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Simon Bottery: NHS can't look to social care to fix workforce fears

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Many of the headline numbers for the social care and NHS workforces are remarkably similar.

Both have around 1.1 million fulltime equivalent staff, similar numbers of vacancies and similar percentages of overseas staff.

The two sectors are inextricably linked operationally. Staff move jobs between the two sectors, work together to deliver care and collaborate to commission it.

Yet, as argued in a new report from The Nuffield Trust, The King’s Fund and The Health Foundation, there are also major differences and inequalities. We should see the NHS and social care as two interconnected sectors and work harder to join them up.

The most obvious difference between the two is in pay and conditions. Though they have similar numbers of staff, the NHS pay bill is huge compared to that of social care. Social care has more staff paid on or around the minimum wage (and worrying reports of staff paid below it), high numbers of zero hours contracts and a high turnover rate, with over a third of staff leaving their jobs each year.

Unless it acts responsibly, the NHS could make this worse. As a major employer, typically providing better pay, terms and often career prospects, the NHS already has a significant ‘gravitational pull’ on the social care workforce.

For many care workers, a job as a healthcare assistant in a hospital is already a dream next step, offering more money, greater job security and better training. If the NHS comes knocking, it may be hard for them to say no.

On current trends, in a decade’s time the NHS will have a shortfall of 108,000 fulltime equivalent nurses. There are 42,000 nurses currently working in social care.

Luring staff away from social care could be tempting, but it would be selfish and self-harming. Social care staff support people in need of care, and their work often frees up NHS hospital beds and keeps people out of them in the first place.

One solution is for the NHS to identify how it can work better with social care rather than competing with it for staff. Greater involvement of local authorities in integrated care systems and sustainability and transformation partnerships would be a basis for more joined-up thinking on workforce.

Better coordination with the NHS will not itself solve the social care workforce problem. Its origins run much deeper, into the essential way the sector is funding and organised.

A long-term workforce solution will require long-term funding reform – something the long-awaited green paper is intended to kick off – but this year’s spending review will need to fill the short-term finance gap.

Some of this extra money needs to find its way through to pay. If staff can continue to move to Aldi for an extra pound an hour, social care will always have a problem retaining staff.

A similarly pragmatic approach is required towards international migration, which – like the NHS – has been important in papering over the cracks in the social care workforce. The government’s current proposal would require new entrants to either earn over £30,000 a year (uncommon in social care) or leave after a year.

This is a particularly unhelpful requirement in a sector where continuity of staffing is at a premium. Such an approach may work in agriculture but not in social care. Apples may not notice who picks them, but users of care services care who cares for them.

A combination of the pragmatic and the visionary, the short term and the long term, and the NHS working with social care can develop a workforce fit for tackling the increasing challenges that face the sector. As with the similar challenges in the NHS, there is no time to waste in acting to close the gap.

Simon Bottery, senior fellow, social care, The King’s Fund. Closing the gap: Key areas for action on the health and care workforce has been published by The Nuffield Trust, The King’s Fund and The Health Foundation

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