Social care staff are taking up roles in tourism and hospitality and urgent action is needed to prevent a “tsunami of unmet need” rippling across essential services this winter, the care regulator has warned.
Ian Trenholm, chief executive of the Care Quality Commission (CQC), said health and care staff are “exhausted and depleted” and working under intense levels of pressure, with many services at or over capacity.
The regulator is warning of a “serious and deteriorating” situation in terms of recruitment and staff retention in adult social care, which is a severe problem for the sector.
Staff cannot be expected to work harder than they already are if services are to get safely through the winter, Mr Trenholm said, warning that many people may not get the care they “desperately need”.
The vacancy rate in care homes has steadily grown to reach 10.2% as of September – meaning in a year’s time one in 10 care home staff will not be in that job, the CQC said.
It said staff shortages vary across the country, with the sector having to compete with others such as hospitality, tourism and retail which can offer more competitive pay.
The CQC is concerned that this will only increase as these industries open up and offer incentives to speed up recruitment, while social care staff may also take up vacant nursing posts in hospitals.
Some care homes which are registered with the CQC as providers of nursing care are having to hand back these registrations because their “attempts at recruitment have failed” and they no longer have the nursing staff to keep this status.
Care homes are also experiencing falling occupancy rates, while profitability per registered bed was at a three-year low as of March 2021 based on the regulator’s analysis of providers which, if they were to fail, could disrupt continuity of care locally.
The CQC noted there have been feelings of “uncertainty, anxiety and fear” over safety in care homes and restrictions on visits, which may have led to families choosing not to send their loved one into a facility.
Mr Trenholm said the workforce needs better pay, training, conditions and stability and to see social care as somewhere that is an “exciting and vibrant” place to work and a long-term career choice.
And while £5.4 billion pledged by the Government over the next three years is welcome, there is a need for funding now so providers can “urgently increase capacity”.
The regulator said increased stability in social care is key to easing pressure on the NHS – by reducing emergency attendances in the first place as well as delayed discharges back into the community.
But it is warning of a ripple effect of this pressure making itself felt across all services this winter without urgent action.
During a briefing to launch the CQC’s annual State of Care report, Mr Trenholm said: “If nothing changes social care will continue to lose staff to other sectors, outside of health and social care.
“It’ll lead to reduced capacity and choice and poorer quality of care.
“The impact of that will ripple right across the wider system, and those ripples will build and become a tsunami of unmet need across all sectors.”
He said areas with high vacancy rates and low population densities are of particular concern, adding: “What we know is that people are leaving social care to go and work in hospitality and tourism.
“So areas like the South West are particularly hard hit, and are going to particularly struggle to resolve this particularly difficult problem.”
The majority (85%) of adult social care providers were rated outstanding or good as of July 2021, with 3,271 (14%) told they require improvement and 284 (1%) adult social care services rated inadequate.
The CQC said its analysis shows that most care homes have faced their challenges well, with the regulator assured that 69% of more than 5,000 homes inspected since summer 2020 were managing eight measures of infection prevention and control.
More than a quarter of inpatient services for people with a learning disability and/or autistic people were rated inadequate (8%) or requires improvement (20%).
Matthew Taylor, chief executive of the NHS Confederation, said social care is “at serious risk of a significant erosion”.
He said: “As this report shows, social care staff, including nurses, are leaving in their droves which presents a real risk to the continuation of services and creates worrying instability in the care market.”
Dr Jennifer Dixon, Health Foundation chief executive, said it is not sustainable to expect health and care staff to continue under such intense pressure.
Nuffield Trust deputy director of policy Natasha Curry said: “The pandemic has left staff burnt out and exhausted, pay and conditions remain unattractive compared to other sectors, the door to international recruitment has been slammed shut, and a mandatory vaccine policy threatens to remove thousands of needed staff from the sector.”
Age UK said older people are getting stuck in hospital when they are fit to be discharged, because there is not enough care to support them at home.
This is “deeply ominous” for the NHS and “miserable and counterproductive” for the patients concerned, charity director Caroline Abrahams said.
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