Why the UK nursing home team is at breaking point

Since the reopening of the post-COVID economy, staff shortages in England’s healthcare sector have been a growing concern. In October 2021, British charity Skills for Care warned that at 8.2%, adult welfare vacancy rates in England were exceeding pre-pandemic levels (which in 2019 were 8%). That number has already surpassed 10%, according to Skills for Care’s monthly tracking.

The UK government has sought to remedy this crisis, in part, with the new health and social assistance levy, which took effect in April 2022. This levy is being implemented as an increase in National Insurance contributions.

Experts have pointed out that this is having a disproportionate impact on household budgets for low-income and under-50s. They also warned that this will not solve the problem.

This is because a relatively small share – £5.4bn of the £39bn to be raised over the next three years – must go towards social assistance, with the rest to be spent on the NHS. And half of that £5.4bn will be used to offset the cap on assistance costs for the self-financed. Crucially, just £500m has been allocated towards workforce reform, and that amount should be spent not on the much-needed pay rise for recruitment and retention, but on training and qualifications.

Our ongoing research (the results of which have not yet been published) looks at the financial impact that COVID has had on nursing homes and their staff. We interview managers, service staff, and support staff from for-profit and non-profit vendors of all sizes. We found that many people don’t think caregivers need more training – they are, as some have reminded us, among the best-trained workforce in the economy. What they need is better working conditions and better pay.

A caregiver gives an elderly lady her dinner in a kitchen.

On the other hand, the shortage of qualified nurses is one of the biggest pressures on nursing homes and the NHS. Therefore, more than offering more training to existing caregivers, we need to improve the remuneration and conditions of the home care team and train new nurses to work in the sector.

Effects of the pandemic on the workforce

From senior managers to caregivers, people employed in the care sector repeatedly emphasized that better wages and working conditions were crucial to filling the care workforce shortage. Steps already taken towards greater professionalisation – such as the register of carers established in Scotland in 2001 – have shown not to have contributed to improving the salaries and conditions of carers and, by extension, staff.

While welfare has benefited in 2020 from the COVID shutdown in sectors that recruit from the same workforce, it has struggled over the past year to compete for talent. Retail and tourism in particular offer higher wages and better working conditions. And people working in these industries tend to enjoy comparatively higher social esteem for roles that are less demanding mentally and physically.

The media has periodically pointed out the immense pressure the pandemic has placed on the care workforce. But the extent of pressure our caregivers have been under is staggering.

Nursing home staff continue to face overwhelming workloads. Many worked 14 to 16 hours a day, weeks on end without rest and many months without vacation.

They also suffered devastating outbreaks of COVID at various stages of the pandemic. While these mostly claimed the lives of fragile residents, workers were also affected. As a result, they lived and worked with the constant fear of catching and bringing COVID into nursing homes.

The resulting preventive measures, whether imposed by the government or employers or self-imposed, have led to social isolation. At the beginning of the pandemic, it was not uncommon for nursing home workers, including managers, to move to their workplaces or avoid social contact in order to minimize the risk to their residents and family members.

Government rules have changed over time, but as our ongoing study and media reports show, the care team felt deeply that they were living by different rules than the rest of society. When the end of the lockdown on July 19, 2021, was dubbed “Freedom Day,” caregivers and the vulnerable people they care for rightly resented that description.

On an individual level, these workloads, working conditions, and emotional pressures have led to high rates of burnout and mental health concerns. Across the industry, this has resulted in ever-increasing staff turnover rates and staff shortages.

A medical worker in protective gear and scrubs looks at the camera.

Managerial thinking often equates staff reduction with efficiency and cost savings. But we’re finding that understaffing in nursing homes is really taking a toll on the industry. Providers are struggling to keep services running. Recruitment agency fees have skyrocketed, and due to sponsorship costs and visa fees, recruiting abroad is just as expensive. And then there are the usual recruitment costs that accrue with increased staff turnover.

Spending by nursing home providers is also increasing elsewhere as overheads become more expensive with inflation. Those who have significant amounts of state-funded residents cannot pass on the additional costs and are therefore feeling the pinch. Large private chains have already announced that they will raise rates by as much as 10% this year, citing staff shortages as a prominent reason, in addition to rising food and energy prices.

The welfare reform that the government has begun to implement does not even come close to solving this crisis. Of course, spending more on personnel will benefit everyone – service users, service providers, workers and, ultimately, the taxpayer.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The conversation

The conversation

Derya Ozdemir Kaya is currently working on a project investigating the financial impact of COVID-19 on nursing homes and her staff, funded by the Economic and Social Research Council (ESRC).

Marianna Fotaki leads a UKRI Covid scheme funded project ‘Understanding the financial impact of Covid-19 on the UK nursing home sector – implications for business and the workforce’

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