Demand for homecare is outstripping supply. Councils are reporting high levels of unmet need in the community and NHS hospitals are struggling to discharge people back home.
Our four previous workforce surveys across 2021/22 painted a clear picture of worsening workforce shortages in the homecare sector. The Skills for Care data for 2021/22 shows a decrease of 50,000 filled posts in social care and a vacancy rate of 13.8% in homecare, which is the highest ever recorded. However, our latest member survey findings from September 2022 suggest this situation is continuing to escalate and urgent action is needed to address these issues if winter pressures are to be met.
Inadequate capacity is contributing to greater burdens on the NHS, including more people with deteriorating health; longer ambulance waits; inability to respond fast to all emergencies; cancelled clinics; cancelled operations and difficulty in reducing waiting lists.
A quarter of delayed discharges from hospital are due to people waiting for homecare, as there is a critical shortage of homecare workers. This hinders the ability of hospitals to admit new patients, contributing to increased ambulance response times and NHS waiting lists of over 7 million people.
In the community, unmet need is high and rising. Councils have waiting lists for assessments, direct payments and care services of more than half a million. Over 1.6 million people need support with care at home and are unable to access it due to insufficient funding and workforce capacity.
Lack of timely access to health and social care services is contributing to further constraints in the labour market. And a record number of people are economically inactive due to ill health. National data also shows that 27.6% women and 7.4% of men have left the workforce to care for older family members or children, due to unavailability or unaffordability of care provision.
Many factors, both long and short-term, influence retention and recruitment of homecare workers and thus workforce capacity. Inadequate government investment in state-funded homecare and poor commissioning practices have led to low pay and substandard terms and conditions of employment. The sector has also been adversely affected by Brexit, COVID-19 and international conflict. Alongside the tightening of labour markets, pressure on supply chains and rising energy costs all contributing towards increased inflation. This has led to a rapid rise in business costs and cost of living, placing further pressure on low-paid workers and their employers. Unlike other business sectors, where increased costs can be passed to consumers, state-funded homecare agencies are unable to charge councils high enough fees to cover rising costs. Some local authority fee rates for homecare do not even enable compliance with the legal minimum wage, before considering escalating operational costs, such as wages, sick pay and fuel.
To understand the current impact of workforce pressures on our members, we conducted a survey of Homecare Association members during September 2022, representing just over 58,500 careworkers supporting over 100,000 people in their own homes.
- Homecare providers are finding it extremely challenging to recruit staff, with 84% of providers reporting that recruitment was harder than this time last year and nine out of ten of providers (89%) agreeing that recruitment is the hardest it has ever been.
- Homecare providers are also experiencing high levels of staff turnover, with over half (59%) of providers saying more careworkers are leaving than this time last year and two thirds saying 66% more careworkers are leaving than before the pandemic.
- The most common reasons given by careworkers for leaving were: needing to earn more or wages / cost of living pressures (67%); needing to travel /cost of travel (58%) and feeling burnt out, stressed or exhausted (52%).
- Homecare providers feel they are unable to improve pay and working conditions in the state funded market, with 80% of providers saying that local authority and NHS fee rates were too low to cover costs and this was preventing them from making changes to staff pay and conditions that they wanted to make.
- Workforce shortages were impacting on the amount of care being delivered, with nearly half of providers (47%) reporting that they were providing less care than this time last year.
- 1 in 5 (20%) respondents said they had sponsored visas for careworkers since careworkers were added to the shortage occupation list in February. And 30% had not seriously considered sponsoring visas.
The homecare workforce is highly skilled, responsible and committed. Their true value is known by everyone involved in the sector. Supporting people in their own homes can be rewarding and varied; and we need more people to do it. Investment in homecare is vital to recruit and retain the workforce to meet the needs of an ageing population.
We continue to urge the government to:
- Provide sufficient funding to address the rising cost of delivering care - and recognise the high inflationary costs being experienced by homecare providers, including a 9.7% increase in the National Living Wage, and higher fuel prices (which have resulted in additional costs to the sector of £107m p.a), ensuring these are adequately accounted for in the Local Government Settlement.
- Invest in homecare to maintain and build workforce capacity - social care urgently needs a sustainable financial footing. It is paramount that the fair cost of care exercises being undertaken by local authority commissioners reflect the true amount needed to recruit, support, and retain a skilled, competent and compassionate workforce. Deficits identified must be shared openly and addressed quickly.
- Workforce strategy - ensure the government works with the sector to develop a credible 10-year workforce strategy for social care, aligned with the NHS People Plan.
- International recruitment – reduce the complexity and cost of the process and find ways to support providers with ensuring recruits have affordable accommodation and transport.
Read the full reportFinal 1912 Autumn Workforce Report.pdf