What does the social care workforce look like across the four countries?

Key points

• In each of the UK countries, the social care workforce represents a large proportion of employment. In England alone, most recent figures estimate up to 1.6 million people are employed in the sector.
• However, there are shared challenges around recruitment and retention of the workforce, linked to poor pay and conditions and perceptions of the attractiveness of the sector.
• England is the only country that does not have a non-departmental public body responsible for the regulation and registration of its workforce. In the other UK countries, all social care workers must sit on a register, and in Scotland and Wales a qualification is necessary to work in social care. There is early evidence that this is having a positive impact on retention and perceptions of the workforce.

Source: *Nuffield Trust analysis of ONS Annual Population Survey 2021. Annual Population Survey chosen to allow for cross-country comparison using estimates of employment by occupation figures. Totals for each country are from those who stated they were either residential, day, or domiciliary care managers and proprietors, nursing auxiliaries and assistants, houseparents and residential wardens (providing care and supervision in residential facilities), care workers and home carers, or senior care workers³. These figures should be treated with caution, as survey data will include some people working in children’s services due to occupation categorisation and reporting bias. Moreover, these figures will differ from workforce statistics reported by each country’s national workforce organisations, which use more precise definitions.   .

Similar challenges

All four countries of the UK share similar challenges around the workforce. Workforce conditions are poor, with many on zero-hour contracts and earning close to the minimum wage (although the proportion of workers on zero hours contracts varies across the countries).⁴ In addition, there is little opportunity for continued professional development. The sector therefore experiences high turnover due to low levels of recruitment and retention.⁵ There are as such high levels of vacancies, and we have previously calculated that to provide care for people over 50 with high unmet needs in England alone would require up to 90,000 additional workers.⁶ This figure is much higher when adults of all ages and needs levels are factored in.

Proposals for greater international recruitment of social care staff have been made by the government⁷, although questions remain over how to migration can be facilitated in a sustainable way. Following recommendations made by the Migration Advisory Committee (MAC) in December 2021, the government made care workers eligible for the Health and Care Worker visa. They must, however, earn at least £20,480 per year or £10.10 per hour to qualify (it is set at £13,520 for senior care workers).⁸

In December 2022, MAC raised concerns over the level at which this salary is set and whether the salary threshold may perpetuate the underlying issue of low wages in the sector.⁹ A broader strategic and whole-system approach is required should international recruitment become a mainstay for the adult social care workforce.¹⁰

England

Skills for Care came into being in 2001 and is the delivery partner to the Department of Health and Social Care for the development of the social care workforce in England. Skills for Care acts as the main source of knowledge of the workforce, and collects comprehensive data in the Adult Social Care Workforce Dataset as well as publishing yearly reports.

Most recent figures published by Skills for Care in 2022 estimate the total regulated adult social care workforce at 1.5 million people (1.62 million filled posts)¹¹, of which 595,000 were employed in residential and nursing care (including 295,000 and 280,000 respectively, and 10,000 jobs in Shared Lives settings)¹², and 735,000 in domiciliary care.¹³

There are significant challenges with the recruitment and retention of people working in social care. On average in 2020/21, there were around 105,000 vacancies across England on any one day. Turnover was around 34.4%.¹⁴ The Resolution Foundation estimates that 61% of the care workforce in England were paid below the Real Living Wage between 2017 and 2019.¹⁵ This is a particular issue in domiciliary care where travel time and fuel costs often reduce actual take home pay to below the statutory minimum wage.¹⁶

England is the only country in the UK for which there is no professional body which is mandated by – and accountable to – government, that is responsible for the regulation of social care workers. Stakeholders have suggested this has hindered the development of a strong professional identity underpinned by shared improved status, standards and qualifications (i.e. professionalisation). ¹⁷ The absence of a professional body and associated register makes having an accurate picture of the workforce more difficult.

There is a growing interest in professionalisation as a solution to the workforce shortages that England faces.¹⁸ The rationale is that developing a strong professional identity for social care workers, facilitated by registration and adherence to common professional standards, would make the sector more attractive to new entrants as well as encouraging workers to stay within the sector by offering more opportunities for career progression in social care. However, there is to date a limited evidence base on the effect of professionalisation on retention and recruitment levels.¹⁹ Beyond this, one of the biggest challenges with the professionalisation of the English social care workforce is its size, as well as the vast number of settings in which the workforce operates. Developing mandatory registration as a first formal step in professionalising the workforce would require large amounts of planning and resources, especially if registration is to increase the attractiveness of working in the sector.

As part of plans to reform the adult social care sector announced in December 2021, the government has committed an investment of at least £500 million into workforce development and wellbeing initiatives up to 2024/25.²⁰ This has been supplemented with a number of short-term funding injections:

• £162.5 million was allocated in September 2021 via the Workforce Recruitment and Retention Fund to support local authorities which operated between October 2021 and March 2022.²¹
• An additional £300 million was announced in November 2021 to address workforce capacity pressures over winter 2021/22.²²
• Up to £15 million of funding to support international recruitment was announced in September 2022 for winter 2022/23.²³

The Department of Health and Social Care has published its findings on the impact of the Workforce Recruitment and Retention Fund on staff recruitment and retention.²⁴ The additional funding has been perceived by local authorities to help keep staff in employment and address capacity issues. However, the short timeframe over which the fund was administered has limited the extent to which improvements have been embedded in the long term.

Wales

Social Care Wales came into being in 2017 (as a continuation of the previous Care Council for Wales) and was set up under the Regulation and Inspection of Social Care Act (Wales) (2016) in line with the Social Services and Wellbeing Act of 2014. As such, Social Care Wales acts as a Welsh government sponsored body, a non-departmental public body that is legislated, funded, and accountable to the National Assembly for Wales. It has three main functions around workforce regulation, workforce development and service improvement.²⁵ A 10-year workforce strategy for health and social care was published by Social Care Wales and Health Education and Improvement Wales in October 2020.²⁶

Social Care Wales is in the process of implementing a mandatory qualifications-based register with continuous professional development schemes, under which all registrants must demonstrate compliance with Fitness to Practise.²⁷ Stakeholders have suggested this has formalised the need for more structured information.  

Social Care Wales acts as the main source of knowledge for the workforce and publishes workforce reports, including workforce profiles for commissioned care provider services and local authority regulatory services. Social Care Wales estimates that there were 72,440 people working in social care in Wales in 2021.²⁸ This includes 30,531 in staff employed in residential care providers, and 20,644 staff employed by domiciliary care providers.

As in England, Wales experiences challenges with the recruitment and retention of its staff working in social care. 56% of care staff in Wales earned less than the Real Living Wage between 2017 and 2019²⁹. In December 2022, the Welsh government announced an estimated £70 million to local authorities and health boards to implement the real living wage uplift – to £10.90 an hour.³⁰ Employees will see this benefit in June 2023. This is considered to be a significant step to improving working conditions and esteem for the social care sector.

Social Care Wales estimates that there were 5,581 posts vacant or held in 2021 – representing 6.1% of the workforce.³¹ They also estimate that 68% of these vacancies are in commissioned care providers, while 32% are in local-authority owned providers.³² To date, there has been limited evidence of the impact of registration activities on professionalisation efforts and whether it has enabled a greater recruitment and retention of the workforce. Some concerns have been raised that the need to undertake a qualification in order to be a social care worker could act as a disincentive for individuals, especially for those who only work a few hours a week.³³ A further complexity is where staff work across the English/Welsh border and are therefore subject to two separate legislations.

Scotland

The Scottish Social Services Council (SSSC) came into being in 2001 under the Regulation of Care (Scotland) Act. As such, the SSSC acts as a non-departmental public body that is legislated for, funded by, and accountable to the Scottish parliament. Its main functions are around registration and regulation of workers, development, and ensuring Fitness to Practise.³⁴

Registration is mandatory, and qualifications-led, making it an offence to exercise social care work without being on the register. Applicants can sit on the register before acquiring their qualifications (registration with condition).³⁵Registration started shortly after the Regulation of Care Act in 2001³⁶, with the aim of developing a strong professional identity that would be valued both by workers and service users³⁷as well as strengthen the sector’s skills base, and is still ongoing. Workers employed in domiciliary care services have been registered in their entirety since October 2020.³⁸ Stakeholders reported that holding a mandatory register for almost 20 years had real benefits in terms of knowledge of workforce make-up, its movements, and for future planning.

The Scottish Social Services Council develops and publishes official and national statistics on the social services workforce and publishes yearly reports on workforce data. These cover social care workers and social workers for both adults and children in receipt of services.

In 2021, there were around 208,360 staff employed in adult services, of which 73,120 were employed in housing support/care at home services and 51,010 are employed in care homes for adults.³⁹ While the number of staff employed in adult care homes has decreased since 2012 (-5.9%), the number of staff employed in housing support/care at home services has grown substantially (+17.5%). The median age of staff employed in care homes for adults has fallen from 50 in 2020 to 45 in 2021.⁴⁰ The median age of those employed in housing support/care at homes services is 47, having risen from 46 in 2020. 85% of the adult care home workforce are female, while 77% of the housing support/care at home workforce are female.⁴¹

As in England, Scotland experiences challenges with the recruitment and retention of its social care staff. In 2021, 63% of care homes for adults reported vacancies, a 15-percentage point increase from 2020.⁴² 71% of care at home services reported vacancies in 2021, a 12-percentage point increase from 2020. Most alarming (but perhaps not surprising) is that public services reported vacancies most highly at 81%, compared to private services (63%) and voluntary services (62%).⁴³ The reasons most frequently reported by adult care homes and care at home providers for vacancies being hard to fill include too few applicants (78% and 77% respectively), too few applicants qualified (38% and 30%), and too few applicants with experience (51% and 43%). ⁴⁴ 

In February 2022, the Scottish government announced pay for those providing direct social care to adults would rise to £10.50 per hour.⁴⁵ This will rise to the Real Living Wage of £10.90 in 2023/24, supported by an additional £100 million of government funding.⁴⁶

Northern Ireland

The Northern Ireland Social Care Council (NISCC) came into being in 2001 under the Health and Personal Social Services Act (Northern Ireland). As such, the NISCC acts as a non-departmental public body that is legislated for, funded by, and accountable to, the Department of Health in Northern Ireland. Its main functions include the registration and regulation of social care workers, setting standards of conduct and practice, and supporting the learning and development of the workforce.⁴⁷

Registration is mandatory but not qualifications-led, making it an offence to exercise social care work or call oneself a "social care worker" without being on the register (although the offence falls on the registered employer rather than employee).⁴⁸ At present, there are no plans to introduce mandatory qualifications. Being on the register is intended to demonstrate that a worker is compliant with the standards of conduct and practice, making them accountable for the quality of care they provide.⁴⁹ Stakeholders suggested that introducing mandatory qualifications would help to raise the quality and status of the workforce, and it remains a long-term ambition.

The NISCC has completed the registration of the designated groups of social care workers, with the final group of domiciliary care workers registered in 2018. Northern Ireland is the first UK country to achieve complete registration of its domiciliary care workforce. It is also the first country to undertake an evaluation of its registration process⁵⁰, which finds that mandatory registration and adherence to Fitness to Practise standards has increased confidence among the workforce. Service users and workers have also reported a positive impact on the quality of care.

The register continues to grow year on year, supported by improvements to facilitate the registration and renewal process. Between March 2020 and March 2021, the register increased by 16%, a large proportion of which (40%) was due to the introduction of an emergency register to respond to the Covid-19 crisis in 2020.⁵¹In August 2021, there were 37,103 registrants on the NISCC register, including 15,252 adult residential care workers, 14,439 domiciliary care workers, 2,285 day care workers, and 2,177 supported living workers.⁵²

As in England, Northern Ireland experiences challenges with the recruitment and retention of its social care staff. Staff vacancies remain high. In September 2022, the vacancy rate for social workers was 10.5% and 12.6% for other social care staff.⁵³ Particular challenges in the country include raising the value and status of social care and determining the most effective models of delivery for social care, given the current lack of legislative change to the social care system. The implications of Brexit have also raised concerns around free movement of workers across the currently open border with the Republic of Ireland.