King's College London

Background

The social care sector employs an estimated 1.6 million people in England alone. Problems with retention and recruitment are well documented. However, there is little evidence on the actual causes of these problems, or the impact staff turnover and shortages have on people who use services.

Improved understanding of the causes and consequences of staff decisions to join and leave social care would help policymakers to improve recruitment and retention. Previous work has documented other jobs that workers take when leaving the social care sector, including roles in the NHS. It is also commonly reported that social care workers leave the sector to take better paid jobs in the retail sector.

This work will provide new evidence on the impact of job opportunities outside of social care. It will also look at what this means for people who use social care services.

Aims

We aim to explore how changes in alternative job prospects affect retention and recruitment outcomes in the social care sector.

1. In particular, we will look at the impact of:
   1. changes in the local availability of retail jobs
   2. wider changes in potential pay and vacancies in other local jobs
   3. changes in job opportunities within the NHS
   4. We will use the results from (1) to estimate the impact of changes in social care labour supply on the health outcomes and levels of satisfaction of people who use care services.

Method

We will use the Adult Social Care Workforce Dataset. It has linked employee-employer information on over 750,000 social care workers employed in 20,000 care locations across England.

We will combine this information with other publicly available data and the Electronic Staff Record (ESR) to measure NHS employment opportunities and the links between NHS jobs and the social care workforce in England.

We will look at outside job prospects for potential social care workers to identify the impact of these factors on their employment decisions.

• We will use survey data to study the impact of changes in wages and job vacancies outside of social care, in roles that social care workers commonly move to. In particular, we will use the UK Labour Force Survey and the Annual Survey of Hours and Earnings to document the jobs that social care workers move to and calculate how many who leave the social care move to each industry.
• We will study how changes in wages outside social care impact social care worker numbers. We will also explore online vacancies or business information from the Office of National Statistics (ONS) to look at outside opportunities for social care workers.
• We will look at how NHS jobs vary in different geographical areas to study how social care staff numbers change and look at common local trends.
• We will study how any changes in the social care workforce impacts outcomes for people who use services.

To do this, we will study the health outcomes of nursing home residents. We will look at A&E arrivals in the Hospital Episode Statistics (HES) as well as care quality outcomes from Adult Social Care Survey (ASCS). We will explore using ONS death rates to examine the impacts on mortality, as well as Care Quality Commission (CQC) inspection ratings and other relevant information.

Timeframe

January 2024 – December 2025

Funding

NIHR Policy Research Programme: NIHR206121(06). Funding also from the British Academy (Postdoctoral Fellowship Scheme) and the ESRC (through the ESRC Centre for Microeconomic Analysis of Public Policy at IFS).

Policy relevance

Policy makers do not currently set pay in the adult social care sector, but the local government settlement does fund a large share of social care, so has a real influence. We aim to provide evidence that feeds into decisions made regarding the sector, including funding and regulation. This work will also be of interest to adult social care providers, local authorities, and other relevant bodies, such as Skills for Care.

Involvement

9 October 2024: George Stoye spoke about this study at the Unit PCIE Advisory Group. Questions for discussion at the meeting included:

• What sort of factors do you think staff might consider when deciding to join or leave the social care sector?
• What outcome should we be looking at when we're thinking about outcomes for care recipients?
• Does it matter if the NHS hires straight out of care homes?
• Should the NHS consider the potential impacts on the social care sector when it makes hiring decisions?

Dissemination

Outputs include two or three papers (aimed at high-quality economics or medical journals) studying the various influences described in aims 1 and 2. These will be published between 2024 and 2026, alongside presentations at academic conferences.

We will produce shorter pieces to summarise key findings for a policy audience. These will be shared on the Policy Research Unit (PRU) and Institute for Fiscal Studies (IFS) websites and print and broadcast media as well as social media.