Number of registered nurses in social care plummets by 20%

The latest figures on the adult social care workforce, published in a report by Skills for Care, show there were 10,500 fewer nurses working in the sector in 2018 compared with 2012.

“Skills for Care are now collecting information about nursing assistants and associates”

Skills for Care

According to the skills body’s report – The size and structure of the adult social care sector and workforce in England – nursing was one of the only jobs in adult social care to see a “significant decrease” over that time period.

This was in part down to widespread shortages of nurses, with many nursing homes struggling to recruit the staff they need, it said.

However, the report also suggested organisations were increasingly creating nursing assistant roles to take on some tasks traditionally done by registered nurses.

Overall, the number of roles in adult social care has continued to rise with an estimated 1.62 million jobs in the sector in 2018 – 19,000 more jobs than the previous year.

“This could be related to recruitment and retention issues”

Skills for Care

However, expansion of the workforce has slowed in recent years, despite increasing demand from an ageing population.

Meanwhile, the figures show regulated professionals such as nurses, social workers and occupational therapists made up only a small proportion of the workforce in 2018, at 5%.

A further 7% were in managerial roles – frequently undertaken by nurses. But the vast majority – 76% – were in “direct care” roles such as care workers, senior care workers and support workers.

The figures show there were 41,000 registered nurse jobs in the sector in 2018 – down 3% or 1,000 fewer roles than the previous year.

The vast majority – 36,500 – were in “care homes with nursing” in the independent sector, while around 2,500 nurses were working for independent sector non-residential care providers such as nursing agencies.

Overall, the figures show a substantial drop in the number of registered nurses employed in the sector.

“The nursing workforce crisis in adult social care has reached a tipping point”

Dawne Garrett

This figure increased from 51,100 to 51,500 between 2012 and 2013, but has decreased every subsequent year since then.

“This could be related to recruitment and retention issues, but also may be a result of some organisations creating ‘nursing assistant’ roles to take on some tasks previously carried out by nurses,” said the report.

Skills for Care said it would be keeping a close eye on trends in the social care nursing workforce from now on.

“Skills for Care are now collecting information about nursing assistants and associates and will monitor changes in the number of these roles,” said the report.

The figures show fluctuations in the number of jobs in care homes with nursing – where residents are more likely to have serious illnesses and greater care needs – and the total number of nursing homes, which fell from 4,600 in 2014 to 4,350 in 2018.

According to the report, this suggests a “consolidation in the sector” – also seen in care homes without nursing – “whereby a similar amount of care was being delivered at fewer locations”.

The total number of jobs in nursing homes increased to 295,000 in 2018 – up 10,000 from 2017.

However, the number of registered nurses employed in such settings has fallen in recent years by around 16% – or 7,000 – between 2012 and 2018.

“No law stipulates what mix of registered and non-registered staff should be in place”

Dawne Garrett

The report suggested a significant increase in the adult social care workforce would be needed to keep pace with future demand.

To grow in line with the projected number of people aged 65 and over in the population, it said the number of adult social care jobs will need to increase by 36% – 580,000 more jobs – to 2.2 million jobs by 2035.

The Royal College of Nursing said the figures showed there were simply not enough nurses working in adult social care.

“The NHS often grabs headlines but the nursing workforce crisis in adult social care has reached a tipping point,” said Dawne Garrett, RCN professional lead for older people and dementia.

“Nurses in social care routinely work many hours of unpaid overtime to keep residents and clients safe because they are covering for vacancies,” she said. “This puts nurses under impossible strain and puts residents at risk.”

Dawne Garrett

Dawne Garrett

Dawne Garrett

She said one issue was the fact there was a lack of accountability in law for ensuring there were enough nurses in the sector.

“No law stipulates what mix of registered and non-registered staff should be in place to provide safe and effective care to residents across England,” she said.

Meanwhile, services were “severely underfunded” and “essentially left to wither on the vine”, Ms Garrett added.

“Without a substantial investment, this crisis will continue. Our members have a clear message for the government – change the law so that health and social care services can’t be starved of much-needed staff,” she said.

The government’s Long Term Plan for the NHS in England, published in January, promised to “ramp up NHS support for people living in care homes”.

This will include rolling out NHS England’s Enhanced Healthcare in Care Homes approach across the country by 2023-24.

According to the plan, this will ensure stronger links between primary care services and their local care homes, with all settings supported by a consistent team of healthcare professionals, including a named GP.