Written evidence submitted by Methodist Homes (RTR0116)

Contact: Laura Catchpole, Policy and Public Affairs Manager,

 

About MHA

MHA is the UK’s largest charity providing care to older people.  Our mission is to help people to live later life well.  This involves helping people to be connected and engaged in their communities through local groups, offering residential communities for people who want to live somewhere independently with additional support, and providing care homes for people who need full residential support with care, dementia or nursing needs. 

 

We are a proud employer of over 7,000 people across the country in a variety of roles, and support around 4,000 volunteers, helping to strengthen communities, reduce isolation and provide vital assistance to more people.

 

Our employees include more than 3,200 care assistants or senior care assistants; 260 nurses; 400 care home, residential community or community managers; 500 domestic assistants; 500 chefs or kitchen assistants; 150 activities coordinators; 190 maintenance workers or gardeners; 140 chaplains; 62 music therapists and many more roles and professions.

 

Across MHA we are regularly recruiting for more than 420 posts.  This includes a vacancy rate of 17% of our nurses.

 

We would be delighted to provide further information to the Committee in an oral evidence session.

 

Summary

The Government’s plan for health and social care, set out in ‘Build Back Better: Our plan for health and social care’ (7 September 2021) and in the ‘People at the Heart of Care: adult social care reform white paper’ (1 December 2021) present a historic opportunity to create social care provision that is person-centred and meets peoples’ needs in the place they want to live, be that in their home, a residential community or a care home. 

 

We welcome the ten-year person-centred vision for social care, in particular measures to give people more choice, control and support to live independent lives, and to ensure people have access to outstanding quality and tailored care.  However, these important aims will not be realised unless we have a thriving, vibrant social care workforce.  To create this, we need a fundamental shift in pay and conditions for all those who work in care.

 

We know that the current care sector structures and mechanisms are unsustainable and are in need of bold and far-reaching reform.  Low pay and poor recognition have dogged the social care sector for too long, with the majority of care workers paid just the minimum wage.  Covid-19 and Brexit have then compounded staffing issues. As the recent CQC ‘State of Care’ report stated, “social care staff are exhausted and the workforce is depleted. The negative impact of working under this sustained pressure, including anxiety, stress and burnout, cannot be underestimated.”[1]

 

Charging reforms, which will include the development of a ‘fair rate for care’, are currently being developed and must provide local authorities with a funding settlement that enables a higher rate of pay for all care staff, with adequate funding to recognise higher levels of experience and skills with higher pay bands.  This must allow for parity of pay and benefits with equivalent NHS roles.  Therefore fair pay rates for the social care workforce must be an essential component to the ‘cost of care’ exercises that will be undertaken by local government over the next year.

 

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?

Short term

 

While we appreciate the Government have put forward funding to support the sector, there is a mixed picture on how this is making it to the frontline.  As the National Care Forum have found 32% of providers have had funding for all their services from round one funding, with 17% of providers receiving funding for all services in round two.[2]

 

Not only has the funding mechanism been slow – to date we have only been contacted by 34 out of the 100 English local authorities that we work with. However the more crucial factor for us, is the variation in approach from each local authority, making it difficult for a large national provider, such as ourselves to implement.  Each local authority has a different proposal for how the WRRF can be used. Some of the proposals are ill-thought out, with offers of new starter bonuses, failing to recognise the valiant contribution of existing staff; or proposals of wage uplifts, providing a short term fix, with no consideration of how these wage uplifts can be sustained. For a large national care provider, we have found it impossible to adopt these proposals locally, as it would be inequitable for the rest of the workforce. We cannot pay a bonus to staff in one part of the country and not pay equivalent staff the same.

 

It would be more helpful if providers could work in partnership with local authorities to determine what would best work for them from a nationally agreed set of solutions.

 

 

While some local authorities are attempting to provide retention bonuses through the WRRF, as a national care provider, this only works if it is available to all staff in England, as has been made available in Scotland and Wales.

 

It is worth noting that our retention rate in services in Scotland and Wales has been higher than that in England over the last year, although we cannot say for certain that is due to the bonus that all staff received.

 

We believe retention is the better investment: if we could stop people leaving we wouldn’t need to invest so much in recruitment. We have great people working in the sector and their resilience has been phenomenal. We are doing what we can as an employer, but it needs national recognition.  The relentless pressure of the past two years, which has grown significantly since the Omicron wave and the focus on protection for the NHS has led many care workers to question their employment choices – Skills for Care estimate a third of care workers leave the sector every year.[3]   

 

 

MHA is keen to realise the benefits of the apprenticeship levy. However our utilisation of our levy funding pot, has gradually reduced since March 2020 due to a focus on responding to the pandemic and grappling with the workforce shortage.  We have also had to revise the way in which we support our people to gain qualifications.  Apprenticeships require a 20% ‘off the job’ training during paid working hours, which has not been sustainable in the current staffing crisis. Currently we host around 197 people doing apprenticeships, which means we are not recouping the full levy we pay.

 

Medium term

 

The ‘People at the Heart of Care: adult social care reform’ White Paper (1 December 2021) proposes many positive steps to support and develop the workforce. But while providing funding for training is a good thing, the Government is focussing on the wrong staffing issue. At MHA we have a strong training offer and offer pathways for career development and while this may not be the case for all providers, on the whole there is a lot of work already underway in improving training. In 2021, operational staff at MHA undertook over 10,000 hours of face to face mandatory, statutory and regulatory training and other development sessions. In addition, over 93,000 e-learning courses were completed by operational colleagues.

 

The White Paper has unfortunately missed an opportunity to address the critical issue of care worker pay, which in itself is central to achieving the Government’s ambition of a fair price for care. This topic is only mentioned a handful of times, but the important aims visualised in the White Paper will not be realised unless we have a thriving, vibrant social care workforce and to create this, we need a fundamental shift in pay and conditions for all those who work in care. 

 

73% of care and support workers across the sector are currently paid the minimum wage of £8.91 an hour.  MHA has been proud to pay all of our staff at least the Real Living Wage since 2018, which is currently £9.50 an hour (£10.85 in London). Whilst this has been a positive move for our staff and organisation, we would like to go further and pay our staff a higher wage, but current funding streams do not allow for this.  Local authority fees for care usually do not cover the actual cost of delivering care.  LaingBuisson estimates that residential care homes for older people in England currently need to charge fees of £696 to £849 per week to generate a sustainable return, whilst residential nursing care costs between £969 and £1,075 per week. Yet average council fees paid were £596 for residential and £764 nursing for 2020/21.[4]

 

The planned increase in the national minimum wage to £9.50 an hour from April 2022 will be good news for all workers who are paid minimum wage.  However, £9.50 per hour is still not commensurate with the level of skill, responsibility and commitment required for roles in the care sector.  Our experience at MHA has shown that our modest increase in salary to £9.50 an hour for care staff is welcome, but still not enough to address the recruitment and retention issues faced across the sector.

 

Carers must be competent and confident in safeguarding, life support, first aid, infection prevention and control, and much more.  They support people in taking their correct medication and with their mobility, using hoists and other equipment safely.  This is alongside the dedication, compassion and emotional intelligence needed to ensure they maintain peoples’ dignity, and quality of life.  


Comparable roles in health services, for example Band 3 Health Care Assistants, are paid around £4,000 a year more than social care colleagues on minimum wage and have more favourable NHS pension and sickness policy benefits.  A report earlier this year by Community Integrated Care shows that other public sector roles with an equivalent scope, complexity and accountability, such as senior teaching assistants and police community support workers, are paid on average £7,000 a year more than care workers.[5]

 

It is vital that the planned charging reforms, which will include local authorities establishing a ‘fair rate for care’, must include enough to enable better pay and conditions (such as improved pension and sickness policy benefits), as for all employees in the sector.  Pay scales must also allow for progression and higher wages to recognise skills and experience, commensurate with NHS pay scales. We therefore call for a financial settlement that allows for increased pay for all care workers, with sufficient funding baked into the ‘fair rate for care’ to enable this.  This needs to include enough funding for increases to pay for all frontline care and support workers, with additional funding to reward senior and more experienced care workers with higher pay bands.

 

We agree with the Government’s Social Care Taskforce’s Workforce Advisory Group recommendation in August 2020 that, “Government should instigate a review involving employers, commissioners, and employee representatives with a view to implementing a new career-based pay and reward structure, in-year, for social care which will be: 

(a) comparable with the NHS and equivalent sectors; 

(b) fully-funded by Central Government; and 

(c) mandatory on employers and commissioners of services.” [6]

 

 

We do not feel that LAs are prepared should a care provider need support in a staffing emergency. The acute workforce crisis, exacerbated by the rise of the Omicron variant, led us to be concerned about maintaining our services over the Christmas period. We contacted every local authority with whom we work, asking them about their plans for supporting care homes if staff absence becomes acute. The majority of responses, with a few exceptions, simply asked what we were planning and offered no proactive staffing support.

 

While MHA has contingencies in place and our colleagues so often go above and beyond in covering shifts, we have to be assured that if the worst happens and we don’t have enough people to care for our residents safely, that there are plans in place locally to support us.

 

665 (as at 12 January) of our care homes closed to new residents because of outbreak and a lack of available staff to allow for additional residents, and some of our housing with care schemes are unable to implement new care packages for residents. 

 

Long term

Adult Social care needs a comprehensive workforce plan, this is something that is missing from the People at the Heart of Care: adult social care reform’ White Paper. As a nation, we need to value our care workers. We need more people to see caring for others as a professional career choice, with good career pathways and consistent training, with roles seen as skilled and valuable to society. With an ageing population and rise in people with higher needs such as those living with dementia, a more strategic approach is need to ensure that along with health professionals, there are enough people skilled to take up roles in social care.

 

Professional carers who have given their all to protect those most vulnerable during the pandemic and gone above and beyond in maintaining the system during epic staffing shortages, not only a deserve parity of status with equivalent health professionals including pay and benefits, but a long term comprehensive national workforce plan as suggested by the Future of Social Care Coalition[7] is needed.

 

The recent £500m funding and White paper policies acknowledge that investment is needed in the workforce and some of the proposals are welcome, but it stops short of considering what may be needed as future models of care are developed.

 

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?

 

We welcome the White Paper’s commitment to developing a new universal career structure and training opportunities to enable people to progress and realise their potential.  A consistent, high quality approach to developing knowledge and skills, with recognised benchmarks and a portable Care Certificate, will improve quality of care, reduce duplication and increase efficiency in training across the sector. 

 

Plans to improve the portability of the Care Certificate are most welcome and we would urge for this to be made a priority. Currently, while a new recruit may present a care certificate, we are unable to validate and accept the training and will initiate our own training schedule to be confident the new staff member has access to good quality training. New care workers at MHA undertake 115 hours of training in their first 6 months of working in care, this includes training towards their Care Certificate.

 

Therefore as portability of the Care Certificate is introduced the external validation and accreditation must be recognised good quality providers and the sector must have full confidence in its delivery.

 

Similarly in the introduction of the Knowledge and Skills Framework, needs to be backed up by a robust processes and quality endorsed provision that must include mandatory training subjects. The focus must avoid the numbers of people on seats, which attracts funding and be driven by real outcomes for learners, which is not just a certificate but the behaviour change and outcomes for people in their care. The Knowledge and Skills Framework should go further and complement revised pay bands as we have recommended above.

 

Regarding the Skills Passport we are keen to learn more about how the system will work. How it will be accessed, governance around the training undertaken, assurances for care providers that quality training has been completed and delivered by an appropriately approved provider. This will remove any ambiguity for the sector and furthermore ensure our regulators, upon inspection, are able to pass judgement on a satisfactory trained workforce with increased confidence and consistency.

 

In addition, the offer for Registered Managers really must include the breadth and depth of learning that covers both business skills, people management and health and social care specific requirements.

 

However, beyond this the key must be to make the social care sector an attractive place to work and that is not just about training.  Low pay and poor recognition have dogged the social care sector for too long, with the majority of care workers paid just the minimum wage. For example, in the setting up of the Health and Social Care Levy, the Government has chosen to provide greater support initially to the NHS, this creates a disparity, where the adult social care sector remains under-funded and therefore unable to resolve entrenched workforce issues.

 

Coupled with this is an ageing workforce - the average age group of our frontline care workers are people in their 50s. To address future sustainability of the care workforce, more needs to be done to ensure that working in social care is seen as an attractive, valued and rewarding career. This includes training, long term planning and pay, as mentioned previously.

 

MHA recommends:

 

 

Long-term investment in the social care workforce will have far-reaching benefits and should be seen as a central component to the Government’s levelling up plans.  For the 1.54 million people who work in social care it will provide them the pay they deserve for the skilled and demanding work they do. It will mean that more people are able to access the care they need and will improve the quality of care as more people are recruited into the sector and retained long term.  

 

Further, social care investment will boost economies in every community by increasing local spending power and supporting local business in the supply chain such as gardeners, caterers and trades.  Social care is a key part of local infrastructure – an economic contributor, an employer and a safety net for informal and unpaid carers.  It is as important as schools and nurseries in enabling people to go to work. Investment in social care will therefore help level up communities through supporting thriving local businesses, jobs, volunteering and of course providing the vital safety net for those who need it

 

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

 

Whilst there have been staffing issues in the care sector for a while, we are currently experiencing the most acute workforce recruitment and retention crisis that we are aware of historically.  This is being felt across social care and is the result of many years of low pay in the sector, compounded by valued staff leaving due to changes to immigration rules, and exhaustion from the pandemic. Around 150 MHA staff left due to the mandatory vaccine regulations introduced in care homes and we expect to lose more in the extension of this to wider social care provision, which will affect our housing with care staff. We know, from exit interviews with leavers and staff focus groups, that many people leave for higher paid job opportunities.  Meanwhile social care employers also face competition from a range of other sectors, who are also under-staffed but can often afford to pay higher wages, as they have a greater ability to increase their consumer prices. For example, in November 2021, supermarket chain Lidl announced an increase in entry level wages and Amazon have offered Warehouse Operatives a sign-on bonus of £3,000 in many areas. In recent exit interviews in November 2021, 45% of staff leaving MHA were leaving for a job in a different sector.

 

Pay and recognition

The pandemic has shone a light on the vital contribution that the social care workforce makes to every community in the UK, and it is now widely accepted that this vital workforce has been underpaid and undervalued for too long.  There have been more than 100,000 vacancies in the sector for over 10 years, and at the moment more than 105,000 social care jobs will be advertised on any one day.  

 

Under-investment in the workforce has also led to high staff turnover rates, at around 28.5% in 2020/21.  This means around 410,000 people leave their jobs over the course of the year with only around 63% staying within the sector.

 

“Social care is always seen as a ‘lesser’ job…we are the forgotten sector.” – MHA care home employee in focus group, May 2021

 

As we have previously suggested, we need a fundamental shift in pay and conditions for all those who work in care, so that they adequately financially rewarded for the important work they do. It is vital that local authorities are funded to pay providers a fair rate for care that includes agreed pay scales, and improved pension and sickness policy benefits, as the founding remuneration for all employees in the sector. This framework must be baked into the ‘fair rate for care’ and the ‘cost of care’ exercise that will be undertaken by local authorities next year.

 

We cannot ignore the increasing cost of living, which will force more people out of social care into higher paid work, if this is not addressed:

 

“Care workers are undervalued and underpaid, looking after the most at-risk people in our society whilst themselves being at dire risk of in-work poverty.”[8]

 

Investment through the commitment to training and a long term comprehensive workforce plan, would also help enormously to demonstrate the adult social care workforce matters.

 

Burnout

Our staff have faced unprecedented challenges over the past two years due to the pandemic and continuing outbreaks of Covid-19. This is combined with the current staffing crisis. They have stepped up with commitment and professionalism. Many have provided more end-of-life care than ever before and taken on additional clinical tasks. All staff have swiftly adopted new and changing rules on infection prevention control and given ever-more compassionate care and friendship while older people have been unable to see their loved ones. We are acutely aware that these pressures bring increased risk of anxiety, stress and burnout and our care home managers have done a tremendous job to try and mitigate this, drawing on the investment we have made in wellbeing resources. But this can only do so much, in light of a struggling social care sector, where the wider labour market offers more financially rewarding and stress-free opportunities.

 

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

Nurses

There are simply not enough UK nurses to meet the demands required in the NHS, private health providers and across social care. Unfortunately this means the social care sector is in direct competition with the NHS. MHA consistently has eight nursing vacancies at any one time and we find it difficult to increase the benefits we can offer. As a consequence we have been unable to recruit enough nurses and have had to remove nursing provision from at least three care homes over the past few years.

 

MHA supports the restoration of a full bursary for nurse training and modules or specialisms included for care home nursing, including work placements. An additional solution is to improve the access to nursing training via vocational routes and to develop training pathways for care assistants. There could be a role for Integrated Care Systems to take a lead in ensuring nursing provision is sustainable across the wider health and social care sector.

 

Care assistants and other roles

Other roles in the social care sector such as care assistants, particularly covering night shifts, kitchen and laundry staff have been equally hard to recruit to as we face competition from other industries, such as hospitality, that can put their prices up and pay higher wages.  With most local authorities already paying below the actual price of care, we do not have this option and cannot compete.

 

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?

 

As we have set out above, the adult social care sector needs a long term comprehensive workforce plan aligned to the NHS People Plan, which must have a strategy to create a sustainable workforce and adapt as care models and needs evolve and avoid further staffing crises which have been so damaging to the wider health and social care sector.

 

It must address:

 

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?

 

Health and social care integration has the potential to make a real difference to the lives of people, particularly frail older people and the ultimate goal is surely for all aspects of care to be person-centred outcomes and flow with seamless transitions amongst all the institutions and people involved in a person’s care. Integration cannot be for its own sake – it has to lead to good things for people who need care.

 

The integration agenda has at the moment, a tendency to focus on commissioning and budgets particularly in the health sector. However, good health and wellbeing are not just clinical issues, the care sector needs to have parity with health services. There is an opportunity for Integrated Care Systems to support local workforce planning across the health and social care sector, but we fear this will focus on the health workforce.

 

Our concerns have grounds:

 

 

 

 

Conclusion

This year will be a historic year for the social care sector as long-awaited reforms on charging, workforce development and integration are developed and agreed.  It is vital that these funding reforms are built on a foundation of higher wages for our nation’s care workforce to enable care staff to be remunerated fairly for the skilled, responsible and life-changing work they do.  This must be a fundamental part of the ‘fair rate for care’ that national government and local authorities will pay for care in the future in order to ensure we have the thriving, stable, quality social care sector that the nation needs.

 

Jan 2022

[1] The State of Health care and Adult Social Care in England 2020/21, CQC, October 2021

[2] Survey of NCF Membership – Impact of the Omicron variant, National Care Forum, January 2022

[3] Recruitment and retention data – 2019-20, Skills For Care, December 2020

[4] Care Cost Benchmarks - Eleventh edition, LaingBuisson, 2020,

[5] Unfair to Care, Community Integrated Care, July 2021

[6] Social Care Sector COVID-19 Support Taskforce: Workforce Advisory Group report and recommendations (publishing.service.gov.uk), Adult Social Care Taskforce, August 2020

[7] A Social Care People Plan Framework, Future of Social Care Coalition, July 2021

[8] Care Providers: It’s time to pay a real living wage, Living Wage Foundation, September 2021