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It is vital the government resolves social care funding to achieve a credible workforce for the future

4 min read

Staffing levels in health and social care settings should be mandated to ensure we have the right number of professionals, with the right skills, to provide safe and effective care, writes Baroness Watkins.

New legislation to tackle unsafe staffing may be crucial to protect people who use health and social care services and to boost staff wellbeing and productivity. The Royal College of Nursing (RCN), UNISON and the British Medical Association (BMA) argue that staffing levels in all health and social care settings should be mandated, thus putting accountability for delivering this safeguard in the government’s hands.

2020 is the World Health Organisation International Year of the Nurse and Midwife. Nursing’s contribution to health and life outcomes is unique, however, it is a profession experiencing global shortages. This is why, as a nurse myself, I am asking this question today.

There are not enough healthcare professionals in the UK to meet society’s needs. There are almost 44,000 vacant nursing posts and at least 9,319 FTE unfilled medical roles in England alone. While there are more nurses than ever, in fact the nursing workforce has grown at a slower rate than the increase of people needing care, who are presenting with more complex conditions than previously. A major European cross-national study confirmed an association between higher nursing staff levels and better patient outcome.

When most of us think of ‘nursing’, we conjure up images of people working in hospitals, however shortages within community and social care settings are critical.

It is undeniable that social care has been an ever-tangling Gordian Knot for successive governments, however the workforce crisis coming to a head in social care has a direct knock on effect on patient care and to our entire health system. Where there are not adequate services available in the community, patients cannot be discharged from hospital. There are also parts of the country where the crisis is so severe that they are closing services and ‘deregistering’ nursing homes because they aren’t able to recruit the nurses needed.

Data from Age Concern reports that at any one time there are approximately 122,000 vacancies, meaning nearly one in every 10 roles in the adult social care sector. The RCN and Queen’s Nursing Institute reports a significant reduction in the number of qualified District Nurses employed in England since 2009. The number of Health Visitors (HVs) has also reduced in several parts of England, there needs to be a standard ratio of HVs to the number of children under 5 years of age.

The current government is tackling these issues with a clear vision for the future NHS workforce. However, it is vital to address the short-term challenges during this parliament by considering legislation on safe staffing and clarity on roles, responsibilities and accountability. It would ensure that we have the right numbers of professionals, with the right skills, in the right place at the right time to provide safe and effective care. We need to create a system in which workforce decisions are made proactively - with sufficient investment reflecting what is needed for safe and effective care, and incentives for generating the right numbers and skill level of staff to meet population need safely.  

We need political will for credible, urgent action to address the workforce shortage in social care as well as healthcare. Many older people with dementia are being failed by our social care system in part due to the cost of care and workforce shortages. It is vital that the government resolves the issues on funding of social care if we are really to achieve credible workforce plans for the future.

Without certainty in funding for social care, employers cannot invest and plan for the workforce. Dignity in care for all our population will only be achieved by proactively planning our future health and social care workforce.


Baroness Watkins is a Crossbench Member of the House of Lords. 

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Read the most recent article written by Baroness Watkins - There’s still time to avert nurse strike action


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