Timely Discharge Series: Time to act now!

Liz Jones, is Policy Director at the National Care Forum (NCF). The National Care Forum is the membership organisation for not-for-profit organisations in the care and support sector. NCF supports its members to improve social care provision and enhance the quality of life, choice, control and wellbeing of people who use care services.

This is the fifth blog in the BGS’s ‘Timely Discharge’ series. We aim to raise awareness of the detrimental effects on older people of being stuck in hospital when they are 'medically fit for discharge'. Our blog series explores the causes of delayed discharges, the knock-on effects to the wider health and social care system, and what needs to change.

Hindsight is a wonderful thing – but foresight is even better. For months now, the National Care Forum has been warning of a staffing crisis in social care. Back in July 2021, we raised the alarm, following a survey of our members, where nearly 60% said they have seen the rate of exit increase since April 2021.

In August 2021, a survey of our membership found that nearly three quarters of respondents had seen an increase in staff leaving and 46% said their employees were leaving the sector entirely.

And now our survey of registered managers of care services in October 2021 finds an average vacancy rate of 17% amongst respondents.  67% report limiting or stopping admissions of new people into care homes or turning down new requests for home care. 33% have limited or stopped admissions from hospitals. The end result has been approximately 5,000 people being unable to access care and support from these services since 1 September, among this sample alone.

The data from other key stakeholders confirms this workforce crisis in social care  – Skills for Care’s latest report shows a sector where sickness rates have doubled, vacancies rates have grown, turnover rates have increased and staff are reflecting very high levels of burnout and stress; the CQC’s latest State of Care report has a very strong message about the pressures on the social care workforce, where the CQC recognise the situation facing the sector as ‘serious and deteriorating’. They describe a workforce that is exhausted and depleted from unrelenting pressures of the last 18 months. 

Why does this all matter? It matters because of the essential role that social care plays, both in the lives of the people and their families who need it and in the wider functioning of the health system. If social care providers cannot help with new requests for care at home or offer places to people who need to move into a care home then those people and their families face impossible circumstances. It matters because people are not being discharged from hospital when their acute healthcare needs have been met, or they and their families are struggling at home, in need of care and support. It also matters because it means that care providers sometimes do not have enough staff to support new request for care and support from people with high or complex needs.

This situation cannot continue – it has to stop. So, what needs to happen?

Some immediate things that will help now to respond to the social care workforce crisis include:

• the urgent need for action to support the social care workforce with a retention bonus – they have worked tirelessly through the pandemic, rising to the challenge of additional workloads, and have done amazing work to support people under extremely difficult circumstances; all other countries in the UK have paid their care staff a bonus in recognition of all that they have done over the last 18 months – it has not gone unnoticed in England that there has been no Government bonus for care staff as there has in Scotland, Wales and Northern Ireland.
• a pay increase for social care staff – given that between 60% and 70% of all care is commissioned and paid for by the state, via local authority and health commissioners, it is absolutely clear that the ability of social care providers as employers to increase the amount they pay their staff is hugely dependent on the income they generate from the services they provide. If the price that the state pays remains significantly below the true cost of providing those care and support services, this inevitably constrains care home providers’ ability to offer better pay to their staff.
• It is clear that the social care sector is competing with other sectors for staff, especially the healthcare sector as well as the hospitality and retail sector, both in terms of keeping the staff they have and recruiting new staff.  As a temporary solution, the government should add care workers to the Shortage Occupation List now for a defined period, to enable more workers from overseas to work in UK care homes with Skilled Worker visas. This will help now with the immediate workforce pressures.

Following the publication of the CQC report on 20 October, the government announced £162.5 million additional workforce retention and recruitment fund; whilst investment is always welcome, given that there are 1.54 m people working in social care and 105,000 vacancies in the sector, this is a drop in the ocean of what is really needed to address these challenges.

Working in social care is incredibly rewarding. Our workforce help people to live their best lives every day, making a difference to families and communities across the country.  Our workforce is made up of amazing people with a huge level of skill and experience.  Social care providers need help to pay them at a rate which recognises those skills, experience and contribution. Our social care workforce is undervalued and underpaid, and this must change.