Speakers at a recent event discussed how to improve recruitment and retention in health and social care
The scale of the problem facing the NHS and social care is daunting. An ageing population is putting more pressure on both health and care, and there is not enough staff to meet demand. By the early 2030s, we will need to fill an extra half a million jobs in social care, and 475,000 in the NHS. There is a problem with both recruitment and retention.
In May, participants from across the health and social care sectors met to discuss the challenges facing both sectors. The event, titled Health and Social Care Workforce: Wellbeing, Integration and Sustainability, and organised jointly by Care England, Future Care Capital, and Talent for Care, brought together representatives from the two sectors to discuss how to create a sustainable workforce. The event took place before the publication of the NHS Long Term Workforce Plan in June.
It’s not just that staff are choosing to leave after years of burnout – as Professor Irene Gray, a non-executive director of Future Care Capital, pointed out in an introductory speech, one in four student nurses leave before they have even finished their course. And while jobs in nursing and medicine are attractive, social care is very much the poor relation, often badly paid and lacking a consistent career pathway.
So what can we do both to attract more staff into the two sectors and, once there, retain them? A number of speakers mentioned the need to make social care more financially attractive. Liz Kendall, the shadow spokesperson for social care, said that a Labour government would, adapting a model pioneered in New Zealand, introduce “new fair pay agreements.” These bring together employer representatives with worker representatives to agree minimum pay terms and conditions and would be binding throughout the sector. “What many of you know, as good employers, is that what’s good for staff is good for quality,” Liz said.
There was also a need to think more imaginatively about how to bring staff into the sectors. Kathryn Halford, chief nurse at Barking, Havering and Redbridge (BHR) University Hospitals NHS Trust, said that we should rethink the requirement for people to enter the NHS workforce via an academic qualification. BHR, which serves an area of high deprivation, had introduced apprenticeships to attract more local people into employment.
Martin Green, chief executive of Care England, suggested developing skills and competency frameworks aimed at enabling under-represented groups to join the workforce. As an example, he cited the many disabled people who could make a “huge contribution” to social care. “We don’t engage them effectively,” he said. “And we also have structures that are not conducive to flexibility. I might be a disabled person and I might want a role in social care. It might not be a full-time role, it might not be a part-time role, it might be about doing some things at some points – we have got to have the flexibility within our systems to be able to accommodate that.”
Several speakers mentioned the need for greater flexibility in working patterns. One attendee reporting on a table discussion spoke of the need to “drag an old system into the future” and the challenge of balancing the needs of individuals with different requirements in terms of working hours.
Some of the discussions focused on the current rigidity in funding systems. One speaker reporting on a table discussion said that the number one item on their wishlist was “multiyear funding”, adding: “The only way we are going to be able to get value for money and provide sustainable partnership is by being able to look further ahead, not getting funding midway through the year or at the end of the year when we are then rushing to spend it. We are not doing the best by taxpayer money when we are having to spend it so quickly.” Several others shared the sentiment.
Greater partnership between the two sectors was key to both recruitment and retention, speakers and attendees agreed. Martin said that most citizens have no interest in whether a particular service is provided by health or social care, and his vision was that staff should be able to move seamlessly between the two systems. He also argued that we need a national workforce strategy for social care, similar to that for the NHS, with the integrated care systems having the ability to tweak it for local circumstances. Some attendees pointed out that it is much easier to recruit into the NHS than into social care, and one, reporting on a table discussion, suggested creating a national health and social care recruitment campaign.
Guilty until proven innocent
There was also some concern about the demoralising effect of the current regulatory system. Bhavna Keane-Rao, a health and social consultant, asked: “How do we support staff without stepping on the regulator’s feet? At the moment it’s very much a case of ‘If there’s a mistake you’re guilty and you have to be proven innocent.’”
Martin argued that the current regulatory system was “framed in the context of finding fault and apportioning blame. I do not think that is conducive to delivering really good professional development.” He suggested it would be better to move to the model used in the airline industry, where, “after a critical incident, they do a forensic analysis, which is non-judgemental of what happened. When they’ve done that analysis, they give key messages to individual practitioners about where their practice needed to change.”
There was widespread consensus amongst attendees about the areas needed for improvement: better pay and career structures, more opportunities for flexible working, a willingness to spread the net further in recruitment, and greater partnership working between health and social care. Participants also recognised that a truly sustainable health and social care system should be centred on the needs of the people using it. As Martin said: “We need to be creative in how we deliver care, and that requires a lot of good core values, but we also need to train people to have the autonomy and skills to respond effectively to what people need. We need to be sector-neutral.”