Social care nurse vacancy rates fall but reliance on overseas

Vacancy rates for registered nurses have fallen in the social care sector – but fears remain that there are still not enough staff for an ageing population.

Skills for Care published its latest annual State of the Adult Social Care Sector and Workforce in England report today, covering 2023-24.

The report showed improvements to nurse vacancy rates in the adult social care sector, as well as improvements to the gender balance in the workforce.

"We know what we need to do to tackle the challenges facing the adult social care sector and workforce"

Oonagh Smyth

However, it also demonstrated persistently high turnover rates, high numbers on zero-hour contracts and a vulnerable reliance on international recruits.

Registered nurses were found to have a “relatively high” turnover rate of 30.5%, compared to 9.2% for registered nurses and health visitors in the NHS – and the overall turnover rate of 24.2% for the adult social care sector at large.

It further found that 16% of registered nurses were on zero-hour contracts.

According to the report, there were – as of March 2024 – 34,000 registered nurses and 750 registered nursing associates working in adult social care.

Skills for Care highlighted that this represented a 13% decline in filled registered nurse posts since 2017-18, when there were 39,000 nurses.

However, the number of filled nurse posts had increased from the 33,000 in 2022-23.

"This shows that previous problems with recruitment for this job role are starting to improve," stated the report. 

Similar trends were found in vacancy rates, which had improved in recent years but were worse than they were in 2017-18.

Among registered nurses, vacancy rates were 9% in 2023-24, compared to 14.6% in 2021-22 but 8.5% in 2017-18. Across all roles, the rates were 8.3%, 10.6% and 7.2% respectively.

“But by continuing to make it hard for migrant care workers to come here, ministers risk making a bad situation worse"

Claire Sutton

The number of vacant posts in adult social care as a whole in 2023-24 stood at 131,000 and 2,900 of those vacancies were for registered nurses.

Overall, the adult social care workforce grew by 4.2% from 2022-23 to 2023-24, with 1.7m people in post on the latest count.

The report found that this increase was driven by a “record level of international recruitment” in 2023-24 when 105,000 overseas recruits started in direct care-providing roles.

However, it warned that recent changes to visa rules, including the move to ban care workers from bringing their dependents with them, had led to a decline in interest from overseas.

“The lower number of granted Health and Care Worker visas is likely to continue and it may therefore be challenging for the sector to continue growing as it has been prior to these changes,” said the report.

Claire Sutton, transformation lead for the independent health and social care sector at the Royal College of Nursing (RCN), said the decrease in social care vacancies “masks the harsh reality” of the sector which, she claimed, still had “nowhere near” enough staff.

Ms Sutton said: “Registered nurse numbers continue to decline as domestic recruitment collapses, forcing employers to recruit internationally to fill gaps.

“But by continuing to make it hard for migrant care workers to come here, ministers risk making a bad situation worse.

“In social care there are still over 130,000 empty posts and significant numbers of vulnerable people at risk.”

As well as the reliance on overseas, the report highlighted the relatively low pay which non-registered care workers receive.

Ms Sutton said the report was evidence that the UK Government’s plans to reform social care pay, and employment law in general, “couldn’t come soon enough”.

She added: “[The reforms] must have teeth and deliver the fair pay agreement the sector so desperately needs.

“When wages are so low, it is little wonder recruitment and retention are such a challenge. Improving wages and workplace rights in social care are crucial to bolstering the sector’s workforce and easing pressure on the NHS."

Similarly, NHS Employers chief executive Danny Mortimer said sector leaders remained “concerned” by the pay figures and reliance on overseas talent.

“These figures… show worrying trends in how competitive social care pay and terms are in the labour market, and the risk that the care sector’s growing reliance on international recruitment and its global workforce is undermined by changes in migration policy,” he said.

“Social care staff from overseas play an increasingly vital role in social care services and contribute valuable skills and knowledge.

“However, as these figures highlight, we are headed for a cliff edge in the social care workforce in the years to come as both domestic and international workforce numbers dwindle and the number of people who need vital social care support surges.”

Overall, vacancy rates for adult social care were found to have fallen by 33,000 nationwide over the past two years.

Turnover rates for the sector at large fell from 29.1% in 2022-23 to 24.8% for 2023-24.

In a foreword to the report, Skills for Care chief executive Professor Oonagh Smyth said there were “plenty of reasons to be cheerful”, pointing to the improvements in vacancy, turnover and gender balance rates.

She also highlighted the existence of the organisation’s Workforce Strategy, published in July, as a reason to be optimistic about the sector.

“So, we know what we need to do to tackle the challenges facing the adult social care sector and workforce; now we all just need to work together, with government, to make it happen," she said.

However, she said: “All of that is definitely good news but, when we look beyond those headlines, a more nuanced – and perhaps more familiar – picture starts to emerge.

“It’s no wonder people are leaving the sector in droves"

Natalie Grayson

“In last year’s report we talked about the adult social care workforce being a ‘leaky bucket’, and this report shows that the bucket clearly still has holes.”

The report suggested that, currently, there is on average one adult social care post for every six people aged 65 and over, and that settings with worse staff ratios had poorer Care Quality Commission ratings and higher turnover.

Skills for Care itself did not put forward specific recommendations. However, it highlighted “positive employment factors” which, according to its data, boosted employee retention.

These included being paid above minimum wage, guaranteed hours, full-time hours, training and qualifications.

Responding to Skills for England’s publication, union GMB said it was evidence for the need for a better pay deal in social care.

National officer Natalie Grayson said: “Despite the fact every single one of us will likely be touched by the care sector in our lives, care workers have been underpaid and undervalued for years.

“It’s no wonder people are leaving the sector in droves.

“A fair pay agreement in social care will drive up wages, implement sick pay and paid travel time and give care workers a national voice.”

Sam Foster, executive nurse director of professional practice at the Nursing and Midwifery Council, welcomed the report.

“It’s encouraging to see further growth, including a small but consistent rise in registered nurse filled posts,” she said.

“However, a familiar high turnover rate underlines the urgent need for sustained investment and proper recognition of nursing professionals.

“That recognition needs to begin through education, with more students being offered placements in social care settings to build their knowledge, skills and experience of this rewarding career pathway.”

Meanwhile, Ms Foster said it was “essential” that the overseas nurses propping up social care were supported and received access to the right resources, training and opportunities.

More widely, she said a “comprehensive, long-term workforce plan” was needed for social care going forward.