Adult social care providers are facing increased running costs, with some struggling to pay their staff a sustainable wage, which affects recruitment and retention.
The Care Quality Commission’s annual State of Care report, which examines all aspects of healthcare including ambulance services and dentistry, details how staff working in social care felt overworked, exhausted and stressed, sometimes to the point of becoming ill, injured or leaving their job altogether.
Over half of respondents to the CQC’s survey of adult social care providers in England said they were having challenges recruiting new staff and 31% said they were having challenges in retaining them.
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However, there had been a steady decrease in staff vacancy rates for care homes, found the study – from 11% in January to March 2022 to 7% in April to June 2023 as about 70,000 people arrived to work in the UK from overseas in direct care roles in the independent adult social care sector in 2022-23. This compared with 20,000 in 2021-22.
Providers of adult social care services told the CQC that recruiting staff from overseas had enhanced the diversity and skills of their teams and helped resolve staffing issues.
Modern slavery
The increase in overseas recruitment corresponded with a small but growing trend of unethical international recruitment practices, found the CQC. In 2022-23, there were 37 referrals for concerns regarding modern slavery, labour exploitation and international visas – more than four times the number made in 2021-22.
Without government intervention, we may not be looking at gridlock next year, but a total impasse” – Prof Martin Green, chief exec, Care England
Overall, of adult social care providers in England, more than half (54%) said they were having challenges recruiting new staff and 31% said they were having challenges in retaining them. Supported living services and extra care housing services reported having the most difficulties recruiting new staff.
Pay differences revealed that, as of December 2022, median social care worker pay (at £10.03 per hour) was 9p lower than the median hourly pay for sales and retail assistants and £1.08 lower than healthcare assistants. This was impacting adult social care providers’ ability to retain staff, found researchers.
Professor Martin Green OBE, chief executive of Care England, said that although the vacancy rate had been alleviated the workforce pressures facing the sector were worsening. He said: “The gridlock which characterised the health and social care system last year has been aggravated by new pressures for care, including inflation, the cost of living and ongoing challenges with the workforce. Despite 70,000 new international workers in the care sector, resulting in a net reduction of 13,000 vacancies, we have lost 57,000 domestic workers. This is not sustainable. Without central government intervention, we may not be looking at gridlock next year, but a total impasse.”
The CQC’s chief executive, Ian Trenholm, says the annual report showed health inequalities were being exacerbated by economic conditions and workforce pressures.
“The combination of the cost-of-living crisis and workforce challenges are leading to an increased risk of unfair care,” he said.
Satisfaction with pay among NHS staff has fallen considerably. According to the briefing for the 2022 NHS staff survey national results, just over a quarter (26%) of NHS staff were satisfied with their level of pay. This was seven percentage points lower than 2021 and 12 points lower than before the pandemic (2019).
Satisfaction with pay was lowest among nursing and healthcare assistants (13%) and ambulance staff (16%), but there has been a downward trend in all occupation groups since 2019 or 2020.
NHS data
NHS workforce data shows that, overall, there has been an increase in the number of full-time equivalent (FTE) staff working in NHS hospitals, community health service trusts and other organisations in England (excluding primary care staff). The number of all FTE staff increased by 5% between May 2022 and May 2023. The number of professionally qualified clinical staff (which include hospital and community doctors, qualified nurses and ambulance staff) and make up over half of these, increased by 4.4% over the same period.
Industrial action by NHS staff unhappy with pay and conditions was exacerbating workforce pressures, found the CQC, with the number of people on waiting lists for treatment growing to record figures and people who can afford it increasingly turning to private healthcare.
This risked the development of a two-tier system of health care, said the report.
Recruitment and retention of staff remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant.
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