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The adult social care workforce is struggling with high vacancies and turnover, but how many people work in this sector in England, and what are their roles?
Demand for adult social care is growing, but the workforce is not keeping pace with this demand. In 2022/23, there were 1.79 million adult social care roles in England: 1.635 million filled posts and 152,000 vacancies. Yet despite a substantial increase in international recruitment, vacancies remain high. Turnover is also high, at 28.3%. Solving the staffing problem will require sustained and long-term prioritisation and investment.
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Current make-up of the sector
Social care is provided and organised by approximately 18,000 organisations, and delivered in approximately 39,000 establishments. As of 2022/23, 78% of adult social care staff worked for independent sector employers, 8% were employed by direct payment recipients, 7% worked for local authorities, and 7% were in the NHS.
The two main service settings are residential and domiciliary (home-based) care, both of which employ more than 500,000 staff. By job role, 76% of posts were direct care workers (people who work directly with patients).
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International staff
International staff make up 19% of the adult social care workforce: 6% European Union (EU) and 13% non-EU.
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The number and proportion of international staff working in social care increased in 2022/23, driven by an increase in the proportion of non-EU staff (the proportion of EU staff has fallen since 2019/20). This increase has been driven in large part by care workers being added to the Shortage Occupation list in February 2022, making it easier for care workers to move to the UK.
In 2022/23, 70,000 people started work in direct care roles having arrived in the UK during that year, up from 20,000 in 2021/22. This increase has offset a fall in the number of British workers in the sector and has contributed to slightly lower vacancy rates.
Visa rules changed in spring 2024. The situation now is that only Care Quality Commission (CQC)-registered providers in England can sponsor care workers; the salary threshold is either £23,200 or their occupation-specific threshold, whichever is higher; and care workers can no longer bring dependants to the UK as part of their visa. It is too early to assess the impact of these changes on the social care workforce.
Some social care roles have more international staff – for example, 41% of registered nurses and 23% of care workers are non-British. The figure for senior managers and personal assistants is just 7%.
Demographics
Compared with the population of England, a higher proportion of adult social care workers are female and from an ethnic minority group, but a lower proportion are disabled (though disability may be under-reported in the sector). By job role, the proportion of female staff ranges from 69% of senior management to 90% of occupational therapists, while the proportion of staff from an ethnic minority background ranges from 15% of personal assistants to 44% of registered nurses.
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The proportion of the social care workforce that is female has remained steady, but the proportion of ethnic minority staff has increased over time. The proportion of the workforce that is aged over 55 has also increased, from 23% in 2016/17 to 28% in 2022/23.
Vacancies
In 2022/23, the vacancy rate in the adult social care sector in England was 9.9% – higher than the NHS vacancy rate in England (8%) and substantially higher than the UK vacancy rate (3.4%). Vacancy rates are lower than average in local authority roles but above average for roles employed via direct payments. By service, vacancy rates are lower in residential care but higher in domiciliary care. By job role, managers/supervisors have lower vacancy rates, while direct care workers and regulated professionals (nurses, occupational therapists, etc.) have higher rates. The overall vacancy rate fell slightly over the past year but is higher than every previous year since 2016/17.
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Turnover
The overall turnover rate in 2022/23 was 28.3%, but this masks variation. There was a substantially lower turnover in local authority roles, community and day care, and managerial/supervisory posts, and higher turnover in the independent sector, residential care, and direct care posts. Turnover has been relatively stable since 2016/17.
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Satisfaction
There is no direct measure of satisfaction among the adult social care workforce, but the following factors all impact on turnover rates – a way of seeing whether staff are sufficiently satisfied with their jobs to stay in them.
Pay: turnover is lower for care workers paid above the minimum wage. In 2022/23, the median hourly rate for care workers was £10.11. In the past year, high inflation means that pay has fallen by 35p per hour in real terms. Pay progression is also an issue; care workers with five or more years’ experience only earn 6p more per hour, on average, than care workers with less than one year’s experience – a difference that has fallen over time.
Contract type: turnover is higher for staff on zero-hours contracts. In 2022/23, 22% of staff were employed on a zero-hours contract, rising to 50% of care workers working in domiciliary care.
Training and qualifications: turnover is higher for staff who do not receive regular training and those without social care qualifications. In 2022/23, around half of the adult social care workforce held a relevant social care qualification.
Conclusion
The adult social care sector is struggling to recruit staff. Although the large numbers of international staff working in adult social care are crucial to keeping the sector running, international recruitment cannot be seen as a long-term solution due to growing global competition for these workers. Concerns have also been raised around the exploitation of care workers from overseas.
The sector is also struggling to retain staff. Low rates of pay as well as challenging working terms and conditions – particularly for staff on the front line – all contribute to high turnover rates. It is essential that issues around pay, conditions and other factors that drive poor retention rates are addressed.
Improving recruitment and retention are even more important given the predicted increase in demand for adult social care. Skills for Care estimates that due to the growth of the population aged 65 and above, the sector may need 440,000 extra roles by 2035. It is therefore vitally important for adult social care to have a long-term workforce plan.
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