Written evidence submitted by Scottish Care (IAS0009)

Written evidence submitted by Scottish Care to Scottish Affairs Committee Inquiry on Migration December 2017

About Scottish Care

1. Scottish Care is the representative body for independent social care services in Scotland. This encompasses private and voluntary sector providers of care home, care at home, housing support and day care services across the country. Scottish Care counts over 400 organisations as members, which totals over 830 individual services. Scottish Care is committed to supporting a quality orientated, independent sector that offers real choice and value for money. Our aim is to create an environment in which care providers can continue to deliver and develop the high quality care that communities require and deserve.

2. In relation to older people’s care, this sector provides 89% of the care home places in Scotland and over 50% of home care hours[1]. There are more older people in care homes any night of the week than there are people in hospitals - as at 31st March 2016 there were 873 care homes for older people providing support to 33,301 residents any night of the year, with 89% of these residents located within the independent sector[2].

3. Independent sector social care providers across care home, care at home, housing support and day care services employ nearly 103,000 professional paid staff, which constitutes the largest health and care workforce in Scotland next to the NHS and 51% of the total social services workforce[3].

Executive Summary

4. Given our wide range of members offering critical social care support across Scotland, Scottish Care would argue that we can offer an informed and evidence-based perspective on skill shortages in care homes and the care at home/housing support sectors across Scotland.

5. We are responding with general comments on:

• The supply and demand for nurses and other staff within the care sector in Scotland
• The impact of the Brexit decision
• We also consider the wider recruitment and retention issues and related issues of migration for the social care sector in Scotland.

6. The evidence we present is both based on research we have undertaken or commissioned and evidence from other stakeholders including from regulatory and scrutiny colleagues.

Nursing

7. There were around 6,650 nurses working in the social services sector in Scotland at the end of 2016, representing around 10% of the nursing workforce in Scotland. 4,700 nurses are employed in care home, care at home, housing support and day care services and of this, 99% are employed in the independent sector. Care homes for adults employ 69% of the total nurses in social services and nurse agencies employ another 27%[4].

8. The following evidence for this statement is taken from our Report on Nursing Data 2017 (published November 2017)[5]:

As close as can be reasonably estimated, the nurse vacancy level across respondents to the 2017 survey (comprising 60% of the total sector) is 31%. However the vacancy level for some providers in the survey was as high as 60%. To put this into perspective, nurse vacancy levels within the NHS in Scotland currently sit at around 4.5%[6].

9. In fact, an extremely troubling trend is evident when examining nurse vacancy levels in more depth across independent sector care providers.  There were some parts of the country where the recruitment of nurses was considered to be particularly challenging, particularly Edinburgh and Aberdeenshire. However over a quarter of respondents indicated that they had difficulties in recruiting in all the areas they operated so whilst the exact nature of the issue may vary slightly by service or by area, it is impacting on all services regardless of their location. It is clear that difficulties are being faced by organisations operating in urban or rural settings, and those in-between[7].

European and overseas workforce in nursing

10. 98% of respondents in our 2017 workforce survey recruit nurses from the UK. Approximately 59% of care homes employ staff whose country of origin is outwith the UK. Nearly 42% recruit from the European Union[8].

11. Whilst there is currently research being undertaken to determine an accurate figure, all the studies undertaken by Scottish Care suggest that the EEA population within the independent social care nursing sector is between 6-8%.

12. Obviously, Brexit is likely to have significant implications for this recruitment channel which is already presenting even more difficulties for the social care sector in filling nurse posts in the future. This is highlighted by the fact that 65% of respondents indicated that they had found it more difficult to recruit nurses from Europe than in the previous year.

13. Additionally, over 26% of organisations recruit nurses from out-with the European Union. This figure has risen by 7% since the previous survey, indicating a shift towards more international recruitment strategies being adopted by care organisations. However, such approaches benefit medium to large scale organisations and the social care sector in Scotland, unlike the rest of the United Kingdom, has a substantial SME and single provider element within its composition[9].

Social care workforce

14. Scottish Care has undertaken two distinct pieces of workforce data research in 2017: the first for care at home and housing support services in the spring where the total workforce is approximately 68,000 individuals and the second for the care home sector, where the workforce is slightly over 50,000 individuals, which was undertaken in the summer.

15. Both of these studies highlight significant challenges in relation to workforce recruitment and retention and the emerging impacts of Brexit.

16. In terms of the care home study 77% of respondents indicated that they were having greater difficulty in recruiting care staff in 2017 than in the previous year. The annual turnover within the care home sector is recorded at 22% of the total workforce. It is also worth noting that this survey highlighted a substantial increase in the use of agency staff, with 28% of organisations having increased their use of agency services in the last period of time.

17. Respondents were also asked to detail the country of origin of their staff. From the results, we know that approximately 6% of the care home workforce originated from the European Union and a further 6% from other countries. Inevitably, Brexit will therefore have a significant impact on the care home sector labour market and it will be important to monitor any changes in these numbers, providers’ experiences of recruiting from the EU and any barriers to enabling workers to enter this sector in Scotland.

18. The care at home and housing support survey also highlighted similar challenges re recruitment and retention. A total of 9 out of 10 organisations indicated that they had current support worker vacancies and 89% indicated that they were having difficulty filling support worker posts. Alongside this there was a particular challenge re supervisors with 21% of organisations having vacancies in these roles and 17% having difficulty in recruiting for these positions[10].

19. Whilst all the organisations sought to recruit support workers from the UK, a sizeable number at 60% recruited from Europe.

20. In terms of the profile of the overall care at home and housing support workforce within the study, 9.6% were described as coming from the EEA and 1.7% from outwith Europe. It will be self-evident that the impact of Brexit both upon further recruitment for support workers and the existing workforce is likely to be significant especially when the high levels of vacancy are taken into account. In total just over a third (35%) of the care at home and housing support workforce is replaced each year.

21. In terms of recruitment strategies for newcomers, the figures are quite illuminating in terms of reliance on overseas recruitment:

• Managers: 24% EU, 15% out-with EU
• Supervisors: 37% EU, 21% out-with EU
• Care staff: 44% EU, 25% out-with EU
• Nurses: 63% EU, 45% out-with EU

Conclusion

22. In view of the research which we have undertaken in 2017 and in particular the current difficulties in the supply of nurses, Scottish Care is of the opinion that allowing employers to recruit from outwith the EEA provides an important avenue of support to the sector and therefore ultimately for those people who need its services.  However, whilst there are general nurse shortage issues in Scotland, the specific nurse recruitment and retention challenges facing the social care sector and nursing homes in particular must be recognised if a crisis in social care is to be avoided.  We have previously strongly recommended that social care nurses for care homes (SOC 2231) be placed on the Shortage Occupation List for Scotland so that employers of them in care home services are able to recruit from outwith the EEA if necessary. 

23. Anecdotally we are aware of increasing difficulties faced by providers in attempting to recruit from the EEA post Brexit and we are concerned that these difficulties will develop to further negatively impact upon the care sector in Scotland. At the current time, despite initiatives such as the Scottish Living Wage and significantly as a result of reduction in public spend on social care, all other mitigatory measures are not meeting current demand never mind developing demand. It is routinely possible to get paid more money to stack shelves in a local supermarket than it is to deliver care and support to some of our most vulnerable citizens.

24. In overall terms the social care system in Scotland is significantly dependent upon the skills, experience and abilities of those who come to Scotland from elsewhere. Historically this has contributed a great deal to the care of some of our most vulnerable citizens. As an organisation, we are profoundly concerned that there is already evidence that Brexit is having a negative impact on both retention and current recruitment from the European Union. Whilst it is difficult for us to assess future policy direction, as a national membership organisation it would be our hope that whatever system replaces current practice is one which is as flexible, permissive and responsive as possible. The current recruitment and retention crisis facing social care in Scotland must not be made worse by any system of migration that deters or presents undue barriers and obstacles to those who may wish to come to nurse or care in Scotland.

25. Scottish Care is profoundly concerned that the impact of reducing the availability of workers from the EEA, both nurses and support workers, will have a negative effect on the delivery of social care in Scotland.  It is our firm belief that to fail to address the extreme lack of nurses and support workers in the social care sector will severely compromise both social care and NHS services in the very near future.

Becca Gatherum - Policy and Research Manager, Scottish Care              

December 2017