Time to shift focus on the social care workforce

In January, the House of Commons health committee published its inquiry into the NHS workforce. Although the number of hospital nurses had gone up, the number working in social care is falling behind, despite the need for them. So what are the answers needed for a greater workforce strategy?

In January, the House of Commons health committee published its inquiry into the NHS workforce. Although the number of hospital nurses had gone up, the number working in social care is falling behind, despite the need for them. So what is needed for a better workforce strategy?

Picture: David Gee

The problem the NHS is facing in recruiting and retaining nurses has been a regular feature in the headlines in recent months. From the impact of the pay cap to the numbers leaving the NHS, the state of the workforce has been pored over in great detail.

But what about the social care sector? While it may not have grabbed attention, the challenges facing the nursing workforce in care homes and other services are just as great if not greater, says Professor Martin Green, chief executive of Care England, the body that represents providers.


fewer nurses working in social care in 2016-17 than in 2012-13

‘The workforce in social care settings is often overlooked. But the sector is facing significant challenges, particularly as a consequence of competition with the NHS,’ he says.

The latter is a point acknowledged by the House of Commons’ health committee, which unveiled its inquiry into the nursing workforce in England in January.

Number of nurses in social care falling

The report said while the number of hospital nurses has gone up, the number of nurses working in social care is falling at a time when more are needed.

According to Skills for Care, there were 43,000 nurses in social care in 2016-17, 4,000 fewer than the year before and down by 8,000 since 2012-13. It has left 9% of posts vacant.

But that only tells part of the story. The evidence suggests there is also a lot of churn – one in three nurses change jobs every year.

Pay is certainly a factor, says Skills for Care, in its submission to the health committee.

Nearly one in five nurses is believed to be on a zero-hour contract, while pay rates are generally below those in the NHS.


of nurse posts in social care vacant

But it goes further than that. The impact of the EU referendum already appears to be having an effect. Between 2016 and 2017 there was an 89% drop in the number of nurses from the European Economic Area joining the UK register.

NMC pass mark involvement

However, the fall in nurse figures can also be attributed to the Nursing and Midwifery Council (NMC) raising the pass mark on its International English Language Testing System in February 2016.

In January 3,697 EU language packs were requested from the NMC. In February, that figure dropped to 861. And access to training and development, the health committee says, is ‘even worse’ in social care than it is in the NHS, which has seen the continuing professional development budget cut from £205 million to £84 million in the past two years.

What is being done nationally?

The government in England maintains plans are in place to tackle the workforce problems in nursing. 

  • The 1% pay cap in the NHS is being lifted in 2018, although details of the rise have yet to be revealed.
  • Training places are increasing – rising by 25% this year to more than 25,000 places in England, the biggest ever expansion, according to secretary of state for health and social care Jeremy Hunt.
  • New routes into nursing through apprenticeships and nursing associate schemes.
  • A Homes for Nurses scheme, giving 3,000 NHS workers first refusal on affordable housing generated through the sale of surplus NHS land.
  • NHS Improvement is running a three-year retention programme providing direct support to all mental health trusts and half of hospital trusts.
  • Health Education England’s draft ten-year workforce strategy promises the NHS will act as a ‘key engine for growth’ of nurses in social care.


So, what’s the solution? The health committee wants to see further reassurances given to EU nurses that they will be able to remain in the UK with their families after Brexit, and a review of language tests to ensure they are not placing an unnecessary burden on staff from abroad.

It has also called on NHS England to establish a nursing well-being reference group to advise on improving working conditions.

Government response and acknowledgement

In response, the government has pointed out much is already being done. The number of training places is being expanded and new routes into nursing through nursing associate roles and apprenticeships are being tried. There is also a major retention programme being run by NHS Improvement.


But British Geriatrics Society nurses and allied health professionals council chair Clifford Kilgore questions whether the impact of these steps will be felt in social care.

‘A lot of the plans focus on the hospital sector, but there are more nurses in the community, primary care and social care sectors combined than in hospitals.’

He says there needs to be more support for nurses working in social care, particularly newly-qualified staff.


of nurses in social care on zero-hour contracts

‘In hospitals you have senior nurses and doctors to help you, but in social care you can find yourself working alone, managing the risks that complex patients present. That’s difficult.

‘It’s why the nursing associate and apprenticeships may not be as successful.’

Royal College of Nursing professional lead for older people and dementia care Dawne Garrett believes the solution lies in the NHS being more proactive in working with social care.

‘We need to develop a culture of shared learning and training. There are some good examples. I know of a stroke unit, for example, where care home staff have done placements. They have developed the skills to care for patients once they’re ready to be discharged.’


But she says such good practice remains ‘pretty sporadic’. She would also like to see care homes become places where students can do placements, but says attempts to make this widespread are being undermined by the lack of experienced mentor nurses because of the high turnover rates in the sector.

But, she says, it is not necessarily all doom and gloom. ‘There’s a lot to recommend working in care homes. There’s great potential to develop relatively quickly, to fashion new roles and take on leadership responsibilities. It could become a really attractive career option. But only if nurses get the right support.’

What is being done locally?

Berwick Grange is a 52-bed nursing home in the West Yorkshire town of Harrogate.

Like many homes, it relies on staff from abroad to care for residents. Among its carer workforce, it realised it had a number of registered nurses from outside Europe.

But the home – run by the Methodist Homes group – was unable to put them to full use because they had not yet passed the English language test or some of the other clinical assessments required by the Nursing and Midwifery Council.

The staff said they did not have the time or money to complete the necessary steps.

But thanks to funding provided through the Care England-backed Teaching Care Home Pilot, the home was able to provide specialist language tutoring and a refresher training programme for seven carers to help them become registered to work as nurses.

Chief executive of the Foundation of Nursing Studies Theresa Shaw, says this is just one example of many.

‘There are some fantastic care homes out there doing great work, but they don’t get the profile.

‘There is a negative perception of the sector – that nurses are working there because they can’t get jobs in the NHS. We need to change that.’


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