The Department of Health and Social Care (DHSC) is not doing enough to support a “sustainable” adult social care workforce and should produce a “robust national workforce strategy”, a review has found.
The report by the National Audit Office (NAO), which scrutinises public spending, criticised the government’s failure to have an up-to-date workforce strategy which took account of major developments in the sector, including the Care Act 2014, and for its lack of oversight of workforce planning in local areas.
It found there was no major workforce modelling or mapping of skills to support the government’s objective for greater integration between health and social care.
Councils were wary of challenging providers about workforce development issues due to the pressures they faced, the report said, and few were directly addressing providers’ recruitment and retention problems.
Although many people working in care say it is rewarding, the report found “widespread agreement that workers feel undervalued and there are limited opportunities for career progression, particularly compared with similar roles in health”.
Amyas Morse, head of the National Audit Office, said: “Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.
“Pressures and demands on the health and social care systems are increasing, so the Department needs to respond quickly to this challenge by giving the sector the attention it deserves and needs, instead of falling short and not delivering value for money.”
A spokesperson for the Department of Health and Social Care (DHSC) said it “recognises there are challenges in the social care workforce – that’s why we’ll soon launch a consultation on the adult social care workforce and are committed to publishing a health and care workforce strategy in the summer”.
Health Education England (HEE) launched a consultation on the health and care sector workforce late last year which the NAO said was “short and lacking detail” in its coverage of the care sector.
The DHSC and Skills for Care have now taken over the adult social care element of the consultation from HEE and have developed a set of consultation questions specific to the adult social care workforce that will go live soon.
Lack of strategy
The NAO identified problems with the DHSC’s actions including:
- No evidence that the department is overseeing workforce planning by local authorities and health and care partnerships. Without a national strategy “few local areas have detailed plans for sustaining the care workforce”.
- No up-to-date care workforce strategy and roles and responsibilities of the bodies involved in delivering care are not clear. Its last workforce strategy was published in 2009 but is only available on the National Archives website. It gives responsibility to some organisations that no longer exist and has not been refreshed despite major changes such as the Care Act 2014.
- No published forecasts on the social care workforce since the disbanding of the Centre for Workforce Intelligence in 2016.
The NAO recommended that the DHSC produces a “robust national workforce strategy” with the support of the Ministry of Housing, Communities and Local Government, and that it “encourages local and regional bodies to align their own plans to it”.
It said the department “also needs to invest more to enable commissioners to set appropriate fees for providers, so they can pay staff adequately and afford to offer career development and training opportunities”.
As well as national failings, the NAO said local and regional bodies and partnerships were “not taking the lead on workforce planning in the absence of a national strategy”.
Under the Care Act 2014, councils must ensure services continuously improve and encourage a workforce that supports the local care market through standards, skills, qualifications and apprenticeships.
In case studies, the NAO found that councils do this through contract arrangements with providers. But councils told the NAO that they were “cautious about challenging providers over their investment in workforce development”, due to pressures facing providers and the negative consequences if a provider left the local authority funded market.
Few of a sample of 22 local authority market position statements, in which councils describe their activities to support local care markets, included “defined actions to address the issues that providers are experiencing with recruiting and retaining staff, or workforce development”.
Turnover and vacancy rates
The turnover rate in adult social care, with most workers providing direct care to service users, reached 27.8% in 2016-17 compared with 23.1% four years earlier. The vacancy rate was 6.6%, more than double the national average despite a reduction from the peak of 7% the previous year.
In addition, around half of care workers were paid £7.50 per hour or below (compared to the National Living Wage of £7.20 in 2016-17), equivalent to less than £15,000 per year.
“This, along with tough working conditions and a poor image, prevents workers from joining and remaining in the sector,” the report said.
The DHSC estimates the workforce will need to grow by 2.6% every year until 2035 due to increasing demand for care and complexity of needs. However, the NAO highlighted that annual growth in the number of jobs since 2013 had been 2% or lower.
The NAO also said the DHSC was unable to “demonstrate that the sector is sustainably funded, which impacts workforce planning”.
With local authorities spending 5.3% less on adult care in 2016-17 than in 2010-11, and further reductions expected, it said the social care market was “operating in challenging circumstances”, and care providers “are struggling to recruit and retain workers and are incurring additional costs as a result”.
Meg Hillier MP, chair of Parliament’s Public Accounts Committee, said the report showed the social care workforce was in “a precarious state”.
To date, the DHSC had “done little to help councils and providers prevent a looming workforce crisis”, she added.
Councillor Izzi Seccombe, chairman of the Local Government Association’s community wellbeing board, said the “worrying” report reflected the “historic underfunding of social care which is putting severe pressure on the care workforce, the provider market and the availability of care”.
“Councils only employ a minority of these staff using their own pay rates,” she said. “However, the increasing staff turnover rate and a vacancy rate more than double the national average amongst the wider provider group, shows the sector is struggling to recruit and retain staff who feel undervalued.”
Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said: “It is helpful that the report identifies that many people working in the sector find it rewarding, but if those same staff do not believe they are valued for the work they do, and believe there are limited opportunities for career progression, particularly compared with similar roles in health, there is a constant challenge of resulting high staff turnover, and difficulties with recruitment and retention.
“ADASS hopes the upcoming Adult Social Care green paper will provide a long-term, sustainable funding solution, and is committed to working with the Government to support them to achieve this. ADASS recognises, however, that the workforce challenges cannot be resolved with funding only and welcomes the report’s recommendation that the Department should produce a robust national workforce strategy to address the major challenges currently facing the care workforce.”
Adult social care workforce in numbers
1.34 million – total adult care workforce in England in 2016-17
1.23 million – the number of jobs with independent organisations
113,000 – local authority jobs
4.4% – average vacancy rate in residential care homes
11% – of workers in care homes are on zero-hours contracts
28% – turnover of care workers on zero-hours contracts
23% – turnover of care workers on fixed-hours contracts