Written evidence submitted by The Disabilities Trust (RTR0088)
Who are The Disabilities Trust?
We are a charity that works alongside people with an acquired brain injury, autism, and/or learning or physical disabilities to help them live as independently as possible. Our high-quality services across the UK support people to move forward with their lives. These include: assessment and rehabilitation centres, hospitals, care homes, supported living accommodation, care in people’s homes and a school. www.thedtgroup.org
As a charity which provides support for those with physical disabilities, acquired brain injuries (ABI), learning difficulties and autism (ASD) and currently employs over 1,600 members of staff, The Disabilities Trust understands the challenges faced by the social care workforce, including encouraging recruitment and retention.
Despite the Government’s announcement in September 2021 of £5.4 billion over the next three years solely for social care reform, The Disabilities Trust is concerned that the promised reform does not move fast or far enough to meet the pressing needs of social care in relation to its workforce and funding. Without dedicated and long-term planning for social care and its invaluable workforce, difficulties in recruiting and retaining high-quality staff may continue to be felt by individuals, families, communities and providers like The Disabilities Trust.
As such, The Disabilities Trust are calling for:
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? 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?
The adult social care workforce is the sector’s biggest resource. Even prior to the coronavirus (COVID-19) pandemic the sector faced adverse trends, including challenges with recruitment, retention and staff turnover.
Difficulty in recruitment, training and retaining social care staff is widely acknowledged as a historical issue1, resulting in a national workforce shortage of 105,000 vacancies during 2021. This is confounded by a national high staff turnover of 34.4% during the period of 2020/21, all of which places enormous strain on the social care sector and those employed in it. National staff sick absences have also nearly doubled, rising from 5.1 days to 9.5 days (on average) across a year. Skills for Care (2021) also noted that whilst staff vacancy rates have decreased during the pandemic (2020/21), since March 2021, the vacancy rate has increased again, now back to pre-pandemic levels which they interpreted as indicative of challenges in recruitment and retention, rather than a decrease in demand2. Furthermore, the current workforce shortages faced across the economy means that whilst other sectors can increasingly offer competitive salaries to attract and retain staff, social care remains restricted by chronic and sustained underfunding. There is an immediate and pressing need to increase pay for care staff to make the sector more competitive with others, notably the NHS.
With a current vacancy rate of 9.64% (for 2021), which has risen from 7.97% in 2020, The Disabilities Trust suggests that a cohesive and ambitious long-term, integrated workforce plan is required to ensure the short, medium and long-term needs of the social and healthcare workforce are met.
A long-term Integrated Workforce Plan for both sectors:
A long-term Integrated Workforce Plan would enable both the health and social care sector to understand staffing needs across the system, taking into account regional differences, future demands (i.e. addressing an increase in the number of working-aged disabled adults requesting care) and trends across the sector (i.e. sickness rates). We also need a plan with wider considerations than just vacancies and recruitment, but which also takes into consideration staff wellbeing, flexible working hours, health and safety and career development to ensure the social care workforce feels valued and staff are retained.
This will assist in ensuring social care is seen as an attractive position within an integrated system, with recognition that these roles are highly skilled. An integrated plan should also address the scarcity of clinical skills and roles, which is felt both within the NHS and wider health and social care settings such as those operated by The Disabilities Trust.
Dedicated funding for the social care workforce:
Even though the Covid-19 pandemic has highlighted the value of both our health and social care workforce, our current system does not adequately remunerate people for the essential, rewarding, challenging and skilled work they do. The Disabilities Trust pays its front-line workforce above the national minimum wage, however, our ability to adequately reward our staff and retain skilled employees is limited by the systemic under funding of the sector.
Despite evidence suggesting the vacancy rate within the social care sector (as a whole) has increased by half from six to nine percent, the Government has not provided any detail on how this immediate issue will be addressed, including stemming the movement of those in the social care sector to other sectors, such as hospitality. As such, any plans for recruitment and retention need to be backed by dedicated, explicit and ring-fenced funding for the short-, medium- and long-term to ensure the workforce is properly remunerated for the essential work it does.
Repositioning of the social care sector
Historically the social care sector has been viewed by society as an unattractive, unskilled place to work with poor career opportunities. Whilst during the height of the pandemic the public perception of the value of care shifted slightly this has not endured and translated into increasing recruitment for the sector. The Government’s recent ‘Made for Care’ campaign seeks to encourage the public to reimagine the sector as a valid employment opportunity, however, this needs to go further. Social care workers need to be recognised as professionals, following a career opportunity ripe with possibilities and progression. There is an opportunity to change the brand and language of social care which describes the complexity and skill involved in the role, increasing its attractiveness to new recruits. Whilst this reimagining of the sector can be informed and pursued by organisations in their local recruitment campaigns it also needs to be driven by the Government to achieve the cross society change it requires.
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:
Standardised training and career development programme for the social care sector:
Professionalising care work would help to ensure that those working in the sector are respected and valued and have the necessary skills and knowledge to provide top quality care. Social care workers are providing all levels of vital care, that is increasingly medicalised, complex healthcare. The fact that values led, dedicated carers are so undervalued and undermined must be systemically corrected.
A standardised, reformed and accredited Care Certificate with a gateway to career development and a programme for workforce training is crucial for both social care staff and students to learn the skills specific to caring for individuals, including both the elderly and working-aged disabled adults. Investing in the workforce through training and qualifications will support genuine parity of esteem between health and social care. Achieving this parity has the potential to attract new talent and improve recruitment prospects for the sector.
Without funding and a comprehensive plan to reduce the challenges faced by the sector and its workforce it will remain difficult to meet the expectations of working life, including flexible working, career development and competitive retirement plans.
Increasing the attractiveness of working within the social care sector, including ensuring opportunities for career progression and training will also go some way in detracting the movement of staff from the social care sector to other industries, such as hospitality. Many clinicians are looking for flexible working hours, of which social care provide; however, due to systemic underfunding and high demand for clinicians, the sector is unable to meet the higher pay offered by the NHS and private practice.
Additionally, social care professionals need to feel valued, fairly paid and have the opportunities within their career to want to remain within the social care sector. If these are not addressed there is a risk professionals will move from the social care to health sector, exacerbating the workforce shortage within the sector.
Funding to train roles in high demand:
Without training and career opportunities for both staff and students, the skills needed to meet the complex needs of working-aged disabled adults may not be met. We need to see apprenticeships for those leaving University, attracting young talent to a career within social care.
Despite preconceptions that the increased demand for social care is driven solely by an ageing population, the number of working-aged disabled adults has also increased by 4% since 2010/11. The same figure for older adults during this period has, in comparison remained static3.
Demand for clinical staff is high. Therefore, healthcare professionals are able to demand higher pay, which is often more likely to be met in NHS and private sectors, as these are not restricted by the same underfunding experienced by the social care sector. To ensure sufficient numbers of healthcare professionals for both sectors, including nurses, Speech and Language Therapists (SaLTs), Occupational Therapists (OTs) and Clinical Psychologists a number of factors ought to be addressed:
Without reassurance that training, and opportunities are possible for those seeking to work within the social care sector, students and staff seeking career opportunities may transition to the health sector or beyond the care sector as a whole.
What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?
Increasing the attractiveness of working in the social care sector:
The Disabilities Trust strongly feels recognition of the value of social care is vital in reducing staff turnover and improving recruitment. Despite being a rewarding, complex and challenging sector, both historically and throughout the COVID-19 pandemic, the sector has been left feeling undervalued and overlooked.
A report published in July 2021 by Community Integrated Care (CIC) found that many frontline social care workers are undervalued by as much as 39% – nearly £7000 per year – in comparison to their peers in equivalent positions in other public funded sectors4.
We know from many of our dedicated staff, pay is not the main reason why people choose to work in the health and social care sectors; however, it does have an impact on attracting and retaining skills and talent. The Disabilities Trust argues that there should be due consideration on what the publicly funded health and social care system’s offer is to staff, and whether that involves guaranteed and consistent levels of pay, training and recognition of the immense social value of their roles.
Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?
Whilst emphasis on social care reform tends to focus on our ageing population, the increase is demand for social care support is greater amongst working-aged disabled adult, having risen by 12% since 2015/165. As such, The Disabilities Trust are keen to see a long-term workforce recruitment and retention plan which ensures the skills and supported needed to care for this complex group is available, including:
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?
The Disabilities Trust recommends an Integrated Care Plan, which takes into account the needs of both the health and social care and considers the following:
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?
It is difficult to argue against the improved integration of services across health and social care which has the potential to improve people’s lives. However, much of the discussion to date continues to focus on systems and legal frameworks, leaving out the very human implications of a fragmented or disjointed system, for those receiving care and those delivering it. As health and social care work at their best collectively, The Disabilities Trust recommends integrated care systems (ICS) which not only focus on systems, processes and legislation, but also focus on the invaluable health and social care workforce and takes into account the needs of each respectively.