The health and care sector in Scotland is facing significant recruitment and retention problems at a time when we need to expand the workforce. We need to take action now.
Today, I was giving evidence to the Scottish Parliament Health Committee's inquiry into workforce recruitment and retention. It's a timely look at the issue given the problems the sector faces and the need to recruit thousands of extra staff to cope with growing demand. And that's before the uncertainties of Brexit, which understandably concerned MSPs as well.
We should start with the data. For the NHS we have pretty good workforce statistics because NHS Scotland uses a common payroll system and therefore ISD can publish a decent analysis of trends. For example, we know that nursing vacancy rates have been growing and currently stand at 2566 WTE. There are similar proportional problems with doctors and allied health professions, including Occupational Therapists.
The same is not true for the social care sector. This largely privatised sector is hugely fragmented and data is heavily reliant on registration with the SSSC. The problem with this is that not all staff are yet registered and some important groups, like PA's and childminders, don't have to register. The interaction with volunteers is another complication. We are therefore reliant on partial employer data and our surveys to plug the gap. We do know that many employers are holding high numbers of vacancies and have turnover rates that would make the worst outbound call centres blush.
This is also an ageing workforce. In social care the median age in all sectors is in the mid to late forties and younger staff are much more likely to be looking to get out of the sector. There is also gender segregation with men making up only 15% of the workforce. One of the barriers in attracting young men into the sector is the prevalence of part-time working. The data actually understates the problem because the SSSC defines full-time as more than 30 hours per week.
In preparation for today's session, I went back and looked at our member surveys in the last 18 months or so. What struck me was the similarity in the concerns of members from low paid home care workers, to professional posts such as district nurses and health visitors. They all point out that these are tough jobs, physically and emotionally, that are getting more complex. The job satisfaction that used to be a feature of the job has been undermined by cuts that leave them with not enough time to care. They also point to limited training and the loss of admin staff support and poor IT systems.
Pay and conditions are a big issue, particularly in the social care sector. In Living Wage Week we should be redoubling our efforts to ensure that care workers are getting at least that rate. We also need to tackle poor working practices such as insecure work, zero/nominal hours contracts and the treatment of travel time. As many staff have said to us, why should we work in such a tough job, with registration standards, when we can earn more stacking shelves.
Finally, let's look at some solutions.
- We must start by valuing the care workforce. Paying them properly with fair work principles being delivered through procurement and sectoral bargaining. That will also help to address gender segregation.
- Workforce planning is more of an art form than a science, but we could do better. Not least by widening the scope from the narrow group of professions currently included. We also need to recognise the scope for expanded roles and initiatives like UNISON Scotland's Skill Charter could contribute to this.
- Cutting admin support is a false economy, leaving front line staff to perform these functions, usually not as competently. Investment in IT systems and equipment that actually works would also help.
- Structurally, in social care at least, fragmentation of providers has to be addressed. Does a country the size of Scotland really need a thousand adult care providers?
With a growing demand for health and care workers we need to take action now if the workforce is going to be there when demographic change impacts on many more people living in Scotland. We can make some structural changes and coordinate workforce planning. However, none of that will work unless we value the workforce.