CQC Insight 15: Staff vacancies in care homes

Introduction

One of the key messages from our State of Care report for 2020/21 was that staffing pressures were being felt by people using and working in all health and care settings. We highlighted, however, that the impact was being seen most acutely in all areas of adult social care, including care homes and home-care services. In this sector, providers were competing for staff with the retail and hospitality industries, which can offer higher salaries.

We also highlighted that staff from adult social care may take up vacant posts in hospitals – especially registered nurses. We warned that these influences, combined with the effects of the requirement for all care home workers to be fully vaccinated against COVID-19, which came into effect on 11 November 2021, may lead to more care staff leaving.

These workforce pressures were reflected in information submitted to CQC by providers of residential care (care homes), which showed an increase in vacancy rates between April to September 2021.

This article provides an update to that data, showing that care home staff vacancies have continued to increase across England. We also give a breakdown of vacancies by region.

The data is taken from our provider information return (PIR) of residential adult social care. The data for this update consists of PIRs returned between 1 April to 31 December 2021, relating to 8,260 services, which is about 54% of all residential adult social care services. We plan to update these figures as the dataset builds and widen our analysis of workforce issues in other areas of adult social care.

Staff vacancy rates across England

The care home staff vacancy rate has continued to steadily increase throughout 2021 in England. The rate nearly doubled from 6% at the end of April, to 11.5% at the end of December 2021 (figure 1).

This month-by-month increase in staff vacancy rates is reflected in information for all types of social care published by Skills for Care. Although our figures are generally higher than Skills for Care’s, when similar methodologies are applied, the results are comparable.

Staff vacancy rates by region

We also looked at care home staff vacancy rates at a regional level. Figure 2 shows regional vacancy rates in quarters 1, 2 and 3 (April to June, July to September and October to December 2021).

The quarter 3 figures show that the south generally has higher care home staff vacancy rates than the north. The regions with vacancy rates higher than the England average are the South East, the South West, the East of England and London, whereas the regions with lower than average rates are the Midlands, the North East and Yorkshire and the North West.

The North East and Yorkshire had the lowest staff vacancy rate in quarter 3 (9.6%), and London had the highest (12.5%).

Comparing the change between quarter 1 and quarter 3 vacancy rates shows that the East of England had the largest increase – 6.8 percentage points, whereas London had the smallest increase at 2.8 percentage points. The East of England had the lowest vacancy rate in quarter 1 (5.3%) and London the highest (9.6%).

Further exploration of workforce issues

We will continue to monitor and publish these vacancy figures. We will also provide more information on workforce issues in adult social care more widely, including:

• more context from the adult social care PIRs on the reason for vacancies
• the findings from our adult social care workforce survey carried out by our inspectors during their conversations with residential and home-care services. This survey explores the impact of workforce challenges and staffing shortages on people using the service and on the staff delivering the service
• information we may collect about the impact of workforce issues on the adult social care market more generally.

We know that adult social care services are under exceptional pressure during this winter. This is compounded by the Omicron variant of COVID-19, which is causing huge increases in infections. We will increase the number of infection, prevention and control inspections we carry out over the winter months, while expanding them to gather information on visiting practices.

As stated in our Update from our Chief Inspectors on our regulatory approach, we will also:

• inspect where there is a clear risk to safety. Using appropriate focused and targeted inspection methodologies
• begin a programme of activity to inspect providers currently rated as requires improvement to identify where improvement has taken place and possibly re-rate, with a view to supporting the creation of additional capacity in the system
• carry out activity to support the system over winter, including supporting the establishment of new designated settings to help ensure people can be safely discharged from hospital when they are medically fit to leave.