Written evidence submitted by The Work Foundation (RTR0115)
 

Introduction

1. The Work Foundation is the leading think tank for improving work in the UK. We have been an authoritative, independent source of ideas and analysis on the labour market and the wider economy for over a hundred years. As the pace of economic change continues to disrupt the ways we work and do business, our mission is to support everyone in the UK to access rewarding and high-quality work and enable businesses to realise the potential of their teams.
    
2. Our evidence submission focuses on the social care sector and our recent research report on ‘Social care: a guide to attracting and retaining a thriving workforce’, published together with Totaljobs in May 2021. The mixed-methods research included:

-          A rapid literature review

-          A survey of over 1,000 adult social care workers on Totaljobs’ candidate database

-          A survey of over 3,800 workers in Totaljobs’ candidate pool

-          Analysis of candidate data held across the Totaljobs Group (online profiles and CVs)

-          Expert interviews with policy stakeholders.

3. We have chosen to respond to questions 1 and 4.

Executive summary

4. The COVID-19 pandemic has highlighted the essential role of adult social care within society, but these workers have also been exposed to acute risks and pressures. Before the pandemic, the social care sector had faced a number of long-standing challenges that limit candidate attraction and impacts on the retention of staff. There are approximately 105,000 vacancies being advertised on an average day, and Skills for Care forecasts predict the social care workforce in England will need to increase by almost half a million additional jobs by 2035 to meet demand.[1]

5. The Work Foundation welcomes the UK Government’s Adult Social Care Reform White Paper that sets out a 10-year strategy for the social care workforce. It is vital that the changes proposed are enacted, fully funded and that the Government and other key actors use a window of opportunity created by the pandemic to tackle the challenges around recruitment and retention of staff. Our response includes our insights into what elements of the new Workforce Strategy should include and the key challenges it will need to overcome.

6. Research from the Work Foundation and Totaljobs has found there is potential for the pandemic to have changed the way young people in particular perceive the value of care work, and their own willingness to apply for positions in the sector. However, if job quality in the social care sector does not improve, many young people who do pursue a career in care are likely to bounce back out of the sector quickly.
    
7. The Adult Social Care Reform White Paper sets out plans for a ‘new universal career structures and training opportunities to enable people to progress and realise their potential’. This provides an opportunity to increase job quality within the social care. However, the scope of Continued Professional Development (CPD) is limited to specific occupations and the Government should commit to funding for CPD across all roles in adult social care.
    
8. These issues cannot be tackled in isolation and plans for reform need to take into consideration our key findings on recruitment and retention of staff.

Recruitment:

-          Misconceptions over qualifications could be disincentivising potential new applications joining the social care sector

-          Values-based recruitment should be adopted across the social care sector

-          Wage levels are putting off new candidates from applying to work in the social care sector

-          The new immigration system could be exacerbating staff shortages in some areas.

Retention of staff:

-          Recognition at work is key for retention

-          Improved onboarding periods can help reduce staff turnover

-          Support for mental health can aid retention

-          Increased pay differentials are needed to support progression

-          The impact of mandatory vaccinations on staff retentions needs to be monitored.

Question 1

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?
 

9. The adult social care sector is an important part of the UK labour market with an estimated workforce of 1.54 million.[2] Skills for Care estimate that 6.8% of roles in adult social care were vacant in 2020/21, with approximately 105,000 vacancies being advertised on an average day, and they predict the number of adult social care jobs in the UK is expected to increase by almost half a million additional jobs by 2035.[3]

10. The Work Foundation and Totaljobs research in May 2021 provides a number of insights into the challenges and opportunities for care providers, social care sector bodies and regulators and the UK Government to recruit extra staff to fill social care vacancies.
     

Capitalise on improved attitudes towards care work, especially among young people

11. More than half (53%) of candidate survey respondents indicated their views of social care had improved as a result of the pandemic. Just under a third (31%) of candidates indicated they have considered working in social care, but young people aged 16-25 were particularly positive. 73% of young people stated they somewhat or very likely to pursue a career in social care in the near future, compared with 58% of those aged between 45-54 and 53% of respondents between the ages of 55-64.[4]
     
12. With a large pool of vacancies, and to build on the improved attitudes among young people, there is a need for more practical opportunities to increase direct exposure to social care work. Young people should be provided with opportunities to see first-hand what adult social care work is like, as long as it is safe to enter care homes (and other care settings), and to discuss this directly with recipients of care or with social care workers, to gain an accurate appreciation of the nature of care work.
     

Misconceptions over qualifications could be disincentivising potential new applicants joining the social care sector

13. Nearly half of respondents (47%) in a candidate survey stated that they would not work in social care because they felt they didn’t have the required qualifications.[5] Entry level care roles generally do not require specific qualifications as training and support is provided on the job to build the expertise needed. The Care Certificate in England provides a baseline of skills, knowledge and behaviours utilised for entry-level training for new starters. This research indicates that there are misconceptions about routes into care which could be creating a barrier to attraction and recruitment of new candidates. A more effective outreach and engagement campaign is needed to promote the values and motivation needed rather than specific qualifications.
     

Values-based recruitment should be adopted across the social care sector

14. Work Foundation and Totaljobs research identified values-based recruitment as a crucial mechanism to attract staff who perform well and deliver a high standard of care. Pride in the value of social care is a key driver in attracting people into the sector, and recruiting staff based on their personal values and behaviours, such as empathy and patience, rather than experience or more traditional methods of recruitment could be crucial.
     
15. In recent years, the Department of Health and Social Care, in partnership with Skills for Care, as well as regulatory bodies for adult social care across the devolved nations have promoted and encouraged the use of values-based recruitment. An evaluation of a values-based recruitment approach by Skills for Care in 2016 found that staff recruited through approaches based on values perform better than employees recruited through traditional measures.[6] Values-based recruitment should be adopted by all employers in the social care sector to improve recruitment and retention.
     

Wage levels are putting off new candidates from applying to work in the social care sector

16. Low pay within the sector is impeding potential candidates from applying to work in the social care sector, with over a third of respondents (38%) to the Work Foundation and Totaljobs survey stating it as a reason they wouldn’t apply for a social care role.[7]
     
17. The Low Pay Commission has defined the social care sector as a ‘low paying industry’[8], with the King’s Fund reporting average care worker pay is less than cleaners, shop assistants and health care assistants in the NHS.[9] The median weekly pay for care workers and home carers was in £327 in 2020, which compares to a median income of £479 of all employees in the UK.[10]
     
18. The proposed Government increase in the National Living Wage in 2022 by 6.6%, will be impacted by rising inflation, meaning many of the lowest paid social care workers will see a very small real terms pay rise.
     

The new immigration system could be exacerbating staff shortages in some areas

19. The post-BREXIT immigration system has ended access to a talent pool that has been essential for the sector over a number of years. In 2020, Work Foundation research found that up to 11,000 of those who arrived in the UK over the three years prior to publication and worked in health and social care would have been unlikely to pass the new immigration criteria.[11]
     
20. While the health and social care sectors have been less reliant on EU workers (representing just 5.2% of the workforce across both sectors), their size means the number of health and care workers from EU countries is particularly high at more than 230,000.
     
21. The Health and Care visa has been designed to enable recruitment of migrant workers for essential roles but this does not currently apply to care roles. In December 2021, the Migration Advisory Committee recommended that care worker jobs should be immediately be made eligible for the Health and Care Visa and placed on the Shortage Occupation List.[12] This is potentially a short-term fix to a long-term problem.
     
22. A reduction in European workers joining the care sector could exacerbate staff shortages. This will impact some regions more than others. Prior to the COVID-19 pandemic, London and the South East had the highest proportion of EU care workers. Against high vacancy rates in some areas, this could have significant impact in local areas across the country.

Question 4

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

23. The UK Government’s Adult Social Care Reform White Paper (2021) promises to invest at least £500m to transform the way they support the social care workforce over the next three years. While it aims to overcome some of the challenges addressed below, the Work Foundation and Totaljobs found the following factors impacted retention of staff in the social care sector and they need further focus.
     

The proposed new universal career structures and training opportunities needs to be universal and for all roles with social care

24. We welcome plans set out in the Adult Social Care Reform White Paper for a ‘new universal career structures and training opportunities to enable people to progress and realise their potential’, which will be supported by a Knowledge and Skills Framework (KSF) and career structure for the social care workforce.
     
25. The plan includes funding for Continued Professional Development (CPD) for specific roles such as registered nurses, nursing associates, occupational therapists, and other allied health professionals. Work Foundation and Totaljobs research highlighted a clear appetite for continuous learning among those in lower paid roles, particularly care assistants that extends beyond the basic mandatory training currently required through the Care Certificate. In particular, it found that survey respondent wanted specialised training in the following areas:

Specific caring areas:

• ADHD
• Autism
• Dementia
• Personality disorders
• Self-harm
• Special needs
   

Specific skills:

• Communicating with clients with Dementia and Alzheimer’s
• Dealing with challenging behaviour
• Practical manual handling
• Training specific to daily role.

26. It is crucial that ongoing training isn’t limited to specific occupations, and the Government should commit to funding for CPD across all roles in adult social care. This should be developed through consultation with social care workers and sector bodies.

Recognition at work is key for retention

27. Low pay, insufficient recognition and limited access to opportunities for progression are key drivers for churn within the adult social care. A quarter (23%) of survey respondents who have stopped working in adult social care cited the main reason they left was not feeling valued at work.

28. This was reflected by responses from care workers looking to change jobs. The most common reason for the 37% of care staff who are currently looking for a new role in the sector is wanting higher pay (52%), closely followed by not feeling valued enough (45%) and a lack of progression (31%).[13] Those who are actively seeking to leave the social care sector altogether (14%) list similar reasons. Increasing funding to the social care sector alongside delivering the proposed Workforce Strategy is key to making staff feel valued.
     
29. In addition, there are additional steps employers and providers can take to nurture a culture where staff feel valued is essential for job satisfaction, performance and retention. Day to day recognition, good working conditions and considerate approaches to structuring shifts and facilitating access to leave were all highlighted as important factors that can underpin a culture where care staff feel valued. Care providers should consult with their workforce to understand the rewards and benefits they would value most, and use this insight to develop a package of benefits that reflects staff preferences.
     

Improved onboarding periods can help reduce staff turnover

30. Totaljobs analysis of 15,248 candidates shows that, between 2019-2021, 56% of those moving into social care roles did so from a different sector, such as customer service, retail, catering and sales, which together accounted for 26% of new entrants into the sector.[14]
     
31. Providing a supportive staff onboarding process is a vital step to ensuring high-levels of workforce retention, particularly where a new starter is joining for another sector. This should include undertaking the Care Certificate in England, with a clear personalised learning and development plan which extends beyond that initial core training.

32. For new starters joining from within the social care sector, a key issue was that providers do not recognise training workers have completed with their previous employer. This leads to requirements to participate in the same basic training in areas such as safeguarding or manual handling each time workers move to a new organisation. This is an ineffective use of workers’ time, which could be better invested in the types of more specialist training workers reported they would be interested in (outlined in paragraph 27). As a result, the proposal, as part of the Workforce Strategy, to make Care Certificates portable is welcomed. This could provide with more time and resource to create tailored learning approaches for individual learners to support progression.
     

Support for mental health can aid retention

33. Our analysis of workers’ wellbeing and mental health found these challenges have become more acute through the pandemic with 48% of respondents to the social carer workers’ survey reported they had experienced good or very good mental health over the two weeks before completing the survey, in comparison with 60% in early 2020.[15]
     
34. The additional pressures that adult social care workers have been exposed to throughout the pandemic should factor into organisational strategies to support mental health. Providers should develop employee wellbeing surveys that ask staff about the types of support that would benefit them. Results should also inform personalised training for managers, to allow them to build knowledge about a broad base of tools they can draw on to support staff at risk of poor mental health, and discover which approaches are suitable according to the issue and the individual concerned. The Department of Health and Social Care should support these efforts through consultation with both sector bodies and unions, to develop wellbeing guidance for providers.
     

Increased pay differentials are needed to support progression

35. The National Living Wage has established a minimum income level in the social care sector, but this has diminished the differences in pay between less experienced and more senior roles. Skills for Care research highlights that workers with over five years’ experience earned around 1% (or 6 pence an hour) more on average than those who’ve worked for less than a year, and this can hamper career progression.[16] The Work Foundation and Totaljobs survey found that more than half (52%) of care workers looking for a new role reported the main reason for doing so was to secure a pay increase. Failure to offer progression routes is causing churn, with providers losing more experienced staff and service users not experiencing continuity of care or truly personalised support.
     
36. Workers’ pay is linked to the commissioning process and how the social care sector is funded. The Government White paper sets out a plan to ‘transform support and care in England’ and the Government have announced plans for a health and social care levy to to increase the funding of health and social care. The levy will use a rise in national insurance to raise £12 billion a year on average over the next three years[17], but until 2023 this will be used to fund the NHS in its recovery from COVID-19 and will not be allocated to social care.
     
37. The Work Foundation interviewed key social care stakeholders and they repeatedly highlighted insufficient funding as the core barrier to improving worker pay and terms and conditions, and to funding training.[18]

The impact of mandatory vaccinations on staff retentions needs to be monitored

38. All frontline social care workers will be required by the UK Government to be fully vaccinated against COVID-19 by 1 April 2022 as a condition of employment. Adult social care commissioners have told us they are concerned about the potential impact this could have on a sector that is already under pressure. Although there is limited understanding of how this will impact the workforce, an Institute of Health & Social Care Management survey in November 2021 found that a ‘fifth of managers were expecting to lose five or more staff once the mandate came into effect’.[19] UK Government and sector bodies need to analyse the impact of mandatory vaccinations on the sector.

Jan 2022

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