The depleted nursing workforce in adult social care is so burnt out from caring for too many people that one in three are looking to leave, with the crisis in the sector so deep that the needs of some of the most vulnerable are going unmet, including missing vital medication.

In a stark new analysis published on the 4th day of its annual Congress in Liverpool, an RCN report reveals deep-seated issues in the sector, with the College calling for a long-term funding settlement, including action to address registered nurse shortages and for better pay, terms and conditions.

The scale of the challenge is laid out in a survey of RCN members across the UK working in social care finding that around one in three (34%) are considering leaving or are already actively planning to leave their jobs. Feeling undervalued (66%), too much pressure (59%) and exhausted (54%) were the top reasons for those considering leaving.

Registered nurses are highly skilled, degree-educated professionals. Their skills, knowledge and expertise are crucial in meeting the increasingly complex care demands in social care.  Office for National Statistics (ONS) figures show the number of people aged over 85 will increase by nearly half (45%) by 2034.

The College says social care has been consistently neglected, kicked down the road through reviews and consultations, with the sector now paying the price for a lack of leadership. It is widely recognised that when adult social care does not work the impact is felt right across health and care, yet the necessary reform has never been delivered, nor has the required investment. 
When it comes to attracting more people into the profession, more than a third (38%) said pay and terms and conditions did not compare well with other sectors, with a similar proportion (36%) saying that social care carried negative perceptions.

Of those surveyed by the RCN, a majority said their top priority in the sector was ‘a legal requirement for safe staffing levels, setting a minimum number of registered nurses per resident’. Second to that was a call for a national approach to ensure nurses working in adult social care are paid in accordance with their job’s unique level of professional responsibility, expertise, knowledge, skills and working conditions.

Insufficient capacity in social care also hits services elsewhere with increased avoidable attendance and admission to hospital, and people stuck in beds for longer due to delayed discharges.

A mental health nurses working in social care in Wales said: “I am the only nurse in the building on a day shift for 39 residents. I have to work autonomously … All decisions regarding care are mine as is accountability.”

RCN General Secretary and Chief Executive Professor Nicola Ranger said: “In all parts of the UK we need to see new urgency to address the crisis in social care. Everywhere you look, the lack of political leadership has left the sector neglected, and its workforce depleted and exhausted. As a result, the needs of vulnerable people are going unmet, with staff caring for a totally unsafe number of people. That is dangerous and a tragedy.

“With an ageing population, the scale of the challenge for governments across the UK has never been clearer. We need new long-term investment and a plan to build a strong nursing workforce, with swift action across the board to improve pay, terms and conditions.”

RCN Wales Executive Director Nicola Williams said: “The themes identified in the RCN’s analysis are very familiar from what we’re hearing from our members in Wales: a skilled workforce under immense strain, trying to deliver safe, compassionate care in a sector that’s been underfunded for years.

“Registered nurses working at care homes in Wales have told us that on many weekends, they are the only registered nurse on duty for the entire home, they struggle to take safe, uninterrupted breaks because there is no other registered nurse available to provide cover, and it is difficult to maintain safe oversight when they are the only registered nurse on shift.

“The supply of registered nurses is too small, and the existing funding arrangements do not support the sector to develop a staffing level congruent with the rising care needs of vulnerable people. Without investment in RN posts, the balance between delegation and supervision becomes increasingly fragile and risk management extremely vulnerable, exposing RNs to burnout and decisions that are difficult to manage.

“In addition, we’re hearing from our members working in adult social care in Wales about limited access to continuing professional development (required to keep a nurse's clinical skills up to date). The funding for training and protected time simply isn’t there and this is a missed opportunity. Adult social care needs to be shown the value it deserves with the right funding and national support to create the conditions in which the nursing workforce can thrive.

“Nurses working in social care should be rewarded in the same way as those in the NHS – in pay, terms and conditions that reflect their increasingly complex roles and autonomous practice.

“With the necessary investment, the social care nursing workforce could play an even greater role in delivering complex care, supporting people to stay well in their own communities and reducing unnecessary hospital admissions. In a system struggling with unacceptable corridor care and delayed discharges, this potential is enormous. We owe it to our Welsh population and to the nursing staff who support them to ensure that social care in Wales is safe, sustainable and properly valued.”

The UK wide findings show a workforce at breaking point. The voices of members in Wales underline the urgency of action. The clear priorities for Wales are:

• safe staffing levels across all care settings, including the social care sector
• investment in growing the registered nursing workforce in social care
• guaranteed access to Continual Professional Development (clinical skills training)
• pay, terms and conditions in line with equivalent roles in the NHS
• a long term, fully funded workforce plan for social care.

The RCN says governments across the UK must now take vital steps to reform commissioning and funding arrangements for social care and ensure they allow for services to meet future needs. 

ENDS