A summary: The health and social care landscape in 2024 

According to The Health Foundation, the sector will need an additional £8.3 billion by 2032/33 just to keep up with growing demand. However, the government only provided £4.7 billion for 24/25. 

Lack of funding remains one of the biggest issues within the health and social care sector. This, alongside the absence of upholding strict standards and regulations for recruitment agencies, means that the care being provided to our most vulnerable is declining in quality. 

Other issues facing the health and social care sector include the ageing population, staff shortages, lack of career progression, staff retention, and the NHS being perceived as a more attractive proposition for those driven to work in the care industry. Therefore, the NHS is most likely to receive central government funding, whilst social care funding is to be obtained from the Council Tax.

Lack of due diligence in health and social care 

In health and social care, there has been a systemic lack of investment in high-quality training and support for those providing direct care. The industry’s focus on recruitment has led to shortcuts, where simply ‘ticking a box’ for e-learning courses becomes the norm to quickly onboard care staff and save costs.

Unlike other industries increasingly reliant on technology, social care is about empathy, compassion, and genuine care. However, as resources decline, recruitment is shifting towards efficient yet impersonal app-based methods. This shift eliminates important face-to-face interactions where recruitment managers can assess candidates’ values and suitability. 

At Unity Plus, we believe that these fundamental personable skills, which underpin what it is to be a carer, become impossible to measure without face-to-face contact. As care providers attempt to increase staff and rely on recruitment agencies to fill vacancies, they focus on hiring people who have just completed the necessary e-learning modules rather than those with the compassion and values we want for our relatives. 

Exploitation concerns in health and social care 

Recruitment agencies are not regulated by the Care Quality Commission, and each organisation is accountable for its actions independently. With this in mind, price, not quality, becomes the differentiation factor between recruitment agencies, meaning that it’s all too tempting for agencies to cut corners with their recruitment. Despite the minimum wage being enforced, agencies often pay less, exploiting loopholes while neglecting essential costs like training and well-being. At Unity Plus, we believe investing in staff training and care is essential for delivering the best-quality healthcare.

Find out more about our staff training here.

Over the past two years, concerns have been raised about the Government’s overreliance on adding ‘Healthcare Assistants’ to the skilled workers list to fill unsustainable vacancy rates in our industry. Ultimately, this means that individuals can come to the UK to work on a visa if they can work within this role. At Unity, while we’re not opposed to this in principle, our concern is twofold: 

Firstly, many agencies have exploited this situation by engaging in poor practices. Generally, they charge people to come to the UK and provide them with employment contracts, but they fail to honour those contracts. At Unity Plus, we receive weekly calls from people desperate for work despite having contracts from other agencies that do not honour them. They have large bills to pay for their initial visa costs and no source of income, and they risk deportation if they report their situation to the authorities. Find out more about the mental health challenges often faced by healthcare workers here.

Secondly, the overreliance on this process causes concerns about standards. Nobody receiving a visa in social care is required to have experience as a carer; they only commit to doing so when they arrive. Furthermore, in 2022, the conservative government changed the criteria for communication skills, and those from overseas who are working as nurses no longer need to pass English written and oral tests; they simply need to be deemed competent by their employers.

In a world where employers are keen to bring people across on a visa to backfill a staffing shortage at a reduced salary (they only need to be paid 80% of their English counterparts), where is the incentive to be impartial regarding the individual’s communication skills? Ultimately, the person receiving support suffers. 

Health and social care industry challenges

Growing malpractice in health and social care

As agencies shift their responsibilities to the care provider, who relies on the agency’s assessment of the worker’s fitness to practice, we can reveal that agencies can be guilty of undertaking malpractice, including fabricating training records, so that people who aren’t qualified to work with vulnerable people can do so and sending staff who have no experience of working in health and social care onto a shift in care homes where they could potentially put people at risk of serious harm.

We’re aware of one instance where an individual attempted to work with us and did not have the right to work in the UK. When our team challenged them, they stated that other agencies allowed them to work and produced bank statements that showed another agency had paid money directly into their account, not through payroll. We’ve also been informed that individuals registered with an agency send others in their place to complete work in their name. At Unity Plus, we do not condone or implement these practices. 

Lack of regulations in health and social care 

Bad practices like this result from the sector’s lack of funding and the lack of a regulatory body for recruitment agencies. 

At Unity Plus, we believe that while the implementation of the Care Act in 2014 and its amendments to the Health & Social Care Act have strengthened the Care Quality Commission (CQC), the core issue remains that the CQC regulates care providers but not the agencies that supply staff to them. Regulation 2 of the Act states that “person employed” includes volunteers, contractors, agency staff, and bank staff. However, agencies themselves are not regulated under this Act. 

Regulation 15 clarifies: “Providers retain legal responsibility under these regulations when they delegate responsibility through contracts or legal agreements to a third party, independent suppliers, professionals, supply chains or contractors. They must, therefore, make sure that they meet the regulation, as responsibility for any shortfall rests with the provider.”

Since agencies are not accountable to the CQC, and care providers rely on agencies for 14% of their staffing needs (Skills for Care, October 2023), the responsibility falls on care providers to ensure compliance. In practice, providers trust agencies to be transparent and honest. This trust can be abused, allowing agencies to supply staff who do not meet the “fit and proper person’s test and falsely claim they do, passing accountability onto the provider.

The regulator for care agencies is the Employment Agencies Standards Inspectorate, which does not assess the suitability of staff for working with vulnerable people. Its role is to ensure agencies comply with the Employment Agencies Act 1973 and the Conduct of Employment Agencies and Employment Businesses Regulations 2003, focusing solely on employment rights.

Additionally, care providers have contracts with local authorities, which more frequently assess adherence to the Health and Social Care Act and work with providers to improve performance. However, local authorities do not oversee employment agencies and are only aware of them when the provider identifies a staff member as an agency employee. In these cases, the local authority simply asks for the staff member’s profile to be kept on file.

Addressing industry challenges in health and social care

So, without a regulatory body for health and social care agencies, how does Unity Plus maintain high standards and regulatory compliance and address industry challenges? 

Staff shortages are one of the biggest challenges the healthcare industry faces. Challenges in recruitment and retention have a huge impact on the quality of care provided.

Unity Plus is dedicated to supporting our clients with the challenges that they face day to day. While we can support successfully with staff shortages, we must give the homes qualified, well-trained, dedicated staff. Below are some of the practices that we adopt to allow us to do this:

• Recruitment: The staff we recruit all have a minimum of a year’s experience in a healthcare setting in the UK. This allows us to ensure that all staff have the required skills. All staff are taken through a 2-part Interview process, which consists of a telephone interview and then a face-to-face Interview. We assess all candidates based on their communication skillset, knowledge, and competency.

• Retention: We have an extremely strong onboarding process. All our staff are contacted individually throughout their first year working with us. We contact all staff after 1 week, 4 weeks, 3 months, 6 months, and then upon completion of a full year with us. The purpose of the calls is to maintain regular communication with our team, checking in on their progress, queries, and mental health, and to discuss their views on how we can change and develop to be better for our staff. 

• Technology: We use technology to monitor, track, and improve performance. We have a detailed compliance log that ensures all compliance requirements are met, leaving no room for errors. Our client matching tool enables us to match the right staff with the right clients. This takes into account who has worked at a home previously to allow continuity of care. The client matching tool monitors how many shifts a staff member has worked at each home. It’s also directly linked to feedback from the home, so if we know that a home has provided great feedback regarding a staff member, the client matching tool will highlight this, allowing us to ensure that those staff members are prioritised for those clients.
  
  We recently developed an app that allows our clients to request and monitor their shifts easily and more efficiently. The app will allow them to detail specific requirements, authorise shifts, submit timesheets, and more. This will make it easier for them to manage their bookings, giving them more time to focus on their daily lives.
  
  
• Building relationships: We invest a lot of time in getting to know our clients and their needs. This allows us to tailor our services to adapt to their changing needs. Our Business Development team regularly visits our clients to ensure they are satisfied with the service we provide, the standard of staff that we send, and our ability to monitor any changes to their requirements.

• Quality of care: This is at the heart of everything we do. As a result of this, our office team has a combined total of over 150 years of experience in senior roles in Health and Social Care. 

• Offering career advancement opportunities: We believe strongly in learning and growth. Our people are the most important aspect of what we do. As a result of this, we currently have two managers who are enrolled on a Level 5 NVQ. In addition, we have 10 members of our Customer Relations team who have been enrolled in a Level 3 NVQ. We have worked closely with the Training company to devise a personalised training plan to fuse customer service based completely around healthcare.
  
  Unity Plus also has a detailed training plan for Senior Carers. This is for both existing seniors and for our carers who are interested in progression. This allows our Healthcare Assistants the opportunity to grow their skills and progress. The training plan is based on the continued support of our nurses and existing clients, highlighting the strong relationships we have built.
  
  All of the above strategies aim to improve the quality of care while supporting our clients with the day-to-day strains that they face. Seeing an exceptional standard of care delivered makes everything we do worth doing.
  
  Find out about our future growth plans and recent business wins here.

Future predictions of health and social care within the UK

Political influence 

The general election always presents an opportunity for policy change; however, in the most recent election, there has yet to be much evidence that significant changes will occur within or for the sector.

With this in mind, a lack of regulation of employment agencies will likely continue to encourage poor practices, ultimately putting those being cared for at risk. Malpractice will likely continue without leading sector members taking control of the situation and setting up a self-regulatory body. 

Although we hope for positive changes within the sector moving forward, any promises from the new government will likely take years to come to fruition. With this in mind, it’s really important that independent care agencies hold themselves accountable for their own actions and work towards creating an environment of high standards and integrity, which will not only benefit the workers themselves.

Technological innovations

Although the government plays a significant role in shaping the sector, other factors, such as technological advancements, also contribute. 

Currently, the most exciting and impactful technology being adopted within health and social care is artificial intelligence (AI), with many of its capabilities still being uncovered and applied within the field. At present, AI is providing an extremely efficient way to manage staff shortages, as well as time management and service efficiency. In most settings, the introduction of AI chatbots has been deployed, allowing patients to easily be directed to the most appropriate resource, which continues to serve as a solution to reducing the strain and demands on the healthcare system. 

Solutions for better health and social care 

Politicians must address the issue that the NHS can only be a fully functioning healthcare system if social care is addressed first and foremost. This should be a cross-party pledge to reform social care, not just to look at the funding the sector receives, but also how it’s regulated. We would welcome the opportunity to collaborate with a cross-party committee and other providers to develop a robust, practical regulatory framework that enhances the quality of care for people.

Join our regulatory association

At Unity Plus, we would like to see a regulatory form to hold recruitment agencies to the same standards as their care provider counterparts (e.g., the Care Quality Commission (CQC) under the Care Act and Health & Social Care Act). 

Without a regulatory body like this, we call for other like-minded agencies to join us in forming an Association of Health and Social Care Agencies (AHaSCA), where we self-regulate to drive up the quality of people who work in agencies and reduce the risks to those in our care of poor practices. 

Whether you’re a care worker or a care organisation looking to work with us, get in touch with our friendly team.