One of my most thought-provoking conversations this month has been with Deborah Sturdy, the Chief Nurse for Adult Social Care in England. Having met Deborah previously, I remain in awe of the impact that she has had in raising the profile of nursing in social c are. However, as she says herself, the profile of social care sector nursing continues to need to be strengthened and understood both professionally and politically.
I want to share a quote from Gillespie (2023), who wrote on International Nurses Day celebrating the role of nursing in social care, to frame this piece:
‘From the nurse in a complex care at home provision who drives a multifaceted approach to bring people with complex health and care needs home. To the nursing associate who has led an initiative to reduce sedation in a care home for people with dementia and, in doing so, has seen falls reduce. Or the chief executive officer leading a group of care homes where they're seeing the health and wellbeing of their “families” improve in their care. Nursing in social care is often nurse-led and driven by person-centred practice.’
Last December, Lord Allan of Hallam posed a question for debate asking the government what steps it is taking to support public-sector workers in the NHS and the social care sectors (Waitzman, 2022). This debate, which took place in March 2023, involved a challenge to the Department of Health and Social Care (DHSC) which had not, and still has not, published its workforce plan.
There was widespread support for clarity on the future shape of social care to be very much included in the plan. Baroness Pitkeathley asked specifically:
‘When we finally see it (the workforce plan), which I hope will be before the House rises for the Easter Recess, will it ensure that those who work in social care are properly recognised, rewarded and trained so that, at last, their status is comparable with those who work in the NHS?.’
This raised, among many key issues, one that I was not aware of – that for nurses in social care there is no continuing professional development (CPD) funding currently.
Skills for Health workforce data (2022) showed that, in 2021/22, there were 32 000 registered nurses in adult social care (filled posts). The data also showed a wider concerning picture for this workforce, which I do not believe is widely known:
- Registered nurses were one of the only filled posts in adult social care to see a significant decrease over the period (down 18 000 filled posts, or 36% since 2012/13)
- The number of registered nurse jobs decreased year-on-year between 2012/13 and 2021/22 (from 50 000 to 32 000)
- Around two in five registered nurses (44.1%) were estimated to have left their role within the preceding 12 months; this was approximately 11 000 leavers
- There was an estimated vacancy rate of 14.6%, equivalent to around 4900 vacancies at any given time
- Registered nurses in adult social care had a much higher turnover rate (44.1%) than their counterparts in the NHS (11.5% for registered nurses and health visitors)
- Around 12.6% were on zero-hours contracts, down from 18.1% in 2012/13.
In preparation for the debate, Waitzman (2022), a House of Lord's researcher, reported information showing that, despite multiple strategies for reforming social care over the years, the sector is in crisis. Waitzman (2022) reported the current vacancy position of the social care sector as detailed by Skills for Care:
- The vacancy rate has risen over the same period to the highest rate since records began in 2012/13. The number of vacancies increased by 52% in 2021/22, by 55 000 to 165 000 vacant posts.
This shows that the decrease in filled posts is due to recruitment and retention difficulties in the sector rather than a decrease in demand.
Against this worrying landscape, discussions with Deborah were focused on the joint work that we could do. I came away better informed and wanting to know much more about nursing in social care, in addition to a commitment to ensure that there was a social care voice at the Nursing and Midwifery Council, and to progress our key lines of enquiry work into the options for regulating advanced practice. We also committed to progressing the work that Deborah has been discussing with Skills for Care and the Council of Deans of Health about encouraging the extension of pre-registration placements in social care settings. I very much look forward to continued work with Deborah and extending my knowledge and understanding of nursing in social care.