Care and Support At Home Workforce

Skills for Care data (available on the My Local Area on the Skills for Care website) from 2023-24 estimates that the West Sussex care and support at home workforce comprises 7,400 filled posts – An increase on the 2022/23 estimates of 6,700 filled posts. However, it also shows 1,800 vacant posts across the adult social care workforce in West Sussex.

There are challenges with the care and support at home workforce as the roles are demanding and carry high levels of responsibility, including frequent lone working and managing customer’s complex needs. Traditionally these critical roles are not highly remunerated and arguably not as highly valued by society as they should be, and it is challenging for the market to compete with other industries which are able to pay more. Previous information from Skills for Care has shown that West Sussex has a higher than average use of zero hour contracts with data showing 57% of non-residential care workers on zero hour contracts. In market engagement for the West Sussex Market Sustainability Plan 2023-2025, providers told us about the dangers of ‘burnt out’ staff, with a temporary increase in recognition and morale during the pandemic which since reduced.

In 2020 the health and care worker visa was launched to allow professionals to come to the UK to be employed in an eligible job within the NHS, an NHS supplier or adult social care. Initially this included senior care workers and in February 2022 care workers were added to the shortage occupation list. Organisations wishing to sponsor international recruits must be registered with the Home Office and apply for a license. The recruitment and capacity position for care and support at home in West Sussex has significantly improved in the last 2 years, and this may in part be a result of providers taking the opportunity to apply for licenses and sponsor international recruits. Hence there has been substantial benefit of international recruitment in meeting demand for services. However nationally, international recruitment has raised a number of challenges for the sector, with issues of breaches of compliance, risks of exploitation and unethical and potentially illegal practices occurring in parts of the UK care market, and as a result of these issues, UKVI can and will take action to suspend or revoke licenses.

WSCC is working with provider representatives to mitigate risks of this in West Sussex, with a proactive approach in making sure providers are aware of their obligations, a monitoring approach when visiting and reviewing services and a reactive approach when issues and concerns arise. Changes in immigration rules came into force in 2024 increasing the skilled worker baseline minimum salary and meaning that social care workers can no longer bring families with them on their visa. This is likely to impact on the volume of international recruits in social care and on the care and support at home market workforce. Skills for Care have reported a decrease in total number of international recruits joining the workforce from an average of 26,000 per quarter in 2023/24 to just 8,000 in quarter 1 of 2024/25.

This map shows the distribution of WSCC funded customers receiving care and support at home across the county and the concentration of customers in different areas. It shows the predominance of demand for services on the coastal strip and south of the county, and the more distributed spread over the rest of the county. This does not reflect the additional estimated 1600 people self-funding their care across the county.

Quality of Provision

The image of a graph below shows the current CQC ratings of care and support at home providers in West Sussex by area.

Overall, 91% of home care services in West Sussex are rated by the CQC as either outstanding or good. This is the 3rd highest percentage in the Chartered Institute of Public Finance Authorities (CIPFA) nearest neighbours comparable group of local authorities, just behind Devon (92.5%), and Dorset (93.9%).

West Sussex is ranked 41st nationally (of 151 local authorities) in the percentage of home care services rated either outstanding or good.

WSCC provides reactive and proactive support to the care sector to ensure that services offer quality care that achieves person centred outcomes. WSCC’s Quality Assurance and Market Support team provides proactive support to the care sector for example through signposting, information, advice and guidance for individual support to services and partnership working and networking across the sector. This market support aims to drive continuous improvement in the market and support more services to attain and maintain good and outstanding CQC ratings.

A quality pathway is in place for professionals to report quality concerns that do not meet safeguarding thresholds, but that indicate potential quality concerns. As part of this pathway WSCC reviews concerns, identifies themes or patterns and takes appropriate action – be that feeding into the Quality Assurance and Market Support team for reactive support for individual providers, or taking necessary contractual action.

WSCC has developed a contracts management approach with an aim to ensure consistent practices and risk-based approaches across the high number of services contracted with the council. All contracted providers are risk assessed and RAG rated through an annual assessment to determine frequency and type of monitoring. Where the RAG identifies a service as high risk, a review of the contract performance will be undertaken, and a site visit will be undertaken no less than 6 monthly. The focus of the review can include aspects such as workforce, care planning, engagement, financial processes, delivery according to policies and procedures.

In response to recent concerns around quality relating to international recruitment practices, this will be included within consideration of information as part of the contract management approach. It is acknowledged that there is a risk of exploitation of the workforce and poor practice in the care and support at home market. WSCC wants to work with providers to remind them of their regulatory obligations, to provide fair and ethical treatment of all staff, and to improve quality and practice and will do this through the mixture of proactive and reactive mechanisms outlined.