Alleviating winter workforce pressures in adult social care

This is a rapid piece of work undertaken during October - November 2021 to compile a list of things that providers say could be most helpful in alleviating workforce capacity pressures this winter.


The list represents the views of providers as conveyed by their main representative organisations, and has been collated by the Care and Health Improvement Programme (ADASS and the LGA). The list is for consideration by Directors of Adult Social Care and providers as they work together on local solutions and maximising the benefit of the Workforce Recruitment and Retention fund. This list also includes some of the key policy asks of Government in managing and mitigating these pressures. 

Whilst very welcome, the £165m workforce recruitment fund is a small step in supporting and incentivising recruitment and retention to care roles and care careers. Any professionalisation of the care workforce must come with concomitant increases in pay and conditions and parity of esteem with the NHS. 

Social care providers have compiled this list of things that could be most helpful in alleviating workforce capacity pressures this winter.

These asks are organised into five thematic areas:

  • Practical support through the Workforce Recruitment & Retention Fund
  • Core financial asks
  • Changing the narrative 
  • Make it easier to join and stay in social care
  • Commissioning approaches

Plus: a final section covering national policy asks of Government 

Principles

Some principles to support the best use of the workforce recruitment and retention fund include:

Councils working together from the outset with their provider and local system partners to agree how to maximise the workforce recruitment and retention fund in alleviating local winter workforce pressures; this will include speedy decision making about how the funding will be used, including any passporting arrangements

Light touch, proportionate reporting requirements for any passported funding, in line with DHSC grant conditions

Reaching local agreements on whether funding will be used to increase staff hours, offer bonuses, incentives or cover other costs eg childcare, taking account of any unintended consequences or adverse impacts on local workforce supply from doing so

Practical support

Providers say that the most effective action councils can take will be to passport the recruitment and retention funding directly to providers who can ensure it is then used in the most targeted and rapid way to maximise its value. Feedback from the previous workforce funding grant clearly showed that this approach had the greatest and most immediate impact 

Other practical support can include:

  • Consider support needed for the whole of the local market to manage and mitigate winter workforce pressures, not just provision funded by councils or which is CQC-registered, including the recruitment and retention of Personal Assistants, and unpaid carer support.
  • Consider targeted use of the recruitment and retention fund to incentivise recruitment and retention of staff in job roles under most pressure locally.
  • Work with providers to target local recruitment campaigns and approaches at job roles with the greatest gap between supply and demand, and to target different cohorts of people eg. over 50s, younger people, and men.
  • Consider support needed for the whole of the workforce, including administrative, catering and other ancillary staff, not just frontline care workers, nurses and managers.
  • Fund recruitment co-ordinators to provide dedicated recruitment capacity across SME providers in a locality.
  • Explore together ways in which lengthy recruitment and starter processes can be reduced to get people into post more quickly eg making use of the free and fast track DBS system, offering taster or insight sessions on care work, and fast-track induction.
  • Support movement of staff across providers or sharing of staff across networks of providers in line with current Government guidance.
  • Introduce incentives to work in social care in rural areas eg, free driving lessons, help with paying for a car, wheels to work schemes
  • Maximise opportunities to employ people awaiting visas or accreditation eg nurses with non-UK qualifications can work for up to 20 hours a week where there is a shortage of UK workers. 
  • Incentivise weekend contracts from Friday to Monday for parents able to share childcare at weekends.
  • Review local agency/bank supply and demand with providers, and collectively agree any changes to agency arrangements needed, avoiding any unintended consequences or disruption from the development of competing sources of temporary staff eg through council-run staff bank schemes.
  • Develop or build on established local bank arrangements to build a sustainable supply of temporary staff for the medium to long term and consider development of joint or pooled bank arrangements with the NHS.
  • Explore development of more ‘Live In’ care contracts- for some, accommodation included could make a carer role more attractive.
  • Collectively invest in measures to support staff and team mental health and wellbeing and reduce sickness absence arising from stress and mental ill-health across the local care system; this could include provider access to council Employee Assistance Programmes or occupational health advice, and employing or embedding wellbeing champions in provider services.

Core financial asks

  • Fund social care providers in a way that enables payment of Real Living Wage and guaranteed minimum hours contracts to staff, including continuing payment on plan.
  • Ensure fees paid to providers reflect increased costs being experienced, for example, increases to wages necessary to attract staff.

Changing the narrative

  • Develop a local care and health system-wide recruitment campaign to attract people to health and social care careers, reducing competition between the NHS and care for the same pool of people, and promoting parity of esteem and opportunity.
  • Talk positively about careers in care, emphasising aspirations, strengths, enabling, changing lives, making a positive difference by working in care.
  • Lead from the front with active, positive messaging about working in care from local politicians and community leaders. 
  • Recognise the professionalism of social care and promote and recognise the opportunities to progress in social care – can join at entry level and within a relatively short time be supported and trained to develop into a specialist area eg working with people with autism or dementia, or progress into management.
  • Recognise and promote the high level of responsibility held by Registered Managers, and the great career opportunity that it is.
  • Help to engage other professionals to better understand and promote social care as a positive career option e.g. education providers, DWP staff, Housing Associations, Careers Advisors.
  • Develop a culture of appreciation, recognition and reward for people who work in social care commensurate with the complexity and challenges of the care roles and responsibilities.

Make it easier to join or move roles in social care

  • Develop one stop shops/Career Academies in localities that enable providers to understand and draw on the full range of initiatives and support available to recruit and retain care workers, providing a single platform to promote and access job opportunities locally, and which can be utilised to match people and vacancies. 
  • Develop integrated career pathways that are clearer to navigate and which will enable seamless movement across and between health and social care.
  • Introduce Personal Portfolios that evidence training completed, learning, skills and experience gained, and which move with the individual to different employers to reduce time spent on duplicate induction training and resultant delays to start dates. 
  • Explore ways of retaining care staff within the local system rather than them moving out to other sectors altogether, for example, if a provider fails, staff are supported to move into vacancies with neighbouring providers quickly and efficiently.
  • Ensure DWP have capacity and capability to promote social care employment opportunities, and are more responsive to provider requests for support.
  • Better understand conversion rates from health and social care courses into social care jobs and work together to improve eg. better links between employers and colleges.
  • Support and invest in current Registered Managers, and identify aspiring managers through a coordinated Leadership Programme which offers a career structure, training, and professional development.
  • Consider incentivisation schemes where care staff can ‘refer a friend’ to join the care workforce.

Commissioning approaches

  • Commission for outcomes, not task and time.
  • Councils and provider partners remain open and responsive to innovative and creative ways of mitigating workforce pressures within the local system, with resources being deployed flexibly, speedily and with minimal constraints or barriers.
  • Recognise that as we move to values-based recruitment and recruit more staff with non-social care experience, it will take time for them to be fully operational and this will need to be reflected in staffing levels and induction processes.
  • Enable more collaboration between SME providers without fear of losing out on contracts.
  • Support providers in adopting strengths-based, personalised approaches to care that improve quality, retention and job satisfaction.
  • Enable providers to end hourly contracts and offer guaranteed hours to staff to provide more stability and security for those working in the sector.
  • Ask for data once and use it for multiple purposes, removing multiple asks and multiple formats.

National policy asks of Government

  • A single bonus payment to staff employed in frontline care in January 2022, in recognition of their dedication and commitment to provide care during the pandemic, building on learning from other nations’ similar schemes; this to be distributed via councils on a head count basis.
  • Commit to immediate pay increase for those working in care, and harmonise pay and conditions with NHS.
  • Immediate suspension of the implementation of VOCD in care homes.
  • While being clear and honest about the crisis that is affecting social care in terms of capacity and potential quality, also advocating social care as a worthwhile and rewarding career which plays to people’s strengths and positively changes people’s lives.
  • Identify big impact ways to promote positive images and messaging about people with learning disabilities, older people and others who access social care, comparable to the shift in mindsets that the London Olympics achieved for people with disabilities.
  • Lead from the front with more positive messaging from senior politicians.
  • Exempt frontline care staff and employers from the NI levy.
  • Set up a national jobs board that can then link easily to local portals.
  • Ensure the national social care recruitment campaign is aligned to local campaigns as far as possible so people are not lost between two systems, and offer support to local areas who don’t have a local recruitment portal to link to.
  • The national recruitment campaign should enable providers, particularly those from VCSE and in local communities, to leverage interest in their vacant roles - we can do more with joint marketing.
  • Revise migration policy to add all care workers to the Shortage Occupation List and reduce the salary threshold for immigration.
  • Waive the Immigration Skills Charge for care workers, reducing the cost of obtaining the legal Right to Work for care workers.
  • Understand that there is a balance of risk between restricting staff movement between settings to minimise cross infection, and having the flexibility to ensure that shifts and rounds can be safely covered, with movement towards ending the restrictions on movement between care settings for double-vaccinated and tested care workers.
  • Recognise legitimate vaccination certificates of care workers from outside the UK, in addition to those supplied by the NHS.
  • Consider exemption from quarantine for live-in care workers arriving in the UK from outside the Common Travel Area, provided they are double-vaccinated, PCR-tested, and without symptoms of COVID-19.
  • Set up a national reference checking agency for care and ensure free and fast DBS checks are expanded to support speedy onboarding. 
  • Commit to a 10 year workforce strategy which sets out explicit skills and competency frameworks, and improves the portability of qualifications, so that people can move seamlessly between different employers in the care and health sector.