Last month, a care home in Leeds was forced to close its nursing wing, not because of funding cuts or lack of demand, but because of staff shortages. Donisthorpe Hall’s chair of trustees, Robert Ross, released a statement at the time citing “the current climate of nursing shortages”, which meant they had been forced to rely on a “constant turnover of short-term” agency staff. Days later, Hawkesgarth Lodge care home in Whitby also had to shut as a result of the “national shortage of trained nursing and care staff”.
And last August, the social care regulator, the Care Quality Commission (CQC), found that a care home in Derbyshire was so short-staffed that residents had resorted to caring for each other. Local papers are littered with stories like these. The main cause of these shortages is the sheer number of unfilled vacancies, although sickness absence and failure to cover parental leave are also factors. Latest figures from the Office for National Statistics show that of the 751,000 externally advertised job vacancies in the UK for the three months to January 2017 across the whole economy, more than 15% – about 117,000 – were in the health and social work sectors.
On any one day, there are 90,000 vacancies for social care jobs in England, according to Skills for Care, which on Thursdayholds a conference on the issue. And NHS Jobs has more than 15,000 vacancies on its website.
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.”
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.”
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.”
According to the Trades Union Congress, these recruitment and retention issues have not only been exacerbated but caused by the cap on public sector pay rises. NHS staff and local government workers both have their pay rises capped at 1% a year, which is typically below the rate of inflation. The TUC calculates that some public sector employees, such as midwives, nurses and social workers, will see their real pay, which accounts for the impact of inflation, drop by more than £3,000 by 2020 if the government sticks with the 1% limit on salary increases. Adjusting for inflation (CPI, 2016 prices), a nurse, for example, would have earned £30,929 in 2010, but only £28,462 last year.
And the pool of newly qualified staff is also dwindling in some areas. Figures released last month showed that applications by students in England to nursing and midwifery courses at British universities had fallen by 23% since the government announced it was abolishing NHS bursaries in 2017. “The government simply hasn’t hired enough people to cover the work, and cutting bursaries for health students has made the problem worse,” says Frances O’Grady, general secretary at the TUC.
Even if Wednesday’s budget does give social care more money, this is only part of the problem. “We could talk about money until the cows come home, but it’s not all about that,” says Sue Evans, the president of the Public Service People Managers’ Association and head of HR at Warwickshire county council. “Here the government are not just taking away the funding – they don’t speak very highly about the public sector, they don’t value it. The reputation of the public sector as a whole has taken such a colossal knock … and then they wonder why we’re finding it hard to recruit [people].”
Evans believes the hard work undertaken by local authorities to attract people into public services by offering apprenticeships, working with careers services in schools and concerted recruitment drives for new social workers is constantly undermined by the government. “We’re beavering away and winning awards for our workforce development, but whenever anyone from the government stands up, they never say anything good. It’s disappointing that the government’s ambition for the public services isn’t backed up by their rhetoric, and the way they talk about us.”
All of this is before article 50 to leave the European Union has even been triggered, and the devastating impact this could have on the health and social care workforce. In care alone, the number of non-British EU nationals working in the system has shot up by more than 40% in three years, according to official figures. In all, the UK will need to attract and train 1.6 million health and social care workers up to 2022, to replace those who leave the profession (including migrants), according to analysis published last week by the Institute for Public Policy Research.
Paul Hackett, director of the Smith Institute thinktank, says: “People think nursing is the only place where people from the EU work, but they are everywhere. We don’t know what the tipping point is for some of these services. For some, Brexit could be that tipping point, whereas for others it will be just another problem to add to what they are already facing.”
“We can’t fall into the trap of thinking everything is wonderful before Brexit because things are awful anyway. There are some sectors, like health and social care, that get all the headlines, but the 2010 administration in particular just took the heart, legs and arms off local public services and it’s not going to be easy to get people back.”
And an ageing workforce could also exacerbate shortfalls. People under the age of 25 make up less than 10% of the adult social care workforce, according to Skills for Care, while more than one-third are over 50. In the NHS, one-third of nurses are due to retire in the next decade, according to the Institute for Employment Studies.
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 more 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.”