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In the face of warnings of a winter crisis in social care, the current health and social care secretary is reportedly planning for international recruitment ‘on a mass scale’ in the sector. But is a short-term drive in recruitment from abroad the solution?

Steve Barclay may have taken note of the damning warning from his colleagues on workforce problems in health and social care. Last month, the Commons Health and Social Care Committee concluded that the NHS and social care ‘are facing the greatest workforce crisis in their history’.   

Why are 1 in 10 social care posts vacant? 

The situation in social care is desperate, as the latest data on vacancies in England show. In 2021/22, there were 165,000 social care vacancies – almost 1 in 10 posts. This has risen by more than 50% from 107,000 vacancies in the past year. These shortages are already affecting disabled, sick and older people who need care. A national survey of local authority leaders recently found that around 1 in 20 people accessing social care services are not being offered their preferred care option due to recruitment and retention issues.

So, what’s causing recruitment and retention problems in social care? Firstly, the sharp increase in vacancies in the past year is partly to do with availability of potential care workers. Economic inactivity in the UK has risen since the pandemic started. Across the economy, there are labour shortages and employers are scrambling to find staff. The end of EU freedom of movement under the post-Brexit immigration system has also contributed to workforce shortages in social care. While international recruitment may ease current staffing shortfalls, Barclay would have to work around government policy that aims to restrict it. Many roles in the sector don't meet salary and qualifications requirements for visas.

It’s not just that there are fewer staff available from abroad and in the UK. Recruitment challenges also reflect the attractiveness of work in social care compared with other sectors. Long-term political neglect and underfunding of social care have affected pay, terms and conditions, and quality of work in the sector. The government’s migration advisory committee stated earlier this year that ‘[…] the single most important factor that underlies almost all the workforce problems in social care [is] the persistent underfunding of the care sector by successive Governments.’

Unlike in the NHS, social care staff are employed by thousands of (mostly private) provider organisations or individuals with care needs. There’s no national oversight for pay or conditions. It’s left to the local authorities who commission care to incentivise higher pay or care providers to pay higher rates. But underfunding by government has limited the price that local authorities are able to offer providers, making it harder for providers to increase wages in response to rising vacancies. Pay for care work has always been low but now the premium it previously offered on jobs in retail and hospitality is disappearing. In 2012/13, care workers earned 13 pence per hour more than sales and retail assistants, but last year they earned 21 pence less per hour.

What is government doing about it?

In their recent report, MPs roundly panned the lack of government action to address workforce problems in social care. Last year, a limited workforce ‘strategy’ was published as part of the white paper on social care reform. This committed £500m towards learning and development for social care staff over 3 years, amounting to around £110 a year per worker. MPs, the government’s migration advisory committee and local authority leaders have all highlighted the necessity of increasing pay to improve recruitment and retention of social care staff. But there is currently no plan to do so. And overall funding promised for the sector will barely keep pace with demand, let alone cover wage increases.

Over 13 years have passed since the publication of the last national workforce plan for social care. A new plan for growing and supporting the workforce is long overdue, and as part of this government’s initial priority should be increasing pay. This will not only require additional funding but also action to ensure funding reaches staff, for example through a national pay scale (as in the NHS) or a sector-specific wage above the national living wage (as introduced in Scotland and Wales). Government must consider these and other measures as part of its people plan.

Migrant workers have long been vital to the UK’s health and care workforce and we need an accommodating immigration policy to support NHS and social care providers ethically recruit staff. But a short-term drive on international recruitment would not solve the sector’s workforce problems. The challenges in social care are severe and growing. It’s high time our political leaders planned longer term to better support some of the most vulnerable people in our society and their carers.

Lucinda Allen (@LucindaRAllen) is Senior Policy Officer at the Health Foundation.

Charles Tallack (@CharlesTTHF) is Director of Data Analytics at the Health Foundation.

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