Addressing social care workforce challenges: what can England learn from Wales, Scotland and Northern Ireland?

1.6 million people work in social care in England alone. People who work in social care bring their skills and compassion to support individuals to lead fulfilling lives, but the workforce is stretched and shrinking. Long-standing issues of low pay and challenging conditions, perceptions of low skill and a lack of professional status have led many to leave the job they love, and have discouraged others from considering social care as a career.

High vacancies and turnover are a challenge across each UK country, and these have been exacerbated by the growing pressures of the cost-of-living crisis and burnout from Covid. We are seeing that reliance on agency staff is increasing, with implications for quality of care as well as costs for providers.

Many providers of care are struggling to maintain services as a result, and some have been forced to close – putting further pressure on staff and creating additional pressure for councils who cannot find sufficient supply of care for people. Plans announced recently to buy additional beds in community settings such as care homes to accelerate hospital discharge may well get nowhere if there are no people to staff them.

All four UK countries are struggling with workforce pressures and it’s clear that none have successfully tackled the issue. But it is striking that the Migration Advisory Committee has singled out England for its inaction, warning that “the conditions now faced by the social care sector are unsustainable”. In contrast, the committee has commended Scottish and Welsh governments for their “clear action” to address pay and professional status of staff working in social care.

So is there anything England can learn from its closest neighbours when it comes to workforce reform in social care?

What have the UK countries done to strengthen the professional status of staff?

*The UK National Living Wage is going up to £10.42 in April 2023, and Real Living Wage to £10.90. Wales has maintained its commitment to paying the updated Real Living Wage for staff in social care when this increases in April 2023. Figures in brackets indicate payment before tax and national insurance deductions.
Source: New horizons: What can England learn from the professionalisation of care workers in other countries?

The table above shows selected strategies that the four UK countries have put in place to support the recruitment and retention of social care staff. Perhaps the most striking difference between England and its neighbours is the absence of a national workforce regulator to introduce qualifications and a mandatory register for a majority of people working in social care. Workforce regulators in Scotland, Wales and Northern Ireland have driven a number of improvements in the terms and conditions for social care staff, with Scotland and Wales taking steps to address poor pay by increasing minimum hourly wages for people working in the sector.

All three of England’s UK neighbours have also nationally awarded one-off bonuses to staff in recognition of their contribution throughout the Covid-19 pandemic. Despite recommendations to the DHSC by the independent Social Care Covid-19 Support Taskforce, in England one-off Covid bonuses were instead provided at the discretion of local authorities and providers, leading some to question the absence of a nationwide bonus for all staff.

Have there been any benefits?

Having a mandatory register for care workers in Scotland, Wales and Northern Ireland has improved data and knowledge of the sector – an important resource at the height the pandemic that was used to help identify staff in Wales in need of infection control training. There is also early evidence that registration may improve standards and contribute to giving staff a sense of professional belonging.

But registration is a time-consuming process and not an end in itself. More robust evidence will be needed to understand whether benefits will be worth it against the time it will take for England’s 1.5 million staff.

There have been an increasing number of calls for the need for competitive pay for people working in social care. Salary increases above the minimum wage for social care staff in Scotland and Wales show that this can be achieved and have the potential to deliver positive impacts on the value and recognition of the profession. But experience in Scotland shows that salary increases can also destabilise the sector if they are not accompanied by sufficient funding. And, as our research suggests, it’s not all about pay. Career progression opportunities also need to be in place if staff are to stay working in social care for the long term.

Scotland and Wales have pursued more generous minimum wages for people working in social care that could help providers to compete with other local employers. But across the UK, the difference between the wage of a new starter and a more senior employee diminishes with every rise in national minimum wage, with impact on the retention of more experienced staff.

The pay differential between new starters and experienced staff in England is becoming more and more squeezed and has decreased to only 7 pence per hour, and the UK-wide increase to the National Living Wage this April will squeeze these differentials even further. Pay increases will need to be coupled with clear career pathways if they are to make a long-term impact on recruitment and retention of people in social care.

What now?

While none of the UK countries have it sorted (as indeed do few others around the globe), Scotland, Wales and Northern Ireland have at least laid the foundations for long-term workforce reform. The creation of a national register for staff working in social care in the other UK countries feels like a first step to giving social care work the visibility, status and identity it so often lacks.

Their national bodies have also driven improvements to pay which, although far from being resolved, demonstrate that tangible changes to policy can be achieved through national leadership. England appears to be several steps behind its neighbours in grasping the scale of the problem, as it continues to inject short-term pots of cash that do not offer the longevity the system needs to durably solve the workforce crisis.

But despite best efforts, all four countries have a long way to go to ensure that social care has the staff it needs. They all will struggle in the absence of a long-term sustainable funding commitment and, crucially, a comprehensive workforce strategy. Many of the bricks to build a more sustainable workforce are still missing. Without staff, there is no social care system. We need to urgently invest in people working in social care, or we risk having no social care system at all.