Social care crisis : dealing with staff shortages (UK)

Last year’s report by Skills for Care on the state of the adult social care sector and workforce in England estimated that just under 340,000 social care employees leave their jobs each year. On average, in care homes there are about 2,800 unfilled manager jobs at any one time while, despite concerted recruitment drives, vacancy rates for social workers in the statutory sector have jumped from 7.3% in 2012 to 11% in 2016, and turnover rates continue to climb.

Sharon Allen, chief executive of Skills for Care, says: “Recruitment and retention is without a doubt the biggest issue for adult social care employers because to have sufficient [levels] of the right people with the right skills is absolutely fundamental to providing quality care and support. It is a big concern for everybody and we’re trying to help promote careers in social care … but there are many challenges.”

With 80% of all jobs in adult social care held by women, something is clearly making women want to leave the sector. And the problems are not just confined to social care. In the NHS, figures from NHS Employers show that 77% of the workforce is female. There are currently 24,000 nursing vacancies (including in social care), according to the Royal College of Nursing (RCN).

In community health nursing, there has been a 12% drop overall in full-time equivalent staffing numbers since September 2009, despite growing demand.

In the East Midlands, district nurse Mary Black says her team and other colleagues are struggling to cope, because of a mixture of unfilled vacancies, maternity leave and long-term sickness absence, which directly affect patient care. “We firefight every single day: moving patient visits, ringing round to see if other teams can help, and we often have to cancel or defer. We have bank and agency nurses to cover vacancies, but not usually sickness or maternity leave, so it means the staff who are left have lots more visits to do each day,” she says. “There is no continuity, as often there’s a different agency nurse each day and there are a lot of duties and patient visits that an agency nurse can’t do, so the complex patients fall to our permanent members of the team. Agency staff often cancel at the last minute and sometimes don’t turn up.”

Black says: “It often feels like we’re not giving our patients a very good service, we cannot spend the time with them that they often need. Incidents and complaints will have risen.”

Rob Davies, a senior physiotherapist at a large hospital in the south-west, which he asked not to be named, says it struggles to attract recruits from further afield. For the last eight months, there have been 12.5 full-time equivalent vacancies for junior physiotherapists and two for senior specialist ones. With major trauma status, and a busy outpatient unit, an overnight and weekend service, the 140 members of the physiotherapy team are swamped, even when they have a full roster of staff. Stress is now the biggest cause of workplace sickness, he says. “[Staff shortages] affect everything from how you manage the caseload, and what you can do for patients, and it contributes to staff stress. It affects morale. I’m surprised that more of us in our department don’t go off sick.

“When you don’t have the right staff levels, we have to see patients on a prioritised basis,” he says. “Patients don’t get the quality and sometimes it means people get sub-optimal outcomes. It’s frustrating and demoralising.” Some of his colleagues have voted with their feet: leaving for private sector jobs with better work-life balance, or moving somewhere with lower house prices. “They are on the same money as it’s nationally done but the property prices are different,” Davies says. In the South-West, the shortages are particularly acute for more junior grades. “It tends to be easier to recruit more senior physios as they are a band up so the pay is better but it still can be an issue getting the right people down to us.”

Last month’s report on the public sector workforce by the Reform thinktank is blunt about the impact of staffing problems. “Public services fail when employees fail,” it concludes. “This is the dramatic lesson from a number of high-profile errors in recent public service delivery. In many instances, quality is compromised, not because of individual incompetence, but the way the workforce is structured and organised.”

With potentially fewer candidates from the EU and more existing staff retiring, it will be crucial for the NHS and social care sectors to attract younger people. Allen says that there is already close working with schools and job centres to promote social care as a career and adult social care has had “phenomenal success” with apprenticeships, although the government’s levy on large employers to help fund apprenticeships could risk this success. “There’s more we can do to promote social care as a really great career for young people,” says Allen. “It’s not just about getting people in, it’s about keeping them.”