Government must explore ‘new pathways’ to boost social care workforce

Domestic nursing recruitment and retention challenges are undermining workforce stability in the social care sector, according to a new report.

The State of the Adult Social Care Sector and Workforce in England report, published by Skills for Care last week, shows that while vacancy rates are falling and filled posts are on the rise, these gains are being driven mostly by international recruitment.

Concerns have also been raised around staff turnover, especially among nurses.

Return to pre-pandemic levels

Vacancy rates have returned to pre-pandemic levels (around 7%) but remain nearly three times higher than in the wider economy, the report shows.

Registered nursing roles saw one of the largest increases in filled posts spotlighted in the findings, up 5.7% (1,900) from the previous year to 35,000 in the independent care sector.

Registered nurse vacancies in the independent sector fell from 8.9% to 6.7%, but 2,100 unfilled nursing posts still remain.

Overall, the number of posts in adult social care grew by 2.2% over the past year, with a 3.4% increase in filled roles across the sector.

While this reflects increased capacity, the report warns that current gains are not sustainable without addressing the sector’s deep-rooted recruitment and retention issues.

Reliance on overseas recruitment

The report found that just 57% of nurses working in adult social care in England were British nationals, while 30% had a non-EU nationality and 13% had an EU nationality.

The number of British workers in the sector declined by 30,000 as a whole in 2024/25, while 50,000 new international recruits were hired to fill critical roles, including registered nurse posts.

Turnover among registered nurses also remains high at 32.8%, more than double the rate for social workers (12.8%) and occupational therapists (13.5%).

This comes as the sector lost an estimated 9,700 nurses over the past year, the report states.

Around 18% of registered nurses and nearly a third (29%) of care workers are employed on zero-hours contracts in England, according to the report.

‘Harsh realities’

The Royal College of Nursing (RCN) transformational lead for the independent health and social care sector, Claire Sutton, said the findings showed the ‘harsh realities’ of the recruitment challenges facing the sector.

‘Registered nurse numbers continue to decline as domestic recruitment collapses, forcing employers to recruit internationally to fill gaps,’ Ms Sutton said.

The RCN lead said the government’s employment rights bill ‘couldn’t come soon’ enough, but said it ‘must have teeth’ to deliver the change the sector needs.

The bill, which was introduced to Parliament on October 10, affects most UK workplaces and looks to bring major changes to the independent health and social care sector, including to zero-hour contracts and sick pay, and to establish an Adult Social Care Negotiating Body for pay.

‘When wages are so low, it is little wonder recruitment and retention are such a challenge. Improving wages and workplace rights in social care are crucial to bolstering the sector’s workforce and easing pressure on the NHS,’ she added.

Growing the domestic workforce

Oonagh Smyth, chief executive at Skills for Care, said the government must ‘explore new pathways’ to improve workforce capacity.

‘To meet growing and changing care needs, we must prioritise domestic recruitment and invest in learning and development for our workforce.’

‘On a knife edge’

Skills for Care also reported that the median hourly rate for care workers was £12.00, only around 56p above the National Living Wage (NLW).

Professor Martin Green, chief executive of Care England, said: ‘These figures show how even small pay rises can tip a sector already on a knife-edge. Providers want to pay their staff fairly, they know how hard they work and how much they give, but they can’t do it without proper support.’

‘Unless the government sets out a clear plan to meet these rising costs, providers will be pushed into making impossible choices, and the fragile stability we’ve worked so hard to rebuild will start to fall away,’ he warned.

A Department of Health and Social Care spokesperson said: ‘It is welcome to see the continued improvement in retention – with vacancy rates now the lowest since the pandemic, and staff turnover at its lowest in almost a decade. With the government’s increase in the minimum wage and the introduction of the living wage, we are putting money in the pockets of some of the most deserving people in our society: care workers.

‘As the secretary of state announced last month, we are establishing the first ever Fair Pay Agreement, backed by £500m, to further improve the terms, conditions, and pay of care workers, and to help them stay and progress in the social care sector.’

Last month, the government announced a £500m cash injection to improve pay, terms and conditions for adult social care workers across England – but sector leaders have warned the investment will not be enough to tackle serious workforce challenges.

In May, the government announced plans to ‘end’ the recruitment of care workers from overseas in a move condemned by nursing and social care leaders as ‘pandering and scapegoating’.

This came after data published in January showed a 65% annual drop in visa grants when compared with data from 2023.

At the RCN Congress, also in May, nurses warned of ‘incredibly miserable’ consequences of axing the care visa route.

In December, the Nursing and Midwifery Council (NMC) published its latest registration data which suggested the recruitment of nurses from overseas had slowed.

The number of internationally educated professionals who joined the NMC register in the six months to September 2024 was down 16.6% (-2,501) compared to the same period last year.