Nearly one in five nurses working in adult social care are on so-called “zero hours” contracts, reveals a report by auditors that lays bare the worrying extent of nursing staff shortages across the sector.
Vacancy rates among nurses have more than doubled despite a falling number of jobs, and turnover among nursing staff is also high, according to the hard-hitting report on the social care workforce.
“Without a valued and rewarded workforce, adult social care cannot fulfil its crucial role”
The National Audit Office report reveals 19% of registered nurses working in the care sector in 2016-17 were on zero hours contracts – a figure described as “shocking” by the Royal College of Nursing.
Overall, the highly critical report paints a picture of a sector facing a mounting workforce crisis, blaming ministers for not doing enough to plan ahead or ensure care is seen as an attractive career.
Issues like “lack of prestige”, lower pay and poor career development were all deterring nurses from coming into care sector roles, warned the report, which was published today.
It highlighted an urgent need for the newly rebadged Department of Health and Social Care to develop a robust national workforce strategy, working in partnership with the Ministry of Housing, Communities and Local Government.
“High vacancy rates and turnover can disrupt the continuity and quality of care”
More investment was also needed to enable care providers to boost staff pay and offer career development and training to nurses and others, it stated.
“Without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society,” said head of the NAO Amyas Morse.
“Pressures and demands on the health and social care system 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,” he said.
The NAO report showed vacancy and turnover rates were particularly high among nurses and care workers, with the vacancy rate for nurses more than doubling between 2012-13 and 2016-17.
“High vacancy rates and turnover can disrupt the continuity and quality of care for service users and also means providers incur regular recruitment and induction costs,” said the report.
The vacancy rate for registered nursing jobs in care was 9% in 2016-17, up from 4.1% in 2012-13, despite the overall number of nursing jobs falling from 51,000 to 43,000, it said.
Meanwhile, it highlighted that the vacancy rate in 2016-17 was highest among registered managers – often qualified nurses – at 11.3%.
It noted that 96% of managers worked in the independent sector, where average pay in 2016-17 was £29,600 a year, with questions around whether “salaries matched the responsibility of the role”.
NHS workforce planning has ‘serious shortcomings’
The turnover rate among all care staff was 27.8%, but this was 32.1% for registered nurses and 33.8% for care workers, according to the report.
A “lack of prestige” associated with working in care, compared with working for the NHS, and “poorer options for career and pay progression”, were among issues raised at a 2015 symposium hosted by the department to look at the recruitment and retention of nurses in care, the report said.
It showed average pay for nurses working in care rose by 12% in real terms between 2011-12 and 2016-17 – from £24,900 to £27,900 per year. However, the average pay for a registered nurse working in the NHS was around £31,000 in 2016-17.
“Despite real-terms increases, opportunities for pay progression is lower for nurses in care than in the NHS,” said the report. “There is no formal mechanism for linking changes in nurses’ pay across the health and care sectors.”
Difficulties in recruiting nurses meant some care providers were abandoning efforts to provide nursing care for the most vulnerable residents, the report revealed.
“Local authorities told us of nursing homes re-registering as care homes because they could not recruit nurses,” it said. “This may exacerbate local shortages of nursing home beds and cause disruption for people with nursing needs.”
Meanwhile, the report suggested that nursing shortages could get worse in the light of Brexit and the fact that fewer nurses from the European Union were now coming to work in the UK.
“It is little wonder a tenth of nursing posts in social care couldn’t be filled last year”
Of all job roles in care, nursing has the highest proportion of non-British staff from Europe, who make up 16% of registered nurses currently working in the sector. In addition, the proportion of EU nursing staff working in different regions varies from 7% in the North East to 26% in the South East.
But the supply of EU nurses was diminishing, noted the report, flagging that the number joining the register had “dropped steeply” since July 2016 while the number leaving the register had increased.
Overall, it claimed that major failures in policy and planning had got in the way of efforts to bring health and care closer together and develop the care workforce.
However, it acknowledged that some work was under way including a partnership between the government and Care England to pilot five nurse-led “teaching care homes”, as previously reported in Nursing Times.
The NAO report highlighted that the pilot was now being extended to a second wave of care homes across England. It cited other initiatives to increase the overall supply of nurses such as boosting training places and the creation of the nurse associate role to bridge the gap between nurses and support staff.
However, nursing unions and other bodies said they agreed with the NAO that the government needed to do much more. The Royal College of Nursing said the NAO report painted “a damning picture of a cut-price service that lets down older people and those who work hard to care for them”.
“With a shocking one in five of the 43,000 nurses in the care sector on zero-hours contracts, it is little wonder a tenth of nursing posts in social care couldn’t be filled last year,” said RCN chief executive and general secretary Janet Davies.
“The report is right to say the government must fund care homes and homecare agencies adequately via local councils – allowing them in turn to pay staff properly,” she said.
“The Department of Health and Social Care needs to address these issues urgently”
Unison said the report exposed the government’s “lamentable approach to social care”, while the Commons’ public accounts committee said it showed the sector’s workforce was in a “precarious state”.
“The Department of Health and Social Care needs to address these issues urgently,” said cross-party committee’s chair Meg Hillier, Labour MP for Hackney South and Shoreditch.
“To date it has done little to help councils and providers prevent a looming workforce crisis,” she said. “The secretary of state has had ‘social care’ added to his title but this change of name must be backed up by action to tackle this problem and reduce pressures on the NHS.”
The findings of the NAO report were welcomed by councils and their directors of adult social care, who have continued to highlight the impact of funding shortfalls.
Margaret Willcox, president of the Association of Directors of Adult Social Services, pointed out that the report had found many people in the care sector do find their work “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,” she said.
Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said issues around pay needed to be discussed on an “industry-wide basis so that some sensible common approaches can be developed”.
The Department of Health and Social Care said it would soon be publishing its health and care workforce strategy to tackle issues raised in the NAO report.
“Everyone is entitled to good quality care and we recognise there are challenges – that’s why we will shortly publish a health and care workforce strategy to address these issues,” said a spokeswoman.
She added: “We’ve provided an extra £2bn funding to the sector and this week announced a further £150m for next year – in the summer we will outline plans to reform social care to ensure it is sustainable for the future.”
Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission, said: “People who use adult social care services, their families and carers, need skilled staff who are valued and properly supported to carry out their critically important roles to deliver great care.
“We share the NAO concerns about the difficulties the sector faces in recruiting and retaining care staff, nurses and managers and see evidence from our inspections of the detrimental impact this can have on the quality of care people receive,” she said.
“The NAO report highlights some of the key issues that need to be addressed in the discussion about the future of adult social care as we look forward to the publication of the government’s green paper later this year,” she added.
The government announced in November that it would publish a green paper on care and support for older people by summer 2018. The consultation paper will set out plans for how government proposes to improve care and support for older people and tackle the challenge of an ageing population.
Figures published this week by NHS Digital in a separate report provide information on the 109,300 workers employed by local authorities in adult social care services – representing roughly 7% of the entire social care workforce in England.
These showed that, as of September 2017, there were 185 registered nurses employed by local authorities to work in social care. The figures also included information on people in management roles, such as registered managers of care settings who may also be nurses by background.
The statistics showed services run by councils included 40 care homes with nursing alongside other residential and day care services.
The vacancy rate for staff with professional qualifications was 9%, though just 1% of this staff group – mainly social workers and occupational therapists but also including registered nurses – were on zero hours contracts.