Written evidence submitted by the Local Government Association (RTR0035)
1. About the Local Government Association
1.1. The Local Government Association (LGA) is the national voice of local government. We are a politically led, cross-party membership organisation, representing councils from England and Wales.
1.2. Our role is to support, promote and improve local government, and raise national awareness of the work of councils. Our ultimate ambition is to support councils to deliver local solutions to national problems.
2.1. Across the country, social care aims to support people to live the lives they want to lead. We owe an enormous debt of gratitude to our frontline care workforce who have given so much in supporting people of all ages who depend on social care.
2.2. There are more jobs in adult social care than in the NHS - 1.67 million in 2020/21 compared to 1.3 million in the NHS. In addition, it is estimated to contribute £46.2 billion to the economy on an annual basis and supports 603,000 jobs through indirect spending as well as the 1.2 million employed directly in the sector.
2.3. However, social care employers’ ability to attract and retain staff with the right skills, values and abilities is hampered by low pay, poor terms and conditions, lack of parity of esteem compared to NHS workers in comparable roles, and the absence of a career development framework which might incentivise people to remain in care work.
2.4. According to Skills for Care data, on average, 6.8 per cent of roles in adult social care were vacant in 2020/21. This is equivalent to 105,000 vacancies being advertised on an average day. In addition, the staff turnover rate of directly employed staff working in the adult social care sector was 28.5 per cent in 2020/21. This equates to approximately 410,000 people leaving their jobs over the course of the year.
2.5. It was welcome that the recently published Adult Social Care White Paper acknowledged that people working in adult social care should be rewarded, valued and properly trained. However, this acknowledgement falls far short of the radical changes needed to bring care workers in line with their NHS counterparts in terms of pay, terms and conditions and career development.
2.6. For example, whilst a Knowledge and Skills Framework (KSF) and career structure framework will help with professionalisation of the care workforce, this does not in guarantee more people joining and remaining in care work. A KSF also does not offer structured career development and progression in the way it does in the NHS. Action on both pay and a career structure integrated with that in the NHS are key to improving the future supply and retention of care staff. Unless the development of a KSF is linked to pay, reward and career progression, it is unlikely to provide sufficient incentive to new joiners.
2.7. Whilst additional £500 million to improve recruitment and retention of the social care workforce is welcome, the funds still fall short of the £1000 per person Winter Bonus the Association of Directors of Adult Social Services (ADASS) have said would offer an appropriate recognition of the contribution and sacrifices made by the care workforce during the pandemic.
2.8. As noted in the LGA’s alleviating winter workforce pressures in adult social care report, there are a number of ways workforce capacity pressures can be alleviated this winter and beyond. For instance, committing to an immediate pay increase for those working in care; develop a culture of appreciation, recognition and reward for people who work in social care; active, positive messaging about working in care from local politicians and community leaders; and recognise and promote the high level of responsibility held by Registered Managers, and the great career opportunity that it is.
3. 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?
3.1. There are more jobs in adult social care than in the NHS - 1.67 million in 2020/21 compared to 1.3 million in the NHS. However, social care employers’ ability to attract and retain staff with the right skills, values and abilities is hampered by low pay, poor terms and conditions, lack of parity of esteem compared to NHS workers in comparable roles, and the absence of a career development framework which might incentivise people to remain in care work.
3.2. In our response to the recently published Adult Social Care White Paper, we welcomed the acknowledgement that people working in social care need to be valued, rewarded and properly trained and developed with the right skills to do an increasingly complex professional role. However, this acknowledgement falls far short of the radical changes needed to bring care workers in line with their NHS counterparts in terms of pay, terms and conditions and career development. As long as retail and hospitality can offer better pay and conditions than care work, which is still regarded by many as unskilled labour, payment at National Living Wage rates will not alone successfully secure the skilled workers needed to provide safe, quality care for those who have cause to draw on it in our communities.
3.3. The White Paper also states that funding will be provided to support councils to prepare their local markets for reform, including moving towards paying providers a fair rate for care which reflects local costs, including workforce. However, councils have faced a £15 billion real terms reduction to core government funding between 2010 and 2020. As such, it is likely that the funding allocated for reform will be insufficient to achieve all of the Government’s stated priorities.
3.4. Whist we support the commitment to working with commissioners and providers on terms and conditions, this will only be effective if allied to Government action and funding to develop a pay and career system that is competitive with that of the NHS.
3.5. Without major improvement in pay, terms and conditions and career progression, and parity of esteem with the NHS, many of the proposals in the White Paper will not alone deliver the outcomes desired. For example, whilst a Knowledge and Skills Framework (KSF) and career structure framework will help with professionalisation of the care workforce, this does not in itself guarantee more people joining and remaining in care work. A KSF also does not offer structured career development and progression in the way it does in the NHS. Action on both pay and a career structure integrated with that in the NHS are key to improving the future supply and retention of care staff. Unless the development of a KSF is linked to pay, reward and career progression, it is unlikely to provide sufficient incentive to new joiners. As highlighted above, adult social care competes with other sectors including retail and the NHS, this relying on the NLW is insufficient, as this is a common wage floor for the whole economy.
3.6. The KSF should be integrated with that operating in the NHS where this is a more structured career path, including opportunities for progression, to allow seamless flow of skills and progression opportunities across both parts of the health and care system to reverse the current one-way flow from care to health.
3.7. We welcome the proposal for a portable care certificate which we hope will provide assurance about the skills and competencies of care workers moving around the sector and help employers provide more targeted training. It will also support the flow of staff between the health and care system. A Continuous Professional Development (CPD) fund open to all care roles, not just Registered Managers, should also be provided in the same way as for regulated professions as part of the Government’s commitment to professionalising the care workforce.
3.8. In principle, we support the White Paper’s aspiration to maximise apprenticeship opportunities, however, this can only happen where employers have the capacity to fully support apprentices without this having any adverse impact on care delivery. Staff need protected time to support apprentices to fully benefit from this important opportunity alongside additional funding to allow for backfill, which is essential if employers are to be incentivised to offer these apprenticeships and if low retention rates for apprentices are to be addressed.
3.9. In the LGA’s alleviating winter workforce pressures in adult social care report, we lay out what providers told us would make the most difference with workforce recruitment and retention in the short, medium and long-term:
3.9.1. A single bonus payment to staff employed in frontline care in January 2022, in recognition of their dedication and commitment to provide care during the pandemic, building on learning from other nations’ similar schemes; this to be distributed via councils on a head count basis.
3.9.2. Commit to immediate pay increase for those working in care, and harmonise pay and conditions with NHS.
3.9.3. Immediate suspension of the implementation of vaccination as a condition of employment (VOCD) in care homes.
3.9.4. While being clear and honest about the crisis that is affecting social care in terms of capacity and potential quality, also advocating social care as a worthwhile and rewarding career which plays to people’s strengths and positively changes people’s lives.
3.9.5. Identify big impact ways to promote positive images and messaging about people with learning disabilities, older people and others who access social care, comparable to the shift in mindsets that the London Olympics achieved for people with disabilities.
3.9.6. Lead from the front with more positive messaging from senior politicians.
3.9.7. Exempt frontline care staff and employers from the National Insurance levy.
3.9.8. Set up a national jobs board that can then link easily to local portals.
3.9.9. Ensure the national social care recruitment campaign is aligned to local campaigns as far as possible so people are not lost between two systems, and offer support to local areas who don’t have a local recruitment portal to link to.
3.9.10. The national recruitment campaign should enable providers, particularly those from VCSE and in local communities, to leverage interest in their vacant roles - we can do more with joint marketing.
3.9.11. Revise migration policy to add all care workers to the Shortage Occupation List and reduce the salary threshold for immigration.
3.9.12. Waive the Immigration Skills Charge for care workers, reducing the cost of obtaining the legal Right to Work for care workers.
3.9.13. Understand that there is a balance of risk between restricting staff movement between settings to minimise cross infection, and having the flexibility to ensure that shifts and rounds can be safely covered, with movement towards ending the restrictions on movement between care settings for vaccinated and tested care workers.
3.9.14. Recognise legitimate vaccination certificates of care workers from outside the UK, in addition to those supplied by the NHS.
3.9.15. Consider exemption from quarantine for live-in care workers arriving in the UK from outside the Common Travel Area, provided they are vaccinated, PCR-tested, and without symptoms of COVID-19.
3.9.16. Set up a national reference checking agency for care and ensure free and fast DBS checks are expanded to support speedy onboarding.
3.9.17. Commit to a 10-year workforce strategy which sets out explicit skills and competency frameworks, and improves the portability of qualifications, so that people can move seamlessly between different employers in the care and health sector.
4. 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?
4.1. As noted in the LGA’s alleviating winter workforce pressures in adult social care report, there are a series of ways in which current plans for recruitment, training and retention are able to adapt as models for providing future care change. For instance:
4.1.1. Develop a local care and health system-wide recruitment campaign to attract people to health and social care careers, reducing competition between the NHS and care for the same pool of people, and promoting parity of esteem and opportunity. A local recruitment campaign would take account of local care and health workforce gaps, demand and drivers, which vary nationally depending on a range of factors, and develops tailored recruitment messaging to encourage people into, or to return to, careers in both care and health for the benefit of the local care & health system as a whole. This would reduce competition from the same pool, which the NHS usually has the upper hand as it has better pay, conditions and career prospects. Anything which could encourage people to move between the two parts of the system seamlessly would be invaluable.
4.1.2. Talk positively about careers in care, emphasising aspirations, strengths, enabling, changing lives, making a positive difference by working in care.
4.1.3. Lead from the front with active, positive messaging about working in care from local politicians and community leaders.
4.1.4. Recognise the professionalism of social care and promote and recognise the opportunities to progress in social care – can join at entry level and within a relatively short time be supported and trained to develop into a specialist area, for example, working with people with autism or dementia, or progress into management.
4.1.5. Recognise and promote the high level of responsibility held by Registered Managers, and the great career opportunity that it is.
4.1.6. Help to engage other professionals to better understand and promote social care as a positive career option, for example, education providers, DWP staff, Housing Associations, Careers Advisors.
4.1.7. Develop a culture of appreciation, recognition and reward for people who work in social care commensurate with the complexity and challenges of the care roles and responsibilities.
4.1.8. Commit to immediate pay increase for those working in care, and harmonise pay and conditions with NHS.
5. What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?
5.1. The LGA does not believe there is a “correct balance”. For instance, one of the challenges of the adult social care sector is that there is no reliable mechanism for modelling demand for our future care workforce and establishing whether we can expect there will be sufficient domestic supply to meet future demand.
5.2. The LGA’s Care and Health Improvement team (CHIP) are currently developing a workforce modelling and capacity planning tool in conjunction with four health and care systems. The tool will enable councils to better understand the size and composition of the workforce needed to achieve the outcomes required for local residents both now and in the future. Outputs from the modelling tool will inform local strategies for dealing with short term workforce challenges over winter as well as informing longer term transformation plans and the implementation of new models of care and support, including Integrated Care Systems (ICS).
5.3. We should expect that the labour market will require international recruitment to bolster numbers for the foreseeable future, and unless we can make a career in care a much more attractive option for young people, we are unlikely ever to be able to meet demand exclusively from the domestic labour market.
5.4. The Migration Advisory Committee published its annual report in December 2021, and included a call for Government to immediately relax immigration rules for all care worker roles to improve immediate recruitment and retention problems. This is something the LGA has been long calling for.
5.5. It was therefore welcome that on 24 December 2021, the Government added care staff to the Shortage Occupation List. The temporary measures are expected to come into effect in due course and will be in place for a minimum of 12 months, at which point they will be reviewed. Although these measures will help short-term, we need a plan to tackle the long-term issues with recruitment and retention.
5.6. It would also be helpful if adult social care sector could have access to the overseas recruitment network operated by NHS England in order to speed up emergency recruitment.
6. 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:
6.1. As laid out in our alleviating winter pressures paper, there are a number of changes that could be made to the initial and ongoing training of staff in the social care sector. For instance:
6.1.1. Explore together ways in which lengthy recruitment and starter processes can be reduced to get people into post more quickly, for example, making use of the free and fast track DBS system, offering taster or insight sessions on care work, and fast-track induction.
6.1.2. Set up a national reference checking agency for care and ensure free and fast DBS checks are expanded to support speedy onboarding. Care provider are already supposed to be able to access expedited DBS checks, but anecdotally most are saying this is not happening.
6.1.3. Develop one stop shops/Career Academies in localities that enable providers to understand and draw on the full range of initiatives and support available to recruit and retain care workers, providing a single platform to promote and access job opportunities locally, and which can be utilised to match people and vacancies.
7. What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?
7.1. In the Government’s own workforce survey conducted by Capacity Tracker published in December 2021 reported that the main reasons for staff leaving care work were better pay elsewhere outside of care sector; better hours and working conditions elsewhere outside of the care sector; not wanting to be vaccinated as a condition of work; and feeling burnt out/stressed.
7.2. Remedial action to begin addressing some of these issues are set out throughout this submission and in more detail in our report summarising what providers say would be the most impactful steps to take to alleviate winter workforce pressures. Actions include the immediate suspension of the implementation of VOCD in care homes; committing to immediate pay increases for those working in care; and exempting frontline care staff and employers from the National Insurance health and social care levy.
8. Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?
8.1. There are specific roles, and/or geographical locations, where recruitment and retention are a particular problem within the adult social care sector. To fix these issues, there needs to be reliable modelling and local research to identify these ‘hotspots’ and then understand the reasons for this, which will vary widely nationally.
8.2. National recruitment campaigns for the adult social care sector have had limited success and local messaging is what is needed. Skills for Care suggests there has been little or no impact from national campaigns in their November 2021 report. For instance, he adult social care vacancy rate has risen by 2.3 percentage points between 2012/13 and 2020/21. This rise in vacancies over the period suggests that the sector is struggling to keep up with demand as the adult social care sector continues to grow, coupled with the effects of an ageing population. Although the vacancy rate has decreased slightly in 2020/21, the absolute number of vacancies remaining high presents a challenge for the sector. The LGA will continue to monitor this trend and any side effects on other workforce measures.
8.3. Tailored, local messaging is what is needed. In the Skills for Care’s findings of their study on national recruitment campaigns for adult social care, participants in the study felt that effective coordination of national recruitment campaign with local activities and partnerships would be a key factor in the success of nationally-led recruitment campaign delivered locally.
8.4. The only sustainable solution is to make a career in care and attractive proposition to young people which means tackling pay, reward, progression and public perception and ideally integrated health and care careers.
8.5. Furthermore, we have heard anecdotally that a lack of affordable housing is a factor in some areas in terms of recruitment.
9. 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?
9.1 The LGA, in collaboration with a number of national partners from across the care sector including Association of Directors of Adult Social Services (ADASS), the Care Provider Alliance, Skills for Care and Think Local Act Personal last year published a sector vision for a future workforce strategy. The vision acknowledged that reform of the workforce, valuing people who draw on social care, and shifting towards the vision all go hand in hand. The vision called for:
9.1.1. Staff to be recognised, value and rewarded
9.1.2. Invest in training, qualification and support
9.1.3. Clear career pathways and development opportunities
9.1.4. Building and enhancing social justice, equality, diversity and inclusion in the workforce
9.1.5. Effective workforce planning
9.1.6. Expansion of the workforce in roles which enable prevention and support the growth of innovative models of support.
9.2 The report explores each priority in turn and sets out the kind of actions needed to deliver on those priorities.
9.3 There should be an integrated Health & Care People plan. This would help address the lack of parity of esteem between NHS and social care. Historically, there has been a Health Education England (HEE) People Plan for the NHS and there have been unsuccessful attempts to establish a similar one for adult social care. A joint/integrated plan with the NHS would demonstrate Government willingness to achieve parity of esteem-the NHS.
10. What is the role of integrated care systems (ICS) in ensuring that local health and care organisations attract and retain staff with the right mix of skills?
10.1. Integrated Care Systems (ICS) will comprise an NHS Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). In England, ICBs will be established as statutory bodies. The ICB will be responsible for the day to day running of the NHS, while the ICP will develop an integrated care plan to address the system’s health, public health and social care needs.
10.2. ICS will have an important role in workforce planning, including forecasting and addressing workforce pressures and gaps; recruitment and retention; and designing and developing a workforce able to support high-quality, joined up, person-centred and community-based care to support people to maintain their health, wellbeing and independence. This will entail working closely with adult social care and public health commissioners and providers in order to ensure the capacity and quality of the workforce across the whole health and care system.
10.3. The sustainability of the adult social care workforce is absolutely crucial to the effective operation of the NHS. In recent years, all areas have experienced the impact of the fragile social care market on inpatient services. ICSs will need to focus on the broader workforce outside of hospitals, in the adult social care, public health and the community and voluntary sector.
10.4. ICS potentially provide a framework for achieving greater alignment and parity, but this will only be achieved if social care have an equal place at the table, which is not currently evident. Local government will have one representative on the ICB but will not have delegated authority to act on behalf of the adult social care sector.
10.5. NHS England are in the process of designing the core accountabilities on workforce issues for ICS and the self-assessment systems they will use nationally. There is therefore a window of opportunity to ensure that the workforce responsibilities and accountabilities of ICS take full account of the social care sector. Whilst most initiatives will be developed locally, some consistency and minimum activity will be needed at a national level.