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Julia Darby discusses the longstanding challenge of recruiting adult social care (ASC) workers through innovative textual analysis of an extensive database of job advertisements.

Image courtesy of interviewee. February 28, 2024

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This video video discusses the significant challenges facing the adult social care sector in the UK, particularly in the context of unfilled vacancies and recruitment difficulties exacerbated by the COVID-19 pandemic. Key issues highlighted include low pay, poor working conditions, and a lack of long-term commitment from the government to reform the sector despite various proposals over the years that have failed to materialize into meaningful action.

The analysis examines the increase in job vacancies and the limited effectiveness of short-term financial incentives, such as signing bonuses, which have proven insufficient to attract workers compared to higher-paying roles in other sectors. The challenges are compounded by demographic pressures due to an aging population and rising chronic health conditions. The data spotlighted suggests that many roles in adult social care fail to meet the salary thresholds set for attracting migrant workers, further straining the workforce.

While there has been some governmental acknowledgment of the issues and attempts at reform, such as recommendations from the Migration Advisory Committee, the lack of substantial progress or long-term strategies means the sector continues to experience significant staffing shortages. There are concerns about the potential for exploitation of migrant workers in the sector and a recognition that without genuine systemic change, unmet care needs and associated pressures on the NHS will persist.

Ultimately, the text emphasizes the urgent need for a comprehensive, long-term workforce strategy to adequately address the root causes of the ongoing challenges in adult social care.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

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The reason for getting into this work was

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that there have been unfilled vacancies, large numbers

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of unfilled vacancies in the care sector

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during the pandemic.

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We know that care workers had a particularly tough time.

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Uh, there have been promises of reform in the sector

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to address long-term challenges in recruitment

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and retention, but the promises have resulted in,

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in white papers, in, green papers in the promise

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of a bill and just being kicked down into the long grass.

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Um, the fiscal situation at the moment means

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that there hasn't been the long term commitment

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and only small amounts of money thrown at it.

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So the small amounts of money relatively

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to what's needed in the long term is why we talk

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about sticking plasters.

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Um, and these things are having some impact,

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but not solving the root problem.

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The prior literature on, recruitment

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and retention in the sector has pointed to a lot of factors

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that contribute to the problem.

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Um, low pay is the primary one,

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but challenging working conditions, so unsociable,

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sometimes inflexible hours, the physical

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and emotional strain of the, the job

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and burnout being quite common in the sector.

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There's also the issue

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that paid hours are very often quite different from the

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number of hours they're committed to the job, particularly

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for the people that are visiting clients in their own homes.

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And travel between clients is often goes unpaid.

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Um, so low paid jobs, limited progression in earnings,

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even when the responsibility grow.

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So the incentive to take on more responsibility is quite

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limited in terms of the pay.

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Um, and the adult social care employers find themselves

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unable to compete with better paying conditions in the NHS

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for say, nursing or Aries.

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And there's been a long-term erosion now

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of pay differentials relative to other low paid works such

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as supermarket jobs, cleaners, warehouse workers,

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where arguably the conditions are, maybe not great,

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but, somewhat better than in

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some of the social care jobs.

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And then you add to that the demographic, the demographic

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pressures for aging populations

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and growing numbers of people in the population having

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chronic conditions, some of them exacerbated by covid.

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The demand is being driven up.

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Um, and so the existing literature has primarily talked

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about these challenges and called for some sort of solution

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to those challenges.

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Um, so then we came in

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and thought, well, what, what sort of strategies are there

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that we can identify?

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Um, and we came at this with a big data set

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of job adverts, essentially.

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And these are job adverts advertise online, collated

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by a company called Ad Zuna.

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Um, their job,

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job adverts posted online for all kinds of jobs.

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So, the first thing we had to do was identify the jobs

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that we were interested in within there.

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Um, and so we, we designed an algorithm

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to identify the health

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and social care well at Zula, identify health

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and social care jobs broadly.

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And we looked at what was happening in those kinds

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of vacancies, and then we drill down further to try

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and isolate adult social care jobs.

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Um, there's, there's not a great deal of data.

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The government is trying to do better,

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or the office national statistics

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and various agencies within the sector are trying

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to do better on the, the data specific to adult social care.

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But by using tech searches of the adverts, we were able

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to hone in on particular social care jobs, restrict those

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to adult social care jobs,

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and then look at what the adverts are saying,

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how they're trying to entice people to these jobs.

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Um, we could find out about salary information,

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not necessarily on a consistent basis, so we had

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to do some work with that.

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Um, but also when signing bonuses or golden hellos

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or whatever you want to call them,

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and we looked at various different ways

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of different euphemisms for a signing bonus.

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When we, at, when we looked at those, we found that,

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certainly during the period

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that the government was giving small amounts of money

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to sort out problems with recruitment in health

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and social care, you see a rush

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of signing bonuses being offered in adverts.

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And this went from virtually nothing pre pandemic

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to quite large numbers

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of the adverts offering these bonuses.

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And we started comparing them in size to the sort

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of bonuses, signing bonuses being offered for other jobs.

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So these, these, these are quite interesting,

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incentives in assigning bonus that are usually

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for high skilled jobs where there are shortages

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for things like doctors, dentists, they've been used

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for years attracting teachers to,

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to jobs in particular geographical locations

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that have been hard to get

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or in subject areas that have been hard to get.

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Um, and they seem to work to some extent in,

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in those kinds of jobs,

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but it's a bit different to see them advertised

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for lower paid jobs and news.

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Me media picked up on these kinds of bonuses being offered

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during bits of the pandemic and after lockdowns and,

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and as airports opened and so on.

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But when we looked at the data, we discovered

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that these signing bonuses,

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the massive increase was in two areas.

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Really, health and social care was one,

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and a lot of that was adult social care

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where the trends had changed.

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And then another one was the logistics, which kind

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of picks up warehousing

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and, HTV driver services.

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And we just started comparing the, the design

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of these bonuses between those sectors.

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And, we started to worry

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that these were not solving a problem in adult

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social care, really.

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I mean, you don't want to sniff at some money being given

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to people, but 500 pounds being split into two parts.

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So 250 pounds signing bonus at the end of your first month

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and then another 250 after six months

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or a year was the typical design of this.

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And, so don't want to sniff it the money,

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but it's also part of taxable pay.

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It's not really the same as giving you a boost in your,

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your, very close to minimum wage.

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Essentially in the uk,

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we have a migration advisory committee

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that makes recommendations

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to the government about which workers should be added

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to a short job patient list.

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And typically these are high skilled jobs,

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and typically there's quite a high salary threshold,

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and that salary threshold has actually been increased.

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Um, back in 2021, the migration advisory committee

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made very strong points in a paper they'd been asked

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to write about adult social care about,

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pay being the major problem to attract workers

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to the sector, but suggesting that it might be useful to add

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at least temporarily adult social care workers to the list

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of shortage occupations

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with the lower salary threshold applying.

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So, the announcement

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that the government would take on this recommendation

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with respect to the visas as opposed to with respect

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to the pay came, on Christmas Eve of 2021

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and they fleshed out more of what the policy would look like

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by the 15th of February.

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Uh, in 2022, our data only goes up to March.

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So by that point, March, 2022, we didn't have a great deal

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to be able to say about whether this was gonna have a big

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impact, but

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what we could do was look at the salary threshold

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that the jobs had to meet,

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and we were quite skeptical about how well that was gonna do

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to attract workers, based on past adverts.

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At any rate, because the wages typically offered

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by the sector, both looking at, annual survey

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of hours and earnings data from the office,

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national statistics, and looking at our job advert data,

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a very small proportion

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of the jobs would get over the threshold to allow people

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to sponsor migrant workers to come and have those jobs.

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Um, so part of the reason that

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the pay, the recorded pay and the pay

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and the adverts is so low by comparison

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to the threshold is

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'cause a lot of the workers at the time we were looking did

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not work full time in adult social care.

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So the hours are below full-time hours,

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a very small proportion work 37 hours a

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week or more.

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So we looked at that

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and thought, this doesn't look like it's going to do

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a great deal to attract workers,

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but of course, there's lots of people who do actually want

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to come to the UK for various reasons from other countries.

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We probably on reflection,

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underestimated how popular that would be.

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And there have been a lot of visas given, for

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we imagine that means

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that the job adverts have changed in nature,

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but I'm afraid that's for future work.

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Uh, we, we now have a license for more more recent data.

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Uh, we've yet to start working on it yet.

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Um, we have a funding bank funding application in place,

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but we're hoping we'll be able to look at that

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to see what's been happening.

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In the meantime, the migration advisory committee

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and others have started to get quite worried about,

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migrant workers being exploited in adult social care,

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potentially by their employers who they're stuck with

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because they're sponsored.

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Uh, and so they can only move to another sponsored employer,

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but but also by the, the recruiters, some

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of whom are not your average recruit recruitment service.

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Uh, so the concerns about exploitation

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have really been problematic.

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And of course, changes in visas not allowing fam not

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allowing people to bring family members with them

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are gonna make it much, much harder

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to attract people into adult social care as migrant workers

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where other countries

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that have shortages are offering them

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essentially a better deal.

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The government has, in principle, both the UK government

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and the Scottish government have, in principle

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done quite a lot of work on potential reforms.

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I mean, even if we go back to 2011,

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there was an independent commission chaired

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by Andrew Di Dough about

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how we in the future should be funding adult social care.

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And he reported in 2011 there was a care act in

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2014, proposals to be implemented in 2016,

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delayed till 2020,

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and then the pandemic now indefinitely postponed.

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That's followed by Theresa May's government, promising

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to publish proposals for an adult social care,

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reform in a green paper that ended up being

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coming out in 2018 after Theresa May had left office

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and was followed by 2019 Conservative Party election

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manifesto pledge from Boris Boris Johnson in January, 2020

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promising to fix social care,

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and bringing forward a plan, for changes

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that would be implemented by 2024,

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which was subsequently delayed.

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We then how build back better in 2021, more plans

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for adult social care

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and funding commitments that were part of, Liz Trust's,

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health and Social Care Levy.

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Uh, so again, didn't get very far.

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The 2022 Autumn statement,

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had a two year delay to the funding reforms announced.

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Uh, there's still no long term workforce strategy from

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the UK government.

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I guess we wait and see what the election manifestos say

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next time round within Scotland.

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There was an independent, review of adult social care,

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reported on by,

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and that led to proposals for a national care service.

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And, something quite different about that.

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It, the main thing was it was going

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to transfer the responsibility

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for providing adult social care from councils

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to the new National She Care service.

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And that resulted in a bill that was originally scheduled

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for debate in March, 2023, which was delayed till June

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and further delayed.

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And in December we were told that that

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delayed further still.

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So the plans need to be reduced in,

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cost essentially, as they looked further ahead

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and saw that the costs would escalate

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with aging populations, everybody got cold feet essentially.

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So they have been attempts to look at this by governments

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and by academics, by many others.

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And they have come up with proposals,

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but none of these proposals have been taken forward.

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The bottom line is all the time there are initiatives,

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most recently an initiative to get waiting lists down.

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So some of the wider implications

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of not having enough social care workers

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and their impact on the NHS,

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but also their impact on the labor force participation

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of the people who are waiting for hospital treatment

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or the people who are reducing their hours of work

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or giving up their jobs to become carers,

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unpaid carers for family members.

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So recognition of these kinds of issues has now led

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to, more money being thrown at bringing waiting list

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down, putting care packages in place, trying

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to improve elements,

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but not actually having a long-term plan.

14:07.305 --> 14:11.195
Still, this short-term provision of funds that's been used

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for signing bonuses really hasn't had much impact on the

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number of unfilled vacancies.

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It's very different even from

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the HGV drivers when there were shortages.

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They offered bonuses, quite significant bonuses up

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to 2000 pounds, possibly more in some cases,

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but around 1,500 to 202,000 pounds.

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So three, four times that offered to social carers,

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and they found they only needed to offer those bonuses

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for a relatively short time.

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And vacancies came down,

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the vacancies didn't come down in the same

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way for adult social care.

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Um, easing visa requirements as well,

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Um, has had some impact clearly from the number of visas

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that have been offered, but again,

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has had some unintended consequences

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and still hasn't got at the root cause.

15:01.945 --> 15:04.165
So our concern is

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that without more fundamental long-term plans,

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there are gonna be unmet care needs that will continue

15:11.335 --> 15:13.975
to grow with the consequential problems for the NHS

15:14.035 --> 15:14.735
and elsewhere.

Challenges in Care Sector Recruitment and Retention

00:00:00 - The reason for getting into this work was that there have been unfilled vacancies, large numbers of unfilled vacancies in the care sector during the pandemic. We know that care workers had a particularly tough time. there have been promises of reform in the sector to address long-term challenges in recruitment and retention, but the promises have resulted in, in white papers, in, green papers in the promise of a bill and just being kicked down into the long grass. the fiscal situation at the moment means
00:00:35 - and only small amounts of money thrown at it. So the small amounts of money relatively to what's needed in the long term is why we talk about sticking plasters. and these things are having some impact, but not solving the root problem. The prior literature on, recruitment and retention in the sector has pointed to a lot of factors that contribute to the problem. low pay is the primary one, but challenging working conditions, so unsociable,
00:01:07 - and emotional strain of the, the job and burnout being quite common in the sector. There's also the issue that paid hours are very often quite different from the number of hours they're committed to the job, particularly for the people that are visiting clients in their own homes. And travel between clients is often goes unpaid. so low paid jobs, limited progression in earnings, even when the responsibility grow. So the incentive to take on more responsibility is quite
00:01:38 - and the adult social care employers find themselves unable to compete with better paying conditions in the NHS for say, nursing or Aries. And there's been a long-term erosion now of pay differentials relative to other low paid works such as supermarket jobs, cleaners, warehouse workers, where arguably the conditions are, maybe not great, but, somewhat better than in some of the social care jobs. And then you add to that the demographic, the demographic
00:02:12 - and growing numbers of people in the population having chronic conditions, some of them exacerbated by covid. The demand is being driven up. and so the existing literature has primarily talked about these challenges and called for some sort of solution to those challenges. so then we came in and thought, well, what, what sort of strategies are there that we can identify? and we came at this with a big data set
00:02:45 - And these are job adverts advertise online, collated by a company called Ad Zuna. their job, job adverts posted online for all kinds of jobs. So, the first thing we had to do was identify the jobs that we were interested in within there. and so we, we designed an algorithm to identify the health and social care well at Zula, identify health and social care jobs broadly.

Analyzing Recruitment Challenges in Social Care Jobs

00:03:17 - of vacancies, and then we drill down further to try and isolate adult social care jobs. there's, there's not a great deal of data. The government is trying to do better, or the office national statistics and various agencies within the sector are trying to do better on the, the data specific to adult social care. But by using tech searches of the adverts, we were able to hone in on particular social care jobs, restrict those
00:03:47 - and then look at what the adverts are saying, how they're trying to entice people to these jobs. we could find out about salary information, not necessarily on a consistent basis, so we had to do some work with that. but also when signing bonuses or golden hellos or whatever you want to call them, and we looked at various different ways of different euphemisms for a signing bonus. When we, at, when we looked at those, we found that,
00:04:17 - that the government was giving small amounts of money to sort out problems with recruitment in health and social care, you see a rush of signing bonuses being offered in adverts. And this went from virtually nothing pre pandemic to quite large numbers of the adverts offering these bonuses. And we started comparing them in size to the sort of bonuses, signing bonuses being offered for other jobs. So these, these, these are quite interesting,
00:04:51 - for high skilled jobs where there are shortages for things like doctors, dentists, they've been used for years attracting teachers to, to jobs in particular geographical locations that have been hard to get or in subject areas that have been hard to get. and they seem to work to some extent in, in those kinds of jobs, but it's a bit different to see them advertised for lower paid jobs and news.
00:05:24 - during bits of the pandemic and after lockdowns and, and as airports opened and so on. But when we looked at the data, we discovered that these signing bonuses, the massive increase was in two areas. Really, health and social care was one, and a lot of that was adult social care where the trends had changed. And then another one was the logistics, which kind of picks up warehousing and, HTV driver services.
00:05:55 - of these bonuses between those sectors. And, we started to worry that these were not solving a problem in adult social care, really. I mean, you don't want to sniff at some money being given to people, but 500 pounds being split into two parts. So 250 pounds signing bonus at the end of your first month and then another 250 after six months

Challenges in Attracting Adult Social Care Workers

00:06:26 - And, so don't want to sniff it the money, but it's also part of taxable pay. It's not really the same as giving you a boost in your, your, very close to minimum wage. Essentially in the uk, we have a migration advisory committee that makes recommendations to the government about which workers should be added to a short job patient list. And typically these are high skilled jobs,
00:06:57 - and that salary threshold has actually been increased. back in 2021, the migration advisory committee made very strong points in a paper they'd been asked to write about adult social care about, pay being the major problem to attract workers to the sector, but suggesting that it might be useful to add at least temporarily adult social care workers to the list of shortage occupations with the lower salary threshold applying.
00:07:30 - that the government would take on this recommendation with respect to the visas as opposed to with respect to the pay came, on Christmas Eve of 2021 and they fleshed out more of what the policy would look like by the 15th of February. in 2022, our data only goes up to March. So by that point, March, 2022, we didn't have a great deal to be able to say about whether this was gonna have a big impact, but
00:08:01 - that the jobs had to meet, and we were quite skeptical about how well that was gonna do to attract workers, based on past adverts. At any rate, because the wages typically offered by the sector, both looking at, annual survey of hours and earnings data from the office, national statistics, and looking at our job advert data, a very small proportion of the jobs would get over the threshold to allow people
00:08:34 - so part of the reason that the pay, the recorded pay and the pay and the adverts is so low by comparison to the threshold is 'cause a lot of the workers at the time we were looking did not work full time in adult social care. So the hours are below full-time hours, a very small proportion work 37 hours a
00:09:03 - So we looked at that and thought, this doesn't look like it's going to do a great deal to attract workers, but of course, there's lots of people who do actually want to come to the UK for various reasons from other countries. We probably on reflection, underestimated how popular that would be. And there have been a lot of visas given, for we imagine that means that the job adverts have changed in nature, but I'm afraid that's for future work. we, we now have a license for more more recent data.

Migrant Worker Exploitation in Care Sector

00:09:38 - we have a funding bank funding application in place, but we're hoping we'll be able to look at that to see what's been happening. In the meantime, the migration advisory committee and others have started to get quite worried about, migrant workers being exploited in adult social care, potentially by their employers who they're stuck with because they're sponsored. and so they can only move to another sponsored employer, but but also by the, the recruiters, some of whom are not your average recruit recruitment service.
00:10:12 - have really been problematic. And of course, changes in visas not allowing fam not allowing people to bring family members with them are gonna make it much, much harder to attract people into adult social care as migrant workers where other countries that have shortages are offering them essentially a better deal. The government has, in principle, both the UK government and the Scottish government have, in principle done quite a lot of work on potential reforms.
00:10:43 - there was an independent commission chaired by Andrew Di Dough about how we in the future should be funding adult social care. And he reported in 2011 there was a care act in 2014, proposals to be implemented in 2016, delayed till 2020, and then the pandemic now indefinitely postponed. That's followed by Theresa May's government, promising to publish proposals for an adult social care,
00:11:18 - coming out in 2018 after Theresa May had left office and was followed by 2019 Conservative Party election manifesto pledge from Boris Boris Johnson in January, 2020 promising to fix social care, and bringing forward a plan, for changes that would be implemented by 2024, which was subsequently delayed. We then how build back better in 2021, more plans
00:11:46 - and funding commitments that were part of, Liz Trust's, health and Social Care Levy. so again, didn't get very far. The 2022 Autumn statement, had a two year delay to the funding reforms announced. there's still no long term workforce strategy from the UK government. I guess we wait and see what the election manifestos say next time round within Scotland. There was an independent, review of adult social care,
00:12:21 - and that led to proposals for a national care service. And, something quite different about that. It, the main thing was it was going to transfer the responsibility for providing adult social care from councils to the new National She Care service. And that resulted in a bill that was originally scheduled for debate in March, 2023, which was delayed till June and further delayed.

Challenges in Adult Social Care Reform Efforts

00:12:52 - delayed further still. So the plans need to be reduced in, cost essentially, as they looked further ahead and saw that the costs would escalate with aging populations, everybody got cold feet essentially. So they have been attempts to look at this by governments and by academics, by many others. And they have come up with proposals, but none of these proposals have been taken forward.
00:13:24 - most recently an initiative to get waiting lists down. So some of the wider implications of not having enough social care workers and their impact on the NHS, but also their impact on the labor force participation of the people who are waiting for hospital treatment or the people who are reducing their hours of work or giving up their jobs to become carers, unpaid carers for family members.
00:13:56 - to, more money being thrown at bringing waiting list down, putting care packages in place, trying to improve elements, but not actually having a long-term plan. Still, this short-term provision of funds that's been used for signing bonuses really hasn't had much impact on the number of unfilled vacancies. It's very different even from the HGV drivers when there were shortages.
00:14:25 - to 2000 pounds, possibly more in some cases, but around 1,500 to 202,000 pounds. So three, four times that offered to social carers, and they found they only needed to offer those bonuses for a relatively short time. And vacancies came down, the vacancies didn't come down in the same way for adult social care. easing visa requirements as well, has had some impact clearly from the number of visas
00:15:14 - has had some unintended consequences and still hasn't got at the root cause. So our concern is that without more fundamental long-term plans, there are gonna be unmet care needs that will continue to grow with the consequential problems for the NHS and elsewhere.

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