A shortage of registered nurses is impacting care homes to a point where providers are considering the withdrawal of nursing care altogether, a study into the sector has found.
According to the report, jointly produced by the Centre for Health and the Public Interest (CHPI), University College London (UCL) and Warwick Business School (WBS), the shortages are leading to a decline in safety and quality within care homes, as well as high expenditure on recruitment and staff agencies.
One of the findings of the report, funded by the Economic and Social Research Council, is that the financial viability of the care home sector is partially dependent on care workers undertaking more intense work without additional pay.
Research conducted in the years immediately prior to the 2020 pandemic identified upward pressure on care home wage costs caused by the introduction of the national living wage and a shortage of staff, particularly registered nurses.
While government support worth over £2bn meant the sector avoided financial collapse during the peak of the pandemic, very little of the additional funding was dedicated to supporting staff and improving their health and wellbeing, despite the immense pressure they were under both at work and in their personal lives, the report found.
‘Therefore, it is not surprising that the care home sector has struggled to both recruit and retain staff since lockdown restrictions were removed and the wider economy reopened,’ the authors concluded.
In England, according to the report, 11% of social care staff and 13% of registered nurses in care homes are employed on zero-hours contracts, meaning that they only get paid when they are required to work.
With the sector registering a nursing staff turnover rate of 38.2% (compared to 8.8% in the NHS), several senior home managers told researchers that they might cease to provide nursing care for older people, as they were unable to recruit staff. This was also a trend previously identified by the Care Quality Commission.
One large care home provider reported that expenditure on agency staff increased from 6% of its wage bill in 2020 to nearly 23% in late 2021.
Around one in 20 care home providers formally flagged that they were at significant risk of being unable to meet their duty to provide safe care due to challenges to their agreed safe staffing ratios in the first five months of 2022.
Exacerbating the ongoing challenges, financial support from the government in England for the care home sector – including the provision of enhanced sick pay for care home staff – ceased in March 2022, while enhanced sick pay for care home staff in Wales ended in August 2022 and was terminated in Scotland in October 2022.
A senior manager for a small for-profit organisation quoted in the report said: ‘We will probably change our registration so that we no longer offer nursing care because it’s unsustainable.
“We can’t get the nurses… when we’re paying our starting salary for nurses of £21 an hour, it’s a good rate of pay and we can’t get good nurses.’
The report made several recommendations to policy makers, including the improvement of sick pay and benefit entitlements for care workers, the development of plans to tackle staff shortages and government focus on the enhancement of the overall wellbeing of staff.