Difficulty retaining staff is a big problem in health and social care – but we can address that by offering more flexibility and autonomy.
Both health and social care face a growing problem of low retention rates. In 2021-22, more than 34,000 nurses left their role in the NHS, an increase of 25% on the previous year. In adult social care, an estimated one quarter of directly-employed staff leave their employer each year, while the turnover rate may be as high as one in three for those in care worker roles.
We know that many staff leave because they experience stress and burnout, often as a result of high workload. So what can we do to improve wellbeing amongst people who work in health and social care – and how can we encourage them to stay? This was one of the topics discussed in an event in May, titled Health and Social Care Workforce: Wellbeing, Integration and Sustainability, and organised jointly by Care England, Future Care Capital and Talent for Care. The event drew participants from across the two sectors. As well as hearing from prominent speakers in health and social care, participants discussed topics at their own tables and reported back.
The three clear themes to emerge were professional development, autonomy and flexibility. There was wide agreement that social care needed clear career pathways and opportunities for training. Martin Greene, chief executive of Care England, said: “We need some really clear skills and competency frameworks within social care – particularly because we’re going to have staff who are going to come into the workforce, and will leave it for a while to do either education or caring responsibilities. They need to know where they slip back when they want to regain their role in social care or health.”
A speaker reporting back on a table discussion drew attention to how opportunities for those working in social care differed from those in health care: “Our pay, our terms and conditions are different. There’s a feeling within social care that there isn’t a career pathway for life – it is more of a transient workforce with an unclear pathway and a lot of the roles taking on senior responsibilities aren’t incentivised. For a little more money, the amount of responsibility and potential blame that comes with that really stops people from looking to progress.”
Agency work ‘frees’ people from non-core tasks
Both speakers and attendees drew attention to the importance of autonomy, and the freedom to have control over one’s own work, in health and social care roles. Reporting on a table discussion, one attendee mentioned the common belief that the reason staff leave roles to work for an agency is that it pays more. But this is not the whole story, he said: “We’ve got to look inwardly, and we’ve got to take ownership for why they’re moving away…When you start to build in 35 days holiday, pension and sick leave, it’s still a good package.” The real reason so many depart for agency work, he added, was that people were tired of a culture that requires staff to perform non-core tasks, such as attending meetings and writing unnecessary reports. Agency work frees them from those activities.” Another recommendation from an attendee was simply to “make sure people have the autonomy to make things happen.”
Bhavna Keane-Rao, a consultant who previously worked for the Care Quality Commission, talked about the importance of shifting from a culture of blaming staff for mistakes. “To retain your staff group, you have to encourage them,” she said. There was “no such thing as a perfect care facility,” she added, yet the response to mistakes was often to blame staff rather than help them – possibly because defending staff meant taking on the regulator. “At the moment we are very much of the view that ‘if there’s a mistake then you’re guilty and you have to be proven innocent.’”
Flexibility and autonomy were closely related. Many people working in health and social care have family responsibilities, and would prefer to have control over the hours they worked. Bhavna gave the example of a carer who was willing to work from 6am to 10am – but then wanted four or five hours off to go and look after her mother. “Some of these amazing workers are carers as well,” she said.
Gen Z have different career aspirations
Another delegate, reporting on a table discussion, said that HR departments tended to regard high turnover among the younger generation (Gen Z) staff as a nuisance. But this generation, it was pointed out, also put a high premium on flexibility and the ability to move in and out of jobs: “Young people don’t have the same career aspirations as older people. They come into things, they get out of things, they get back into things – that’s a very different world.”
Leaders needed to be able to be more responsive to staff needs, delegates agreed. One gave the example of enabling care assistants to to train for other roles in the building, so that they could provide cover for others – both benefiting the organisation and providing the employee with more variety.
There was a consensus that employers needed to make working conditions better for staff, ranging from simple things like providing access to drinking water to providing more flexibility for staff to choose working hours that suited them. To do this required good, effective leadership, delegates agreed. As one said: “Let’s make the right thing to do the easy thing to do – create the right cultures for people to want to work here, not just to be employed and move somewhere else if they don’t like it.”