Nurses who work in the care sector are under-valued compared to those in health, according to an influential committee of MPs, which has called for a national recruitment campaign to tackle negative perceptions and showcase care nursing as an important and rewarding career.
A report by the Public Accounts Committee (PAC) on the state of the adult care sector concluded it was in “a precarious state” and called on the Department of Health and Social Care (DHSC) to act swiftly to turn things around.
“The prestige given to roles in care is worse than that of comparable roles in health”
Issues highlighted in the report – titled The adult social care workforce in England – include high turnover and vacancy rates among key staff groups such as registered nurses.
“Care providers have difficulty recruiting and retaining workers, particularly to the roles of care worker, registered manager and nurse,” said the report, which made it clear demand for nursing home and care provision is only set to increase.
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In 2016-17, the turnover rate was particularly high among registered nurses at 32.1%, said the report, which concluded poor perceptions of the sector and lack of recognition were damaging recruitment and retention.
“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,” said the report.
“We urge government to publish this year, and then implement, a credible long-term funding plan”
It flagged up evidence from workforce body Skills for Care, which has called for “greater parity of esteem” between care and health, and more effort to show working in the sector is a “fulfilling vocation”, with genuine opportunities to build a successful career.
The body said it was “a source of national shame” that care work was currently seen as a “minimum wage sector”.
“We share the frustration of Skills for Care with the way low pay in the care sector is too often taken to mean low skill,” said the PAC’s report. “Despite being low paid, care work is not low skilled. Yet care workers and nurses in the sector are not valued in the same way as comparable roles in the health sector.”
“There is not enough publicity and public recognition of how social care can transform people’s lives for the better, how many people working in care find it very rewarding, or that more than 80% of care services are rated good or excellent by the Care Quality Commission,” it said.
“Instead, care services are usually only in the public eye if something has gone wrong,” the report added.
While some care providers had successfully used techniques such as “values-based recruitment” to reduce turnover, many were still struggling despite deploying new approaches, the committee was told.
“The paucity of nurses is crippling the sector, with some care homes being forced to close”
Sue Learner, editor of care home review website carehome.co.uk, told Nursing Times a lack of nurses meant some settings had been forced to close.
“The paucity of nurses is crippling the sector, with some care homes being forced to close due to a lack of nurses and others paying exorbitant agency fees,” she said.
“Care homes are now offering golden handshakes in a bid to attract nurses and some are even offering a holiday in the sun plus a car,” said Ms Learner.
“The situation looks set to worsen post Brexit, with some care homes, particularly in London and the south-east of England reliant on EU nurses,” she added.
The PAC report warned that the UK’s departure from the EU could have a “significant impact on the care workforce” and said the DHSC must put plans in place to avoid being “caught unaware” by potential staffing shortfalls caused by Brexit.
Skills for Care is developing a national recruitment campaign to address the negative perceptions of working in care and the PAC called on the body and the department to make this happen, with prominent support from senior figures such as health and social care secretary Jeremy Hunt.
“They should ensure it is ambitious in scale and scope, seek to change the public narrative around care from overwhelmingly negative to positive, and have senior involvement from the department,” said the committee.
The report criticised an overall lack of workforce strategy and planning, and highlighted concerns about the amount of support and training for registered managers – who have a key impact on the quality of care provided and are often nurses by background.
“The pressures on recruiting and retaining staff are very real, across the sector”
The committee noted that the section on care in the draft health and care workforce strategy, being led by Health Education England, was “very short”.
“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,” said the PAC.
The committee also raised questions about professional standards and regulation within the sector.
Currently, the only regulated groups are registered nurses, social workers and occupational therapists, with the majority unregulated “which limits the development of a well-trained and professionalised workforce”.
However, it acknowledged that training and learning cost money and said some providers may need extra funding in order to invest in staff development.
Other areas of concern included the government’s oversight of care commissioning by local authorities.
“We raised concerns that social services and the NHS at local level could end up bidding against each other for beds and we were told that there were instances of this happening,” said the report.
“The adult social care tipping point, which we and others have long warned about”
Overall, the PAC highlighted the need for “urgent” action and stressed that the government’s forthcoming green paper on social care should not be used to prolong the debate.
“Adult social care needs sustainable funding and a stable workforce. The sector is scraping by and without an explicit, long-term plan backed by government it could soon be on its knees,” said PAC chair Meg Hillier.
“We urge government to publish this year, and then implement, a credible long-term funding plan for care,” said the Labour MP for Hackney South and Shoreditch.
“This must go hand-in-hand with financial and other support to improve the recruitment, development and retention of the care workforce,” she said.
The report was welcomed by care commissioners, providers and unions, who have long warned of a “crisis” in the sector.
Meg hillier mp
Glen Garrod, president of the Association of Directors of Adult Social Services (ADASS) said the PAC’s findings would “come as no surprise to anyone working in social care across the country”.
He said the upcoming green paper – and a parallel programme to look at issues affecting working age adults with care needs – must provide “a long-term funding solution for social care”.
“The pressures on recruiting and retaining staff are very real, across the sector, and proper resourcing to ensure that social care is seen as the fantastic occupation that it is, must be delivered as well,” he added.
Linda Thomas, vice chair of the Local Government Association’s community wellbeing board, said councils had “done all they can to prioritise and protect” adult social care, but had struggled against a backdrop of cuts amid rising demand with the funding gap set to exceed £2bn by 2020.
“Unless immediate action is taken to tackle increasingly overstretched council budgets, the adult social care tipping point, which we and others have long warned about, will be breached, which will lead to a substantial increase in people’s care needs not being met and overspending by councils,” she said.
“A long-term solution that delivers genuinely new and sustainable funding for social care is desperately needed, otherwise councils risk not being able to fulfil their statutory duty under the Care Act,” said Ms Thomas.
“We are working on a joint health and social care workforce strategy”
She added: “This needs to be supported by a realistic workforce strategy which recognises and values the vital roles played by the frontline care workers, managers and nurses.”
The DHSC said it was well aware of the issues, including when it came to staffing shortages, and was working to address them.
“We know the social care system is under pressure — that’s why we’ve provided an extra £2bn funding to the sector and a further £150m for the next year, and will shortly outline the government’s plans to reform social care to ensure it is sustainable for the future,” said a spokeswoman.
“We are also working on a joint health and social care workforce strategy to ensure the system is able to meet the demands of our growing ageing population as well as looking at ways to promote social care as a career of choice and attract staff to the profession,” she said.
The department recently held a consultation on the adult social care workforce in partnership with Skills of Care and said responses from this would feed into the health and social care workforce strategy due out later this year as well as informing the green paper.