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

The importance of hand hygiene in social care settings

Hands are the most common way in which microorganisms can be transported and subsequently cause infection. In order to prevent the spread of microorganisms to those who might develop serious infections by this route, hand hygiene must be performed effectively.

There is considerable evidence that Service User contact results in contamination of health care professional’s hands by pathogens that cause health care associated infections (HCAI). Effective hand hygiene is recognized as the single most important procedure for significantly reducing/preventing infection, leading to improved morbidity/mortality rates.

A recent study in France has shown that good hand hygiene practice was particularly valuable during periods where infections were active within the community. In the UK this winter we have seen increased pressures on our health services as a result of the influenza outbreak (the so called Australian Flu).

In France during January to March, France like the UK experienced a widespread influenza outbreak. Care homes that took part in the study which had implemented additional measures reported a 30% lower mortality rate than the control group.

It seems prudent then to continue to raise awareness of social care staff in the UK to the importance of effective hand hygiene in social care settings.

In most care settings, staff receive training in infection control including hand hygiene. But over time, staff can become complacent and underestimate what poor hand hygiene can cause to vulnerable Service Users.

In 2017 the World Health Organisation ran a campaign designed to improve hand hygiene and highlighted:

The 5 moments of hand hygiene at the point of care:

1.       Before Service User contact

2.       Before Clean/Aseptic procedures

3.       After body fluid exposure/risk

4.       After touching a Service User

5.       After touching a Service User surroundings.

Correct technique for hand hygiene:

Bare Below the Elbow.

The Department of Health (2007, 2010) state that hand hygiene is not performed effectively if sleeves and cuffs are close to wrists.

Bare Below the Elbow means:

  • No long-sleeved clothing (or capacity to fold above elbow)
  • No wrist watches
  • No bracelets or wrist bands
  • No rings except one plain wedding band
  • No nail varnish, false nails, nail jewellery or nail extensions
  • Natural nails must be kept short and neat

Hand decontamination using an effective technique, will ensure that all surfaces of the hands are covered. Clinical staff must use the Ayliffe (6 steps) hand hygiene technique. Lancaster university have produced a video on how to use the technique.

Protection of Service Users

An audit should be carried out to ensure alcohol hand gel units readily available. They should be easily accessible and available in sufficient quantities if they are to be used effectively. Consideration should be given to the provision of additional dispensers if needed, or pocket-sized bottles of hand rub where required to supplement these, particularly during outbreaks. The Service should also ensure that sinks are equipped with a suitable hand sanitiser and paper towels to ensure hands can be washed thoroughly.

Regular spot checks should be undertaken to observe staff practice that ensures staff are sanitising their hands between all episodes of personal care. The spot checks should also include checks on hand washing technique and knowledge of when gloves and other personal protective equipment (PPE) should be used.

Staff Training

Although Infection prevention and control training (including hand hygiene) is a mandatory requirement for care staff. The manager should ensure that regular refresher courses are made available to staff to ensure the continuation of best practice.


There is a great deal of evidence that the failure of care staff to carry out correct handwashing techniques can have serious consequences in the spread of infection and on the lives of Service Users. The World Health Organisation, NICE and a whole raft of research including the French study show how important it is that care staff follow the correct procedures for handwashing.

Given the pressures that care staff are under it is easy for them to become complacent when carrying out correct hand washing techniques. It is the duty of managers to ensure that staff are following best practice and have the resources available to carry out the task. Increasing staff awareness of the importance of hand hygiene along with refresher training will help to prevent contamination and infection.

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

Can robotic seals reduce stress and anxiety in people with dementia?

The use of robotics in social care services is gaining traction. You only have to look on eBay and Amazon and you will find PARO the robotic seal.

Developed in Japan and modelled on the features of a baby harp seal, PARO is the most common therapeutic pet-type robot used in studies with people with dementia. The therapeutic version (version 9) is an autonomous robot that is similar in weight to a newborn baby, and has 5 sensors that are processed by artificial intelligence software to enable PARO to respond to the user and the environment. Typically, active during the daytime, PARO can move its tail and flippers, open and close its eyes, and make sounds similar to a real baby harp seal.

Paro has been around for some time invented in Japan in 2005. So, it’s taken some time to get established. It is now used in health and care services around the world

It is claimed that the robotic seals reduce stress and anxiety, scientists have said.

The cuddly animals respond to touch and speech. The devices look like toy seals.

They have built-in sensors and their artificial intelligence allows them to “learn” and respond to the name given to them by service users. They can also react to being stroked and spoken to by wriggling, turning to the person, opening their big eyes and squeaking.

Research has shown the seals can reduce stress and anxiety, promote social interaction, facilitate emotional expression, and improve mood and speech fluency.

But although they were shown to enhance the wellbeing of people with dementia, there were concerns about meeting the infection prevention control requirements as they can be hard to clean.

Hygiene and cleaning tests were carried out over nine months by the University of Brighton’s School of Health Sciences on a 10-bed dementia ward run by Sussex Partnership NHS Foundation Trust. The results show that PARO was maintained within acceptable limits for NHS Infection Control.

Lead researcher Dr Penny Dodds, who recently moved from the university to the charity Dementia UK, said: “To our knowledge, this was the first testing of the infection prevention and control aspects in the world and we are delighted with the results.

“We have demonstrated that, under controlled conditions, PARO was safe within the hospital setting for an acute care dementia unit. It is hoped that this can allay concerns from those who have been hesitant about using PARO in the NHS.

“It is anticipated that PARO will receive Medical Devices Status in the UK shortly and the distributor is preparing PARO for the UK market – we could be seeing PARO on wards throughout the country in the not-too-distant future.

“The successful research means we can now offer our cleaning testing protocols for use. This work is ongoing and the next stage will be to see if a weekly clean can be reduced to 15 minutes.”

Dr Dodds said there were similarities to using pet therapy but PARO is easier to supervise.

“Unlike real pets, PARO always behaves, has rechargeable batteries, is always available – and PARO should last about 12 years,” she added.

“The most important aspect is the improvement PARO makes to a patient’s quality of life.”

Dr Doug Brown, chief policy and research officer at Alzheimer’s Society, said: “It’s great news that PARO has sealed the deal, bringing these robots one step closer to supporting people with dementia.

“With no cure for dementia and no new treatments for over 15 years, it’s important to develop innovative ways to support the 850,000-people living with dementia today.

“These novel seal robots can boost social engagement, improve mood and reduce agitation in some people living with dementia. Although it is vital that they are used alongside human contact, and never replace it.”


Staff working with people dementia are always looking towards innovation to help them improve the quality of life for service users who suffer from this disease. Paro the robotic seal is one such innovation that is claimed to reduce stress and anxiety. One could argue why not have dogs in the care facility. The trouble is they are unpredictable, they can transmit disease, and most importantly, they go home at the end of the day.

There is however an ethical question we have to address when we choose to use robotics. What happens to our moral character and our virtues in a world where we increasingly have more and more opportunities to transfer our responsibilities for caring for people to robots? Where increasingly, the quality of those robots encourages us to feel more comfortable with doing this, to feel less guilty about it, to feel in fact maybe like that’s the best way that we can care for people. I would suggest there is no substitute for compassion.

Albert Cook BA, MA & Fellow Charted Quality Institute

Managing Director
Bettal Quality Consultancy

Validation Therapy for people with dementia

All staff who care for people with dementia, particularly advanced dementia, are very aware that it can be a particularly difficult challenge. With the progression of the condition service users withdraw into themselves more and more, they don’t let anyone come near them and they no longer remember recent events.

However, in order to meet people’s needs, staff must have some means of communicating with the person – either verbally or non-verbally. Dementia Support suggest there is another method that can help those who care for people with dementia to make a positive connection with them. This method, developed by Naomi Feil in the 1980s, is known as Validation Therapy, and it enables staff to react effectively in response to a service user’s behavior.

By using the Validation method, staff can reduce tension between themselves and those in their care, and begin to develop a closer relationship with them. One critical element of validation, for example, is that it shows that you have respect for who they are and that you accept their current feelings and expression of their emotions.

The central belief and goal of Validation Therapy is that people with dementia should always be taken seriously – no matter what they say, feel or how they act.

Objectives and goals of validation therapy

Whenever you use the Validation method, you are making a connection with the feelings of those in your care. Knowing their Life History, therefore, plays an important role in providing this advanced level of care.

The objectives of Validation Therapy will give staff an understanding of what the approach is trying to achieve:

Cognitive Goals: Improves the persons capabilities
Physical Goals: Improves their wellbeing
Emotional and Personal Goals: Resolves any past conflicts
Social Goals: prevents social isolation of the person

In order to achieve these goals staff should aim to meet the following intermediate goals:

Convey the persons esteem
Reinforce their identity and self-respect
Maintain dignity
Reduce stress
Improve wellbeing
Revive past emotions
Establish effective communication
Communicate at the emotional level.

The aim of Dementia Care & Support, is always to give managers practical, step-by-step advice so that they and their staff can learn quickly and effectively how to apply advanced care techniques in their daily work. Rather than offering unnecessary theory, here are their fast-track tips for implementing the Validation Method in your care service:

First, observe the person in your care

Within a short period of time, you’ll notice certain behavioural patterns that recur time and again. You’ll then be able to draw on these later.

Convey to them a feeling of their own esteem

Esteem is a prerequisite for gaining their confidence. You can express your esteem for them by:

• Giving them your full attention
• Showing them that “I have time for you”
• Adopting and reflecting back to them their manner of expressing themselves and their body language
• Being tactile and being close to them.

But don’t overdo it and be sure to express only genuine feelings. Even if people with dementia often give the impression of being confused and disoriented, they’re still exceptionally sensitive to feelings and moods. They will pick up on the exact tone of your voice and the intention behind it.

When using Validation Therapy, there are a set of rules of communication that you can follow that are especially appropriate to the feelings and behavior traits of people with dementia. Dementia: Care & Support have put together the following checklist for you to use in your care home.

Validation therapy also encourages carers not to contradict the person with dementia and to instead enter their world, rather than trying to bring them (usually unsuccessfully) into your own.

‘Validation is about being in the moment with the person,’ explains Julia Pitkin, one of the first validation practitioners in the UK. ‘Being corrected can make a person feel devalued.’ Whether you call it special care or validation therapy, both approaches recommend using distraction techniques rather than lying.

So, for example, if a service user keeps asking where her husband is, instead of reminding her he died five years ago, you could say, ‘it sounds like you’re really missing him, how did you meet? Can I see some wedding photos?’

Empathy and respect are what matters, say supporters of both approaches. Feeling listened to and supported, they argue, helps people with dementia regain their dignity and feel a greater sense of calmness and peace.


Managers and staff are always on the lookout for new approaches to engaging and communicating with people who suffer from dementia. Validation Therapy is not new, but the benefits of this approach are now being recognized. There is a great deal of literature available on this topic if managers are interested. Including: Dementia Care and Support for Care Home Personnel.

There is also a video by Naomi Feil available on YouTube here.

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