Invisible crisis in home care unfolding as social care sector loses up to 50,000 staff in lead up to winter months

The social care sector in England may have lost up to 50,000 workers across all providers of care, heaping pressure onto burnt out existing staff and restricting access to care in the leadup to a very challenging winter, analysis from the Nuffield Trust reveals today.

Providers of home care services could be acutely affected with the number of staff recorded as working in registered providers falling by around 11,000 (2.5%) in the six months to the end of October. This shortfall is fuelling an invisible care crisis in people’s own homes with many unable to access the care they need, increasing care burdens on unpaid carers and impacting hospital discharges.

Figures from experimental data published by the Department of Health and Social Care is likely to substantially underestimate the true fall given not all providers submitted data during that period. Shortages of workers in home care are already having an impact on care with ADASS reporting 1.5million hours of home care unable to be delivered between August and October this year due to lack of staff.

A Chart of the week and accompanying blog published by the Nuffield Trust confirms a deepening workforce crisis within social care, a sector that employs some 1.5million people. Analysing experimental data published by DHSC to monitor the impact of the pandemic of the social care workforce, it finds:

• The number of staff reported by those providers of social care that submitted data fell by 42,000 in the 6 months to the end of October 2021.
• Adjusting the data to account for the fact that a changing number of providers across all care settings submitted data over this period, the fall in staff numbers would be more likely in the region of 50,000 to 70,000 workers.
• A reduction of staffing within this range would represent the workforce shrinking between 3% and 4% and puts providers, and burnt out staff in a very difficult position ahead of what is expected to be a very difficult winter.
• The workforce shortages estimated in this analysis, across social care providers, are within the range of other evidence suggesting that the vacancy rate had increased by half, from 6% in April to 9% in October.
• Across home care providers specifically, a fall of 11,000 staff during this month period is consistent with estimates from Skills for Care. However, the experimental data is likely to substantially underestimate the true fall given not all providers submitted data during that period.
• Adjusting for home care providers that did not submit data, based on assumptions on size of providers, could lead to fall in staff of 30,000.

The reasons behind staff leaving in different types of providers vary, for example any impact of the mandatory vaccine policy would at present only impact care home staff. However, if the government’s estimates that another 35,000 home care staff could leave their posts due to mandatory vaccination from 1 April 2022 are accurate, we estimate that as many as 110,000 people could lose out on home care as a result. 

Home care providers currently face a toxic mix of workforce challenges, including an increase in staff self-isolating with Covid, staff sickness from flu, rising energy costs, delays in processing driving applications, routes to overseas recruitment cut off, while at the same time they are struggling to compete with other industries offering higher wages or Christmas sign-on bonuses.

While the home care sector needs strategic reform as part of the government’s strategic vision for social care, this winter crisis needs immediate and radical thinking. It must now urgently consider policies that include competitive recruitment and retention packages and fast visa routes for overseas staff, alongside developing a long-term workforce strategy.

Nuffield Trust Deputy Director of Policy Natasha Curry said:

“Gaps in workforce data supplied by providers of social care services means there is uncertainty over the scale of the staffing shortages across this fragile sector.

“But this analysis does paint a bleak picture of a deepening crisis just as over-stretched care staff prepare for what is expected to be one of the sector’s most difficult winters. Unless further and immediate action is taken, it’s likely we will see even more care staff leave the sector this winter at the worst possible time.

“While there has been much attention over winter pressures in hospitals, and even to some degree care homes, a shortage of staff providing care within people’s own homes has been an invisible problem.

“The home care system is at the point of breaking this winter. There will be far-reaching consequences for people and health and care services if no urgent action is taken. Unfortunately, more people will be unable to access the care they need, more pressure will land on unpaid carers, and problems getting people into appropriate care settings when they come out of hospital will be exacerbated.”