Who cares?

Building the care workforce of the future

Every day, across the country, hundreds of thousands of hardworking and committed health and social care professionals go to work to care for people at their most vulnerable. They are strongly motivated by their desire to work in a sector that directly helps so many people. Many find their work hugely rewarding but working in the care sector is becoming more challenging. Funding pressures, red tape and low wages contribute to high levels of staff turnover. How do you successfully attract, develop and inspire a care workforce in this environment?

We have carried out research amongst people working in care to better understand what can be done to help. This report contains a diagnostic of the workforce issue and it proposes positive and practical steps that organisations can take to navigate workforce challenges. The health and social care landscape is changing quickly, not least due to the introduction of new and innovative technologies that are transforming how care is delivered. The key to sustainability and success for organisations in the care sector is a workforce that is motivated, equipped and galvanised to embrace the challenge of change. We very much hope this report will help you put that into action.

The burning platform

Demand is increasing but recruitment and retention is becoming more and more difficult

Recruiting and retaining carers is becoming increasingly challenging and there is already a gap emerging between the number of carers we need and the number we have. We can see this in the number of vacancies across the sector.

Vacancies can’t be filled and agency spend is rising, impacting operating margins. Staff turnover across the sector, already high, is increasing and this is seen across all care settings, whether provided by Local Authorities or private operators. Recruitment and retention of care staff is fast becoming the greatest challenge for operators across the UK.

So operators are having to tackle a growing demand for carers whilst the staffing environment is becoming even tougher. Today, it is estimated that the number of staff employed falls 120,000 short of the number required within the adult social care system. Conservative estimates suggest that this could rise to 140,000 by 2030, assuming the vacancy rate doesn’t increase further. If the vacancy rate increases as it has been over the past three years, the gap in the industry’s workforce could be over 290,000 by 2030.

If the vacancy rate increases as it has been over the past three years, the gap in the industry’s workforce could be over 290,000 by 2030.

Carers love caring

Carers are driven by a desire to help people and support individuals in need.

They don’t do the job for the money or with an agenda, it’s to make individuals feel happy and ‘normal’. Seeing positive development, progression and outcomes, and the impact this has on families, is hugely rewarding.

What are the key reasons why your experience is positive? (Top 3 reasons shown)

Squaring the circle

So if carers love caring, why are they leaving?

The issue isn’t as simple as the pay, or the role, or the job, or the individuals. It often lies with employers not always creating and nurturing the most effective working environment. And, as we’ve seen, vacancy rates are high so alternative jobs are available. Loyalty is limited and resignations can be triggered easily, so a carer can leave and have little trouble finding another job at short notice. But the issue can only be addressed if the underlying drivers behind staff turnover, and dissatisfaction more broadly, are understood in more detail. Our research has highlighted a number of these key drivers.

Home managers

"They don't understand our needs or those of the individuals we care for"

"They don’t get it.”

“They have no idea what or how much we do.”

“They ask me to do things without understanding what it entails or how long it’s going to take. And then I get in trouble because it obviously takes longer.”

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Profit-only culture

"Communications are all about targets and metrics, not about how I or my service users might be getting on"

“I don’t want to hear how much money you’re making, I want to know how the clients are developing.”

“Every team meeting starts with a telling off about the empty beds. It’s not my fault.”

“We’re not motivated by these kind of targets. That’s how you incentivise people in suits, not us.”

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"The washing machine has been broken for days. I'm having to take the washing home and do it myself."

“Our clients don’t have activities anymore. There’s no money for it. They suffer as a result.”

“We used to do day trips to the seaside, which was great for the older people. It used to make such a difference.”

“We really need a Hydropool. We’ve asked so many times but the answer is always no. There’s no money.”

“We’re always running out of gloves, paper towels, wipes, pads, etc. How can I do my job without these basics?”

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"They should get older, more experienced carers to do proper practical training. You can learn so much more that way and make sure you're doing the right thing."

“We used to get face-to-face training but they cut that and put in e-learning. It’s nowhere near
as useful.”

“E-learning is just a box ticking exercise so the managers can say that everyone’s passed it.
Someone completes it and then does it for everyone else. How is that useful?”

“You can’t learn in that way. How can I ask questions if I don’t understand something?”

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Career development

"I don't see any opportunities to progress where I'm working so I may as well go and do something else."

“There are no examples of a great career story. There’s no one to aspire to.”

“I’ve never had a conversation about where I want to get to.”

“I don’t really know what I’m expected to do or if I’m any good or what I need to do to be promoted. Or if that’s even an option.”

“I’m just a carer. I’m not really proud of it. I’m a bit embarrassed actually.”

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"I spend more time doing paperwork than I do caring for my service users."

“I didn’t take this job to fill in forms, if that’s what I wanted to do I’d go and work in an office and get paid double.”

“I look around the home and everyone is writing notes but should be caring and doing their jobs.”

“I can’t spend enough time with clients. It makes me feel so bad. It wears me down. I’m constantly disappointing people.”

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What does good look like?

What can operators actually do to mitigate and improve the staffing issue? How can you attract the right people and retain your best staff? Through our research, we have distilled a number of actions, spanning multiple parts of the business, that can help build a more united, productive and fulfilled workforce.

Whilst these are a range of short-term solutions, they must be considered in the context of a wider set of longer-term solutions that the sector will have to consider in order to drive transformational change – e.g. reforming funding structures, driving investment, increasing pay, improving qualification levels, etc.

Importantly, the sector must be aligned. Carers may be the lowest paid part of the workforce, but failure to recruit and retain can make a business unviable. Carers are the cogs that keep the business moving. They care for the service users, fulfilling the fundamental premise of the business, and so they need to be engaged and appreciate the value they deliver. Attracting talent and empowering carers has to be top of the agenda for everyone.

Ensure care is always at the core

  • Create a care-centric culture: Mandate that care and outcomes are central to the business’ vision and values and this is articulated at the forefront of communications
  • Get the right KPIs: Ensure home KPIs are a mix of quality, financial, operational, engagement,  happiness, outcomes, etc.
  • Champion carers: Recognise and advocate carers as the powerhouse of the business

Build the right organisational structure

  • Invest in managers: Recruit and promote experienced managers who have done the job
  • Redefine management roles: Increase the time managers can spend with staff and make sure they aren’t overloaded by revising their responsibilities vs. regional managers and other central functions

Facilitate a smooth day-to-day

  • Streamline paperwork: Rethink internal processes and explore automated and digital options for simple admin tasks
  • Ensure sufficient resources: Respond promptly when resources need replenishing and replacing and keep staff informed of progress
  • Consult on rostering: Plan rotas well in advance and share these with staff whilst being open and flexible to changes
  • Embrace technology: Roll-out digital solutions to carers and managers to better organise rotas, manage care plans, measure progress and outcomes, fulfil admin, etc. - our Flexible workforce hub tool can help with this

Commit to personal development

  • Understand needs: Carve out time for managers to have meaningful conversations with staff around their needs, constraints, preferences, etc.
  • Build resilience: Support carers and provide guidance and training in mental and emotional resilience
  • Promote collaboration: Create a peer-to- peer forum where carers can meet and share best practice, without feeling like they’re competing or being tested
  • Celebrate success: Recognise and highlight great work and positive outcomes

Drive career development

  • Develop career plans: Ensure managers work closely with carers to discuss and outline career aspirations, then create a plan and timeline to get there
  • Codify ‘good, better, best’: Define a set of objectives and behaviours that carers should adhere to, clearly outlining skills to be developed
  • Track progress: Ensure managers feedback and appraise performance of carers vs. their objectives
  • Endorse role models: Identify examples of carers who have worked their way up and communicate their story across the business
  • Focus on training: Invest in meaningful face-to-face training that upskills carers to fulfil their role and develop skills for progression

How we can help:

Through this report we’ve touched on some of the key insights from our research. We’ve seen the critical role that social care plays, the challenges it faces, how staffing fits into that puzzle, what can be done to fix it and why we have to act now.

We can cut our analysis by local authority, type of provider, type of carer, etc. There are a multitude of lenses that we can use to create a picture that’s most relevant to you. And we can help you take these insights and synthesise them into meaningful actions to implement across your business. If you’d like to hear more about our research and analysis, or you would like to discuss how our work can help you or your business, get in touch.

Some examples:

  • Understanding your carer workforce, what drives them and how to develop a compelling employee proposition
  • Sizing the addressable pool of potential carers and / or care home managers in your locations and developing strategies to target them
  • Reviewing your quality and regulatory infrastructure and performance
  • Developing leadership and governance structures
  • Building robust and engaging performance management processes
  • Assessing the potential uses of technology in managing your workforce and understanding the best options for you including using our Flexible workforce hub tool

Contact us

Andrew McKechnie

Andrew McKechnie

Strategy& Deals leader, London, PwC United Kingdom

Tel: +44 (0)7799 602349

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