The social care sector in England may have lost up to 70,000 workers across all settings in the past six months, according to analysis of government figures by the Nuffield Trust.
The independent health think tank found staff numbers reported by social care providers fell from 1,584,535 in the week ending 27 April 27 to 1,542,590 in the week ending 26 October.
That fall of around 42,000 staff based could be in the region of 50,000 to 70,000 workers when adjusting the data to account for the fact that a changing number of providers across all care settings submitted data over this period, the Nuffield Trust said.
A reduction of staffing within this range would represent the workforce shrinking between three per cent and four per cent and “puts providers, and burnt out staff in a very difficult position ahead of what is expected to be a very difficult winter”, it added.
“The reasons behind staff leaving in different types of providers vary, for example any impact of the mandatory vaccine policy would at present only impact care home staff.”
The workforce shortages estimated in the analysis, across social care providers, are within the range of other evidence suggesting that the vacancy rate had increased by half, from six months in April to nine per cent in October.
“Gaps in workforce data supplied by providers of social care services means there is uncertainty over the scale of the staffing shortages across this fragile sector,” said Nuffield Trust deputy director of policy Natasha Curry (pictured).
“But this analysis does paint a bleak picture of a deepening crisis just as over-stretched care staff prepare for what is expected to be one of the sector’s most difficult winters,” she added.
“Unless further and immediate action is taken, it’s likely we will see even more care staff leave the sector this winter at the worst possible time.”
The government has delivered its long-awaited social care white paper today which includes £150m for digitisation and £500m to be spent on social care workforce, but MP’s and care leaders warn the paper should “urgently” support social care now, saying a “difficult winter” ahead needs immediate “solutions” or there will be “no social care system to fix in the future.”
As part of the white paper, the government set out further details on how over £1 billion for system reform will be spent over the next three years to improve the social care sector.
Launching the paper, Minister for Care Gillian Keegan told MP’s that it was “underpinned by three core principles” – to ensure “everybody has choice, control and support to live independent lives.”
The new proposals include a £150 million investment in new technology to improve care quality and safety, support independent living and allow staff to provide focused care where required and £500 million invested in the social care workforce to include training, career progression and greater support for their mental health.
Ms Keegan told MPs the government's reform plans will make the system fairer and the "ambitious" proposals come after previous governments "ducked" reforms.
But, Labour MP, Liz Kendall hit back saying the plan "utterly fails to deal with the immediate pressures facing social care as we head on into one of the most difficult winters on record.
"What we needed today was a long-term vision to finally put social care on an equal footing with the NHS at the heart of a welfare state. This white paper falls woefully short of the mark.
Ms Kendall also asked the minister where the plan was to end waiting lists for care.
“Last week, we learnt that a staggering 400,000 older and disabled people were now on council waiting lists for care with 40,000 waiting more than a year. There are over 100,000 staff vacancies and turn over rates are soaring because of these shortages.”
'There is little to tackle poor workforce pay and conditions'
Care leaders are also warning the government that social care needs urgent measures now, and the steps don’t go “fast or far enough” to “achieve this vision.”
Sally Warren, director of policy at The King’s Fund said: “The steps outlined don’t go fast or far enough to achieve this vision and the funding allocated to deliver it is insufficient. There is little to tackle poor workforce pay and conditions and high vacancy levels in the sector.
“There is nothing in the proposals to deal with some of the most urgent and immediate problems currently facing the sector including high levels of unmet need and a fragile provider market. There is also a lack of new, practical measures to empower people to have personal choice and control over the care they receive.”
Vic Rayner, chief executive of the National Care Forum (NCF) says the white paper does not address the current crisis, particularly in relation to the workforce shortage.
“We need the government to urgently go further, says Ms Rayner. “Staff who have worked in care for years are leaving in their droves through exhaustion, stress and the ability to be paid better in other sectors that can flex and change their wages. Organisations who have delivered care as a vital part of communities are closing their doors, unable to continue in the face of unsustainable pressures."
’What we really need is action today’
The Independent Care Group (ICG) is concerned there is no promise of any more funding which the sector “needs today and tomorrow” to be able to deliver care as well as more “boots on the ground” to cope with the ongoing staffing crisis, alongside the extra pressures of winter.
Mike Padgham, chair of ICG said: “Today’s white paper is welcome, but it is short of support for the here and now, which is what care providers are having to face.
“What we really need is action today. We were already in the eye of a perfect storm, with exhausted and burnt-out carers battling to provide the best care they can as winter sets in; the impact of “no jab, no job” and an inability to recruit from overseas because of Brexit.”
Professor Martin Green, chief executive of Care England, says: “Delivering this white paper is going to be very difficult because of some of the major challenges facing the care sector, but we are all committed to starting on a journey that will deliver better outcomes for citizens and long-term sustainability for social care providers”.
’These care heroes are burning out’
The Directors of Adult Social Services (ADASS) has warned the care and support of tens of thousands of older and disabled people is at risk this winter because of widespread staff shortages among care providers unable to match pay rates being offered in other sectors.
Stephen Chandler, president of ADASS said: "The white paper paints a promising picture of a more professionalised care workforce in the future. What we urgently need now is a bridge to that brighter future, to address the immediate crisis and ensure that everyone gets the care and support they need this winter."
Nicola Richards, chair of Sheffield Care Association who recently founded a new organisation, called Support Social Care Heroes, said: "We've had enough of waiting for politicians to decide our future, so we to step in to fill the gap."
"Staffing is the real issue in the social care sector. These are care heroes who have been working at full speed for more than 20 months and are burning out.
"The proof of the success of the social care white paper will be if the sector can pay staff much more and recognise they are a skilled workforce."
Edel Harris, chief executive of the learning disability charity Mencap, said: "Although the £1.7 billion sounds like a lot, very little of it will find its way to the people who use and give care every day.
"We are facing a very tough winter, with many people not getting the care they need and not enough care workers to help them. We urgently need some solutions now or there will be no social care system to fix in the future.”
The government has launched its new social care website detailing what’s changing and how all the reforms will benefit people. To access the website, go to https://engage.dhsc.gov.uk/social-care-reform/
‘Red lights are flashing’ warns care boss, in advance of the government’s social care white paper
Waiting lists have quadrupled over the last three months as exhausted staff leave for jobs with higher pay and better advancement opportunities. Photograph: Paula Solloway/Alamy
Social care services across England are “rapidly deteriorating”, with waiting lists soaring and councils struggling with care home closures, social services chiefs have warned.
Long-term waiting lists have almost quadrupled and 1.5m hours of necessary home care were not delivered in the three months to November, amid a deepening staffing crisis going into winter.
“Red lights are flashing right across our dashboard,” said Stephen Chandler, president of the Association of Directors of Adult Social Services (Adass), which ran a survey of 85 councils. “Older and disabled people are suffering.”
Half of councils have had to respond to a care home closure or bankruptcy in the last six months.
Starmer calls Tory social care plan a ‘working-class dementia tax’
The bleak assessment comes ahead of the government’s social care white paper, scheduled for Tuesday, which is expected to propose a new strategy for pay and career development for care staff amid an exodus of workers, who currently earn on average just over £9 an hour, to higher-paying employers including Amazon.
Downing Street is under growing pressure to deliver on Boris Johnson’s promise in 2019 that he would “fix the crisis in social care once and for all”. Last week details of a plan to cap care costs at £86,000 sparked a Tory backbench rebellion when it emerged that England’s least wealthy people would still face the sale of their homes to pay for care, while richer people would get to keep a greater share of their wealth.
Sajid Javid, the health secretary, promised council leaders last week the imminent reforms would mean everyone had the choice and control to live independent lives, everyone could access outstanding personal care, and that adult care and support would be there for everyone who needed it. But the government has so far only pledged £1.8bn a year in additional money for social care after the Covid pandemic exposed its fragility. MPs and care experts believes the sector needs an extra £10bn a year.
Adass’s snapshot survey covering the period from August to October suggests close to 400,000 people are now waiting for an assessment for their needs. The number waiting for six months or more has surged from 11,000 reported in September to over 40,000 now.
“This survey confirms our worst fears,” said Chandler. “The government must now acknowledge the scale of the crisis and step in with emergency funding and measures to ensure we can get through the winter ahead.” It is calling for urgent £1,000 bonus payments to retain exhausted care workers. £500 payments have already been made the devolved health and care authorities in Scotland and Wales.
There are well over 100,000 vacancies in England’s social care workforce, and tens of thousands of staff who declined to be double-vaccinated can no longer work under legislation making jabs a condition of employment. Not-for-profit care home chain MHA, which lost 150 staff to the vaccine mandate, is among operators to close some of its homes to new admissions because of staff shortages, which in turn blocks up the NHS discharge system.
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A survey of care workers by the trade union Unison also found that staff shortages meant people were “dying without dignity” and in some cases there were not enough staff to sit with people in their final hours. A third of those surveyed said staffing levels were “dangerously low”.
Javid told council leaders last week that when the social care white paper is published, “people will see how serious we are about the workforce”, and he said “as the NHS was born out of the second world war”, the government wants to “make a change that lasts for generations”. He said he had been concerned to see a young care worker on a BBC TV documentary, fronted by Ed Balls, say he was planning to become a paramedic or nurse because of the lack of career paths in care.
A government spokesperson said: “We are committed to delivering world-leading social care. That’s why we are investing an additional £5.4bn over three years, which will allow us to build our comprehensive adult social care reform programme. Care homes and home care providers are already benefiting from the new £162.5m workforce retention and recruitment fund to assist local authorities and care providers in working together to ease workforce pressures in a variety of ways.”
A care home in Dewsbury has been put in special measures, after inspectors found residents sat all day in the lounge areas with no stimulation apart from the television.
The Care Quality Commission (CQC) found staff at Serene Residential Care which looks after people aged 65 and over, ‘did not have time to spend in conversation or meaningful activity with people because they were busy completing care tasks’.
Despite this, interactions ‘between staff and people were gentle, patient, kind and respectful’, according to inspectors.
The report revealed that the home had no activities staff and inspectors said: “Some people said they felt bored and we saw most people spend their day seated around the room or wandering without purpose.
“People sat all day in chairs around the lounge areas and televisions played at each end of the room. People were not consulted about what they would like to do or to watch on television. There were no activity staff available to engage people in meaningful occupation or conversation and there was no management oversight of this.”
In addition to this, risks at the care home were not robustly assessed or measures put in place to reduce the risk of harm to people.
Inspectors found that staff did not know who was at high risk of choking, or what to do to support them.
‘Where people needed modified texture diets to prevent the risk of choking, these were not consistently given and there was conflicting information in care records. One person who should have had a very soft food consistency was given biscuits and sandwiches. There was no choking risk assessment in the person's care plan,’ according to the report.
Staff did not know which people were at risk of pressure ulcers or who should be seated on pressure relieving cushions. They also did not all know who had diabetes or the signs of concern and which people had a catheter or how to provide appropriate care.
Unsafe moving and handling techniques were used to support people to transfer between wheelchairs and armchairs.
The home, which was previously rated as requires improvement, is now rated inadequate overall and has been placed into special measures. CQC has also rated the service as inadequate for being safe and well-led.
'Significant risks around choking'
Sheila Grant, CQC’s head of adult social care inspection, said: “When we inspected Serene Residential Care Limited, we were very concerned that the provider hadn’t made sufficient improvements since our previous inspection in May and they were still in breach of regulations. This is why we have placed them into special measures and downgraded their rating from requires improvement to inadequate.
“We found a service that didn’t have robust systems and processes in place to ensure there were enough staff with appropriate skills to safely care for people. Staff weren’t appropriately trained in first aid or catheter care which is essential when caring for people in this environment. Also, recruitment checks and references weren’t always received before staff started work.
“Our inspectors saw significant risks around choking. Staff didn’t know who was at high risk, or what to do to support them. One person who should have had soft food was given biscuits and sandwiches. There was no choking risk assessment in the person's care plan which could put them at serious risk of harm.”
She added: "Staff worked with patience and care, although it was disappointing that they had little opportunity to engage with people, other than when supporting them with their care needs."
Care worker shortages force government to lift Covid ban on staff working in more than one care home
The government has changed its guidance for care homes in England and lifted the restrictions on care staff working in more than one home, if there are ‘capacity concerns and to ensure continuity of care’.
Care workers often need to work in multiple settings due to zero hour contracts and to top up their income. Some larger providers also move staff around multiple care homes.
In March this year, the government decided to limit all routine movement between different care settings to reduce the spread of infection and only allow movement of staff in very limited exceptional circumstances.
It has now updated its guidance detailing the circumstances ‘in which some movement of staff may be cautiously permitted’.
The guidance states ‘this enables providers and local authorities to plan proactively for specific service requirements or capacity concerns and to ensure continuity of care’.
From now on care homes do not need to limit the movement of staff who are not providing direct nursing or personal care.
Examples include administrative staff, cooks, cleaners, or managerial staff, and registered managers (where they are not also providing direct care).
However routine movement of staff giving personal care and nursing care is still banned.
But from now, if care homes have periods of unplanned staff absence and there are concerns over capacity, movement of staff is allowed.
Specialist trainers and educators ‘who ensure the continued quality, knowledge and skills within staff teams is maintained and staff with additional, specialist training to meet a person’s needs that could not be delivered by other staff’ will also be able to move around across multiple care homes.
Restrictions can also be lifted if there is a specific risk to a resident’s wellbeing, such as if a resident needs to be cared for by staff they recognise or have an established bond with.
All staff who move between different care homes must be full vaccinated with at least two doses. This would be the case anyway as it became a legal requirement for any member staff working in a care home from 11 November.
They must also take a lateral flow test at the beginning of a working day with a negative result.
It is recommended that any staff moving between care homes and other health/care settings should also have had a Covid-19 booster vaccination and a recent flu vaccination unless they are exempt.
Prime Minister Boris Johnson has narrowly won a Commons’ vote on his social care plans despite criticism that the reforms will hit poorer households.
The proposals, which will mean council support payment will not be included in a new £86,000 social care costs cap, were approved by 272 votes to 246.
The plans were opposed by opposition parties along with 19 Tory MPs.
Under the plans anyone with assets below £20,000 will not have to pay towards the cost of support with washing or dressing at home from October 2023.
People with more than £100,000 in assets will pay up to a cap of £86,000 for their care with people with £100,000 or less receiving help but will also having to eventually pay up to the cap limit.
Money spent on living costs such as food, bills and accommodation will not count towards the limit.
Under new changes announced last week council support will not count towards the cap.
Health & Social Care Secretary Sajid Javid has defended the plans following claims that they will hit poorer people who will still potentially face losing their homes to pay for their care while wealthier people do not.
Mr Javid said “everyone will be better off” under the changes.
Liz Kendall, Labour’s shadow minister for social care, said: “Tory MPs broke the promise they were elected on that nobody would have to sell their home to pay for care.
“Instead they voted to tax ordinary working people, while the wealthiest in our country are unaffected.”
Stewart Stretton-Hill, tax, trusts and estate senior associate at Irwin Mitchell said: “The government’s stance that that everyone should pay less for their care under the new system is ‘technically correct’ but it will result in inequality, hitting those with fewer savings proportionately harder.
“Individuals need to understand that the cap of £86,000 does not mean that’s all they will have to pay if they need care. It’s really important to read the small print to see what is excluded from counting towards that cap.
“This can include care fees paid by the local authority, daily living costs, payments by the NHS for care, fees for care needs that have not been assessed by the local authority, third party top-up payments… the list goes on.”
Caroline Abrahams, Charity Director at Age UK said: “When the Prime Minister announced his intention to activate Sir Andrew Dilnot’s cap on catastrophic costs three months ago Age UK said that this reform was definitely worth having, but increasingly the jury’s out. Since then, the government has failed to give social care the financial settlement it needed at the Spending Review; announced a National Insurance increase to help social care and then admitted almost all the money is going to the NHS; and made vaccination compulsory for care home staff without any plan to replace the thousands of workers its own analysis says will walk away as a result.
“The fact that the government is now intending to effectively gut their proposed cap on catastrophic care costs is therefore just the latest in a series of wholly unsupportive decisions so far as social care is concerned. What are we supposed to think about the Prime Minister’s pledge to ‘fix social care’ now?”
Research highlights challenges faced by social care workers during COVID first wave
New research from Keele University has highlighted the key challenges that workers in the social care sector faced during the first wave of Covid-19.
Social care workers shared concerns that early responses to the pandemic, driven by short-term solutions, did not meet the needs of service users, and also expressed concern about the long-term impact of such changes.
The research, led by Dr Tom Kingstone, with Professors Lisa Dikomitis and Christian Mallen, from Keele University’s School of Medicine, found stories of resilience and rapid adaptation among social care workers. However, there was a deep concern about how new ways of working would impact on service users, particularly the most vulnerable, and what the social work profession would look like post-pandemic. Read more
MPs ignore public consultation and vote for compulsory vaccinations for care home staff
MPs have approved regulations for all care home staff in England to be vaccinated against Covid, despite the government holding a public consultation which found 57 per cent did not support mandatory vaccination.
The government carried out a public consultation earlier this year. Eleven per cent of responses were from care providers, with 28 per cent from care home staff, 23 per cent from the general public and 23 per cent from care service users and their friends and family.
Forty-one per cent were supportive of compulsory vaccination and 57 per cent did not support the proposal. Two per cent were neither supportive or unsupportive. Read more