A strategy for improving recruitment and retention of staff in social care services

The difficulties faced by providers in attempting to recruit staff for social care services continues to present significant challenges. Low wages, conditions of service and lack of career opportunities are often cited as major reasons why it has become increasingly more difficult to attract people to work in social care.

In December last year, Health Education England published Facing the Facts, Shaping the Future: A Health and Care Workforce Strategy for England to 2027.

  • The adult social care workforce is larger than the NHS workforce but has lower average pay, fewer qualifications and more part time staff.
  • Turnover is high and there are 88,000 vacancies.
  • Required growth of between 14% and 31% is forecast by 2030.
  • 18% of the workforce is from overseas with regional variation.
  • 20,300 independent organisations provide care in England.
  • The government is consulting on changing aspects of the system.

The report highlights that the majority of the care workforce is likely to earn at or near the National Minimum Wage. The workforce is 82% female with an average age of 43 and nearly half work part time including 54% of care workers. Zero-hour contracts cover 24% of all staff and 33% of care workers. Turnover is high at over 25% with around 347,000 staff leaving roles during 2016/17, 33% of those leaving the sector altogether.

The sector faces recruitment and retention challenges at all levels, in both regulated and unregulated professions. Vacancy rates are higher than the general economy at 6.6% compared to 2.5%, with approximately 88,000 vacancies. Workforce diversity, as with the NHS, means a combination of interventions are needed to support an adult social care workforce for the future. The government has recognised pressures on the social care system with an additional £2bn, however a number of factors such as pay, large numbers of small employers, contract status and retention and recruitment make workforce issues challenging for the sector.

Increasing demand for adult social care

Demand is growing as people live longer with more comorbidities leading to more complex health and care needs. According to “Horizon 2035: health and care workforce futures”, by 2025 unconstrained demand for lower skilled direct care staff is likely to increase by 12%, (around 120,000 more jobs), and an overall workforce demand increase of 14% (190,000 jobs). Skills for Care suggest that need might be as much as a 31% increase or 500,000 jobs by 2030. Factoring in vacancies approaching 90,000 and the challenge of the current staffing model to meet these demand projections is clear. It also has implications for the wider economy, with labour used to meet this increase not being available to other sectors. There are interventions that can alleviate some of this increasing demand whilst meeting peoples’ desire to remain independent and well at home for longer. These include social care staff supporting prevention and public health interventions; better join up between health and care; more support for carers; and new technology.

Maximising recruitment

There are two focus areas for ASC recruitment. The first is training and skills development. Roles tend to have low entry requirements with around half the workforce having no formal social care qualifications. This is especially true of the vast majority of staff providing direct care and support. The regulated professions tend to perform more supervisory roles. There are no standard training requirements across large parts of the sector with too many staff not receiving training or professional development, despite providing direct care for vulnerable adults whose dignity and quality of life is dependent on the quality of their work. The Care Certificate, developed by HEE, Skills for Care and Skills for Health, provides a standard induction framework across social care and health. There is no mandated skills training or development across employers.

The second recruitment challenge is overseas staff. UK nationals make up 83% of the ASC workforce; 7% (around 90,000), are non-UK EEA nationals and 11% (about 140,000) are from the rest of the world. Direct care staff form the biggest group of EEA staff with about 67,000 workers

The majority of roles have low entry requirements and limited career structures. The 20,300 employers separately determine job titles and structures, which makes demonstrating career pathways challenging meaning staff often seek career progression by leaving the sector. Increases in the National Living Wage have driven up pay for those on the lowest wages but also narrowed pay differentials thereby reducing the attractiveness of seeking promotion or progression in some cases.


The Health and Care Workforce Strategy for England to 2027 has involved consultations with those who have a vested interest across the care industry and was due to be completed last month. Any new strategy will need to take into account that if we are to recruit and retain more staff, we cannot continue to have over 20000 care providers determining staff job titles and career structures. We need a national set of employment conditions that give staff encouragement to seek career progression with available training, that is recognised and financially rewarded.

If staff can be supported to gain satisfaction in their work through training that leads to improvement of skills, career opportunities and financial rewards, then we have the basis for a thriving, consistent and high-quality workforce. We may then begin to see an improvement in recruitment and retention of staff in the social care industry.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


Support for providers to comply with the General Data Protection Regulation

Given the amount of information available to increase awareness, most providers will now be aware that GDPR comes into force on the 25th May 2018. That being said, if readers carry out a trawl of the internet, they will find that apart from the Bettal GDPR Compliance Tool there is no other company advertising support with compliance designed and tailored specifically for social care services.

The purpose of this article is to give readers an overview of the requirements of the General Data Protection Regulation and how the Bettal GDPR Compliance Tool can support providers to achieve compliance.

Essentially, the responsibilities of managers are contained in the GDPR Principles.

GDPR Principles

Article 5 of the GDPR requires that personal data shall be:

(a) processed lawfully, fairly and in a transparent manner in relation to individuals;

(b) collected for specified, explicit and legitimate purposes and not further processed in a manner that is incompatible with those purposes; further processing for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes shall not be considered to be incompatible with the initial purposes;

(c) adequate, relevant and limited to what is necessary in relation to the purposes for which they are processed;

(d) accurate and, where necessary, kept up to date; every reasonable step must be taken to ensure that personal data that are inaccurate, having regard to the purposes for which they are processed, are erased or rectified without delay;

(e) kept in a form which permits identification of data subjects for no longer than is necessary for the purposes for which the personal data are processed; personal data may be stored for longer periods insofar as the personal data will be processed solely for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes subject to implementation of the appropriate technical and organisational measures required by the GDPR in order to safeguard the rights and freedoms of individuals; and

(f) processed in a manner that ensures appropriate security of the personal data, including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measures.”

Article 5(2) requires that:

“the controller shall be responsible for, and be able to demonstrate, compliance with the principles.”

Care Services will need to register with the Information Commissioners Office(ICO).

As can be seen the data controller will need to have systems and documentation in place to address the principles and requirement of GDPR.

Data Controllers will need to demonstrate that:

  • they have a legal right to hold information on service users;
  • they are aware of the kinds of information they hold on services user’s staff and volunteers;
  • the information they hold is accurate and up to date;
  • personal data collected is adequate relevant and limited to the purpose for which it is being processed;
  • people are aware of their rights to access information that is being held about them;
  • appropriate security measures are used with the processing and storage of people’s personal data.

Bettal GDPR Compliance Tool

The Bettal GDPR Compliance Tool designed specifically for social care services has taken months to develop. The Tool draws heavily on the GDPR Principles, compliance guidance produced by the Information Commissioners Office and their own Self-assessment (ICO).

The Tool is designed to:

  • Enable managers to understand their obligations to the GDPR.
  • Provide you with the documentation you require and guidance to meet the GDPR.
  • Audit and check your compliance to GDPR.

The Tool includes:

  • An Implementation Plan.
  • Data Processing Audit Register (Form).
  • Example Privacy Impact Assessment (Form).
  • Example Privacy Impact Assessment (Form).
  • Obtaining Consent (Policy).
  • Information Governance (Policy).
  • Data Breech (Policy).
  • Security of Personal Data (Policy).
  • GDPR Staff Training (Policy).
  • Duties of senior Person Responsible for Compliance to GDPR (Guidance).

Overall the contents of the Bettal GDPR Compliance Tool includes over 30 documents.

Please click here for further information on the Bettal GDPR Compliance Tool where you can download free samples and purchase the full package.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Social care services can contribute to easing pressure on NHS

Severe pressures in hospitals this winter has seen thousands of operations cancelled, causing social care leaders to urge NHS bosses to ‘start listening’ and let care homes do more to help.

Elderly people are among those who are most at risk of illnesses such as flu during the winter months. NHS England has said hospitals, GPs, ambulances and other NHS services have been extremely challenged this winter, and have reported higher levels of respiratory illness and flu.

In the final week of 2017, the NHS 111 helpline received more than 480,000 calls.

Martin Green, chief executive of Care England, which represents independent care home providers, said: “The NHS Acute Trusts could significantly reduce winter pressures by establishing long-term relationships with independent care providers. The care sector has been saying this for years and yet again the NHS has not listened and is in yet another crisis”.

Health secretary Jeremy Hunt apologised to patients following a decision to postpone tens of thousands of operations in January because the NHS is struggling to cope with a surge in patients this winter.

Non-urgent treatments had already been cancelled until mid-January, but this has now been extended to the end of the month.

Handover delays outside A&E departments stop ambulances from getting to new emergencies. The handover of patient by ambulances at A&E departments is supposed to take no more than 15 minutes.

Almost 5,000 people were left waiting in ambulances outside A&E departments for one hour in the last week of December, as 12 hospital trusts revealed they had no beds free. These health trusts were operating at 100 per cent, well above the recommended 85 per cent.

A&E staff can’t move patients out of their department and onto hospital wards, because hospitals can’t discharge patients from their wards into the community. Shropshire County Council is working with care homes to ensure patients don’t stay in hospital any longer than necessary. The council is working to cut the number of patients delayed in hospital, known as a Delayed Transfer of Care (DToC).

At the end of December, Shropshire’s A&E departments got hospital staff from other wards to help with the volume of emergency patients it received and had already commissioned extra beds in care homes, which are block purchased to ensure they are there when needed.

The Shropshire-based care home The Uplands offers nursing and specialist dementia care. It is run by Marches Care and has been drafted in to help this winter. Mandy Thorn, the managing director of Marches Care and vice-chair of the National Care Association (NCA), which is made up of small-and medium-sized care providers says: “If care homes were more involved in local winter planning, which is actually a year-round issue, we would probably see less of a problem with DToC.”

She believes this would be possible if they are “engaged early enough and sensible and respectful contract discussions take place – around block contracts at a price that reflects the additional support that short-term admissions require.”

She says when it comes to care homes being used to address winter pressures it’s “a patchy picture across the country”.

“Smaller independent providers are not always considered when local authorities and CCGs get together to discuss their response to winter pressures. When health and care professionals get together to respond to hospital bed pressures, not every local area takes into account the residential and nursing beds that may be available.”

According to figures from the Institute of Public Care, from April 2012 and April 2017, the number of care home beds available fell by 3,769. Add to this a major staff retention and recruitment problem in the care sector and the country’s ability to respond to a winter NHS crisis gets more challenging.

Market intelligence

Responding to criticism from the care sector that some care homes’ beds are ignored in different parts of the country, Colin Noble, the leader of Suffolk council and health and social care spokesman for the County Councils Network, (made up of 27 county councils and 10 unitary councils), told carehome.co.uk: “I think it comes down to market intelligence.

“Every single day we are working with every single care home. It’s a question of how much of a silo between CCGs [Clinical Commissioning Groups] and councils exists in an area. Local authorities know all of their care homes but that’s not always the case for CCGs.

“It’s a matter of CCGs using the council’s market intelligence about care homes.”

Job satisfaction

Mandy Thorne puts it simply. “Staff in my care home report increased job satisfaction because they see people admitted to us from hospital needing significant support who then leave to go home after a couple of weeks because they are well enough to return to their own homes.

“Long-term residents have also benefited because they can interact with a wider variety of people who come into the care home, and who by seeing people get better and go home they can be more motivated to do more themselves.”


Is it not time that we saw a closer working relationship between social care and the NHS to reduce the pressures of bed blocking. In Shropshire they have set a good example of forward planning, by block booking care home beds in advance. Colin Noble highlights the importance of market intelligence to alleviate the problem and Mandy Thorne suggests that more consideration needs to be given to smaller providers. Surely, making better use of what social care can offer will be of benefit to patients and hospitals and reduce the crises experienced by the NHS each winter. Come on NHS is it not time you started listening.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

It that time of year again – Looking back over 2017

Looking back over the year 2017 I have tried to bring to your attention articles and blogs that you might find interesting in the world of social care. I have covered topics ranging from the crises in social care funding to the use of yoga in care homes.

The central purpose of my blogs is to keep you informed of innovative practice that may improve the quality of life of people who use social care services. In addition, I also include new requirements placed on providers by the Care Quality Commission.

Overall the year 2017 in social care is ending as it began. Social care is still in crises because of underfunding, and has reached a tipping point. A number of care homes have decided to call it a day, and some domiciliary care providers have even handed back their contacts to local authorities because they are uneconomically viable.

Looking forward positively, we are promised a Green Paper on social care funding in the summer of 2018. On the one hand, this may be seen as a method of kicking the problem in the long grass, and further delaying tactics. Alternatively, it may at last be recognised as a problem, where the solution can only be found outside the cut and thrust of party politics and consensus on way forward is agreed by all parties.

All the best to you and yours for 2018.

Happy Christmas!

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


More funding for social care but the long term problem still needs to be addressed


Last Wednesday’s budget which saw the Chancellor of the Exchequer Philip Hammond announce an increase in social care funding in the next 3 years is to be welcomed. The constant pressure by providers of social care services, the NHS and MPs from all sides of the House has at last produced some tangible results, and the Chancellor has been forced to play his get out of jail card.

One could argue that far from the money been allocated to improve the quality of social care services or to alleviate the growing demands for social care by an ever-increasing elderly population. The main purpose of the funding was to ease the strain on the NHS by preventing bed blocking.

However, continuing with the positives. The announcement of more than £2bn of new funding for adult social care in England is welcome, and badly needed following years of funding shortfalls. Combined with measures announced in the 2015 Spending Review including the social care precept, this means that (in theory) more than £9bn of additional money has been allocated to social care in this Parliament.
The government highlights that the package announced since the election means that councils will be able to increase adult social care-specific resources in real terms in each of the final three years of the current parliament. Indeed, if (a big if) the amount councils spent on social care in 2016-17 were maintained in real terms and these new funds added on top, spending would increase by 16 per cent in 2017-18, and by almost one quarter (24 per cent) in the three years to 2019-20.

But the “big if” and “in theory” above gives concern. Largely because councils’ adult care spending isn’t ring-fenced, there’s no guarantee that current funds will be protected. There is a risk that additional earmarked funds simply displace non-ringfenced spending, with ongoing pressure on wider council budgets continuing to bear down on the social care allocation.

The second reason for concern is that even if total real care spending increases, the money the government has set aside will not be sufficient to close the social care funding gap. The immediate cash injection will go some but not all the way towards addressing an estimated funding shortfall of at least £1.3bn in 2017-18. But looking to the end of the parliament, £400m of new funding in 2019-20 means that only around 15-20 per cent of the commonly-used estimate of a £2.3-2.6bn funding gap that existed prior to this Budget has been filled (and even this might be optimistic – some organisations contend that the real value of the gap is much higher still). 

This raises the prospect of further increases in unmet need in coming years. The number of adults who say they don’t get the care they need having already doubled since 2010.

Looking to the future
While a short-term cash injection is very welcome, these concerns suggest that they are no more than a sticking plaster and the job still needs to be done. The debate must now turn to the longer-term settlement for care, so it’s welcome that the government announced in the Budget that it will publish a green paper on how the system can be put on a more secure footing. Long-term reform of social care funding therefore remains vital. Theresa May has said to be determined to find a solution to a problem that has thwarted all governments of the past 20 years, despite a series of reviews and inquiries in that time.

Any solution to this problem must face the challenge of protecting people against the risk of having their lifetime savings wiped out by care costs. The Dilnot Commission (2011) proposal of extending means-testing and capping the lifetime cost appears the right way to go. Indeed, this approach was enacted in the Care Act 2014, but then shelved in 2015. It’s now time to take it back down from the shelf and dust it off.

The other fundamental challenge is sustainable funding for an integrated NHS and care system, as set out by the Barker Commission (2014). This accepts that spending on health and care as a proportion of GDP would need to rise. To fund this, you might have to question the logic of some universal pensioner benefits, National Insurance rates for older workers and higher earners, as well as the increasing focus on taxation of income rather than wealth derived from property, inheritance and capital gains. Other ideas floating around include the suggestion of a “care Isa” to encourage people to save to meet their own costs, a guarantee of a set amount of free care for all and even retrospective payment of costs through an inheritance levy.

At long last the Chancellor in his budget has recognised the plight of social care services and the needs of an increasing elderly population. The injection of £2bn funding is to be welcomed along with the additional local authority contribution. However, some commentators believe it will hardly cover the funding gap. It must be hoped that the Green Paper promised by Theresa May comes to fruition and a realistic solution is found.

The difficulty remains that any long-term solution to social care funding will require a cross party consensus and as history has informed us this will be difficult to achieve.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy