of high-workloads and stress associated with the pandemic is likely to see an increase in the turnover of Registered Managers and other key roles.

4.4 We need to comprehensively address all these factors for all roles. This should include by:

• Make care more attractive to demographics currently unrepresented in the workforce e.g. males, people under 25 years old
• Improve opportunities for learning and development at all levels, especially in digital skills
• Improving pay, terms and conditions
• Enhance productivity and quality through a wrap-around wellbeing offer

4.5 Whilst almost a quarter of the workforce (21%) are from black, Asian and minority ethnic backgrounds, only 15% are in leadership roles. Initiatives to remove barriers to progression, such as the Skills for Care Moving Up programme for aspiring managers from diverse backgrounds need to be supported and prioritised.

5.0   Specific recruitment and retention issues and solutions

5.1 For 2020/21, we estimate that the staff turnover rate of permanent and temporarily employed staff working in the adult social care sector was 28.5% and the estimated vacancy rate was 6.8%. Recently, we’ve seen the vacancy rate increasing to 9.4%1 as restrictions on the wider economy have relaxed.

5.2 Care workers turnover was 34.4%, almost twice that of senior care workers at 17.4%. Registered nurses had the highest turnover rate of all job roles – 38.2% – equivalent to around 11,000 leavers. For comparison, registered nurses and health visitors in the NHS had a turnover rate of 8.8% as at March 2021. More recently, the vacancy rate for registered nurses in social care has risen to 17.4%.[12]

Chart 3: Estimated staff turnover rates by selected job roles, 2020/21.

Source: Skills for Care estimates

5.3 Multiple stakeholders have a role in addressing these issues for registered nurses. DHSC and NHSE/I should work with specialist organisations including Skills for Care; careers advisors, universities and training providers and local authorities to:

• Support employers to promote nursing in adult social care as a rewarding and respected profession to both those already in nursing and those considering it. Raise awareness of social care nursing and address misconceptions, especially amongst health colleagues
• Better align the recruitment and career pathways of nursing in health and social care and increase the focus on placements outside of acute health settings

• Similarly, there should be parity with health once qualified regarding terms and conditions and development opportunities
• Work with employers and other partners to assess any topics that regional/ICS level support would be beneficial for, for example, international recruitment

5.4 It's important to note that turnover is not uniformly high. For 2020/21, the adult social care sector has an experienced core of workers and just over a quarter (26%) of independent sector employers have an annual turnover rate of less than 10%.

5.5 Regional turnover rates were broadly similar across England with the South East the highest at 32.1% and the North East the lowest at 25%. The picture was the same in relation to vacancies with London the highest at 8.9% and Yorkshire and the Humber the lowest at 5%.  Data shows the recruitment and retention situation in rural areas is slightly more challenging than average with higher turnover rates and higher vacancy rates than urban areas.[13] Incentives to encourage social care workers in rural areas could include free driving lessons; help with paying for a car; wheels to work schemes etc.

5.6 Our research shows that value-based recruitment also has a positive impact on retention. A national social care survey like the NHS staff survey would enable a deeper understanding of the workforce.

6.0   A people plan for adult social care

6.1 The proposals in the White Paper signalled a welcome start to the discussion of workforce planning. There is wide-spread agreement that the next step is to develop a comprehensive people plan (sometimes termed a workforce strategy) which includes implementation and funding mechanisms.

6.2 Skills for Care worked with other sector leaders to develop a joint vision for the people plan.[14] The key elements which must be included are:

• Staff recognition, value and reward. Improve recognition through promoting a positive image of social care. Increasing public understanding, reviewing terms and conditions and ensuring the wellbeing of the workforce is a priority.
• Investment in training, qualification and support. If sufficiently resourced and well-thought through, the KSF proposed in the White Paper could make a real difference to care quality and staff retention. The practical application of training to the needs of people being supported is important, as is investing in career-long learning and development opportunities and investing in our leaders of the future.
• Career pathways and development. Building on commitments made in the White Paper, we need to develop a shared understanding on what it means for social care to be recognised as a profession. Development should be encouraged at all levels, promoting specialisation as well as vertical progression.
• Building and enhancing social justice, equality, diversity and inclusion in the workforce. Developing effective Social Care Workforce Race Equality Standards (SCWRES) will play a key role as will embedding compassionate leadership behaviours. The ED&I learning offer across the sector needs to be improved.
• Effective workforce planning across the whole social care workforce. Workforce planning for social care must be treated as an equal priority as workforce planning for health with the sector supported to grow its own expertise in this area. While the HEE Framework Review including the regulated professional workforce is welcome, a separate and distinct workforce plan covering the whole of social care is needed.
• Expansion of the workforce in roles which are designed in coproduction with people who draw on care and support, and in roles which enable prevention and support the growth of innovative models of support. This can be achieved by supporting workforce redesign, strength-based training, technology-enabled care, digital skills and leadership, understanding asset-based community approaches and showcasing innovation.

6.3 Any people plan for social care must be aligned to the NHS people plan, integrate across heath and care and be informed by an in-depth understanding of both sectors.

7.0   Contractual and employment models

7.1 Social care is structurally very different to the NHS: 85% of social care employers have less than 50 employees and all set their own terms and conditions (as detailed above). There is often a combination of local-authority funded and self-funded care.

7.2 Our economic research explored the social care market and found that as competitor industries offered higher wages, adult social care vacancies increased. Our report recommends investing in higher overall levels of pay to enable employers to attract - and have more discretion to employ - workers with the right values.[15]

8.0   The role of integrated care systems

8.1 Integrated Care Systems (ICS) have aimed to be locally led yet anchored in a national framework. There’s a need for a nationally coherent vision for the social care workforce of the future which is sufficiently flexible to allow places to meet the specific needs of their local areas and encourage innovation. Outcomes-based commissioning can play a key role in making this a reality.

8.2 Skills for Care representatives are linked into nearly half the ICS people boards and we analyse ASC-WDS data at ICS level to help understand their system challenges and opportunities.

8.3 ICSs present an opportunity to coordinate services, develop joint outcomes, improve population health and plan on a system-wide basis to attract and retain staff across care and health with the right mix of skills and values. A common outcomes-based goal will create a single vision to underpin transformation.

8.4 The ICS role should be to ensure the right staff skill mix is available to deliver person-centred and outcome-based care through multi-disciplinary teams operating with and around the individual.

8.5 Improved coordination is required at place level with more involvement from the private/voluntary sector. A social care ICS Programme Director would also help coordinate existing effective partnerships and stakeholders locally and would be ideally placed to help each ICS develop workforce strategies based on local variations. ICS structures of engagement need to fully reflect the composition of the social care sector and go beyond just local authorities.

8.6 Increased social care representation is required on people boards to ensure the challenges, opportunities and emerging trends across the breadth of care in their system shape local service offers. There should be a presumption that all ICSs seek to include representative forums such as registered manager networks or care associations in their people function.

8.7 ICS people and recruitment plans need to incentivise care and health to support each other’s needs. ICSs should give consideration to jointly funded recruitment campaigns such as Proud to Care and system-wide retention and health and wellbeing initiatives, including those available to NHS providers. A resourced knowledge exchange programme will help share and scale-up best practice within and between sectors and systems as ICSs develop.

January 2022

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