NHS fees for care homes to fund nursing services will rise by 7.7% in 2025-26, the government has announced.

The increase in NHS-funded nursing care (FNC) will benefit more than 75,000 care home residents in England, said the Department of Health and Social Care (DHSC).

FNC is designed to fund services provided to care home residents by a registered nurse involving either the provision of care, including performing procedures or administering medicines, or the planning, supervision or delegation of such care.

The latest rise, which follows a 7.4% increase last year, will take the standard rate of FNC from £235.88 to £254.06 per week from 1 April 2025. The higher rate, paid to the relatively few residents who received it when the three previous bands were merged in 2007, will increase from £324.50 to £349.50.

Independent providers’ umbrella body Care England said this was the tenth year in which it had worked with the department to ensure that FNC increases reflected the rising costs of care faced by providers.

‘Threat to sustainability of social care nursing’

However, while its chief executive, Martin Green, said that the 2025-26 increase was “a step in the direction”, he warned that the “sustainability” of nursing in social care settings was under threat.

This was as a result of the upcoming rise in employer national insurance contributions – expected to cost providers in England £940m in 2025-26 – and the “shrinking wage gap” between care home nurses and lower-paid staff, due to above-inflation rises in the national living wage.

Care England chief executive Martin Green

Green also referred to the “increasing burden of delegated healthcare tasks”, under which nurses train and supervise care workers to carry out healthcare tasks, such as injections.

He said the rise in the FNC needed to be followed by integrated care boards increasing the rates they pay social care providers for NHS continuing healthcare (CHC) by at least the same amount. CHC involves the full funding of a person’s health and social care by the NHS on the grounds that they have a “primary health need”.

Green added that, without such a rise in CHC rates, “we risk a system where providers simply cannot afford to provide nursing care, which will add to hospital discharge challenges”.

Celebrate those who’ve inspired you

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Do you have a colleague, mentor, or social work figure you can’t help but gush about?

Our My Brilliant Colleague series invites you to celebrate anyone within social work who has inspired you – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a few paragraphs (100-250 words) explaining how and why the person has inspired you.

*Please note that, despite the need to provide your name and role, you or the nominee can be anonymous in the published entry*

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

Providers say they will have to cut jobs and reduce the amount of care they deliver because of the increased costs imposed by the Budget, a survey has found.

Almost two-thirds (64%) of organisations said they would need to make staff redundant, while 57% said they would have to hand care contracts back to councils and NHS commissioners, reported the Care Provider Alliance (CPA).

The CPA – an umbrella body for organisations representing providers – surveyed 1,180 organisations about the impact of the increases to the national living wage (NLW) and employers’ national insurance contributions (NICs) announced in last month’s Budget.

Tax and wage increases

From next April, employers will have to pay NICs at 15% – up from 13.8% – on staff earnings above £5,000 a year, down from £9,100, while the NLW will rise from £11.44 to £12.21.

Think-tank the Nuffield Trust has calculated that the two measures will cost England’s almost 18,000 independent care providers an additional £2.8bn in 2025-26, about £2bn of which would need to be found by councils.

This dwarfs the £600m in additional grant authorities have been promised for social care in 2025-26, which is expected to be available for both children’s and adults’ services.

Providers predict cuts to care and jobs

The CPA found that, without further government assistance:

• 73% would have to refuse new care packages from local authorities or the NHS.
• 57% would hand back existing contracts to local authorities or the NHS.
• 77% would have to draw on reserves.
• 64% would have to make staff redundant.
• 76% of providers would have to cut training and resources for staff.
• 86% would not be able to maintain wage differentials between staff.
• 22% indicated they would have to close their businesses entirely.

Among the 479 home care respondents, 42.9% planned to shorten care visits.

Most (77.6%) of the 628 care home providers who responded said they were planning to reduce or stop planned maintenance, while 79.7% said they would have to halt capital investment.

‘People’s lives will deteriorate’

“Without adequate support, we now know for certain that services will close, care providers will stop delivering public services, and care workers will lose their jobs,” said CPA chair Vic Rayner, who is also the chief executive of the National Care Forum.

“Critically, a huge number of people who rely on care and support will go without or see their lives deteriorate.”

The fee paid to care homes to fund nursing costs will rise by 7.4% from April 2024 in what leaders have described as a “in for the sector”, the government announced today.

The standard weekly NHS-funded nursing care (FNC) rate will rise from £219.71 to £235.88, while the higher rate will increase from £302.25 to £324.50, said the Department of Health and Social Care (DHSC).

The higher rate is paid to the relatively few residents who received it when the three previous bands were merged in 2007.

The DHSC said the scale of the increase had been based on data supplied by social care providers on their costs, which had then been quality assured.

‘Win for the sector’

Care England, which represents independent providers, hailed the increase, which follows rises of 5% in 2023 and 11.5% in 2022, as a “win for the care sector”.

“Care England has worked tirelessly with the Department of Health and Social Care over nine years to ensure that the FNC rate reflects the true cost of providing nursing care,” said chief executive Martin Green.

“This latest uplift represents a win for the care sector operating in a challenging time and is a testament to our collective efforts.”

About funded nursing care

Funded nursing care is designed to finance services provided to care home residents by a registered nurse involving either the provision of care or the planning, supervision or delegation of the provision of care.

It is paid to care homes in England by NHS integrated care boards (ICBs) as, under section 22 of the Care Act 2014, registered nursing costs generally cannot be met by a local authority.

However, Green warned that the legal position on FNC needed to be reviewed in the light of the increasing complexity of needs met by residential care homes.

“The government must now lend consideration to the legal definition of FNC to ensure its fit for the future given the increased levels of complexity seen in residential care, and how care providers have had to adapt their services to meet the ever-changing needs of their residents,” he said.

‘Need to reward and recognise social care nurses’

Green also stressed the importance of care home nursing staff being “recognised and rewarded accordingly, in line with NHS nurses”.

Care homes have struggled to retain nurses in recent years, with the turnover for adult social care nurses hitting 44.9% in 2021-22, before falling to a still high 32.6% in 2022-23, according to Skills for Care data. This was far higher than the turnover for NHS registered nurses and health visits at the same time (10.9%).

However, separate Skills for Care data has shown vacancy rates for registered nurses falling, from 11.3% in March 2023 to 8.2% in January of this year.

Inequalities in access to adult social care are deepening due to the cost of living crisis, staff shortages and squeezed council budgets.

That was the message today from the Care Quality Commission in its annual State of health care and adult social care report.

The regulator said council funding for care was not keeping up with need, with requests for care per 100,000 population up 4.9% from 2017-18 to 2021-22, while the numbers receiving care as a result fell by 2.2%.

It found that a quarter of providers surveyed in July 2023 had considered quitting the sector over the past year, as council funding failed to keep pace with their rising food, energy and staffing costs.

Reduced service capacity

Workforce shortages had resulted in reduced service capacity. The number of registered care home beds shrank by 0.6% in the year to July 2023, and home care providers deemed hard to replace delivered almost 15% fewer hours’ care in the first three months of 2023 compared to the same period in 2021.

Care home profitability was at historic lows, and with council-funded care being less profitable than the private market, the CQC found a greater proportion of fees had come from private sources in the past year.

This risked leaving people in deprived areas, who are more dependent on state services, going without care, it warned.

Specialist services for people with learning disabilities and autistic people, including supported living, saw a sharp fall in their profit margins from 2021-23, driven by rising staff costs.

However, with a much smaller private market, they were less able to subsidise state-funded provision through self-funder fees, meaning that it was “vital” for them to receive increased funding.

People going without care due to cost of living

At the same time, the CQC found that some self-funders were going without some of the home care they needed because of the cost of living crisis and increased provider fees.

Staffing shortages resulted in providers deprioritising less urgent visits, sending one carer for calls that required two, overloading staff rotas, giving workers overlapping calls and leaving too little travel time between visits.

And despite the number of vacancies across social care falling in 2022-23, mainly due to international recruitment, 54% of providers surveyed reported recruitment difficulties and 31% retention challenges.

While the CQC welcomed Skills for Care’s decision to develop a sector-led social care workforce strategy, the regulator said it was vital that the government produced its own staffing plan.

“The work that Skills for Care do will be positive, but it will need to have an outcome which is why we are calling for a national workforce strategy,” said James Bullion, the regulator’s chief inspector of adult social care and integrated care. “The sector alone cannot solve those problems.”

State of social care ‘unremittingly grim’

Charity coalition the Care and Support Alliance said the 2022-23 State of care report was “without doubt the worst we have ever seen and within it, the picture painted of how social care is currently performing is unremittingly grim”.

The CSA’s chairs, Caroline Abrahams (Age UK), Emily Holzhausen (Carers UK) and Jackie O’Sullivan (Mencap), added: “In particular, the growing inequality in people’s ability to access social care, and the vanishingly small options for those with little money, living in poor areas, is a source of huge concern to us.”

For the Association of Directors of Adult Social Services, president Beverley Tarka said: “Funding is not keeping up with people’s needs, so fewer can access care and people who can’t afford to pay for care themselves are more likely to be going without the support they need.

“And it’s left care staff overworked, stressed, and poorly paid, meaning many leave their jobs and we have difficulty recruiting people to replace them.”

People in deprived areas ‘unable to access care they need’

Nuffield Trust senior policy analyst Sally Gainsbury said: “Local authorities were already struggling to meet growing need for care services before rising cost pressures hit, so inevitably this means more people unable to access care they need, particularly in more deprived areas.

“Financial pressures as well as repeated failed reforms have left social care services fragile and seen council-funded care packages shrinking with increasing numbers of people shut out from publicly funded care.”

The situation prompted widespread calls for the government to not only find more money for the sector in next month’s autumn statement but also provide long-term investment in social care.

Call for more money

“Immediate investment is needed in the autumn statement to end the gridlock, address unmet and under-met need and ensure timely access to social care for all who need it, not just those who are able to afford it,” said the Local Government Association (LGA)’s community wellbeing board chair, David Fothergill.

“Local authorities need a good funding settlement this autumn to avoid further cuts to care, and a government commitment to a fully funded social care workforce strategy is long overdue,” added the CSA’s chairs.

Provider representative body Care England’s chief executive, Martin Green, said: “Social care must be seen as an essential part of national infrastructure. The social care sector is brimming with talent and provides essential support for our citizens.

“We need a government that understands the importance of social care and sets about creating an environment where it flourishes, rather than struggles.”

DHSC defends record on investment

A Department of Health and Social Care spokesperson defended the government’s record, saying the sector had access to an additional £8.1bn from 2023-25 “to put the adult social care system on a stronger footing including buying more care packages, helping people leave hospital on time and boosting the workforce”.

This comprises:

• £3.2bn extra through the existing social care grant, though this is for both adults’ and children’s services, with an expected 40% due to be spent on the latter.
• £1.6bn to tackle delayed discharges, with the funding split between councils and NHS integrated care boards.
• £1.6bn through increasing the adult social care council tax precept by 2% and raising standard council tax by 3% in each year.
• £1.08bn through the market sustainability and improvement fund, designed to help councils increase provider fees, tackle waiting lists and boost recruitment and retention.
• £570m through a separate market sustainability and improvement fund – workforce fund, which has the same objectives but is particularly focused on tackling staff shortages.

However, Gainsbury, for the Nuffield Trust, added: “Continued short-term funding injections into social care are fuelling uncertainty and leaving the sector susceptible to shocks, unable to invest in the workforce and infrastructure needed for the future.”

The social care workforce has been boosted by 58,000 overseas staff over the past year, revealed government immigration figures published today.

But while care homes have made a dent in record vacancy levels experienced in 2022, staffing gaps have remained stubbornly high in domiciliary care, according to separate data issued by Skills for Care.

The rise in overseas staff joining the workforce came on the back of the government’s decision to add ‘care workers’ and ‘home carers’ to its shortage occupation list for skilled workers in February 2022, enabling providers to directly recruit from abroad to these roles for the first time.

Immigration figures

This resulted in a rise from 113 to 40,416 in the number of these staff issued with health and care visas from 2021-22 to 2022-23. Over the same period, the number of senior care workers recruited in the same way rose from 6,763 to 17,250, meaning 50,790 more staff joined the workforce through the health and care visa in 2022-23 than 2021-22.

Social care staff accounted for 57% of health and care visas in 2022-23, up from 19% in 2021-22. Over half of health and care visas were granted to staff from India (29,726), Nigeria (17,596) or Zimbabwe (17,421), with all three nations seeing rapid growth in the number of their citizens moving to the UK to work in health and social care.

Photo: Zerbor/Adobe Stock

The rise in the overseas workforce follows a 52% rise in adult social care vacancies in 2021-22, attributed to factors including a loss of competitiveness in pay to retail and hospitality, a drop in the number of migrant staff from Europe due to Brexit and post-Covid burnout among the workforce.

Falling care home vacancies

Vacancies appear to have fallen – and employment increased – since then in the care home sector. Preliminary Skills for Care data showed that, from March 2022 to April 2023:

• There was a 3.8% rise in the number of filled care worker posts in residential and nursing homes from March 2022 to April 2023.
• The nursing home vacancy rate, for all roles, fell from 8.8% to 7.9%.
• The residential home vacancy rate dropped from 7.7% to 6.8%.

However, in domiciliary care, the vacancy rate for all roles fell only slightly over this time, from 13.2% to 13%, while the number of filled care worker posts fell by 1.2%.

Umbrella body the Homecare Association has cited the sharp rise in fuel costs during 2022 as among factors forcing staff to leave their roles.

The extent of the pressures on home care workforce were revealed in the results of Homecare Association research with providers carried out in January and February 2023.

This found that 66% of providers felt recruitment was harder, while 43% said that more care workers were leaving,  than six months previously.

Care England, which represents independent care providers, said the rise in the number of overseas staff could not address the chronic workforce pressures the sector faced, driven by low pay.

£15 minimum wage urged

“Whilst increases in net migration may help to fill vacancies within the sector, ultimately, the workforce crisis will never be truly addressed until the government provides the sector with the funding it needs to adequately reward the workforce with the pay and recognition they deserve,” said its chief executive, Martin Green.

Care England CEO Martin Green

As of last month, the national living wage (NLW) – the hourly pay floor for staff aged 23 and over – rose from £9.50 to £10.42, while the national minimum wage (NMW) for 21- and 22-year-olds increased from £9.18 to £10.18.

This will have boosted the pay of the many care workers who earn around the NLW or NMW.

However, Green added: “Care England has long called for a care wage that sits above the NLW and supports the Trade Union Congress’ call to implement a £15 minimum wage for individuals in care worker roles, fully funded by central government and ring-fenced for this purpose. This would not only improve the workforce crisis in adult social care, but give the English economy a much needed multi-billion pound boost.”

The government risks widespread care home closures if it doesn’t provide councils with significantly more funding to pay providers a “fair cost of care”, a report has warned.

Current funding plans are £850m a year short of what is required to enable care homes to deal with the impact of self-funders being able to arrange care at council rates from October next year, found the study for the County Councils Network (CCN) by market analysts LaingBuisson.

As part of its planned adult social care funding reforms, the government will implement section 18(3) of the Care Act 2014 in full, requiring councils to arrange care in a care home for self-funders who request it, which the government has said will “address the current differential in fee rates charged to some self-funders”.

Self-funder fee gap

In 2017, the Competition and Markets Authority (CMA), in a study of the care homes market, calculated that self-funders paid, on average, 41% more than local authorities for a bed in the same care home, a differential the CCN report said was maintained to this day.

The DHSC has said that “a significant number of local authorities are paying residential and domiciliary care providers less than it costs to deliver the care received”, but that implementing section 18(3) would mean “some providers will over time need to reduce reliance on subsidising state-funded care from self-funders”.

To prevent this leading to widespread market disruption, it has annouanced £1.4bn in funding from 2022-25 for councils to “move towards a fair cost of care”, in return for which they must conduct conduct cost of care exercises to determine sustainable rates for providers and increase fees accordingly.

The CCN report said £378m of the funding was allocated annually for residential and nursing homes. However, it found this “seriously underestimated” the costs of implementing a fair cost of care.

LaingBuisson’s best estimate of the annual costs of implementation was £1.232bn, in line with the CMA’s 2017 estimate of between £0.9bn and £1.1bn for councils to meet the full costs of care for the residents they funded, but leaving a black hole of £854m a year.

‘Widespread care home closures’

Were 50% of funders to take up their rights to have care arranged under section 18(3), LaingBuisson said providers faced losses of £560m given current government funding levels for the policy, representing a 3.8% annual loss of revenue, and risking widspread care home closures, particularly in the South.

CCN adult social care spokesperson Martin Tett said the fair cost of care plan was laudable, but warned: “At the present funding level, these proposals could have a serious impact on the care sector across the country, leading to widespread care home closures and a rationing of care for the hundreds of thousands of people who need it each year. Councils will be left between a rock and a hard place – either by raising council tax to excessive levels and cutting local services, or by seeing widespread care home closures in their areas.”

From a provider’s perspective, Care England chief executive Martin Green said that if the government’s figures “were not immediately revised this could lead to catastrophic financial failure to be experienced by providers, leading to home closures, and an inability to invest in services for some of the most vulnerable members of society now and into the future”.

The CCN urged the government to use funding from the new health and social care levy – funded through a 1.25 percentage point rise in employer and employee national insurance contributions from next month – to deliver the £854m gap identified by the report.

The levy is due to provide £5.4bn from 2022-25 for adult social care, including to implement a fair cost of care and the related funding reforms of an £86,000 cap on personal care costs and a more generous means-test. However, most of the £12bn a year from the levy, and a related dividend tax rise, will go towards the NHS, particularly in 2022-23 and 2023-24, with social care’s share rising over time.

The implementation of section 18(3) and a fair cost of care is designed to support the cap on care costs. This is because, for self-funders, the cap is calculated on the basis of what their local authority would pay to meet their personal care needs, not what the person actually pays. By closing the gap between self-funder and council-commissioned fees in care homes, the DHSC intends to ensure that, as far as possible, what counts towards the cap is what the person actually pays.

A council left an older man, whose health was deteriorating, in a care setting it knew to be unsuitable for almost two months, an ombudsman investigation has found.

The Local Government and Social Care Ombudsman concluded that Warwickshire council had maintained the man’s placement “for a prolonged period with the knowledge his care needs were not being met”.

The watchdog also found the local authority at fault for delays in organising an alternative placement for ‘Mr P’, and for failing to maintain appropriate contact with his wife, ‘Mrs D’.

It identified additional faults on behalf of the council because the care home in which Mr P was staying failed to notify Mrs D of a fall by her husband, and did not adequately assess whether he required treatment after another fall.

The ombudsman found that the care provider and council had also both neglected to provide Mrs D with a formal notification that Mr P’s placement had ended, after he was transferred to hospital and, subsequently, to another care setting.

Warwickshire council issued a written apology to Mrs D and agreed to pay her £500 to remedy the injustice caused to her. The investigation report noted that “harm and distress” caused to Mr P could not be remedied because he had died since Mrs D raised her complaints.

Social worker was ‘largely unresponsive’

Mrs D’s complaints related to a stay by her husband at Orchard Blythe, a care facility operated by Runwood Homes, which commenced in early July 2020. Before this, Mr P had already had two periods of respite care at Orchard Blythe in February and June 2020.

By mid-July, staff at Orchard Blythe had determined that the home could not adequately meet Mr P’s increasing needs and that a specialist service should be sought. Mr P’s social worker was notified immediately of this assessment, with the ombudsman commenting that there was “evidence this point was acknowledged by the Council and reemphasised to the Council by both Mrs D and management at Orchard Blythe at later dates”.

Over the following weeks, Mr P had a series of falls, some of which Mrs D said she was not told about. One such fall in late August caused an elbow injury requiring stitches, which Mrs D said was not picked up quickly enough by care staff. She also raised concerns about her husband’s appearance, that he was becoming distressed and that he had been left sitting in his own urine and faeces.

The council did not contact Orchard Blythe asking for details as to the change in Mr P’s needs until early August. It only began trying to identify alternative accommodation in the middle of that month, which it acknowledged represented a delay.

Over this period Mrs D repeatedly tried to chase up Mr P’s social worker regarding her concerns over the inadequacy of her husband’s care and the possibility of him being transferred. “In my view, the council [social worker] was largely unresponsive,” the ombudsman’s report said.

‘Council failed in discharging its responsibilities’

In summary, the watchdog found, Warwickshire council was “fully aware” that Orchard Blythe could not meet Mr P’s complex needs and therefore was at fault for not finding him an alternative placement.

“The council has a responsibility to ensure that the care and treatment Mr P received was appropriate to his needs and in accordance with the CQC Fundamental Standards,” the report said. “The evidence suggests the council failed in discharging its responsibility in this respect.”

Orchard Blythe admitted to the ombudsman that there was an occasion when Mrs D had not been notified of a fall by her husband – though the investigation found that, in general, staff at the home had monitored Mr P and taken steps to mitigate risk.

The ombudsman accepted that Orchard Blythe staff checked Mr P for signs of injury but found they had not been thorough enough in assessing his elbow injury in August 2020, resulting in a delay of hours before paramedics were called.

The watchdog’s inquiry revealed no evidence of failings relating to Mr P’s personal care and sanitary needs on the part of Orchard Blythe staff.

‘We have undertaken the agreed actions’

Responding to the ombudsman report, a spokesperson for Warwickshire council said it fully accepted the findings of the ombudsman and has “undertaken the agreed actions as a result of their investigation”.

Besides the apology and payment to Mrs D, the ombudsman had considered recommending that Warwickshire put in place service improvements in light of Mr P’s case.

It concluded that the local authority had already identified in its communications areas where it could do better, but said these must be evidenced within two months of the investigation concluding.

by Maya Haddad, Dr Alison Beck and Dr Katherine Belton

Previous research has highlighted the risk factors associated with high stress among care home staff, including high staff turnover and absenteeism and staff malpractice.

But the fragmentation of care home provision, both in terms of different types and sizes of providers of services and the complex process of commissioning and purchasing services, poses significant challenges to ensuring consistent support for staff in care homes.

We spoke to people working in the care home sector in south London during the summer of 2020 to explore the extent to which they feel emotionally supported at work. We also interviewed stakeholders representing various agencies and organisations that support the sector to find out what could be done to improve the emotional wellbeing of this vital workforce.

‘Just get on with it’

We heard that those working in the care home sector face a multitude of stressors that include working long hours for low pay, difficulties in managing the behaviour of residents, not having enough time for self-care or to “reboot” and feeling that, despite the difficulties, you are expected to “just get on with it”.

Most managers we interviewed described unmanageable workloads, consisting of myriad organisational demands, that often led to staff working well above their contracted hours. Several described being on call and available 24/7, including during periods of leave.

Some described feeling that you constantly have to ‘cover’ yourself and ensure you are prepared for upcoming checks. Many registered care managers (RCMs) spoke of feeling in the line of fire and being the first to get blamed when things go wrong because “it is easier to blame one person than an entire system”.

During the pandemic, managers were left feeling physically exhausted and emotionally depleted. They described having to deal with various logistical pressures, such as sourcing food for residents and PPE for staff, not being able to get hold of GPs, and having to accommodate residents who had been discharged from hospital with Covid-19.

As workers increasingly became sick or feared coming into the workplace, there were inevitable staffing challenges. Some likened their jobs during the pandemic to war-time conditions and commented that, “people say this is like the war, but at least during the war you could have a hug”. 

Managers explained they had continued to present at work to role-model that doing so was safe, and would fill in gaps absent staff would otherwise attend to, such as cleaning and shopping. Some continued working remotely while isolating with symptoms to feel they were still “doing something”.

There were also emotional demands, such as having to reassure anxious staff and keep morale up by role-modelling calmness and confidence.

Lack of emotional support

Similar challenges were described by care home staff, including long working hours, restrictions on when to take annual leave, managing challenging behaviour of residents and, during the pandemic, having to manage with a lack of supplies for both staff and residents. Staff felt their role, often complex and comprising aspects such as enabling residents and upholding their human rights, was overlooked and underappreciated by the public, especially compared with health workers’.

Staff told us about the emotional toil of working during the height of the pandemic and managing their fears of becoming ill with Covid-19 or infecting loved ones (some of the staff we spoke to identify as Black, Asian, or minority ethnic and told us that they and their families felt at particular risk). There were also challenges in managing stress, confusion and fear among residents, who often could not grasp why restrictions were being imposed on them.

Neither RCMs nor frontline staff felt there was adequate support to help them cope with the highly emotive material and pressures they are frequently subjected to, both day-to-day and during the pandemic. The majority of people we spoke to felt the sector’s culture does not generally invite staff to discuss the emotional impact of their work and reflect on how they are coping.

While RCMs told us that they have an ‘open door policy’, this was not always understood by their staff. Some did not feel supported, respected or cared for by the management team or organisation, especially during the pandemic.

One staff member felt she had been “left here to die” due to lack of perceived support from senior management. The care home staff we spoke to had mixed experiences with RCMs throughout their careers, with some being more supportive than others, but emphasised the sheer influence that RCMs have on creating a particular working culture.

Need to join up

The care home sector’s governance and financial structures are complex and fragmented. With care homes largely operating as independent private businesses, this brings challenges around ensuring consistency across the sector in how staff in care homes are paid and supported.

This also creates organisational boundaries that inhibit the sharing of learning between care homes. During the pandemic, local RCM digital forums acted as fundamental information-sharing platforms and provided managers with a designated space for peer-to-peer support, as well as helped to encourage a consistent approach to how common challenges should be addressed. We think this is a positive step and encourage the expansion of similar forums beyond the pandemic.

Many health and social care commissioners described a disconnect not only within the care home sector, but also between health and social care. One spoke of a tension of cultures and a “clash of different worlds” between the two sectors due to a differing ethos in the provision of care.

Some mentioned the level of investment in staff training and development in the health sector and told us “far less” was invested in the care workforce. One commissioner we interviewed pressed for a “bigger national debate” about the lack of career pathways for care home staff, especially within the context of Brexit and its potential impact on numbers of qualified nursing staff.

We heard there can sometimes be a disconnect “between what’s happening on the frontline in care homes and in strategic planning”, which can leave RCMs feeling disillusioned by, and distrustful of, regional and national public health strategies. We were told this can also create an impression that things are continuously being ‘done to’ care homes, which can make staff feel disempowered.

We were told that coproduction can lead to greater buy-in among staff and managers, helping to increase loyalty and the benefits associated with it, such as retaining corporate knowledge and increased productivity.

The need for cultural change

Our findings indicate a need for cultural change in care home practice. Most care home managers and providers agree that retaining staff to ensure consistency of care is essential to high-quality provision.

Staff need to feel invested in any improvements of the care home. They need to be asked for their input and have their views heard in the realisation of local improvements in care practice.

Commissioners can influence their relationships with RCMs, ensure these are supportive and recognise the difficult work that they do, providing additional resources where possible. To embed a ‘just culture’ throughout the care sector, RCMs need to feel that their jobs are manageable and their practice defensible.

A combination of training and ongoing support is proving useful and needs to be maintained post-pandemic. Care home providers may be amenable to learning from one another about best practice to improve care and cost effectiveness; this includes performance improvements that can be achieved with a well-supported workforce. Sharing good practice in an appreciative, mutually-supportive forum is particularly important for smaller care home providers who typically lack opportunities to collaborate.

Maya Haddad is an assistant psychologist, Dr Alison Beck head of psychology and psychotherapy and Dr Katherine Belton clinical psychologist at South London and Maudsley NHS Foundation Trust

Care home providers face losing 40,000 staff from the government’s policy of requiring all their staff to be fully vaccinated, exacerbating job losses already suffered this year.

The figure is the Department of Health and Social Care’s (DHSC) best estimate of the impact of its policy of requiring all staff working in care homes to be fully vaccinated, which will come into force in November. It represents 7% of the 570,000 people employed in in CQC-registered homes.

The DHSC calculated each job loss would cost £2,500 to replace in backfill, recruitment, induction and training costs, leaving providers with an estimated one-off bill of £100m.

However, independent sector care homes have already been losing staff since April this year, according to provisional figures released by Skills for Care, which showed drops in job numbers of 0.8% in April, 0.7% in May by 1.6% in June. The  The decline has been steeper for care homes for older people, nursing homes and among care worker roles .

In relation to care worker jobs across the residential sector, estimated losses were 1.9% in April, 1.6% in May and 3.4% in June. This is in contrast to the situation in domiciliary care – for which compulsory vaccination will not apply – which saw estimated job growth of 0.6% in April, 1.1% in May and 0.1% in June.

‘Potentially catastrophic’

The reasons for the drop in care home jobs specifically are unclear, though services have seen significant drops in occupancy as a result of the pandemic, potentially reducing the need for staff. Occupancy rates fell from 84% in March 2020 to 75% in May 2021, among homes without nursing, and 87% to 81% among nursing homes.

However, provider leaders pointed to factors to do with the supply of staff, with care workers exiting the sector due to stress and burnout.

A recent survey by third sector provider umbrella body the National Care Forum (NCF) found that about 60% of members had seen an increase in the rate of staff exit, with 40% of leaving staff departing for another sector.

NCF chief executive officer Vic Rayner warned that the government’s estimates of the impact of the vaccine policy recognised the “very significant and potentially catastrophic challenges for the delivery of care if the right level of guidance and support is not available”.

‘Stress and burnout’

Rayner added: “Early indications from members show that the trend for exiting social care is higher than normal, that some services have to close or be reorganised as a result of these shortages, and that we have a workforce that is stressed, burnt out and looking for the door.”

She also said that while many staff were leaving to join the health sector, others were going to join hospitality and retail, which also face a high vacancy rate. Per 100 jobs, there are about 4.5 vacant positions in accommodation and food service activities according to the Office for National Statistics figures released this month, compared with an average vacancy rate of 2.9% across all industries.

With turnover of 29.6% in residential homes and 36.8% in nursing homes in 2019-20, the government’s analysis suggested that some staff who leave as a result of the vaccination policy would have left for other reasons. The DHSC also said it expected councils to manage the risks to local services of the expected job losses, in line with their duties under the Care Act, for which they would receive support from the DHSC’s regional team.

‘Over-optimistic’

However, on Twitter, Simon Bottery, senior fellow for social care at the King’s Fund, said that these anticipated mitigations of the impact of job losses were “over-optimistic”.

He said that many of the of those who normally leave their jobs go elsewhere in the sector rather than leave residential care altogether, as would be required under the vaccination policy. While some may go into domiciliary care, where the policy doesn’t apply, it’s not clear how much traffic there is between the two sectors, he said.

In relation to councils having contingency plans in place, Bottery added: “I look forward to hearing from those councils who feel they can deal with the loss of between 3% and 12% of their care home workforce.”