DHSC Care workforce pathway for adult social care: call for evidence

Tackling the recruitment and retention crisis in social care

The call for evidence rightly identifies that tackling the current recruitment and retention challenges in social care is a key priority. This will only be possible if social care jobs attract and retain the right people, including by offering clear development and progression opportunities.

The TUC welcomes DHSC’s intention to create a clear, structured progression pathway for workers at all levels in the social care system, including by increasing respect and recognition for care workers’ skills and expertise and enabling workers to see where their role fits in the wider workforce.

As a recent Adult Social Care Committee Inquiry report noted, ‘Adult social care, with the exception of recent proposals for funding reforms, has been historically relatively invisible in terms of national policy and politics.’3  It is no coincidence that the paid adult social care workforce is disproportionately made up of Black and Minority Ethnic (BME)/migrant women – a group of undervalued, underpaid and often exploited workers who have too often been invisible to and ignored by policymakers.

We therefore welcome increased recognition of care workers as skilled professionals. However, there is no proposal to develop a registration system for social care workers in England as found in other caring professions such as the NHS or childcare. As UNISON observes, without an equivalent requirement in adult social care, care workers risk continuing to be perceived as the poor relations of the public sector workforce.4

All social care workers in Scotland, Wales and Northern Ireland must be on a register, with early evidence pointing to a positive impact of this on retention and perceptions of the workforce.5  We therefore recommend establishment of a registration system in England, with no cost to care workers to register.

Nonetheless, a primary route to tackling the recruitment and retention crisis is to ensure that care jobs provide quality employment. The best way to achieve this is to address the poverty pay found in many parts of the sector. The TUC is calling for a £15 per hour minimum wage across the adult social care sector to reduce staff turnover and help fill the thousands of vacancies in care services. This would mean an annual full-time wage of at least £29,250 and pay rises for 541,700 care workers in England.6

As DHSC notes in its proposals, the adult social care sector is a significant economic contributor. Recent TUC analysis shows that a £15 minimum wage in social care would also boost England’s economy by a further £7.7 billion.7 The UK-wide median salary for a full-time care worker in 2022 was £22,058, compared to £33,000 among all full-time employees in the UK.8

The problem of care workers not being fairly renumerated is pervasive at all levels of the workforce and contributes to staff leaving the social care system. Between 2016 and 2022, the pay gap for experienced care staff compared to new starters fell from around 30 pence per hour to 7 pence per hour.9  The Care Workforce Pathway will only be effective at all levels if developed hand in hand with significant pay uplifts to ensure that workers are paid in line with their skills and experience.

A social care workforce strategy

There is widespread consensus that a social care workforce strategy is needed to tackle the current recruitment and retention crisis, ensure care jobs are quality jobs, and meet the rising needs of a growing, ageing population. Calls for a people plan for social care have been made by the Future Social Care Coalition10 , the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) 11 , as well as the Health and Social Care Select Committee, who describe the disparity felt by social care staff compared to NHS counterparts who have such a plan with clear pledges.12

The Government should design and implement a comprehensive and fully-funded care workforce strategy. This would include some of the key building blocks included in the Care Workforce Pathway proposals, notably learning, skills and development. Other critical areas include pay and conditions; equality, diversity and inclusion; and health, safety and wellbeing; and a plan for direct job creation.

International recruitment will continue to be critical to ensuring a fully staffed and skilled care workforce, and as such should be a core element of the Government’s workforce strategy. The consultation proposals briefly recognise that the Care Workforce Pathway should be applicable to international recruitment. The TUC would like to see these proposals developed further as part of an overarching strategy, so that the social care system fully values care workers and their skills, rewards them with good pay and conditions, and ensures they can access training and development as part of a structured career pathway.

The detail for the workforce strategy must be developed and negotiated by workers, unions and employers, similar to the development of the NHS workforce strategy by the NHS Social Partnership Forum.

For too long, the social care system has been the poorer cousin of the NHS. Far from having fair and nationally negotiated pay and working conditions, as happens in the health service, skills and expertise go unrecognised in the absence of a formal grading structure and strong collective voice.13 The TUC therefore welcomes the consultation’s proposals to ‘create parity between equivalent roles in health and adult social care so we can build a more agile workforce’. The existing NHS staff passport - developed in partnership with employers and unions – could provide a template for working across the health and care system to achieve this.

Learning, skills and development

The TUC welcomes the consideration given to learning, skills and career development in the Care Workforce Pathway proposals.

Access to learning and development on a regular basis is key to supporting people to fulfil their potential and develop their career opportunities, and to delivering high-quality care. The changing demands of our social care system mean that it is now more important than ever for workers to be given regular opportunities to update their skills to support their career progression or keep pace with technology change, or develop new skills to support change in the workplace and productivity.

Good learning and progression practices start with the Government and providers seeing it as an integral part of effective workforce planning and strategy, which can be strengthened with constructive trade union engagement and national systems for agreeing pay. In the public sector, trade unions have played a key role in nationally negotiated collective agreements on training, such as the NHS knowledge and skills framework within Agenda for Change.

A social partnership approach that recognises the valuable role trade unions play through their networks of Union Learning Representatives (ULRs) is essential for any skills strategy of the future. ULRs encourage the take-up of learning in the workplace, help workers identify training needs and arrange learning opportunities within their organisation. From 2006 to its closure in 2021, the Union Learning Fund - a national Government-funded partnership between unions and employers - trained more than 40,000 ULRs and provided learning opportunities to over 250, 000 workers per year, including disproportionally high numbers of workers with no or low qualifications.14  Given this success and effectiveness in ensuring some of the most marginalised workers access and benefit from upskilling opportunities, we recommend that the Government restores the Union Learning Fund.

Standardisation and consistency

Standardisation and external assessment by an independent body is important to ensure quality and consistency in training and other forms of worker education.

Currently new starters in the social care sector receive a highly variable training and support at induction (if at all), a situation which continues through their career. Introductory training is delivered through myriad means including in-house induction and training provided by the employer, Skills for Care’s Care Certificate, or training developed and delivered by other education providers. While the Government has promoted the Care Certificate it is not mandatory, and the Care Quality Commission expects only that new starters in services which they regulate will achieve the competences required by the Care Certificate during induction.15

High staff turnover can mean that care workers repeat training when starting at a new provider. Lack of employer confidence in previous training due to the innumerable courses available is a key reason for this. Standardised and externally assessed training would benefit care workers, those who draw on care and employers by reducing the time spent on training at induction, and reduce training costs for employers.

Accessibility

The TUC welcomes the recognition in the Care Workforce Pathway of the importance of training and development at all levels, including senior staff – this is a critical means of boosting morale and retaining skilled and experienced staff within the adult social care sector. Nonetheless, we agree it makes sense to start with direct care roles given these represent the largest single category of job category in the social care workforce and the highly variable training and support received by these workers.

Participation in training and development should not exacerbate the poor employment conditions experienced by many in these roles. Almost a quarter (24%) of workers in the sector are employed on zero-hours contracts 16  and domiciliary workers face a high risk of being paid less than the minimum wage once their travel time is taken into account.17

This must extend to all care staff. The OECD has recommended that governments make training provisions for workers in non-standard employment relationships.19 At present, responsibility for ensuring staff take and are assessed for the care certificate is with employers, even when workers are recruited via an agency and/or temporarily.20 TUC’s discussions with affiliated unions and Skills for Care suggest that the rate of agency workers in care settings is increasing.21  It is therefore critical to address variability in training, including at induction, to ensure that all care workers can access learning and development within the Care Workforce Pathway, regardless of their employment status.

A joined-up approach to learning and skills

The TUC welcomes the Care Workforce Pathway proposals to ensure a more joined-up approach to learning and development at all levels, including with national policy and systems leaders. However, there is no mention of what mechanisms will be used to ensure this happens in practice. Ensuring up to date and comprehensive data and insight into both the workforce and the training and development landscape – including providers and their offer - will be critical. We note the current consultation on the Government’s roadmap for transforming adult social care data in England22 , and strongly recommend that DHSC’s work to upgrade data systems and use is informed by the data needs required to deliver on commitments in the Care Workforce Pathway.

We also urge integration with wider skills policy. The TUC is calling for a new national lifelong learning and skills strategy based on a vision of a high-skill economy, where workers can quickly gain both transferable and specialist skills to build their job prospects.23 The national backdrop is concerning: independent research carried out for the TUC by the Learning and Work Institute shows that the number of adult learners taking courses fell from 3.2 million in 2010 to 1.6 million in 2021.24  In October 2022 the Government published its response to the Review of post-16 qualifications at Level 2 and below in England with confirmation of impending cuts to 3,500 qualifications from 8000 already approved for funding, which could include health and social care certification.25 The TUC therefore calls on the Government to cancel plans to scrap Level 2 and below courses, immediately reinstating Level 2 entitlements that are a direct benefit and route to further learning for thousands of people.

Funding and investment in the care workforce

The recent ‘Next steps to put people at the heart of care’ paper confirmed a cut in the Government’s investment in workforce skills, training and career development from £500 million to £250 million.26  While the Care Workforce Pathway proposals offer some encouraging signs towards improved support to the workforce, including training and development, it appears that the Government will continue to place the financial responsibility for this on care providers.

Chronic Government underfunding of the social care sector in recent years – with last-minute, short-term and insufficient Government funding pots becoming the norm – has contributed to persistently poor employment conditions among the care workforce and left many smaller provers on the brink of collapse. Some employers who want to invest in their workforce and support their staff will not have the financial resources to do so, leading to trade-offs between improving pay and wider conditions and ensuring training and development in line with the Care Workforce Pathway.

The current approach has meant that local authority social care contracts have not kept pace with inflation, and contracts are often short-term with frequent provider changes. Aside from driving down pay and employment standards, frequent contract transfers contribute to short-termism and a lack of consistency in employer-level workforce planning and therefore pose a significant to challenge to achieving the Care Workforce Pathway.

We therefore reiterate our call for a comprehensive and fully funded social care workforce strategy, with the cost to be met by the Treasury, rather than local authorities that remain cash-strapped following cuts since 2010 to the overall funding they receive from central Government.

Summary of recommendations

• Ensure the Care Workforce Pathway is informed by, and supports delivery of, a joined-up, comprehensive and fully funded social care workforce strategy, negotiated and agreed with trade unions and employers.
• Provide adequate Treasury funding to deliver the care workforce strategy, which (i) offsets recent cuts to local authority budgets and (ii) establishes future funding rises at a level that allows local authorities to meet rising demand for care and deliver good pay and conditions, including a £15 per hour social care minimum wage.
• Ensure that all care workers benefit from learning, skills and development support as part of the Care Workforce Pathway, including:
  • • Skills recognition linked to pay and progression.
    • Agreed standards for training to ensure consistency and quality.
    • The right to 10 days paid training and an Individual Learning Account.
    • Cancelling plans to scrap Level 2 and below courses and reinstate any health and care training earmarked for funding cuts.
    • Restoring the successful Union Learning Fund.

To discuss this submission contact Abigail Hunt, Policy officer in public services and social care (Ahunt@tuc.org.uk)

• 3 House of Lords Adult Social Care Committee (2022) A “gloriously ordinary life’’: spotlight on adult social care 
• 4 Department for Health and Social Care. Care workforce pathway for adult social care: call for evidence. UNISON submission, May 2023
• 5 Nuffield Trust (2023) What does the social care workforce look like across the four countries? 
• 6 TUC (2023) £15 minimum wage for care workers would boost England’s economy by £7.7 billion.
• 7 Ibid.
• 8 ONS (2022) Annual Survey of Hours and Earnings 2022 
• 9 Skills for Care (2022) The state of the adult social care sector and workforce in England 2022; Skills for Care (2023) The state of the adult social care sector and workforce in England 2023 
• 10 Future Social Care Coalition (2021) A Social Care People Plan Framework.
• 11 LGA (Nd.) Our vision for a future care workforce strategy. 
• 12 Health and Social Care Select Committee https://publications.parliament.uk/pa/cm5802/cmselect/cmhealth/22/2202.htm 
• 13 TUC (2021) A new deal for Social Care: A new deal for the workforce.
• 14 OECD (2019) Getting Skills Right: Making adult learning work in social partnership.
• 15 Skills for Care (2015) Shared Statement from Skills for Health, Skills for Care & Health Education England
• 16 Skills for Care (2023) The state of the adult social care sector and workforce in England 2023. 
• 17 Resolution Foundation (2023) Who cares? [/]fn Therefore, the TUC is calling for a new ‘Right to Train’ that gives all employees the legal right to ten days of paid leave a year to undertake a skills or training course. This would be underpinned by a renewed Individual Learning Account, supported by Government, employers and working people to maximise skills development in the workforce.  TUC (2022) Skills for jobs.
• 19 OECD (2019) Engaging low skilled adults.
• 20 Skills for Care (nd.) Care Certificate Adult Social Care Organisations Q&A.
• 21 We understand Skills for Care is developing new data on the rate of agency workers in the sector.
• 22 DHSC (2023) Care data matters: a roadmap for better data for adult social care.
• 23 TUC (2022) Skills for jobs.
• 24 TUC (2022) TUC - Number of adult learners has halved since 2010.
• 25 Decisions on which courses will be cut are still ongoing.
• 26 DHSC (2023) Next steps to put People at the Heart of Care.