• COVID-19 is putting unprecedented pressure on people working in adult social care. However, even before the pandemic, staffing was the biggest single challenge for the sector in England.
  • High and increasing staff turnover rates – the proportion of staff leaving their roles in the previous 12 months – are a major workforce issue in social care. Research indicates that this makes it more difficult to attain and maintain high standards of care.
  • Skills for Care estimates suggest that approximately 440,000 directly employed social care staff in England left their jobs in 2018/19. This amounts to a turnover rate of 32.2% for directly employed staff in local authorities and independent providers. The turnover rate has increased by 9.1 percentage points since 2012/13.
  • Regional staff turnover rates vary considerably, with the East of England registering a turnover rate of nearly 36% and London registering a turnover rate of 27.5% in 2018/19. The turnover rate has increased by more than 8 percentage points since 2012/13 in every region other than London, where the rate increased by less than 5 percentage points.
  • Among those who left their roles in 2018/19, the proportion of those who stayed in adult social care was considerably lower in London (32%) than in any other region. This is largely because a higher proportion of social care leavers in London moved to the health sector (20%), relative to elsewhere in England.
  • The long-term impact of COVID-19 on the social care workforce will take time to quantify and understand. In the meantime, a comprehensive workforce plan which accounts for variations in regional staff turnover in social care, and the potental impact of regional staffing pressures in the NHS, is now much needed.

Going into the COVID-19 outbreak, how did regional turnover trends in England vary?

COVID-19 is putting unprecedented pressure on people working in health and social care. But even before the COVID-19 outbreak, while the NHS faced significant staffing and funding pressures, the social care workforce faced even graver issues and the outlook remains concerning.

Other analysis in this series highlights the stark impact of the COVID-19 pandemic on the social care sector. These charts highlight pre-COVID-19 variations in staff turnover trends across regions in England, between 2012/13 and 2018/19. High staff turnover, measured in terms of the proportion of staff who leave their roles in a given year, can be problematic as it points to low staff retention rates. Research suggests that low retention rates have negative implications for the quality and continuity of care.

Data from Skills for Care suggest the staff turnover rate in social care roles in local authorities and independent providers, which accounted for 85% of all social care roles in England in 2018/19, increased from 23.1% in 2012/13 to 32.2% in 2018/19. This increased turnover rate is equivalent to approximately 440,000 directly employed social care staff in England having left their jobs in 2018/19. The increase of 9.1 percentage points in staff turnover over 6 years is concerning.

The picture becomes more complex when we look at regional variation in social care staff turnover rates, which is substantial. In 2012/13, the staff turnover rate was between 21% and 25% across every region in England except the North East (where it was 19.6%). While turnover rates have since increased steadily in every region, the rate of increase has varied, emphasising the relevance of underlying variations in regional labour market supply and demand.

In 2018/19, London registered the lowest turnover rate (27.5%), while the East of England had the highest turnover rate (36%). Further, London saw substantially slower growth in its turnover rate relative to other regions between 2012/13 and 2018/19, with the London turnover rate growing by 4.7 percentage points. Every other region saw a rise of over 8 percentage points in its turnover rate. Previous analysis shows that London also has the highest regional vacancy rate in social care, which underlines the importance of looking into regional differences in staffing needs and trends.

How many social care staff leaving their roles stay in the social care sector?

Another area of interest is the likelihood of social care staff who leave their roles staying within the social care sector. The higher the proportion of staff who stay in the sector after leaving their roles, the less concern there is that social care is losing staff to other sectors.

Skills for Care data reveal that in 2018/19, 40% of social care staff who left their roles in England stayed in the sector. However, this proportion was considerably lower in London, where only 32% of social care role leavers stayed in the sector. In every other region, the corresponding figure was between 39% and 47%. Further, the data reveal that 20% of social care role leavers in the capital moved to the health sector, as opposed to the England average of 14%. This suggests that the NHS is likely to be a particularly strong magnet for social care staff who change jobs in London (and it is not negligible in other regions). Workforce planning should therefore consider the health and social care sectors in tandem rather than in isolation.

What should be done?

A comprehensive workforce plan for social care is now much needed if the sector is to achieve lower staff turnover rates and address other glaring staffing challenges in the coming years. Given the strong links between health and social care, and with the publication of a full NHS People Plan having been delayed well in advance of COVID-19, there is a strong case for policy to consider the health and social care workforces in parallel. Now more than ever, this needs to be made a priority.

Understanding the impact of COVID-19 and how it interacts with long term challenges facing the health and social care workforce will take time. The Health Foundation is establishing the REAL Centre to provide independent, objective and impartial evidence relating to long term issues in the health and care system. Exploring and analysing the factors underlying workforce issues in health and social care will be a primary focus for the REAL Centre.

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