Adult social care workforce in England

Around 1.5 million people worked in the adult social care sector in England in 2021/22, more than in the NHS. The workforce was more diverse than the population as a whole and the majority of workers were women. Around a quarter of the workforce were on zero-hours contracts, including 55% of home care workers.

Recruitment and retention issues

The adult social care sector faces several longstanding workforce challenges, which, it is suggested, can impact on the availability and quality of care. These include:

• High vacancy rates: Skills for Care, the workforce development and planning body for adult social care in England, estimates an average of 6.8% of roles in adult social care were vacant in 2020/21, equivalent to approximately 105,000 vacancies. The estimated vacancy rate for
  May 2022 was 10.3%.
• Rising demand: demand for social care is rising and this is expected to continue. This is projected to lead to an increase in demand for social care staff.
• High turnover: Skills for Care estimates the turnover rate of directly employed staff working in adult social care was 28.5% in 2020/21, equivalent to approximately 410,000 leavers over the year.
• Concerns around low staff morale and burnout, which the Covid-19 pandemic has likely exacerbated.
• Limited opportunities for career progression and little standardisation of training and qualifications.
• Low pay: care worker pay is among the lowest in the economy in general and is falling behind other sectors such as retail.

Most social care staff are employed by private sector providers who are responsible for setting their pay and conditions. However, public funding plays an important role. The Health and Social Care Committee suggested in July 2022 (PDF) that “increases in pay and improvements in terms and conditions will not be possible without an increase in social care funding.”

Government policy

The Government has taken several actions to encourage the recruitment and retention of social care staff, including national recruitment campaigns and providing workforce recruitment and retention funding over the 2021/22 winter.

In December 2021, the Department of Health and Social Care (DHSC) published a white paper on wider plans for social care reform. Chapter six set out the Government’s strategy for the social care workforce, which will be supported by investment of at least £500 million over the next three years (2022/23 to 2024/25). The main policies include:

• The development of a Knowledge and Skills Framework and career structure for the social care workforce.
• A new Skills Passport to hold records of a person’s learning and development.
• Investment in training routes and continuing professional development.
• A wellbeing and occupational health offer.
• Development of a new care workforce hub – a “central digital platform for the workforce.”

The DHSC’s White Paper on health and care integration, published in February 2022, additionally set out proposals aimed at ensuring staff are supported to provide integrated services. This includes exploring the introduction of an Integrated Skills Passport to enable staff to transfer their skills and knowledge between the NHS, public health and social care.

While stakeholders broadly welcomed the general principles in the December 2021 white paper, there are concerns over how adequate the committed funding will be.

It’s been suggested the policies fail to offer a long-term solution to the “fundamental problems” in social care and do not amount to a workforce strategy for the sector. The lack of a focus on pay has also been highlighted. 

Overseas social care workforce

Skills for Care estimates 16% of the adult social care workforce in 2020/21 identified as non-British compared to 8% of the population. 7% of the workforce identified as being an EU national and 9% from a non-EU nationality (excluding British). Historically there has been little direct recruitment of migrant workers into social care. Most migrant workers who started to work in social care were already in the UK.

Freedom of movement ended on 31 December 2020 and a new points-based immigration system was introduced. Concerns have been raised about the impact this may have on the adult social care sector. The Government has emphasised that immigration should not be seen as an alternative to addressing wider issues in the sector.

Following a recommendation from the Migration Advisory Committee in December 2021, the Government made care workers eligible for the Health and Care Worker visa and added the occupation to the Shortage Occupation List. The change came into effect on 15 February 2022 for an initial period of one year.

To qualify for the Health and Care Worker visa, care workers must earn at least £20,480 a year. The Health and Social Care Committee has called for this threshold to be reduced, but the Migration Advisory Committee (MAC) argues this would risk facilitating low pay in the sector. The MAC has also recommended that care workers be made eligible for the visa on a permanent basis.

In August 2022, press reports suggested the DHSC had launched a taskforce to bring more staff from overseas into both health and social care. It is suggested one of the ideas is for an “online support hub” to match people abroad with employers, although no decisions have been taken.