A new briefing from the Health Foundation has highlighted that the future workforce for the NHS and social care sector is at risk without urgent action from the incoming government to establish a sustainable and joined up workforce strategy.

With more than 900 social care workers estimated to be leaving the profession every day, the sustainability of the sector is under threat. 27% of staff left the social care sector in 2015/16, up from 23% in 2012/13. Compounding the issue is a lack of new workers entering the sector. At any one time, there are over 80,000 vacancies for social care jobs in England.

The findings form part of the Health Foundation’s new briefing A Sustainable Workforce – the lifeblood of the NHS and social care, which provides a comprehensive analysis of the NHS and social care workforce in England. It identifies the key workforce challenges across both the health and social care sector, pointing to a combination of issues around recruitment, retention and morale.

The briefing includes the following points:

Pay restraint: Average earnings fell by 6% for health and social care staff in real terms between 2010 and 2017 when adjusted for inflation using the Consumer Price Index (CPI) according to Office for National Statistics (ONS) data. This is a larger drop than the economy as a whole, where average earnings fell by 2%. For the NHS, if the current pay policy continues up to 2020/21, NHS pay at Agenda for Change band 5 and above – which amounts to 625,000 staff including nurses, midwives and health visitors – will have been reduced by 12% in real terms in the decade since 2010/11.

Average earnings fell by 6% for health and social care staff in real terms between 2010 and 2017 when adjusted for inflation using the Consumer Price Index (CPI) according to Office for National Statistics (ONS) data. This is a larger drop than the economy as a whole, where average earnings fell by 2%. For the NHS, if the current pay policy continues up to 2020/21, NHS pay at Agenda for Change band 5 and above – which amounts to 625,000 staff including nurses, midwives and health visitors – will have been reduced by 12% in real terms in the decade since 2010/11. ‘National Living Wage’: In April 2016, the new National Living Wage increased the minimum wage for people aged 25 years and over from £6.70 an hour to £7.20 an hour, with a further increase to £7.50 in April 2017 (cash terms). This is a real terms increase of 8% in the hourly rate in two years. In 2016, 39% of adult social care workers in the independent sector aged 25 years and over were paid less than £7.50 an hour and so will have personally benefited from this increase. By 2020 the National Living Wage is projected to increase to £8.75 per hour – an average annual increase of 3.7% in real terms since 2016. While this increase will have improved conditions for many current workers, the impact on retention may be minimal as pay will have increased in other sectors – so relative pay will not change.

In April 2016, the new National Living Wage increased the minimum wage for people aged 25 years and over from £6.70 an hour to £7.20 an hour, with a further increase to £7.50 in April 2017 (cash terms). This is a real terms increase of 8% in the hourly rate in two years. In 2016, 39% of adult social care workers in the independent sector aged 25 years and over were paid less than £7.50 an hour and so will have personally benefited from this increase. By 2020 the National Living Wage is projected to increase to £8.75 per hour – an average annual increase of 3.7% in real terms since 2016. While this increase will have improved conditions for many current workers, the impact on retention may be minimal as pay will have increased in other sectors – so relative pay will not change. Rising staff shortages: Both health care and social care have become increasingly reliant on agency staff to deliver core services. In social care this is affecting the stability and security of social care employment – one in 10 staff are on a temporary contract (including agency and bank staff), and for support and outreach workers this is 15%. One in four people who work in social care are now on zero-hours contracts, according to Skills for Care.

Both health care and social care have become increasingly reliant on agency staff to deliver core services. In social care this is affecting the stability and security of social care employment – one in 10 staff are on a temporary contract (including agency and bank staff), and for support and outreach workers this is 15%. One in four people who work in social care are now on zero-hours contracts, according to Skills for Care. Workforce continues to be one of the biggest challenges facing NHS leaders in England: The challenge stems from a combination of piecemeal workforce planning, a long period of capped pay increases, and a lack of attention to longstanding morale issues. In the 2016 NHS staff survey, 47% said current staffing levels were insufficient to allow them to do their job properly. And nearly two in five staff reported that they had been ill in the past 12 months due to work-related stress (37%).

Anita Charlesworth, Director of Research and Economics at the Health Foundation, said:

‘It is clear that both the NHS and the social care system in England are struggling to secure the staff they need. As the House of Lords’ Select Committee on Sustainability concluded, this is one of the greatest risks to these vital services. The high rate of staff voting with their feet and leaving social care jobs raises concerns about the sustainability of the service and its ability to ensure high quality care.

‘Retention, recruitment and morale will continue to be a thorn in the side of the health and social care sector if action is not taken to address the root cause of these problems.

‘If pay restraint in the public sector continues to 2019/20, it will have been in place for almost a decade. It is a policy that is testing the resilience of the workforce and the ability of services to improve while maintaining standards of care. Uncertainty over Brexit is another key concern. Around 90,000 social care workers are from the EU, and over 60,000 in the NHS (more than one in 20). If there is a significant reduction in EU health and care staff following the UK’s decision to leave the EU it could have major implications for the quality and availability of services.’

Media contact

Peter Stilwell

peter.stilwell@health.org.uk

0207 664 4647