The adult social care workforce: next in the Secretary of State’s in-tray or last on the agenda?

The Secretary of State for Health and Social Care said recently that addressing the NHS waiting list was “the biggest item spilling out of my in-tray”. But all the signs are pointing to another equally severe and related crisis that has taken on a new urgency: the social care workforce.

With the Comprehensive Spending Review soon upon us, but no sign that any immediate action is planned to address critical challenges in social care, there is a very real risk that staff in the sector will once again be overlooked.

Why is the workforce in crisis now?

Social care has long had staffing difficulties. However, this year is different, with extra factors heaping pressure on top of existing challenges and causing deep concerns in the beleaguered sector. These acute challenges are coming to a head and simply cannot be ignored.

Increases in requests for social care support have risen by 26% in the last three months, with staff also expected to find the capacity to provide 24-hour support to discharged hospital patients in the community. But not only has the workforce vacancy rate now risen above pre-pandemic levels, an unusual decrease in the number of filled posts suggests that employers cannot find and keep staff to meet these demands.

Worryingly, sickness rates have doubled among social care staff since the pandemic began, amid wide reports of burnout, particularly among registered managers. This is ramping up pressure on teams already grappling with chronic shortages. The looming mandatory Covid-19 vaccines deadline in three weeks is also driving some workers to vote with their feet, with the government’s own estimates suggesting that between 17,000 and 70,000 care home workers may leave the sector.

Those who aren’t pushed out may instead be pulled out, lured by more competitive wages, terms and conditions in the NHS after its recent 3% pay rise. In the run up to Christmas, sectors such as hospitality and retail will also be competing for staff, with the latter offering a care worker 21p more per hour on average.

Lastly, the relief valve of bringing in valuable workers from abroad is no longer there, with the number of new entrants from abroad falling from 5% in 2019 to fewer than 2% in the spring of this year, following changes to immigration rules after Brexit.

Déjà vu?

Social care staff are a key pillar of our welfare system, working in a critical intersection spanning family, community, the market and state. Perhaps as a result, historically there has been a “vacuum” in national leadership on the issue, with no government workforce strategy for social care for over a decade. Yet care workers’ activities and skills have been quietly evolving, with workers going above and beyond their contractual duties and hardly ever with adequate recognition or reward.

Even after social care workers have really demonstrated their value and made such sacrifices over the pandemic, still they have remained towards the bottom of the government’s political agenda. With the new immigration rules now in full force and no sign of a pay increase, staff find themselves once again affected by the resulting impasse.

Myopic policy-making and a lack of coordination between the Home Office, the Department of Health and Social Care, and the Treasury mean problems are not always clearly framed. The Home Secretary has been adamant that there will be no special exemption for social care staff. But we know that other countries with similar points-based migration systems have continued to need special routes for care staff – it’s unwise to think the UK can make do without some form of visa route at all.

Despite the Migration Advisory Committee’s verdict that “the root cause… is the failure to offer competitive terms and conditions”, the DHSC has introduced a pay rise for NHS staff but not for counterparts in social care. Underpinning all this is short-termism, with government funding neither secure nor sustainable enough to transform the way that providers operate.

The human toll: what’s been done to mitigate the impact?

Due to staffing shortages, there are early indications that some care providers are unable to accept people being discharged from hospital who need care. It is likely that, as providers continue to struggle with recruitment, services will become unsafe and contracts will be handed back.

Ultimately the impact will be felt most acutely by carers and the people who need that vital social care support – we’ve already seen reports of people being left without care for days while others have been denied care in the place of their choice.

That isn’t to say that no action has been taken. There has been an extension of the infection control fund and some roles have been added to the Shortage Occupation List. The Health and Social Care Levy included £500 million over three years for the wellbeing and training of social care staff. This is welcome, but as it won’t come into effect until next April then staff will not feel that benefit during the gruelling winter when they need it most. The rumoured possible increase to the national living wage will also not address the narrow pay difference between junior and senior care workers, and such measures alone are not comprehensive or fast enough to prevent a winter crisis.

Joining the dots: what needs to happen in the short term   

The reality for 1.54 million staff in social care is that they cannot wait for the next white paper or delayed promise of reform. Immediate, coordinated action is needed now to meaningfully alleviate the worst of the crisis. This could include extending timeframes for the mandatory vaccine policy, widening the temporary visa arrangement to recognise that care workers are needed as much as HGV drivers and poultry workers, and introducing a pay bonus to retain experienced staff over winter, as has happened in other UK nations and as was recommended over a year ago.

Bolder action is possible with political will. Triggered by the pandemic, other governments have been spurred into action, with Scotland introducing a pay increase to bring the lowest paid staff at least in line with their counterparts in the NHS, Germany increasing the sector-specific wage well above the national minimum, and Sweden finding funding for 10,000 permanent employment contracts.

Just because workers are low paid doesn’t mean they ought to be. It was the Secretary of State himself who recently said that “if you value something or someone, you want them to be the best they can be”. The Spending Review is an opportunity for the government to demonstrate exactly how much they value adult social care staff and the people they support.