‘We have a burning platform’: addressing the crisis facing the health and social care workforce

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, was an opportunity to focus on how the sectors could work together more effectively to recruit, retain and look after staff. Attendees heard from experts in both sectors, and shared their own ideas for improvement and experiences of more seamless working.

Speakers were agreed that the challenges facing the sectors are substantial. An ageing population has created growing demand, both in health and social care, but the sectors find it difficult to recruit and retain staff. Introducing the event, Professor Irene Gray, a non-executive director of Future Care Capital, noted that we are currently losing about 24,000 nurses a year, often because of burnout and stressful working conditions. Figures show, she said, that by the start of the next decade, we will need an additional 600,000 social care staff to meet growing need.

The problem is not unique to the UK, however. David Nicholson, chair of the Royal Wolverhampton NHS Trust and Walsall Healthcare NHS Trust and former NHS chief executive, noted that all around the world, governments are struggling with staff shortages and the difficulties caused by the separation of health and social care. “Across the globe, people are thinking about how they can better integrate their services, whether they be health services, social services, social care or housing,” he said. “How can we bring all of those together to get the best possible outcomes for our citizens?”

David argued that we should not see integration as a strategic issue, but as an operational one, concerned with delivery of services to communities and individual patients: “We spend far too much time thinking about the strategic context we work in and not enough operationally about how we make integration work.” He cited the example of Walsall Together, a partnership of health, social, housing, voluntary and community organisations that was working together successfully to improve mental and physical health outcomes and reduce inequality.

An important step towards integration, he said, was to introduce a common pay system for health and social care: “It will open up all sorts of opportunities for people across the system to work flexibly, but also to have careers if they want them.”

Health and social care investment boosts growth

Although social care was costly, David added, it was important that we see it “not as a problem to be solved but as a fantastic link between our institutions and our communities.” There was “massive evidence now,” he added, that expenditure on health and social care is “enormously productive in terms of economic growth.” Liz Kendall, the shadow minister for social care, reinforced this point, arguing that social care is “as much a part of our economic infrastructure as the roads and the railways.”

Martin Green, chief executive of Care England, argued that both sectors are now in crisis. We have got in many ways a burning platform,” he said. Too often, he added our approach to the development of the workforce “has been based on a 1948 model and now we’re in 2023.” This 1948 model was “diagnose, intervene, cure or die,” he said, whereas “the 21st century is about long-term conditions. It’s about enabling people to live well with a long-term condition and how to manage it in ways that enable them to live a life.”

Martin noted that the NHS spent far more money (£100,000 a minute) than the social care sector on training. Rather than have two systems fragmented with differential amounts of money for training and development, Martin said that we should have a single “training and development pot that could be accessed by everybody who works in that health and social care space.”

It was important, he said, to create skills and competency frameworks that would enable people to enter the care and health workforce. Martin also thought there should be skills transference routes – such as the Teach First model used in teaching – to enable people to change career. “At the moment our approach to training is too focused on organisations and processes, and we need to shift the dial on this – we need to talk about people and outcomes,” he said.

Tackling recruitment and retention

Panellist Nastasha Koerner of NHS England drew attention to the high drop-out rate amongst newly-qualified nurses. Efforts to train up new staff were “refilling a leaky bucket,” she said, and there had to be more engagement in schools to let people know the variety of careers available.

Other speakers gave examples of success in areas such as recruitment, retention and integration. Kathryn Halford, chief nurse at Barking, Havering and Redbridge University Hospitals NHS Trust, said that the local community was highly deprived, and so the trust had initiated a “big pastoral care programme to support people into the workforce.” This included introducing apprenticeships rather than expecting people to enter via an academic route. A common response from local people, she said, was: “People like us don’t work in hospitals.”

Kathryn emphasised the need to be flexible in recruiting people to the NHS workforce.

During the pandemic, the trust had recruited nightclub doormen as hospital security. Finding that some had very good leadership skills, they were encouraged to retrain in the NHS, and a few are now ambulance workers, she said.

Some speakers noted that the pandemic had brought about a greater focus on valuing staff. Natasha mentioned that during the pandemic she had managed frontline services in Devon, and that one “brilliant” change had been the trust that was put into every member of staff working out in the community, and that recognition of how vital social care is to health.” She added: “We had to discharge people incredibly quickly. We needed the confidence in the workforce, and we had that confidence because staff were stepping up to say, ‘I can do this.’”

Similarly, Kathryn said that during Covid, staff wellbeing had become central to the way the trust operated. The trust set up “letting it out” sessions where staff could have a chat about the stressful things they were experiencing, such as patients dying or relatives being aggressive. These had proved “really helpful,” she said.

New ways of working

A number of speakers mentioned the importance of having the flexibility to meet employees’ individual needs in order to recruit and retain staff. Joanne Balmer, chief executive of Oakland Care, said the company used “individual time management pathways” to retain staff. It had also “developed bespoke training programmes to enable people to develop new skills and competencies that they wouldn’t ordinarily have done.”

Consultant Bhavna Keane-Rao said that when she visited care homes, staff frequently cited the importance of flexible working hours: “It’s not always about the money. They want flexibility much more.” Some staff might want to work from 6am to 10am and then have four or five hours off to help their own mothers – because “some of these amazing workers are also carers as well.”

Several speakers mentioned the importance of technology in modernising working patterns. Reporting on a table discussion, one asked: “How do we drag an old system into the future? How do you balance the needs of individuals that might have different requirement in terms of the amount of hours that they want to work, where they want to work those hours and when they want to work those hours? We’re looking for that total flexibility,” he said. Companies like McDonald’s and Costa Coffee had led the way in allowing staff to use technology to organise shift patterns, he said.

The most significant takeaway from the event was an agreement that health and social care should stop operating in silos. While people working in the sector were often heavily focused on sector and organisational distinctions, Martin said, people who used those services were not interested in who delivered the service, but rather the quality of the service: “What they want is a good service that meets their needs and delivers them a good life.”