Social care workforce shortage in the UK: why investing now is essential for our well-becoming
Health economists can provide advice on the costs and benefits of health services that ensure the well-becoming of the public. The well-becoming of our communities relies on us protecting the services we may need in times of illness, injury and old age. We cannot predict when our loved ones will need support to live independently or end-of-life care. The COVID-19 pandemic has taught us that working within the health and social care sector takes incredible resilience and commitment. In the UK, all health and social care staff are required to hold values known as the 6C’s, care, compassion, competence, communication, courage and commitment (NHS England, 2022). These key skills enable social carers to play an invaluable role within our communities. However, the funding and salaries of social care staff throughout the UK do not reflect the value of the service they provide for us. Prolonged cuts to local authority budgets between 2008 and 2018 and inadequate workforce planning mean that workforce shortages have become endemic (Stuckler et al., 2017; The Kings Fund, 2022a). As a result, the social care workforce now faces unprecedented challenges in recruiting and retaining staff.
In December 2021, Care England reported that 95% of care providers struggled to recruit staff, and 75% struggled to retain their existing staff (Care England, 2021). Between 2021 and 2022, the number of vacancies across the UK in adult social care increased by 52%. Since 2015, the demand for social carers for working-age adults has increased by 15% due to many people with severe disabilities surviving childhood (The Kings Fund, 2022b). Recent reports indicate a clear unmet need for social care in the UK. According to Age UK (2022), 1.6 million older people were not receiving the care and support they needed prior to the pandemic, and currently, nearly one-third of requests for local government funding result in no support. The recent Skills for Care report (2022) asserts that urgent action in the recruitment and retention of the social care workforce is needed. To keep pace with demand and continually increasing life expectancy rates, we need an extra 480,000 people working in social care by 2035. Moreover, we could lose an additional 430,000 social care workers in the UK if those aged 55 and over retire within the next ten years (Fenton et al., 2022).
The shortfall in adult social care is putting increasing pressure on unpaid carers. In Wales alone, 96% of care was provided by unpaid carers (Welsh Parliament, 2022). Many of these unpaid carers may be of working age and unable to do so because of this commitment, resulting in wider economic costs (Krol & Brouwer, 2015). Unpaid care already had a higher cost impact on employment and welfare benefits sectors prior to the pandemic. For example, in 2017, lost tax revenue and increased spending on benefits to support unemployed carers cost the UK economy £1.7bn a year (Pickard et al., 2018). More recently, a modelling study found that young adults caring for a family member earned significantly lower salaries than those with no caring responsibilities. Moreover, due to young adult carers having worse physical and mental health, welfare benefits, health service costs and providing care from a lower tax revenue amount to £1048 million annually for this demographic (Brimblecombe et al., 2020).
The loss of skilled labour and increased recruitment and training needs result in further expenses to employers. This is particularly a problem in social care in which staff turnover rates from 2021 to 2022 was at 29%, meaning 400,000 people left their jobs last year, no doubt, due to low starter salaries and progression rates (Fenton et al., 2022). The mean annual pay for care workers in the independent sector is as low as £17,900 per year (The Health Foundation, 2021). On average, care workers with five or more years of experience in the sector are only paid 7p per hour more than a care worker with less than one year of experience (Fenton et al., 2022). Crucially, 24% of social care staff are on zero-hours contracts compared to 3% in the wider population. Zero-hour contracts are proven to negatively affect staff morale and mental well-being and increase turnover rates (Ndzi & Barlow, 2022). According to a cross-sectional survey in 2019, 60% of domiciliary care workers were on zero-hour contracts (Ravalier et al., 2019). This survey found that although several factors contribute to stress for domiciliary care workers, zero-hour contracts significantly exacerbate the issue. Some of the contributors to stress in relation to zero-hour contracts were the uncertainty of not having set hours of work or pay, and thus not being able to plan their personal lives and sometimes not being able to pay bills (Ravalier et al., 2019).
The pandemic has shown us that the social care sector is susceptible to labour market conditions. From 2020 to 2021, vacancies within social care decreased due to the lack of job opportunities in the wider economy. However, as of March 2022, job opportunities within the wider economy increased by 2.5%, and adult social care vacancy rates returned to their pre-pandemic levels of 10.7% (Fenton et al., 2022). A rapid review conducted by the Bangor Institute of Health and Medical Research (BIHMR) in 2021 found that during the pandemic, care home and domiciliary care staff faced increased pressures and burnout (Spencer et al., 2021). Care Forum Wales also recognises that towards the end of the pandemic, many staff were leaving their roles within the social care sector to seek better paid and less pressurised opportunities elsewhere (Care Forum Wales, 2021). During the pandemic, more was needed to be done to support and reward new and existing staff who faced increased challenges.
Investing in the social care sector and paying some of our most valuable workforces an appropriate salary has significant economic benefits. The recent Skills for Care report highlighted that the indirect (equipment and supplies purchased) and direct effects (staff salaries) of social care generated £51.5 billion per annum to the economy in England in 2022 and 1.2 billion in Wales in 2016 (Fenton et al., 2022; ICF, 2018; Skills for Care, 2021). In 2021, the social care sector employed 1.54 million people in the UK and indirectly created an additional 600,000 jobs (The Health Foundation et al., 2021). Social care also provides ample support to the NHS, in which greater availability of residential care is associated with fewer hospital readmissions and delayed discharges (Spiers et al., 2018, 2019).
Urgent long-term workforce planning is required to increase capacity and maintain a staffing profile with the right skills and knowledge to meet increased demand. Only 50% of the staff directly providing care have a social care qualification (The Health Foundation et al., 2021). As there is only a slight pay increase for senior care workers, progression may not seem worthwhile to many staff members. Investing in training within the social care sector and setting adequate pay progression scales is imperative. Social carers support people with more complex needs than they did ten years ago and, thus, require additional skills and training to adequately care for people (Fenton et al, 2022). Prior to the pandemic, social care staff often took on responsibilities beyond their training and expertise, such as installing catheters and giving insulin (Hayes et al., 2019). During the pandemic, staff were expected to take on extra responsibilities such as dressing wounds and providing verification of death (NHS Norfolk and Waverley Commissioning Group, 2020; Skills for Care, 2020). The Skills for Care report found that amongst staff that received some training, the average turnover rate was reduced to 31.7% compared to 41.2% amongst those that had not received any training (Fenton et al, 2022). To attract staff during a cost-of-living crisis, it is essential that funding is invested in learning and development to provide promising career pathways and adequate pay progression for new and experienced staff.
In Wales, the Real Living Wage of £9.90 was implemented for all social care staff as of April 2022, and in autumn 2022, the UK government announced a further increase to £10.42 to be implemented as of April 2023. However, despite the economic value generated by social care, public sector pay has, thus far, only increased by 2.5%. This is well below the current rate of inflation, which rose to 10.1% as of September 2022 (Office for National Statistics, 2022a, 2022b). With the current cost of living crisis, people are being forced to spend more on essentials such as food and energy. This means that the public has less money to spend. Increasing public sector pay can reduce turnover rates as well as give people more spending power. This has the potential to strengthen the care sector as well as support the rest of the economy (Murphy, 2022).
In 2021, the government delivered the white paper, People at the Heart of Care Adult Social Care Reform (UK Gov & Department of Health and Social Care, 2021). The white paper stated that £500m would be invested in professional development, funding mental health well-being resources, supporting staff to recover from the effects of the pandemic and introducing further reforms to improve recruitment and support for the social care workforce (HM Treasury, 2021). However, the white paper provided no actual numbers for how the £500m will be distributed. Moreover, the government are yet to deliver on this promise nearly a year after the white paper was published (NHS Support Federation, 2022). The Welsh government has since pledged to invest an additional £10m for domiciliary care (Welsh Government, 2022a). However, it was acknowledged that this would take time to deliver and may not be enough to meet the total demand (Welsh Government, 2022b)
The care and services provided by social care workers are invaluable to our communities. Health and social care staff demonstrated remarkable resilience and commitment during the pandemic. Supporting staff with training and rewarding experienced staff with adequate pay progression is essential. The well-becoming of all depends on protecting the services we may all need in times of illness, injury or old age. The government must deliver on the promises set out in the December 2021 white paper and fund these services appropriately in order to retain and support the staff within our social care sector (UK Gov & Department of Health and Social Care, 2021). Behind the statistics of social care workforce shortages are people’s lives who may not be getting the support that they desperately need.
Age UK. (2022). New analysis finds the pandemic has significantly increased older people’s need for social care. https://www.ageuk.org.uk/latest-press/articles/2021/new-analysis-finds-the-pandemic-has-significantly-increased-older-peoples-need-for-social-care/#:~:text=Before%20the%20pandemic%20struck%20Age%20UK%20estimated%20that,could%20grow%20to%202.1%20million%20people%20by%202030.
Brimblecombe, N., Knapp, M., King, D., Stevens, M., & Cartagena Farias, J. (2020). The high cost of unpaid care by young people:health and economic impacts of providing unpaid care. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09166-7
Care England. (2021). Written evidence Health and Social Care Committee. https://committees.parliament.uk/committee/81/health-and-social-care-committee/publications/written-evidence/?SearchTerm=RTR0069&DateFrom=&DateTo=&SessionId=
Care Forum Wales. (2021). RESPONSE TO THE SENEDD HEALTH & SOCIAL CARE COMMITTEE CONSULTATION ON THE HEALTH & SOCIAL CARE WORKFORCE. https://business.senedd.wales/documents/s119130/HSC43%20-%20Care%20Forum%20Wales.pdf
Fenton, W., Davidson, S., Fleming, N., Holloway, M., Polzin, G., Price, R., & Fozzard, T. (2022). The-state-of-the-adult-social-care-sector-and-workforce-2022. https://www.skillsforcare.org.uk/Home.aspx
Hayes, L., Johnson, E., & Tarrant, A. (2019). Kent Academic Repository Professionalisation at work in adult social care. https://kar.kent.ac.uk/77269/
HM Treasury. (2021). Build Back Better: our plan for growth. https://www.gov.uk/government/publications/build-back-better-our-plan-for-health-and-social-care/build-back-better-our-plan-for-health-and-social-care
ICF. (2018). The Economic Value of the Adult Social Care sector-Wales Final report. https://socialcare.wales/cms-assets/documents/The-Economic-Value-of-the-Adult-Social-Care-Sector_Wales.pdf
Krol, M., & Brouwer, W. (2015). Unpaid work in health economic evaluations. Social Science & Medicine, 144, 127–137. https://doi.org/10.1016/J.SOCSCIMED.2015.09.008
Murphy, R. (2022). Here’s How Rishi Sunak Could Crash Our Economy (Again) Austerity would send us spiralling into a deep recession. https://novaramedia.com/2022/10/25/heres-how-rishi-sunak-could-crash-our-economy-again/
Ndzi, E. G., & Barlow, J. (2022). Zero-hour contracts take a huge mental and physical toll – poor eating habits, lack of sleep and relationship problems. https://theconversation.com/zero-hour-contracts-take-a-huge-mental-and-physical-toll-poor-eating-habits-lack-of-sleep-and-relationship-problems-119703
NHS England. (2022). The 6Cs of Care. https://www.nhsprofessionals.nhs.uk/nhs-staffing-pool-hub/working-in-healthcare/the-6-cs-of-care
NHS Norfolk and Waverley Commissioning Group. (2020). Guidance for delegation of tasks N&W CCG v1 Guidance for Delegated Tasks during Covid 19-Wound Care and Skin Tear Management Rationale. https://www.ahsnnetwork.com/wp-content/uploads/2020/04/
NHS Support Federation. (2022). Fund Our NHS. https://nhsfunding.info/symptoms/10-effects-of-underfunding/staff-shortages-2/
Office for National Statistics. (2022a). Average weekly earnings in Great Britain: October 2022.
Office for National Statistics. (2022b). Inflation and Price Indices. https://www.ons.gov.uk/economy/inflationandpriceindices
Pickard, L., King, D., Brimblecombe, N., & Knapp, M. (2018). Public expenditure costs of carers leaving employment in England, 2015/2016. Health and Social Care in the Community, 26(1), e132–e142. https://doi.org/10.1111/hsc.12486
Ravalier, J., Morton, R., Russell, L., & Rei Fidalgo, A. (2019). Zero-hour contracts and stress in UK domiciliary care workers. Health and Social Care in the Community, 27(2), 348–355. https://doi.org/10.1111/hsc.12652
Skills for Care. (2020). Verification of Expected Death (VOED) with clinical remote support Guidance for Adult Social Care Workers. https://www.skillsforcare.org.uk/Documents/Learning-and-development/Ongoing-learning-and-development/End-of-life-care/VOED-supporting-guidance2.pdf
Skills for Care. (2021). The value of adult social care in England: Why it has never been more important to understand the economic benefits of adult social care to individuals and society. www.skillsforcare.org.uk
Spencer, L. H., Hartfiel, N., Hendry, A., Anthony, B., Makanjuola, A., Bray, N., Hughes, D., Wilkinson, C., Fitzsimmons, D., Edwards, R. T., Edwards, A., Gal, M., Cooper, A., & Lewis, R. (2021). Wales COVID-19 Evidence Centre (WCEC) Rapid Review Have infection control and prevention measures resulted in any adverse outcomes for care home and domiciliary care residents and staff? www.primecentre.wales/resources/RR/Clean/RR00018_Wales_COVID-
Spiers, G., Matthews, F. E., Moffatt, S., Barker, R., Jarvis, H., Stow, D., Kingston, A., & Hanratty, B. (2019). Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence. In Health and Social Care in the Community (Vol. 27, Issue 5, pp. e651–e662). Blackwell Publishing Ltd. https://doi.org/10.1111/hsc.12798
Spiers, G., Matthews, F. E., Moffatt, S., Barker, R. O., Jarvis, H., Stow, D., Kingston, A., & Hanratty, B. (2018). Impact of social care supply on healthcare utilisation by older adults: A systematic review and meta-analysis. Age and Ageing, 48(1), 57–66. https://doi.org/10.1093/ageing/afy147
Stuckler, D., Reeves, A., Loopstra, R., Karanikolos, M., & McKee, M. (2017). Austerity and health: The impact in the UK and Europe. European Journal of Public Health, 27, 18–21. https://doi.org/10.1093/eurpub/ckx167
The Health Foundation, The Kings Fund, & Nuffield Trust. (2021). The value of investing in social care. What are the benefits of further funding for reform to adult social care in England? http://editorial.health.org.uk/publications/reports/the-value-of-investing-in-social-care
The Kings Fund. (2022a). NHS Workforce: our position. https://www.kingsfund.org.uk/projects/positions/nhs-workforce
The Kings Fund. (2022b). Social Care in a Nutshell. https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/social-care-nutshell
UK Gov, & Department of Health and Social Care. (2021). People at the Heart of Care – Adult Social Care Reform White Paper. www.gov.uk/official-documents
Welsh Government. (2022a). Social Care staff to earn the Real Living Wage. https://gov.wales/social-care-staff-earn-real-living-wage
Welsh Government. (2022b). Written Statement: £10 million funding boost for domiciliary care in Wales. https://gov.wales/written-statement-10-million-funding-boost-domiciliary-care-wales
Welsh Parliament. (2022). No respite for unpaid carers as pressures continue to increase. No respite for unpaid carers as pressures continue to increase