Overseas recruitment drives latest growth in adult social care workforce

Overseas recruitment has driven a second consecutive annual increase in the size of the adult social care workforce, Skills for Care has reported.

The number of filled posts in the sector grew by 70,000, from 1.635m to 1.705m, while the number of vacancies fell from 153,000 (9.9%) to 131,000 (8.3%), in the year to March 2024, according to latest figures from the workforce development body.

Vacancy levels hit an all-time high of 164,000 (10.6%) in March 2022, following a year in which the size of the workforce fell for the first time since records began.

The growth over the subsequent two years has been driven by the previous government’s decision to enable providers to recruit care staff from abroad on skilled worker visas from February 2022.

Growth in number of overseas staff

Skills for Care reported that independent sector providers recruited 105,000 people from overseas into direct care roles in 2023-24, up from 80,000 in 2022-23 and just 20,000 in 2021-22.

Over that time, the number of staff from outside the EU working in the sector almost doubled, from 140,000 to 300,000, while the number of British staff fell by 70,000, from 1.26m to 1.19m.

The figures do not take account of the outgoing government’s decision to bar overseas care workers on health and care visa from bringing family dependants with them, which came into force on 11 March this year.

However, Skills for Care said the announcement of these changes, in December 2023, appeared to have resulted in a sharp drop in the number of health and care visas issued, from an average of 26,000 per quarter in 2023 to 3,300 in the first quarter of 2024.

‘Challenging’ for sector to grow given international recruitment fall

“Early evidence suggests that changes to immigration rules in March 2024 will result in much lower levels of international recruitment in 2024-25 in the adult social care sector.

“Given this possibility, and the ongoing difficulties with domestic recruitment, it will be challenging for the sector to continue to grow in-line with demand in 2024-25.”

Skills for Care issued the figures on the day that it launched its 15-year strategy for the future of the adult social care workforce, developed with leaders from across the sector.

This projected that the sector would need an additional 540,000 posts from 2023 to 2040, a growth of 29%, because of the increase in the number of older people over that time, but that England needed to become less reliant on overseas staff because of global competition for care workers.

Vacancy rate remains high

While the sector’s vacancy rate has come down, it remains, at 8.3%, three times of the average for the wider economy (2.8%) and significantly higher than for competitor sectors, such as retail (2.4%), accommodation and food (4%) and the NHS (6.9%), said Skills for Care.

Vacancy rates fell across all parts of adult social care in 2023-24, but they remained much higher in domiciliary care (11.9%) than in nursing or residential homes (5%).

However, independent domiciliary care providers accounted for the majority of the growth in filled posts (43,000 of 70,000), an increase of 7.9%. This compares with growth of 5.3% in independent nursing homes (15,000 roles), 3% in local authorities (3,500) and 2.4% in residential homes (7,000).

The one area in which employment contracted was for personal assistants, whose number fell by 7,000 (5%), reflecting the year-on-year drop in the number of people receiving direct payments, from 230,000 in 2020 to 211,000 in 2023.

State of pay in adult social care

The report followed the new Labour government’s announcement last week that it would legislate to introduce a “fair pay agreement” for adult social care staff, designed to improve pay and conditions in the sector.

In the same week, think-tanks the Health Foundation and Nuffield Trust produced a report on options to raise pay in the sector. This set out that, in 2023, in the independent sector:

• The median hourly rate was £11 for care workers and £11.78 for senior care workers,12 compared with £15.88 for all UK workers.
• Care workers with five or more years’ experience were paid just 8p per hour more than those with less than a year’s experience.
• The median hourly pay for the top 10% of earners was just £1.74 more than that for the bottom 10% of earners.

Impact of pay on employment

Skills for Care’s strategy, meanwhile, indicated that a significant boost to pay, for example would be needed to meet adult social care’s recruitment needs over the coming years.

It said a 5% rise in real wages in the sector could increase employment levels by 9-11%, according to research published this year from the University of Kent and the London School of Economics and Political Science.

In the strategy, Skills for Care set out options for raising pay, ranging from simply enforcing the national living wage (NLW) more tightly to setting a sector minimum wage above the NLW and tying social care pay to the higher levels of remuneration for NHS staff performing similar roles.

Costs and benefits of pay rises

With the exception of the tighter enforcement of the NLW, the measures would significantly increase public spending on social care.

For example, setting a sector minimum that was £1 hour above the NLW, while also ensuring that those with three years’ experience received an additional £2 an hour, would cost the state £2bn a year or £30.9bn over 15 years.

However, according to Skills for Care’s analysis, the measure would mean 264,000 more staff would be recruited and 435,000 more retained over 15 years, generating £4.2bn in savings on recruitment for providers.

In addition, the NHS would save £3.9bn over the period from not having to support people who would be having their needs met by adult social care, while there would also be £29.5bn in “wellbeing benefits” for the people receiving care as a result of the expansion in the workforce.

Government plans ‘to properly reward hard work’

Labour is yet to set out how much it will invest in its fair pay agreement plan.

In a response to the Skills for Care strategy, a Department of Health and Social Care spokesperson said: “We are determined to tackle head-on the significant challenges social care faces.

“Social care workers make an enormous contribution to society and that’s why we have committed to establishing a fair pay agreement to properly reward their hard work and attract more people to the sector.”

Responding to the latest workforce data, Simon Bottery, senior fellow at think-tank The King’s Fund, said: “International recruitment has provided the only real relief to this situation but with the tightening of regulations there are real concerns that this source of workers will now dry up, leaving a huge problem for providers and – most importantly – the hundreds of thousands of people who rely on and request social care services.

“Government plans to mandate higher pay for social care staff…will help make care worker roles more attractive. Wider action will still be needed, both to shore up social care with additional funding, and to develop a comprehensive, longer-term approach to the care workforce that focuses on recruitment and retention. The new Skills for Care workforce strategy will be a first step towards this.”