Engage: Why care home staff in the UK are at breaking point

Since the post-COVID reopening of the economy, staffing shortages in the care sector in England have been of increasing concern. In October 2021, British charity Skills for Care warned that, at 8.2%, adult social care vacancy rates in England were exceeding pre-pandemic levels (which in 2019, stood at 8%). That figure has since exceeded 10%, according to Skills for Care’s monthly tracking.

The UK government has sought to remedy this crisis, in part, with the new health and social care levy, which came to force in April 2022. This levy is currently being implemented as an increase in National Insurance contributions.

Experts have pointed out that this is having a disproportionate impact on household budgets for those on lower incomes and those below the age of 50. They have also warned that it won’t fix the problem.

This is because a relatively small portion – £5.4 billion of the £39 billion to be raised in the next three years – is set to go to social care, with the remainder to be spent on the NHS. And half of that £5.4 billion will be used to compensate for the cap on care costs of self-funders. Crucially, only £500 million has been allocated to workforce reform, and this amount is to be spent, not on the pay uplift so desperately needed for recruitment and retention, but on training and qualifications.

Our ongoing research (the results of which are not yet published) looks at the financial impact COVID has had on care homes for older people and their staff. We interviewed managers, care-giving staff and support staff from for-profit and non-for-profit providers of all sizes. We have found that many people don’t think carers need more training – they are, as some reminded us, among the best trained workforce in the economy. What they do need is improved working conditions and better pay.

Conversely, the shortage of qualified nurses is one of the biggest pressures on both nursing homes and on the NHS. Therefore, rather than offering more training to existing carers, we need to improve pay and conditions of care home staff and to train new nurses to work in the sector.

Pandemic effects on workforce

From senior managers to carers, people employed in the care sector repeatedly emphasised that better pay and working conditions were crucial to filling the care workforce shortages. Measures already taken towards further professionalisation – such as the carers’ registry established in Scotland in 2001 – have been shown to have done nothing to improve pay and conditions for carers and, by extension, staffing.

Although social care benefited in 2020 from COVID closures in sectors recruiting from the same labour pool, it has been struggling in the past year to compete for talent. Retail and tourism in particular offer higher wages and better working conditions. And people working in these sectors tend to enjoy comparatively higher social esteem for roles that are less mentally and physically demanding.

The media has periodically pointed out the immense strain that the pandemic placed on the care workforce. But the sheer extent of the pressure our carers have endured is staggering.

Care home staff continue to experience crushing workloads. Many have worked 14-16 hours a day, for weeks on end without a break, and many months without a holiday.

They have also endured devastating COVID outbreaks at various stages of the pandemic. While these have claimed mostly frail residents’ lives, workers too have been affected. They have lived and worked with the constant fear of catching and bringing COVID into care homes as a result.

The consequent prevention measures, whether mandated by government or employers or self-imposed, have led to social isolation. Early on in the pandemic, it was not uncommon for care home staff, including managers, to move into their workplaces or avoid social contact, in order to minimise the risk to their residents and families.

The government’s rules changed over time but as our ongoing study and media reports show, care staff have felt keenly that they are living by different rules to the rest of the society. When the end of lockdown, on July 19, 2021, was dubbed “Freedom Day”, carers and the vulnerable people they care for rightly resented that description.

On an individual level, these workloads, working conditions and emotional pressures have led to to high burnout rates and mental health concerns. Sector-wide, this has resulted in ever higher staff turnover rates and staff shortages.

Managerial thinking usually equates reduced staffing with efficiency and cost-savings. But we are finding that staff shortages in care homes are actually costing the sector dearly. Providers are struggling to keep services running. Staffing agencies’ fees have reportedly skyrocketed, and due to sponsorship costs and visa fees, overseas recruitment is similarly costly. And there are the usual recruitment costs which accumulate with higher staff turnover.

Care home providers’ spending are increasing elsewhere too, as overheads become more expensive with inflation. Those who have significant amounts of state-funded residents are unable to pass on the additional costs and are thus feeling the squeeze. Large private chains have already announced they will increase fees up to 10% this year citing staff shortages as a prominent reason in addition to soaring food and energy prices.

The social care reform which the government has begun to implement comes nowhere near resolving this crisis. It is clear that spending more on staff will benefit everyone – service users, service providers, workers, and, ultimately, the taxpayer.