Written evidence submitted by Norfolk County Council (RTR0122)

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?

The pressures on the care market and availability of care have been there for some time with difficulty retaining and recruiting staff, however this autumn (with job vacancies in the UK reaching a record high of 1.25m) has seen this situation increase and this has been exacerbated by staff isolating or sick and demand for services increasing. It is therefore clear that the situation is beyond those brought about by the pandemic and therefore root causes need to be addressed.

Social care roles are still being seen by some prospective applicants as jobs not a career. We need to be able to both articulate and action clear career pathways linked to the skills and competences required to progress along the pathway.  The pay rates do not reflect the skills and responsibilities of the role – and local work to examine parity of esteem is considering how pay rates can be determined by complexity of presentation, skills and expertise required to do the job, individual responsibility, lone working etc benchmarked against roles in other similar sectors. This alongside the career pathway would help but it needs to be resourced.

At its core are the issues of – pay, terms and conditions, clear career path, investment in skills and development and wellbeing issues – as well as the overall image and value given to the sector.

The sector is strongly affected by council and health funded contracts care packages and the price paid. Providers will rely almost entirely on these contracts for services for people with learning disability, physical disabilities and mental health needs. For older people, care providers will deliver more care to self funders than council or health commissioned individuals and this has led to significant differences in the fees paid.

It does mean that for most care providers the rise in pay being seen across sectors (and particularly retail and transport) cannot be easily responded to, without significant impact on their business models. Hence the issue of funding to support levelling up social care and ensuring parity of pay with similar jobs, particularly those in the NHS, which would provider far more opportunity for wider career paths.

More widely action is needed to recognise the value of social care to our society and to the effective operation of the health and care system. This means that funding needs to recognise all aspects and delaying support for social care will further destabilise the wider system. It also includes addressing the increasing pay gap materialising between our sector and others and the limited levers and means within the care sector and local government to adequately address this. The increase in the national living wage is far short of the pay being offered in retail and hospitality and does not enable parity with similar roles in the NHS. In an increasingly competitive employment market unless this fundamental gap is addressed there will continue to be workforce shortages, high levels of turnover and issues relating to quality of care.

Targets could be set for job centres to identify appropriate candidates and to support more people into social care.  Essential training requirements mapped and linked to career levels within the sector.

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?

This could be supported by further professionalisation of the social care workforce and expectations and ongoing support for training and development. This would improve recruitment and retention and improve quality of services. The turnover of social care staff is extremely high at c31% and rises to 36% for direct care staff. Almost 30% of people have been in their role for less than a year, although more stay with the sector – but there is a culture of moving between providers and jobs, which does not encourage investment in the workforce, long term training and development of skills and careers.

What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?

What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

At its heart the question needs to be what number of staff are needed to safely deliver quality of care for people in the UK. From a council commissioning perspective alone, we are currently c11,000 hours per week short of home support care, which means that people are needing to be supported in temporary ways and other care is being diverted.  At present there are not adequate numbers of staff applying for social care vacancies and therefore reducing some of the costs associated with international recruitment and simplifying the application process and timeline could support employers to undertake this option.  Clearer support and guidance would help this and could also ensure that there is clarity about the ethical recruitment practice that must apply. There should be no advantage in place to recruiting international employees due to pay, terms and conditions.

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:

• To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?
• Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?
• Could the training period for doctors be reduced?
• Should the cap on the number of medical places offered to international and domestic students be removed?

From a social care perspective, it is important that social care is not seen just through a health lens and to recognise the wide range of roles, specialisms and specific skills across the social care sector. We need to ensure that training is recognised across both health and social care that can support transition across both areas and enable improved care career pathways. As with other parts of the sector, if the care sector had a recognised level body/accreditation (as the Care Certificate is not an accredited qualification) then the sector is likely to be more attractive as a career option.

In addition, in order to support training of nursing associates right across the social care sector there could be a better and more innovative route for oversight and sign off, recognising that the size and type of establishments will not enable registered nurses to be employed in all settings to support training.

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

There is a lack of recognition that social care workers are a skilled workforce and current pay rates support this view.  We need to address the negative perceptions of a career in care, with more good news stories, examples of evidence based approaches that are delivering great care and experiences of people in services. 

Pay, parity of esteem and terms and conditions that compare to roles in other sectors is important. However, the reputation of the sector, which is partly reinforced in some recruitment campaigns, seems to focus on the unskilled workforce and not on career progression. There is also evidence of an ageing workforce with the younger demographics not considering a career in social care due to pay, progression, lone working and unsocial hours. The public perception of the relative value of working for different types of organisations in a health and social care system is important. This hierarchy is often caused by marketing messages (e.g. working in health as part of the NHS is regarded as giving better status, higher pay and better terms and conditions)

The issue of value is also key. Residential care services and home support services are managing increased acuity, requiring additional skills and support networks. Social care workers need to be members of multi disciplinary teams and able to access the support of other MDT members for advice and training. People that feel supported with good access to training will be less likely to leave the profession.

Small organisations can also face further challenges with:

-          Difficulty in cross subsidising and planning for long term developments

-          Economic uncertainty that arises from short term projects and contracts

-          Lack of capacity and expertise to capitalise on opportunities, complete commercial tender documentation or introduce effective HR practices

-          Difficult and expense of providing on-going training and supervision

-          The potential isolation of single specialist roles without access to peer support.

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

Rural locations pose a real challenge as candidates need to be able to drive and are not able to afford to live in the area due to higher house prices. Affordable housing is needed to attract a younger demographic to the area and allow them to live and work in rural locations. There could also be financial support to drive, such as insurance/driving tuition to reach more remote locations

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?

In relation to social care and based on recent work across our health and social care system we need to focus on the following ambitions

Valuing our workforce – demonstrating to the social care workforce that we care and value them as our greatest asset. With focus on:

-          Promoting parity of esteem between health, local authority and independent sector care workers including pay

-          Supervision, coaching, mentoring and professional development

-          Maintaining and improving the quality of learning opportunities, workplace experiences and training

-          Career pathways so the caring profession is seen as dynamic and with potential and opportunity

-          Access to health and wellbeing initiatives

-          Promoting carer-friendly employment practices

-          Developing HR practices and minimum employer standards that support flexible working and embrace diversity

-          Addressing the structural issues that get in the way such as affordable housing, poor transport links and weak broadband connectivity

-          Incentivising good workforce and business practices

Growing and transforming our workforce – ensuring the right people with the right skills and values are in place at the right time with a steady pipeline of new entrants to the social are sector. With focus on:

-          Attraction, recruitment and retention – including professional development opportunities – and succession planning

-          Upskilling care workers to perform a wider range of tasks under the supervision of specialists to work and feel more confident supporting those living with dementia, autism and mental health needs

-          Promoting apprenticeships and putting in place means to enable this for the social care sector

-          Offering business health checks and the development of business skills in managers and providers

-          Exploring new models of care and new worker roles that cross the boundaries of health and social care and can lead to wider opportunity for care career progression

-          Supporting the development and expansion of Health and Social Care Academies for our future workforce

-          Mapping the social care workforce to support workforce planning

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?

Integrated care systems need to work with health and providers to develop models for social care that are fit for the future and ensure that these are properly resources and supported by the system.  Resources need to flow upstream away from crisis care within the hospitals to pre-emptive/proactive approaches in the social care sector.  For example, there are opportunities to manage higher acuity of needs within residential care settings if there is clinical supervision, training and in-reach support to ensure that this is done well and safely. 

Jan 2022