The social care sector, where I work as a consultant for QCS, the leading provider of content, guidance, and standards, is I believe on a cliff-edge (if not with one big foot already dangling over). With the consequences of Brexit Britain laid bare from the restriction of free movement, an ever-changing COVID-19 landscape, and long-standing but unsolved problems of funding, recruitment, and retention of staff, it’s just one one crisis on top of another.
The latest move to hit the social care sector is the mandatory vaccination requirement. The UK Government’s new legislation required that by 11th November, all care home workers in England must be fully vaccinated against COVID-19. It is believed that as many as 32,000 chose not to be vaccinated by this date, while another 30,000 had received their first jab but not their second. As a result, they either worked up until this deadline or left the service prior to the implementation date.
Following further consultation by the Government, a decision to expand mandatory COVID-19 vaccination requirements was made. Rather than have a consistent policy across the entire health and social care sectors, the government decreed that all frontline NHS workers and domiciliary carers can wait until 1 April 2022 to be double jabbed. This is primarily to ease expected pressures within the NHS over the winter.
Many care home workers are therefore now moving across the sector areas to avoid the mandate until it becomes law. This is despite calls from industry bodies to standardise the policy, effectively postponing the 11th of November social care deadline until the spring.
Wages are another factor. Workers often receive higher pay in the NHS while care agencies offer large incentives and welcome bonuses. Other industries such as retail and logistics firms are actively trying to recruit staff too. The result is that high numbers of staff are leaving the care sector, an extremely concerning outcome.
A National Care Forum survey said that care home members fear losing up to 8% of staff as a result, while the government estimates 7% of staff may leave, a loss of 38,000 workers at an approximate recruitment cost to providers of £94m.
When other aspects such as annual leave allowances are factored in, staff shortfalls are becoming significant. According to a recent article in the Guardian newspaper, “on current staff/resident ratios and without other measures to tackle the problem, the care of about 30,000 people could be affected”.
Although the Government’s new drive is designed to protect the NHS and reduce winter pressures, it will likely have the opposite effect. For example, a care manager may be faced with the dilemma of having to send a resident to A&E unaccompanied to maintain safe staffing levels at the service. Despite the hospital stating that the resident is fit for discharge, the manager may be forced to delay or refuse their return. The resident will therefore be forced to stay in hospital and become what is known as a “Bed Blocker”.
This scenario demonstrates how staffing shortfalls are likely to prevent thousands of people from being discharged from hospitals this winter, limiting admissions, and clogging up wards.
The policy is also set to further increase pressure on remaining care home staff who will have to take up the slack by working longer hours. This is particularly concerning from a physical as well as a mental health standpoint as many are exhausted following two years of intense COVID-19-related demands.
Care home managers are therefore looking at increasingly desperate measures to manage chronic staff shortages and try to salvage the viability of their businesses.
One option is to leave beds empty – a policy that is adding to the critical shortage of care places. This is because the CQC is currently assessing services depending on risk. Managers are keen to keep their risk rating down to avoid coming up on the CQC radar.
If they can’t recruit staff, managers have little choice but to review staffing, occupancy and dependency levels and adapt the business to reduce their risk rating and remain viable. It is well known staff will whistleblow to the CQC regarding staffing levels and working conditions. Increased complaints, accidents, incidents, and safeguarding brought on by pressures could lead to a full CQC Inspection, and rightly so, something that would add to the overall stress in the home.
Managers under pressure are looking at other cost saving measures such as reducing the number of domestic staff in favour of care staff, and then asking those staff to complete domestic tasks. Others are implementing ‘buy back leave’ programs – where they literally pay staff for their unused leave days. None of these options are great for the sector, the staff that need to have a well-earned rest, and more importantly for the vulnerable people that need to be cared for.
So how can managers stem this exodus of care workers? And, if it isn’t possible to retain staff, how do Registered Managers and senior staff continue to deliver high-quality person-centred care with fewer staff?
Having worked in the sector for over 15 years, I believe that best practice content around training, recruitment, flexible working, and job sharing can make a profound difference when staff numbers are low.
Registered Managers can continue to lead from the front — as they have done throughout the pandemic — to ensure the care and support they deliver is person-centred and outcome focused. On this front, QCS provides many tools that help managers plan for the future. These include the QCS risk assessment tool, recruitment and rota plans and its recently updated Business Continuity Plan.
The plan addresses COVID-19, vaccinations, contractors, rotas – it is a complete roadmap of how to effectively manage staffing levels. The recruitment plan includes a calendar which covers seasonal activities (such as school holidays), how to effectively target the local area and community, promote flexible family-friendly working patterns and generally appeal to people. Managers can use the tools to constantly assess dependency levels to flex staffing up and down as required.
Although QCS helps enormously with these processes and procedures, I believe there needs to be a fundamental change in the way the social care sector is perceived and supported. Managers are currently firefighters, trying their utmost to deliver a stable service. But they are literally being pushed off the cliff.
Ensuring the quality and safety of care remains the number one priority, even with lower staffing levels. Providers could not have done any more to encourage their teams to get vaccinated. But some staff believe the conspiracy theories they have read on social media. Perhaps more one-on-one training and support sessions could have helped reduce these fears.
Another fear on its way is a possible change in policy that will mandate all staff must have a booster COVID-19 jab. How many more staff will the sector then lose in that case?
The remaining staff of course still have a job to do. Within the care sector, you need to carry on. You can’t just shut-up shop for the day like a retail outlet or a restaurant can. Vulnerable service users are at the centre of this – and they are the ones who will ultimately suffer the most.
Too often the social care sector gets a negative press. Our valued employees are regularly described as ‘unskilled workers’. But they are some of the most highly skilled and knowledgeable people I know.
It’s time for people to wake up to what social care professionals do. Care staff go in day after day, seven days a week. They are committed and caring. They have watched others die during the pandemic, both service users and colleagues. Yet here they still are, supporting our loved ones.
To help them and to save social care, I hope that the government will look at temporarily bringing back freedom of movement for care workers living in the EU. And re-classify social care as a skilled job, which of course it is. That would immediately widen the recruitment pool and help to relieve some of the pressure. And finally they need to bring forward a long-term strategy for social care funding once and for all – to save a catastrophic fall off the cliff.
The article was first published in The Care Home Professional