Agenda item

An update to the Board on the impact of the recruitment and retention challenges currently being faced in the adult social care market, the workforce pressures within the children’s public health and children’s social care commissioned provision and the mitigations being undertaken. Board support is sought to the short-term actions and long-term options being taken locally to assist/improve recruitment and retention.

A comprehensive update was provided to the Board by Zoe Mayhew, Strategy and Commissioning Manager, Targeted Support and Integration. This was accompanied by a presentation, focussing on the service areas that were under most pressure. It covered the impact of the recruitment and retention challenges currently being faced in the adult social care (ASC) market, the workforce pressures within the children’s public health and children’s social care commissioned provision and the mitigations being undertaken.

Data was provided on the increasing staff vacancies for the country as a whole and reporting the position in Warwickshire. There were significant issues with recruitment and retention of front-line care staff across learning disability supported living schemes, domiciliary care services (including extra care housing and specialised supported housing provision), residential and nursing care homes. This was resulting in a commissioned care market that was unstable and at risk of not upholding consistency of service delivery and acceptable standards of quality.

The Council continued to passport the national funding to the commissioned provider market and in total £28million had been allocated since the start of the pandemic. There were three main funding streams concerning infection control and testing, workforce recruitment and retention and additional winter workforce funding. For the longer term, WCC was developing a workforce strategy to respond to the ongoing workforce pressures within the commissioned social care market and a first draft of this strategy would be available in April 2022.

Subsequent sections of the report looked in detail at each of the following areas:

·       Domiciliary Care

·       Residential/Nursing Care

·       Community Equipment Provision

·       Adult Social Care job vacancy and turnover rates

·       Children’s Public Health and Social Care Commissioned provision

The financial implications were reported. This included the inflationary uplift on salaries and an outline of how the workforce pressures within commissioned social care provision were likely to result in increasing costs for the County Council. In response to the challenges a number of short and longer-term solutions were proposed which were set out within the report.

The Board discussed the following areas:

• Councillor Roodhouse spoke of the excessive hours being worked by care staff currently and the lack of recognition they received for their service. A difficulty was people leaving care for better rates of pay elsewhere. The challenges for care staff were increasingly complex in supporting older, frailer people. Providers welcomed the initiatives but were unclear how this would be coordinated over such a large number of organisations. WCC could do more on visibility and career progression. Previously there was a coordinated programme working with universities to provide a pathway from care into health services, but this seemed to have ceased. His view was the market was brittle, that the frail, older people needed more specialist care and yet staff were being paid a minimum wage whilst working long hours. The need to use of agency staff overnight was a further concern. He asked how the initiatives would be rolled out.
• Zoe Mayhew gave an outline of the process used to respond in a prioritised way, matching applicants to care providers. A tracker was used to inform of vacancies and staffing levels. The approach was to identify risk and then mitigate that risk. The system had worked well, but some care providers were not yet participating. There were no known reasons why those providers were choosing to advertise independently and at considerable cost when this was a free service. The points on marketing about career progression could be actioned quickly through a number of existing channels and the use of case studies was a further option.
• A discussion about the use of ‘blue’ and ‘exposed’ beds, as transition where patients returning to care had or might have Covid. This included the arrangements to step down this service and reinstate it to respond to surges in case numbers such as the Omicron variant. National funding was being used for this provision, through the hospital discharge grant. The system had worked very well.
• Comments were submitted on behalf of Phil Johns and Jagtar Singh. Mr Johns referred to career progression issues and gave examples of vacancies in local NHS services. Mr Singh commented about the impact of the mandatory vaccination for NHS staff, using positive messaging about the benefits of vaccination for the NHS to offset concerns by anti-vaccination groups and he supported the points made on workforce issues.
• The Chair was concerned about people on direct payments, sourcing their own personal assistants for care. Paula Mawson acknowledged this, speaking of the new carer strategy and agreed to take this point on board.
• Nigel Minns also referred to the work on career progression. It was important when considering progression from care roles into health that there was also a route into care, so the care market was not decimated. He spoke of the structure of the local care system, which tended to be small family run homes. Warwickshire had not been affected by the big national care home collapses. However, there was less opportunity for career development in small homes and he asked if there were bespoke solutions. Zoe Mayhew gave an outline of the tailored business support provided to care homes to seek to ensure their sustainability. Many seemed to thrive in Warwickshire with some showing steady growth.
• Sarah Raistrick referred to mental health and burn out. The NHS offered a range of packages which could be made available to care home and domiciliary care staff. Similarly, on education a suggestion to extend invites for relevant NHS courses to care staff. She touched on remote monitoring arrangements for some care homes in the north of Warwickshire and a joint training approach could again give validity to care staff. On the career progression points, for some a career in care was the correct option and they may not wish to move into an NHS role. There was a lot which could be done collaboratively. She concluded by referring to the staffing challenges and people taking alternate employment with higher pay rates. Zoe Mayhew added that WCC had extended its employee assistance programme providing mental health support to commissioned care providers, free of charge and there had been very good take-up of this offer. 
• Stella Manzie spoke of the importance of social care and especially domiciliary care to enable people to stay in their own home. The benefits of small local care providers were recognised. However, this provided a challenge of volume and scale for a large trust such as UHCW in working with a large number of care providers.
• The Chair agreed about the importance of domiciliary care, also referring to the Better Care Fund and ensuring it assisted with the issues raised under this item.
• Paula Mawson spoke of the pressures within children’s services giving examples of health visiting, the increasing and more complex referrals via the school health and wellbeing service. The impact of the pandemic on children and young people and their development would need to be monitored.
• Sarah Raistrick recorded thanks to carers from an NHS perspective and the Chair agreed from a board perspective too. A later item would look at Core 20 plus five. A focus under that item could be on health visiting for the 0-5s generally and with aspects on health inequality particularly.

The Chair stressed the importance of this item which underpinned many aspects and would be revisited at a future meeting.

Resolved

That the Health and Wellbeing Board:

1.     Comments as set out above upon the impact of the recruitment and staff retention challenges currently facing the Adult Social Care market.

2.     Notes the workforce pressures within the children’s public health and children’s social care commissioned provision and the mitigations being undertaken to manage pressures and risk.

3.     Supports the short-term actions being taken locally by health and social care partners to assist/improve recruitment and retention.

4.     Supports the further long-term options to assist/improve recruitment and retention that may be available to health and social care partners.

5.     Raises the profile and recognition of care services and particularly domiciliary care.