Stemming the tide: retaining the social care workforce

30 April 2019

The social care sector has persistently high staff turnover and vacancy rates but little is known about the factors that affect these and the implications for service users.

A new project, led by the Personal Social Services Research Unit at the University of Kent (and funded by the Health Foundation's Efficiency Research Programme), hopes to develop a deeper understanding of the drivers of staff retention. By developing examples of what constitutes good working conditions, this project aims to support the development of a sustainable workforce. We spoke to one of the project leads, Shereen Hussein, Professor of Care and Health Policy Evaluation, to find out more.

What do we know about staff retention in social care?

The social care sector has significant problems with high staff turnover and job vacancy rates. The turnover rate is 31%, compared to the UK average across all employment sectors of 15%. 

Understanding what causes this is complicated. Much of the social care workforce is not regulated like doctors and nurses are, the sector is characterised by a large number of (often small) employers, and people move jobs a lot. Many people are employed by agencies, and some of this movement relates to people leaving one agency to work with another.

The vacancy rate is also high, at 8% compared to the UK average across all sectors of 3%. And these rates are increasing, year on year. 

Across the social care sector, recruitment and retention are affected by the perceived low status of the work, by low pay, training, and levels of in-work support. There is little career progression and that means it’s hard to attract and retain people with the right skills and values. 

The way the sector is financed adds to its complexity, with a mix of local authority funding and people paying directly for their own care. This affects the market rates which drive salary levels for social care staff. 

Smaller and not-for-profit organisations have lower turnover and vacancy rates. In general, they have better pay and working conditions and better relationships with staff. Care home settings, where you have a team of people working together, also usually offer more support to staff, whereas in home care, staff usually travel alone from home to home. Local authority-run services have the best pay and rights, however, there are very few of them, because care has often been outsourced.

There are also regional variations, for example, we know that London has higher turnover rates but lower vacancy rates. This can be explained by local differences, as London has a high number of employers and a high share of the UK’s migrant workforce.

What is the impact of recruitment and retention problems?

For home care, partly due to budget constraints and partly due to vacancies and therefore insufficient staffing, workers are often under increased pressure to provide care in quite short time slots (ie 15 minutes). That creates issues around staff wellbeing and is combined with poor working conditions and wages.

For service users, there are issues around continuity of care. If they see a different person every day, that’s likely to impact the quality of their care. Even if each care worker does everything exactly the same way, they’ll miss out on building a personal relationship. A lot of people who need care are vulnerable and have complex needs, and an understanding of those needs is built up over time. 

Part of our research aims to enhance understanding of key predictors of staff retention because if we understand these we can help to retain staff, and this continuity will help to improve care for service users.

What does your research aim to find out?

We want to understand more about what’s happening in social care recruitment and retention. We plan to assess the characteristics of people working in the care sector in comparison to other low-wage service industries. Understanding this will help us to create more tailored recruitment messages. 

We’ll also assess what causes the variation in retention rates between low-wage service industries and between social care providers, looking closely at where people go as they leave social care jobs and why. 

We really want this work to have meaning for the sector. We plan to work closely with stakeholders, including people receiving care, care home staff and service providers, so that we can understand and provide examples of good working conditions and quality jobs in social care. We know that smaller and not-for-profit organisations have lower turnover. Can we learn something from that?

We will be running workshops (at least one in collaboration with the Health Foundation) and working closely with Skills for Care and other organisations like Carers UK, Age UK and the National Care Forum, to produce recommendations that are useful and sector specific. 

Anybody who looks at social care would recommend increased funding, but we want to see what else we can recommend. In the environment we operate in, there are good examples and we’ll try to understand how these could be replicated. We want our research to have a really practical impact that will make a positive difference to people working in social care and to service users.
 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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