Social care workforce crisis How did we get here and where do we go next?

This week, Skills for Care published its annual report on the state of the adult social care workforce in England. The situation is dire. The job vacancy rate – one measure of workforce shortages – fell from a record 10.6% in 2021/22 to 9.9% in 2022/23 but remained above pre-pandemic levels. In comparison, the vacancy rate for the entire UK economy for the same period was around 3.5%. Drawing on findings from the Retention and Sustainability of Social Care Workforce (RESSCW) study, supported by the Health Foundation, we look at some of the factors shaping the workforce crisis and lessons for policymakers.

How we got here: the long tail of the pandemic

Many of the problems faced by the social care workforce – including low pay, job insecurity and poor working conditions – existed before COVID-19. Going into the pandemic, vacancy rates were high and around 1 in 5 residential care workers lived in poverty. Even so, 2020 was a critical moment for the sector.

The pandemic had a devastating impact on both people needing care and social care staff. Government support for social care, including its workforce, was too little too late. In a 2021 survey for the RESSCW study, care workers reported experiencing increased workloads, financial difficulties because of poor support when self-isolating or off sick, and high stress levels. A quarter of care workers had experienced abuse during the pandemic, rising to 40% of those from a minority ethnic background. Unsurprisingly, another survey found that a majority of care workers felt undervalued and neglected.

Despite difficult and sometimes unsafe working conditions, recruitment and retention in social care initially improved at the beginning of pandemic. Social care staffing was likely bolstered because there were fewer jobs available in shops and restaurants due to pandemic restrictions, as social care competes for workers with sectors including retail and hospitality. But as the wider economy reopened, social care vacancies increased significantly. Economic inactivity in the UK has risen since 2020 and remains above pre-pandemic levels, leaving employers – including those in social care – scrambling for staff.

The end of EU freedom of movement under the post-Brexit immigration system initially restricted international recruitment into social care, contributing to a sharp rise in social care workforce shortages in 2021. In response, government lowered salary requirements and visa fees for people coming from outside the UK to work in social care in early 2022. Some 70,000 people from abroad were recruited into direct care roles in 2022/23, up from 20,000 the previous year. Higher levels of international recruitment appear to be helping, with vacancies continuing to fall in recent months. The most up-to-date monthly data are only available for the independent sector, which saw the vacancy rate fall to 8.4% in August 2023. But given global shortages in health and care workers, recruitment must be ethical and sustainable.

Where next: policies to improve recruitment and retention

Workforce problems in social care are immense but not insurmountable. Research from the RESSCW team points to some lessons for policymakers on tackling the social care staffing crisis.

First, national workforce planning must recognise the range of social care services and providers in England. Staff care for adults of all ages with various needs in people’s own homes, care homes and day care centres. Workers are employed by care users themselves (as personal assistants), around 18,000 providers, and agencies across the country. This variety affects recruitment and retention. Analysis from the RESSCW project found that levels of staff turnover vary considerably by care provider. Establishments with contracting employment find it particularly hard to retain staff. Other RESSCW work shows how the availability of public transport impacts the retention of personal assistants, particularly in rural areas.

Second, workforce policy must address the range of factors that may improve social care staffing. For example, more secure employment (such as full-time contracts and guaranteed working hours) has been found to significantly reduce leaver rates. Care workers feeling valued at work, access to training, managerial support and working culture also play important roles in attracting and retaining enough staff. Guidance and interventions are needed to improve the wellbeing of care workers, better protect them against potential abuse and improve the enforcement of worker rights. Given the recent increase in international recruitment, it’s particularly important that these measures recognise that non-British workers and those from minority ethnic backgrounds are at higher risk of abuse.

Finally, while there is no silver bullet to improve social care recruitment and retention, evidence shows that increasing pay and reward is vital. Care workers remain among the lowest paid in the UK and, like many, suffered real-terms pay cuts in 2022/23. Improving pay alone is unlikely to offset poor working conditions, but all else being equal, RESSCW research found that higher pay significantly improves retention in social care. For example, increasing wages by 10% above the mean wage rate could reduce leaver rates by an average of around 3 percentage points. With the 2022/23 social care staff turnover rate estimated at around 28%, that is no small effect. There is also evidence that increasing care worker pay can have a positive impact on the quality of care provision.

Ahead of next year’s general election, Labour and the Liberal Democrats have made initial pledges to improve pay for care workers. And last week, government announced a major increase to the economy-wide National Living Wage, which will increase wages for a majority of care workers (63% of independent sector care workers were paid below this year’s National Living Wage rate prior to its introduction). But without extra government funding for social care, the costs of higher wages risk putting more financial pressure on care providers, which may leave people without the care they need.

Social care desperately needs a long-term and comprehensive plan for its workforce. International evidence suggests reforms to pay, training and conditions for social care staff should be designed together – any changes made in isolation risk unintended consequences. Skills for Care has announced promising work to develop a workforce strategy but it is as yet unclear whether this will receive sufficient government funding and support. Ensuring we have enough staff in social care, along with vital action to improve people’s access to care and increase state protection against care costs, will require significant additional funding. Currently, Treasury purse strings are tight, but with growing demand for care set to continue, whoever wins the next election can’t afford to ignore the social care workforce crisis.

Acknowledgements: This blog draws on findings from the RESSCW project, supported by the Health Foundation and conducted by researchers from the University of Kent, the London School of Hygiene and Tropical Medicine, Bayes Business School at City, University of London and University College London. The authors are grateful to Florin Vadean and Shereen Hussein from the RESSCW team for reviewing and providing input on this blog.

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

Nihar Shembavnekar (@NShembavnekar) is an Economist in the REAL Centre team at the Health Foundation.