Implications of care staff shortages on service delivery?

Paper review:“The independent care homes sector: implications of care staff shortages on service delivery”, by Stephen O’Kell. Joseph Rowntree Foundation, 2002.

"JRF Joseph Rowntree Foundation"I reviewed this paper with my Care Locker ‘hat’ on, with a particular interest in the sections on care home staff recruitment and retention. The sample was small – 18 care home leaders interviewed – but replicable, and as feedback was consistent (and much of it remains consistent with much of what I hear repeated now). I can’t stress enough, either, that this paper is now over a decade old – it was a start point for me in my search for information about care quality in the context of bank and agency staff.

The paper was written in 2002, and there have been considerable structural changes since then: my purpose in reading this was to discover what challenges care home managers face, since we The Care Locker aims to address this particular problem.

Two lots of statistics jumped out at me, and I shall endeavour to get them updated:
– One in seven men and one in three women will spend at least a year in an institution before they die (Evans, 1999);
– A typical nursing home makes barely 50p per day per bed.

Over a decade on from this paper, the need for care isn’t diminishing. But as less and less local authorities want to provide care, there can be little incentive to make the investment needed in care facilities by the private sector (which needs to make a profit). I’m sure there will be charities that step up to the plate, but the economics of it are precarious.

The paper noted the artificial divide between health and social care. I think this is a very valid point, and one still applicable today. I am also aware that there are moves from inside government, largely drive by a data and digital agenda, to join things up. So I’m hopeful on this front, but will research further.
Other issues raised by the paper are:
– a lack of workforce planning, something I’m looking at closely, and will research further (please do feel free to comment on this – I’m up for some debate);
– a lack of management ownership – I’m not sure about this, and will look into this further;
– a general valuing of academic skills over caring and practical ones. This is very much on my agenda, and something I feel there is room to address. (I’m conscious that the NVQ has now now become a minimum standard.)

The authors noted as key factors in staff retention:
– private health care as part of their package. (Am I alone in finding this somewhat ironic?)
– pension schemes.
– inexpensive staff accommodation.
– free education and training (the paper notes two thirds of staff being inadequately trained, and an increasing tendency towards asking carers to take on more medical tasks)
– higher salaries (the paper also notes a lot of movement amongst carers for a few pence more per hour – and given low wages in the sector, I find this unsurprising. Some care workers find it hard to make ends meet).
– free meals.

I am looking further into these as part of The Care Locker’s commitment to recruiting and keeping the best staff.

The paper noted the number of foreign workers coming to work as carers, as this group of people are prepared to work for low salaries (because low salaries in the UK are higher than at home). This comes with its own set of challenges, not least as the paper notes that they don’t stay and that this is unsustainable. This is an area I shall research further as well.

The one, outrageous assertion made by the paper, that was largely unsupported, but the basis for the entire paper if the title is to be believed, was that there is a negative effect where bank and agency staff are used almost exclusively. Indeed, there seemed to be a ‘frowning’ upon the use of bank and agency staff. I’m sure this was based upon conversations between the paper’s author and his interviewees, but this runs counter to my own experience – often the same bank or agency staff attend the same care units repeatedly, so any lack of familiarity about how things work or unfamiliarity to residents/service users is obviated. I would therefore love to take a deeper look at this.

Overall: an interesting paper that threw up some more challenges for me, and some ideas around the things I need to make happen at The Care Locker in order to really make a difference.It didn’t, however, fulfill the promise of its title. It looked at issues creating staff shortages, but made little correlation with service delivery, other than notingthe amount of time people have to waste trying to get staff in to cover.

The Care Locker is a new platform for matching care facilities with caring staff (bank/agency), launching – all being well – towards the end of 2015. Founder Claire Thompson can be contacted on the temporary email address, thecarelocker at

Care workers may join the list to stay informed as we get closer to launch here:

One thought on “Implications of care staff shortages on service delivery?

  1. Pingback: John Kennedy’s Care Home Enquiry | Putting 'care' into the supply of bank and agency care staff

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