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Brexit and social care:
workforce, recruitment and retention

CMM Roundtable with NHG

Q. What impact will Brexit have on the social care workforce? What do we, as a sector, need to do to mitigate the risks and address the issues?

A. Professor Martin Green OBE, Chief Executive of Care England; Vic Rayner, Executive Director of the National Care Forum; Sharon Allen, Chief Executive of Skills for Care and National Skills Academy for Social Care and representing CommonAge; Neil Eastwood, Founder of Sticky People and Author of Saving Social Care; Gaius Owen, Global Projects Sales Director at NHG and Luke Evershed, Group Supplies Sales Director at NHG.

In October, CMM drew together leading names in the sector, along with partner NHG, to explore the impact that Brexit may have on the social care workforce.

The knowledgeable panel, chaired by Emma Morriss, Editor of Care Management Matters took a close look at the workforce, recruitment and retention issues facing the sector and the impact that Brexit is likely to have on what is already a difficult situation.

Background – Brexit and EU citizens

On 23rd June 2016, the UK voted to leave the European Union. Article 50 was then triggered on 29th March 2017, marking the start of two years of negotiations towards formally leaving the EU on 29th March 2019.

Since then, there have been five rounds of negotiations in which the rights of EU citizens have been discussed. In his speech after the most recent round (12th October), David Davis MP, the Brexit Secretary reassured EU citizens living in the UK that their rights and status will be enshrined in UK law by the Withdrawal Agreement. It will involve registration and a new administration process, which he called ‘streamlined and low cost’.

He added that, ‘Any EU citizen in the UK already in possession of a permanent residence card will be able to exchange it simply for settled status in a simple way. They will not have to go through the full application process again.’ However, there are still many points to discuss.

In her Florence speech on 22nd September, Prime Minister Theresa May confirmed that the UK wants EU citizens that live in the UK to stay, that they are valued and contribute to the nation, saying ‘it has been, and remains, one of my first goals in this negotiation to ensure that you can carry on living your lives as before.’

Theresa May also confirmed that Britain wants a two-year transition period following leaving the EU in March 2019. For EU citizens, this would continue to allow the free movement of people, although new citizens arriving from the EU would need to register from 29th March 2019.
However, leaked documents seen by The Guardian (5th September) imply deterring all but highly-skilled workers from the EU. ‘It proposes measures to drive down the number of lower-skilled EU migrants – offering them residency for a maximum of only two years.’

Until Brexit talks conclude, there will be ongoing uncertainty around the impact it will have on EU citizens living and working in the UK and those which we value in our social care system.

Social care workforce

Looking at the social care workforce, it’s important to understand the current picture to identify potential issues. Skills for Care’s new State of the Adult Social Care Sector and Workforce Report 2016/17 sets out the current social care workforce. It estimates that approximately 1.45 million people work in adult social care and 275,000 new job roles will be needed by 2025, if the workforce grows proportionally to the projected increase in the elderly population.

Average staff turnover across the whole sector is 27.8%, rising to 31% in domiciliary care. With 6.6% of roles in social care being vacant, there are approximately 90,000 vacancies at any one time.

Looking to the nationalities of social care workers, 83% of the adult social care workforce is British, 7% (95,000 jobs) have an EU nationality and 9% (125,000 jobs) have a non-EU nationality. Delving into the percentage of EU citizens in specific job roles, 3% of registered managers, 3% of social workers, 16% of registered nurses, 8% of care workers, 2% of senior managers and 6% of administrative/ancillary staff have an EU nationality. A recent Skills for Care survey of 1,200 personal assistants found that 4% had an EU nationality.

With 90,000 vacancies and 275,000 roles to fill by 2025, and Brexit putting at risk the future status of 95,000 EU citizens working in the sector, it could push the sector’s already precarious workforce issues over the top.

Workforce issues facing the sector

As well as already struggling with workforce, the messages coming from Government are unclear and this makes it difficult for providers to give clear guidance to their staff to help them plan for the future.

EU nationals add a lot of value to the social care workforce, they may be more likely to take on evening and weekend shifts, or work in live-in care because they don’t have as many commitments that require convenient work hours.

One employer reported that if his business lost 40 staff who were EU nationals, he would require 60 local staff to fill the shifts. The National Minimum Data Set for Social Care puts this at 44 local staff to replace 40 EU nationals.

It’s worrying then, that data from the Nursing and Midwifery Council has shown a substantial reduction in the number of applicants to the nursing register from EU nationals since the referendum. Data published in November shows that the number of nurses and midwives from Europe leaving the register has increased by 67% over the last 12 months, while the number joining the register from the EU has dropped dramatically by 89%.

Anecdotally, live-in care providers have reported that, although they are not losing their staff who are EU nationals, they are seeing fewer coming for interview.

Brexit’s impact on the value of the pound could also affect staff from the EU as it may make the UK a less attractive place to live and work.

Brexit appears to be having some negative impact on recruitment, but beyond the NMC data, there is no evidence of significant turnover impacts.

However, it’s not just Brexit that is causing workforce issues, there’s the increase in National Living Wage, the Apprenticeship Levy, the sleep-ins crisis and, on a wider level, the financial issues facing health and social care, sustainability and transformation partnerships and accountable care systems. These put pressure on the sector and its ability to recruit and, importantly, retain staff. Added to this is the real crisis in nurse recruitment, where there is an even more urgent need for solutions.

Workforce planning

Given the workforce issues facing the sector that are only going to be exacerbated by Brexit, health and social care needs to futureproof its workforce. It’s essential that both sectors come together to workforce-plan.

Providers need to look at their own future workforce requirements; identify their staff, their nationalities, whether Brexit could impact on their right to work here or whether they may retire soon. Consider what gaps will need to be filled over the next five years. It’s essential that providers use the National Minimum Data Set for Social Care to track this, as it also feeds into the data used for Government and sector-wide workforce planning.

The sector also needs to consider the diversity of the workforce. Social care benefits from having a diverse workforce, which could be seriously affected by Brexit. More needs to be done to ensure the people supporting clients are as diverse as the clients themselves. This need for diversity will only grow. The sector requires a broader set of perspectives which needs to be considered and planned for.

Sector Response

As the country progresses towards Brexit, it is time for the sector to take action.

Social and economic value

As well as health and social care coming together to workforce plan, there needs to be parity of esteem and remuneration for health and social care staff. Messages coming out about the impact of Brexit on health need to include social care too. Social care not only adds social value, it also adds to the UK economy, Skills for Care estimates this to be £41.8bn per annum and it needs to be communicated.

Also, it’s important that social care is seen as the highly-skilled and hugely rewarding work it is. There is an unfair conflation of low pay and low skill and, whilst many in the sector are paid minimum wage, this is a highly-skilled workforce undertaking complex work. It is also a hugely fulfilling role and we need to change public perception of the reality of working in social care.

Public understanding of social care

One way of raising awareness of social care could be to create a sector brand. This would enable it to be recognised widely and come together to share its values, potential and pathways for employees. We then need to communicate this. Social care, unfortunately, competes with the NHS which has a world-renowned brand. However, social care offers as much potential, it just isn’t as understood by the public. Providers need to work together to develop a recognisable brand for the sector, to help address issues around workforce, funding and everything else that is piling on the pressure.

When it comes to recruitment, the public’s understanding of the NHS means that people understand what job roles are on offer. They also have the NHS Health Careers platform which makes it is easy to locate roles. In social care, it is more difficult, there’s no central platform, people don’t know where an entry level role can take them, or even the different types of providers they could work for. It’s only those who have experience of social care who truly understand it.

As a sector, we also need to inform children at a younger age, advise and guide them on the benefits of working in social care, make the most of what we have to offer – far beyond a low-paid, hard work environment.

The sector also needs champions, people who can promote the benefits of social care at all levels. This could be I Care…Ambassadors going into schools or celebrities who have a connection with the sector helping to raise the status amongst media and wider public.
The NHS is held close to people’s hearts, the media may knock it down, but it then builds it back up again. This rarely happens with social care. Social care is generally presented negatively, meaning people don’t see it for what it is, a fantastic service that can support people to live their lives as they wish.

Changing the narrative of care work will also help to change public perception. We need to tell people it’s fun, rewarding and fulfilling; there are opportunities, there’s support, qualifications and development.

Supporting managers and the workforce

We also need to support managers, they are crucial to this. Good leaders make for good services, good managers make for good teams. Focusing on supporting them will help everything else fall into place. Recruiting the right people into an organisation helps, but having the right management, creating the right environment and nurturing their teams can help to retain those workers and slow down the sector churn.

The sector needs to think differently about its workforce – can we offer flexibility or job shares, can we make the most of apprenticeships, what personal and professional development can we offer that might not be into management, but could be into other areas of the sector? Looking to more senior roles, can we hire people who have retired early from the health service, but who don’t want to stop working altogether just yet?

The sector also can’t shy away from the fact that we need to think creatively about how care is delivered. If we don’t have enough people to deliver care in a traditional sense, we need to change the way we care. If younger people aren’t seeing traditional care work as a future career path, what can we do to change the pathway? We need to offer them different opportunities that play to their strengths and interests. It is time to set out a picture of what care will look like in the future and work towards transforming the sector together.

There are opportunities out there if we think smart and look at what we can do not only to attract staff, but to change care delivery.

Other sectors’ response to Brexit

Finally, we need to look at how other sectors are tackling workforce issues relating to Brexit, this will help us tackle ours. Industries such as hospitality and retail have a high volume of EU nationals; we must understand how they are tackling the situation and adapt their approaches for social care.

Value our workers

Most importantly, we need to support our current staff who are EU nationals and tell them that they are valued members of the sector. They are facing uncertainty and worry and will want reassurance, whether that’s a letter of support or assistance with becoming UK citizens if they so wish. We need to nurture the staff we have while the future is uncertain.

CMM and NHG will be publishing a White Paper of potential solutions to the workforce issues arising from Brexit and the wider recruitment and retention issues facing social care. Look out for it in a future issue of CMM.

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