Desperately seeking staff

The problems facing
care homes in recruiting and retaining staff are pushing the sector ever deeper
in to crisis, writes Alan Jamieson.

There must have been
a time when carers chose to work in residential and nursing homes because they
wanted to help people rather than accept better paid and easier jobs in offices
or supermarkets. Now, owners and managers are finding it increasingly difficult
to persuade anyone to take up a job in homes, particularly those that cater for
older people.

This is reaching a crisis
point. Some of the evidence lies in the employment sections of local
newspapers, where care homes  advertise
every week for cooks, catering assistants, carers, care workers, nurses, night
staff, day staff, cleaners. There is a constant and apparently insatiable
demand. Some of the advertisements for nursing staff are close to hysterical
because managers just can’t get applicants.

Other evidence of
high demand and dwindling supply comes from interviews with recruitment
agencies and owners of residential and nursing homes. Invariably, they refer to
wide searches for staff, a high turnover of catering and cleaning staff, and
the importance of offering additional benefits such as pension and travel
contributions to bolster the basic pay of nurses and carers. For example,
Eugene Huntley, owner of a Cornish care home, says: “I advertised regularly and
interviewed 22 people for a part-time carer’s job before I found a suitable
person.” Nearer London, the situation worsens. Wendy Stallwood, manager of a
Buckinghamshire home, says: “We have to offer wages above shops, supermarkets,
community services, leisure centres – if we didn’t, we’d get no applicants.”

And of course demand
keeps increasing. Department of Health figures estimate that out of a
population of nearly 60 million in 2005 more than 20 per cent will be over
pensionable age. DoH statistics reveal that there are more than 800,000 people
in NHS, voluntary and private nursing and residential homes, hostels and
hospitals,1 and the department estimates that demand will increase
at the rate of 3 per cent a year, depending on the availability of homes and
the public’s response. The official policy is, of course, to persuade people to
stay in their own homes if at all possible, but the preferred option for many
older people is to be looked after in a home. Yet in 2001 there was a fall of 3
per cent in the number of beds in these homes.

We know why there is
fall in supply, because care homes have closed for a number of reasons relating
to rising costs. The impact of the Care Standards Act 2000 is yet to be fully
felt but managers are worried about the extra costs it generates. Jim Harris,
manager of a Scottish home, says: “The minimum standards, admirable though they
are, and we are very confident of meeting them, will increase costs. To take
only one example – health and safety – inspectors will be looking at premises,
property, equipment and materials, and they will expect all staff to be fully
aware of all the safety implications of every job they do.” No one suggests
that health and safety have been neglected but every home has to demonstrate
planning, implementation and review of the health and personal care sections of
the standards – along with the other six sections.

Care homes’ costs
continue to escalate for wages, maintenance, equipment, food and other items
too, but it’s the training costs that have everyone worried. The act requires
training in five specified areas as part of the induction process to take place
within the first six weeks of employment. Next comes the foundation programme
with a planned pathway to qualifications.2 By 2005 the – by then
merged – National Care Standards Commission will require a minimum of 50 per
cent of care staff to be trained to national vocational qualification level 2
or equivalent.

The commission was
asked what proportion of care workers now have this qualification. The
commission gave a guess of 5 per cent, some way off the 50 per cent anticipated
within three years. For an owner or manager there are two main problems here. A
manager has to plan and provide the training and assess each worker’s progress,
while the owner will have to bear the formidable costs of providing this
training and assessment. As Huntley says: “We put a lot of effort – and money –
into training and all staff are working towards NVQ level 2 or higher levels,
but I know of homes where the costs and the administration needed seem like
thunderclouds on the horizon.” As for recruitment, all managers consulted in
this survey say that training requirements will make things harder because some
workers are resistant to training and to being formally assessed on the job.

Another problem is
nurse shortages. The Royal College of Nursing says that by 2004, 94,000 nurses
will have left the service, and the government admits there is a shortage of
22,000 nurses.3 This leaves a gap within three years of 116,000
nurses. Among the organisations likely to feel the chill wind will be care
homes for older people. Nurses are able to choose widely to work in NHS and
private hospitals, or for agencies and other providers, and they have to be
specially dedicated or have some special interest to volunteer to work in
nursing homes.

The picture is not
any brighter for care workers. Local newspapers have many jobs advertised in
residential homes: the rates range from £5.60 an hour for cooks, £5 for night
care workers, £5.20 for weekday carers and £6.20 for weekend support staff. To
attract carers into homes, owners have to be prepared to pay above rates
offered by other local employers. Stallwood says: “If we offered these rates,
no one would apply. We have to pay £1 to £2 an hour more than basic rates.”
Nevertheless, the fact is that care homes are searching for suitable people,
paying them modest wages, and asking for professional and sympathetic care for
clients who need a lot of help, all to be done in competition with commercial
rivals. This problem is now a crisis.

Recruitment itself
can be difficult, according to inquiries we made of recruitment agencies, and
home managers. Although over 90 per cent of staff live locally, “local” can
mean a 10 or 15 mile radius, so managers must offer a travel contribution, and
obviously advertising adds to costs.

As for nurses, there
is a wider catchment, and several agencies concentrate their efforts on
recruiting from overseas. Russell Prince of Eurosite says that their target
zones are the Middle East and Asia, while Charles Kelly of Bison Management
says that 90 per cent of his placements come from the Philippines where the
quality of training and of motivation is very high. As demand continues to
rise, more nursing staff are expected to be recruited from New Zealand,
Australia, Zimbabwe and India.

So what can be done,
especially when the act comes fully into force, as owners will have to provide
staffing figures and explain why their retention rate is low or unstable? High
retention rates are generally found in homes where the atmosphere of the care
home (and the company that runs it) is impressive; namely a friendly and
considerate management, where residents are happy, the environment of the home
is pleasant to work in, and health and safety and training are taken seriously.
Then there is the practical help such as flexible working hours, above-average rates
of pay, holiday entitlements honoured, help with travel costs, equipment that
works, and clothing allowances.

These all carry extra
costs, of course, but are essential if the current recruitment and retention
problem is to be sensibly faced and solved. If not, that current 3 per cent
fall in the number of available beds is going to increase.

Alan Jamieson is a
consultant dealing with employment and recruitment matters. He is a former
director of the Careers Research and Advisory Centre, Cambridge


Department of Health, Statistical Bulletins: Hospital and Community Health
Services, 1991-2001
and Statistics for General Medical Practitioners,
1991-2001, DoH. See website

2 The
Standards and the Regulations can be downloaded from the NCSC website or
Department of Health, website on

3 The Royal
College of Nursing, Labour Market Review, RCN, 2002

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