Social Care: a workforce in crisis?

The COVID-19 pandemic has caused unprecedented pressure on our social care system and highlighted the importance of its workforce.

Fears that staff shortages in social care have reached crisis point was one of the key issues identified by academic experts as we move forward towards ‘living with COVID-19’. Shortages are apparent in adult and child social work, domiciliary and care staff, along with registered nurses in care homes.

These workforce issues have significant impacts for other parts of the health and care system, leading to delays in hospital discharges and concerns that care packages can’t be delivered to the most vulnerable people in our communities. An ageing population, funding pressures and competition for staff since the UK left the EU are unlikely to make things any easier.

This article examines the current situation for the adult social care workforce, the reasons behind this ‘crisis’, and how the Welsh Government is responding.

A social care workforce ‘crisis’

Issues facing the social care workforce were raised with the Senedd’s Health and Social Care (HSC) Committee during its recent inquiries on a workforce strategy for health and social care and hospital discharge and its impact on patient flow through hospitals.

Stakeholders highlighted big problems with recruitment and retention, with Care Forum Wales saying ‘it is hard to overstate the current workforce crisis in social care’. The Welsh Local Government Association (WLGA) also says:

There are now substantial challenges in relation to recruitment and retention across the social care sector, both for local authorities and independent providers, particularly in relation to domiciliary care.

Shortages of staff and difficulties recruiting in the social care sector have a big impact. A lack of care staff in the community has led to delays in discharging patients from hospital and can lead to patients being admitted to hospital whilst waiting for homecare to be arranged. This in turn can create pressures elsewhere in the health system such as emergency departments, due to a lack of beds for patients.

Demand has been increasing, yet Local Authority representatives say domiciliary care packages are being handed back with both in-house and commissioned services being under significant pressure. Some agencies can’t recruit and retain staff to meet the packages of care that have been commissioned. This can lead to unpaid carers having to take on the burden, at a time when many are already struggling.

Local Authority representatives also say that the pressures of the pandemic had a ‘devastating impact’ on many staff working in social care and that their mental health and wellbeing continues to be a concern.

Why is there a ‘crisis’?

There are long-standing problems with the recruitment and retention of social care staff. This has been made much worse by the pandemic. Providers say the pressures staff have faced has led to some leaving the sector, and increased difficulties in replacing them.

Many stakeholders say that parts of the social care workforce don’t get the right reward, recognition nor status in return for the difficult job they do. There are concerns that staff have limited opportunity for progression and so the WLGA believes there is a need for appropriate pay and conditions and a ‘pathway to progress within a professionalised care sector’.

Some social care staff are leaving the social care sector to work in retail, leisure or hospitality sectors to earn the same or higher salaries, often with less responsibility. Others remain in the health and care sector but move to work for the NHS.

Parity of esteem between the social care workforce and the NHS workforce in relation to pay, terms and conditions and career progression is seen as a major contributing factor that should be tackled.

ADSS Cymru told the HSC Committee:

…to lose people who have committed years of service because they don't feel valued, they're tired, they're exhausted, they don't feel that they're paid enough, they can get more pay around the corner, that's a real travesty.

How is the Welsh Government responding?

Julie Morgan MS, the Deputy Minister for Health and Social Services has said she recognises the ‘long-standing problems’ with recruitment and retention in the social care sector, saying that social care workers:

… are not rewarded in the way that they should be and they haven't got the terms and conditions that they should have, and they are not equal to people doing the same job in the NHS, for example. And so it is a huge problem.

A Social Care Fair Work Forum has been established, looking at how to improve working conditions in the social care sector. The Welsh Government has asked the Forum to look at national pay structures for social care.

The Welsh Government is providing an additional £10 million to Local Authorities to help ‘increase the capacity of their domiciliary support services in innovative ways’. This will include paying for driving lessons and buying electric fleet vehicles for domiciliary care workers.

Will the situation improve?

Whilst stakeholders including Unison, Care Forum Wales and ADSS Cymru welcome the introduction of the Real Living Wage for care workers, they say realistically this alone will not resolve the issues.

The Welsh Government says it recognises the problems facing the social care workforce. However, the plans and actions it has put in place could take time to deliver change.

Addressing the problems needs a multi-faceted approach and continued commitment and funding from the Welsh Government. The social care sector and those who depend on it will hope to see improvements as soon as possible.

Article by Rebekah James, Senedd Research, Welsh Parliament