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Demand for social care continues to outstrip availability

Updated: May 15, 2023

The state of social care in England has “never been so bad”, the country’s leading social services chief has said, with half a million people now waiting for help.

Sarah McClinton, president of the Association of Directors of Adult Social Services (ADASS), told a conference of council care bosses in Manchester: “The shocking situation is that we have more people requesting help from councils, more older and disabled with complex needs, yet social care capacity has reduced and we have 50,000 fewer paid carers.”

According to the Association of Directors of Adult Social Services more than 2.2 million hours of homecare couldn’t be delivered in the first quarter of this year.

Over 400,000 people rely on care homes in England and more than 800,000 receive care at home. But care services are struggling with 160,000 staff vacancies, rising demand and already tight funding for social care that is being squeezed by soaring food and energy inflation.


About a third of care providers report that inability to recruit staff has negatively affected their service and many have stopped admitting new residents as a result. Last month the Care Quality Commission warned of a “tsunami of unmet care” and said England’s health and social care system was “gridlocked”. Problems in social care make it harder to free up beds in hospitals, slowing down the delivery of elective care.

There are many factors that have led to the difficulties in recruitment but the main one is laid at the door of poor pay. However, I do not solely subscribe to this view. Of course, I recognise the importance of pay, but if we are to solve this problem, we will have to look beyond what we pay people, to how we make caring for people more attractive.

I would suggest we need to consider the following:

• Recognise that caring for people is not a job for everyone and in an economy that has job vacancies that exceed the workforce available it will continue to be difficult. • Prior to Brexit we were able to recruit staff from abroad who needed and wanted the work. The Government needs to speed up this process. • We need to stop the drain of people leaving and make staff feel valued. Not just through pay, but by improvements in terms and conditions and a career structure. • I know from the number of new domiciliary care providers who have registered with the support of Bettal Quality Consultancy there are many people out there committed to providing social care in the community. We need to nurture and support these new companies to succeed.

The consequences of doing nothing

We are not going to recruit the number of care workers we need let alone retain them if we continue to pay them £9.50 an hour on average. Half of health and social care workers say the government’s approach to pay makes them more likely to quit in the next one to three years, according to research by the Trades Union Congress.

Care England, that represents companies that provide most of England’s care homes, last week warned the PM of “a mass exodus of care providers across the country” without immediate support.

Martin Green, its chief executive, said: “This will be devastating not only for those receiving care and their loved ones but also through the catastrophic knock-on effects it will have on the NHS”.

This is against a background statement by Dr Adrian Boyle President of the Royal College of Emergency Medicine who states “I would not want my mother to go into hospital when she is older. Hospitals are like lobster traps, easy to get in to but hard get out of. Hospitals are harming many older people”. A government spokesperson said: “Social care is a top priority, and we are committed to bolstering the workforce and protecting people from unpredictable care costs. We have today launched our annual domestic recruitment campaign, Made With Care, to encourage people to take up a career in adult social care and we are also investing £15m to increase international recruitment into the sector.


The difficulties in recruiting staff to social care is having a devastating effect on many people’s lives. Ranging from carers who are unable to get respite to help them care for their loved ones, to people who being kept in hospital against their will.

Low pay although arguably the major reason why people leave or cannot be recruited to social care is not the only issue. Staff need to be seen as valued with l proper incremental pay scale, improved working conditions alongside a career structure that encourages them to see the benefits of working in social care.

In addition to stem the tide we need the help of staff from abroad as soon as possible. On the positive side, our own experience here at Bettal has shown there is still many potential providers out there judging by the number of people we have supported to gain registration this year.

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

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