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HR challenges in health and social care

The biggest HR challenge for UK care homes in the past ten years is a shortage of skilled care workers in senior roles. There are several reasons for this, the most significant being the perceived unattractiveness and low status of care work, relating to low pay levels and job security. A lack of specialist HR managers can result in long-term vacancies, with the industry already battling a shortage of registered nurses and care home managers. The absence of these roles for extended periods has a severe impact on the level of care you can provide.

By Nicolas Croix

To put this into context, Care Quality Commission (CQC) forecasts show that an additional 1.22 million social care workers will be needed between 2016 and 2036. More conservative estimates are that a 31% increase in the social care workforce, equating to 500,000 jobs, would be needed by 2030 to meet current demand. The CQC also estimates that around 11.5% of care homes do not have a registered manager in place.


With vacancies outnumbering available skilled professionals, roles attract a broader range of applicants, typically of a lower skillset. Care work is not something anyone can do – it takes a particular type of person. In many cases, people taking care jobs quickly realise they aren’t cut out for it, creating high staff turnover and unplanned absences. CQC figures show that at 2016-17 the care workforce in England comprised 1.34 million jobs with a turnover rate of 27.8%. Turnover was particularly high for care workers (33.8%) and registered nurses (32.1%). In the same year, the proportion of vacancies in care was 6.6%, significantly above the UK average of between 2.5% and 2.7%.


Other key challenges include the amount of paperwork and administrative burden on care homes. Routine tasks that do not require a specialist skillset are taking longer to complete, putting additional strain on overworked care workers, and again affecting the level of care they are able to provide.


Exacerbating the long-term shortage of skilled care workers, Britain’s decision to leave the European Union significantly reduced the talent pool before the COVID-19 pandemic had an even more catastrophic impact on the availability of foreign nurses to take jobs in UK care homes. According to the CQC, in light of Brexit there was a sharp decline in the number of new EU nurse registrants from a high of 1,304 in July 2016 to just 46 in April 2017.


Furthermore, NHS bursaries for new nursing students were abolished in August 2017, leading to a 23% fall in applications by students in England to nursing and midwifery courses at British universities. This has led to further concerns about the future care home workforce, with funding cuts leading to a 44% drop in the number of full-time equivalent district nurses between 2010 and 2017. Despite this, there was a 6% drop in new nursing registrations in 2017/18 coupled by a 21% rise in de-registrations.


Since the outbreak of COVID-19, safeguarding the mental health of employees has overtaken the skills shortage as the biggest challenge for HR leaders in health and social care. In a recent study by cloud-based HR software provider Moonworkers, which surveyed 158 senior HR professionals, 54% of the respondents reported employee mental health support as the biggest challenge, followed by staff development (41%), shortage of labour (39%), lack of skilled workers (37%), and increasing paperwork (33%).


To overcome these challenges, almost half (46%) of those surveyed are investing more in staff training and development, with 36% investing in technology, and 37% reorganising shift patterns in the wake of the crisis. 61% of respondents reported that investing in staff training and development has had the most positive impact amongst employees.


The only way to operate any care organisation with minimal HR issues is to employ and reward the best staff: skilled professionals who are passionate about their work, know they’re in the right job, and care both about residents and the goals of the business. To achieve this, organisations need careful recruitment practices, with a water-tight hiring and onboarding process to deliver only the best candidates. This requires investment in three core areas: HR, social outreach, and technology.


HR roles are just as important as skilled care work, with the best HR people most qualified to negate challenges around recruitment and people management – and care organisations should never stop recruiting. Taking on the right people goes back to some basics of good personnel practice: creating standardised interview procedures, using sensible and consistent scoring of candidates, testing for behaviour rather than competence, and scrupulously monitoring recruitment performance. It also involves building and maintaining relationships with local job centres and sector-based work academies, offering visits to the home, and even ‘taster shifts’ to potential applicants.


Some care homes have had success with group selection methods as a more cost-effective way of recruiting. It’s also argued that group selection provides a more genuine reflection of candidates, instead of being grilled by a panel of interviewers. Orchard Care, a private company operating in the north of England, demonstrated that conducting four group interview sessions took 14 hours, compared with the 75 hours it would have taken to appoint the same number of staff if face-to-face interviews had been used.


Investment in social outreach helps take your brand to a bigger audience, widening your talent pool and access to potential applicants. Recruiting via the internet is no longer a ‘nice to have’ but critical in opening up worldwide possibilities. Paradoxically, most recruitment to care assistant roles are typically from a care home’s immediate neighbourhood, so cultivating positive coverage in local media is valuable in attracting staff as well as residents.


Investment in technology ensures care organisations can maintain a better connection with remote care workers who can feel isolated, leading to reduced job satisfaction. Automation of routine tasks also significantly reduces the monotony of repetitive and time-consuming paperwork for all care workers, whilst helping implement new strategies to improve work-life balance and sustain motivation, such as flexible working and other workplace initiatives.


Gateshead-based care home company Helen McArdle Care is family-run and says ‘caring for staff with a personal touch’ enables it not only to retain staff but also rehire workers who had left for alternative employment. The business hosts an annual family fun day, where staff are invited to bring their relatives into work. Helen McArdle Care also empowers its managers hearing of a staff member suffering hardship or other personal problems to offer the appropriate support – though this is a policy all care homes should adopt.


In order to attract the best staff, care organisations must be able to find them in the first place. Another challenge faced by the industry is a lack of sector-based academies providing good enough qualifications, allowing staff to earn better pay, whilst only half of those surveyed by Moonworkers (53%) said the Government's national recruitment campaign helps them in attracting social care workers to their care home.


It’s clear more needs to be done to attract higher volumes of people into health and social care. Only by improving the quality of training and rates of pay and adopting innovative approaches to care home management will the sector become more attractive and start to plug the skills gap, against a backdrop of continued disruption due to Brexit and the COVID-19 pandemic.