Difficulties in staff recruitment and retention in adult social care are not new, but a recent report by Skills for Care warns the sector is now facing an increased number of unfilled care positions. Despite a decrease in staff turnover during the pandemic, this trend has reversed back to pre-Covid levels.
High turnover rates among social care workers come with a high price tag. Among others it has been recently reported that an increasing number of people need prolonged stays in hospitals, putting more pressure on an already stretched NHS.
The causes of shortage
The impact of COVID-19 on social care workers’ mental health
Adult social care workers have been among the most severely affected by Covid-19. Since the beginning of the pandemic, this workforce, already working in a precarious sector with an ongoing legacy of austerity, has experienced detrimental changes in their working conditions which has negatively affected their mental health and heightened their levels of stress and burnout. Some of the reasons behind this are now well known, and were also shared by social care workers involved in our study – Coronavirus and Dementia in Care Homes.
A constant fear of contamination, the uncertainty caused by rapidly changing and often self-contradictory guidelines, the physical and emotional strain of caring for people quickly deteriorating or unable to understand what was happening around them, were highlighted as key stressors.
In addition, social care workers have had to support relatives who could no longer visit their family members and have had to support those same relatives, now grieving, when a family member they had not seen for months has died. They have experienced their own bereavement from sudden loss of residents with whom they had formed lasting bonds and close personal relationships.
While many care workers may not have perceived these experiences as traumatic, others may now be facing post-traumatic stress, and will be carrying the trauma of Covid-19 with them for years to come. Eventually, the negative impact of the pandemic on their wellbeing results in increased turnover and absenteeism.
We’re so fearful. We've gone through the eye of the storm, the height of the pandemic. Now it feels that we're very much going to be dealing with the fallout… (Participant) The year has been hard and we have had a harrowing time. [… ] Losing so many [who lived here] was so hard and still feels raw, but like true professionals we are, we picked ourselves up and carried on for those few who we were able to nurse back to health. (Participant)
A recovering wider economy
Fewer jobs available in the wider economy and social care workers feeling a duty to help during the pandemic are key factors behind decreased turnover during COVID-19. However, turnover rates are now rising as the wider economy is recovering.
As of August 2021, vacancy rates are back above their pre-pandemic levels and are expected to rise, especially with the mandatory vaccination policy. The turnover rate in the adult social care sector was 28.5% in 2020/21 which equates to approximately 410,000 workers leaving their role.
Social care workers lack opportunities for development, receive limited training and recognition, and their salary that does not align with the demands of the job. Adding to this, societal perceptions about their work are usually negative and studies concerning this workforce are only now emerging. As a result, much of the positive work that they perform is not recognised. Increased opportunities in the wider economy means that care workers can seek development opportunities elsewhere.
Without significant reform of the social care sector, one that values and develop social care workers, we can only expect high turnover rates to persist.
The adult social care sector relies significantly on workers from abroad. According to Skills for Care, around 16% of this workforce is from overseas. The new immigration rules, that commenced in January 2021, place increased challenges on individuals that want to come to the UK to work. Together with COVID-19 travel restrictions, these rules have already caused a significant decline in the number of people arriving in the UK to take up social care roles. These figures have worrying repercussions for the future – with an ageing population and consequently an increasing number of people in need of formal care, the sector must make up the numbers to keep up with demand.
What actions are required address care staff shortages?
As a result of the pandemic, a spotlight has been shone on the care social sector and it has become more apparent how vulnerable, pressurised, yet resilient the social care workforce is. There is no single solution to the social care workforce shortage. The scale of the challenge means action in multiple fronts, as highlighted by the Local Government Association:
• Ensure wellbeing is on the agenda – the provision of mental health support is essential to maintain staff wellbeing, build resilience and keep services safe. • Offer good working conditions - progression and career opportunities can make roles in social care more rewarding and attractive. • Invest in education and training- care workers are more likely to leave their role if they have lower qualifications. Education opportunities can result in a more skillful and confident workforce and improve levels of care and job satisfaction. • Recognise and celebrate good work – the workforce needs to be recognised for their efforts, both verbally and through bonuses or awards. Develop a more positive image of the sector by sharing examples of good practice and achievements in adult social care can also attract new candidates and convey the sector as a rewarding place to work. • Build a sense of belonging - empower workers by increasing ownership and making their voice heard when it comes to decisions about them and their job can help to retain people and their expertise.
These actions are not ground-breaking, many in the social care sector have been adopting these and others to help retain workers. They need, however, to be widespread. The recent Prime Minister’s announcement of at least £500m funding for the care workforce across three years is an encouraging measure. A well-planned recruitment and retention strategy is also needed to ensure that those who work in this noble profession can stay in.
Written by Ana Barbosa