2Issue affecting the adult social care workforce
Development of care workers
16.Skills for Care confirmed that the only regulated groups within care are registered nurses, social workers and occupational therapists. By comparison, other sectors, such as health or construction, are more regulated and require workers to be licensed. Training is not mandated for care workers, who are unregulated.45 Skills for Care said that a skilled, knowledgeable, qualified and competent workforce leads to higher quality care.46 This view is supported by the Care Quality Commission.47 Written evidence sent to us by the National Care Forum noted that some devolved administrations have began to regulate the care workforce. This sends a message that care is important, and could help to professionalise the workforce.48 The Department of Health and Social Care (the Department) cautioned that regulation carries costs, estimated to be around £120 per person, and that any additional regulation imposed on the care sector would take money away from the provision of care.49
17.Around two-thirds of care workers new to the sector since 2015 have attained or are undertaking the Care Certificate—a basic level of skill and competence.50 However, the Care Certificate is not mandatory and only covers a basic induction in care, not specialised training, such as stoma care.51 ADASS and Skills for Care suggested that the Care Certificate could be mandated.52
18.The Department accepted that it needs to be more proactive in ensuring that providers offer learning and development to their staff, and is looking into mandatory minimum standards for training.53 The Department confirmed that some providers have improved retention rates by investing in their workforces through training and development, and that there should be an incentive for all providers to do so.54 However, ADASS and Skills for Care cautioned that providers’ small profit margins mean that additional training and development would need to be funded centrally, or providers will need to raise fees.55
Limitations on work undertaken by Skills for Care
19.Skills for Care, the Department’s delivery partner for leadership and workforce development, receives £23.5 million per year from the Department.56 Many of the initiatives run by Skills for Care are small-scale and limited in reach by the amount of funding it receives.57 We received written evidence from two bodies suggesting that initiatives led by Skills for Care would have a greater impact if they were larger in scale.58 By way of contrast, Health Education England receives much more funding in total, and per head of the workforce, to support the health sector, although it is acknowledged that supporting the training and development of the health workforce is more expensive, involving, for example, training junior doctors.59
20.In 2016–17, the turnover for jobs in care was 27.8%, and particularly high for care workers (33.8%) and registered nurses (32.1%).60 Skills for Care promotes the ways in which some providers have been able to reduce turnover through values-based recruitment, but commented that some providers have still struggled to reduce turnover despite deploying such practices.61 In written evidence we heard of concerns over support given to registered managers. The CQC notes the importance that a registered manager has on the quality of care provided.62 Skills for Care stressed that registered managers have much responsibility despite low levels of pay.63 Two organisations wrote to us to suggest that better training for registered managers should be prioritised.64
21.Skills for Care is currently consulting on the care aspects of the draft health and care workforce strategy, led overall by Health Education England. The section on care in the draft strategy is very short.65 Several organisations which wrote to us were strongly critical of the draft strategy, noting its lack of detail and lack of suggestions as to how the care sector could improve.66 The Department confirmed that all the workforce issues identified by us and the NAO will need to be addressed in the final workforce strategy.67
Care work poorly paid and held in low esteem
22.The structural problems of care being low paid and held in low esteem by the public make it difficult for some providers to recruit and retain staff. Skills for Care said it was a source of national shame that care work is seen as a ‘minimum wage sector’.68 In 2016–17, a typical care worker was paid £7.50 per hour.69 We received written evidence that low pay is a big factor in difficulties to recruit and retain, and written evidence raising concerns about care workers not receiving adequate compensation for travel time or expenses.70 Care work does not attract the pay that it should for a skilled occupation.71
23.The prestige given to roles in care, for example care workers and nurses who work in care, is worse than that of comparable roles in health (healthcare workers and nurses respectively). Skills for Care told us of the need for greater parity of esteem between the sectors.72 Skills for Care raised concerns that many media organisations portray care negatively, despite 81% of care services being rated good or outstanding by the CQC. Skills for Care said that there is not enough publicity about how social care can transform people’s lives for the better and how many people working in care find it a fulfilling vocation. Skills for Care told us that the perception that there are few opportunities for career progression in care needs to be tackled.73
24.Skills for Care is developing a national recruitment campaign to address the negative perceptions of working in care. It commented that prominent support for the campaign from senior members of the Department, including the Secretary of State for Health and Social Care, could enhance its impact.74
45 Qq 99, 103
46 Q 165
47 C&AG’s Report, para 1.16
49 Qq 104, 108
50 C&AG’s Report, para 2.16, Fig 11
52 Qq 163, 166
53 Qq 98, 167
54 Q 88
55 Qq 96, 163–166
56 C&AG’s Report, para 6
57 Qq 100, 160–61
58 West Sussex County Council (ASC0015) para 12; Voluntary Organisations Disability Group (ASC0003) p3
59 Q 100
60 C&AG’s Report, para 1.8, Fig 6
61 Qq 74–76
63 Q 79
64 West Sussex County Council (ASC0015) paras 15–16; The Relatives and Residents Association (ASC0010) para 5, Age UK (ASC0006) p2; National Care Forum (ASC0004) pp3–4
65 Qq 139–140
66 National Care Forum (ASC0004) Q6; Voluntary Organisations Disability Group (ASC0003) p4; Care England (ASC0002) Q6; ADASS (ASC0005) para 8; Age UK (ASC0006) p6; Kings Fund (ASC0008) Q6; UK Homecare Association (ASC0013) para 29
67 Q 98
68 Q 78
69 C&AG’s Report, para 2.7, Fig 12
70 Unison (ASC0014) pp1–8; The Relatives and Residents Associations (ASC0010) paras 18, 20; National Association of Care and Support Workers (ASC0009) p1; Kings Fund (ASC0008) Q3; Age UK (ASC0006) p4; ADASS (ASC0005) para 3; Voluntary Organisations Disability Group (ASC0003), pp2–3; National Care Forum (ASC0004) Qq2, 6
71 Qq 71–78
72 Qq 78, 100, 103
73 Qq 82–84
74 Qq 82, 165
Published: 9 May 2018