Navigating Employment Challenges in the Care Industry

  • 09 November 2023 09 November 2023
  • Casualty claims

Insights from BABICM Survey on rates, recruitment, and skills for care

A recent survey conducted by the British Association of Brain Injury Case Managers (BABICM) [i] has unveiled the critical employment challenges faced by the care industry. 

The study highlights the deteriorating recruitment and retention of skilled support workers, with no signs of improvement. These issues have profound consequences, impacting the health and well-being of claimants with complex needs and their families, increasing the financial burden of care costs, and even jeopardising the ability to provide essential care services.

The current estimated vacancy rate in England for 2022/23 for adult social care vacancies in the independent sector is 127,000 and across the whole of the adult care sector is 152,000 per day. [ii]

One of the aims of the survey was to highlight to the medico legal industry the rates of support work that are now being asked for and paid.

Recruitment Challenges:

The survey aimed to shed light on the rates of support work demanded by the industry and the difficulties in recruiting staff. Over a period of six days, it received just over 200 responses, revealing that a staggering 90% of respondents faced increased difficulty in recruiting support staff.

The primary obstacle in recruitment was the shortage of suitable applicants, aggravated by factors such as low pay, more lucrative opportunities in other sectors, poor working conditions, and a lack of necessary skills in many candidates. Brexit, unsociable hours, low employment status, and an undervaluing of the support worker role were also cited as significant contributors to the problem.


The survey explored the rates for support workers, indicating that rates varied considerably. Directly recruited staff typically earned between £13 to £21 per hour, with the majority reporting earnings of £14 to £15 or more. In contrast, agency support worker rates ranged from £20 to £40 per hour. Agency nurse rates were even higher, ranging from £40 to £80 per hour, with last-minute cover costing between £500 and £1000 per shift in some cases.

The updated report on the adult social care sector and workforce in England by Skills for Care (published October 2023), estimates that in 2022/23 in the independent sector, care workers were paid a mean hourly rate of £10.34 (median £10.11, senior care workers were paid a mean hourly rate of £11.09 and personal assistants were paid a mean of £10.92 an hour). Overall, pay rates were higher in local authorities compared to independent sector employers.

Recruitment Incentives:

To attract staff, organisations have had to provide greater incentives, including paying time and a half for emergency cover, double time, and even triple time on holidays like Christmas Day. Additionally, some have had to resort to employing more expensive agency workers due to failed recruitment drives, exacerbating the overall cost per hour.

Consequences of Recruitment Difficulties:

The inability to source staff and failed recruitment drives has severe consequences. Some cases have resulted in individuals relying on family members or community-based support, and in extreme situations, individuals have had to move into residential care facilities. Vulnerable clients are left without support, leading to admission to care homes, while shifts are being reduced in frequency or duration. Families are faced with increasing pressure to provide care in the absence of formal support.

Essential carers report being denied entry into care homes due to their vaccination status, leaving clients with basic care.

When asked about the impact of mandatory COVID-19 vaccinations, over 82% of respondents anticipated that recruitment and retention of staff would be adversely affected. Mandatory vaccinations were perceived by some as an ethical issue, further exacerbating the recruitment crisis. Most respondents viewed this mandate as worsening an already challenging situation and potentially leading to the loss of skilled and experienced staff.

The survey revealed a striking unity of concerns among respondents. Low rates of pay, the aftermath of Brexit, unfavourable employment conditions, the pandemic's impact, and the undervalued status of support work were consistent issues.

However, employers with favourable workforce metrics (such as high levels of learning and development), on average, had better outcomes (lower staff turnover and/or high CQC ratings) [iii].

The consequences of recruitment difficulties are far-reaching, affecting service users, increasing costs, and raising safeguarding concerns. Additionally, it places extra burdens on case managers, leading to a reliance on more expensive services, and increasing the risk of losing community placements.


In summary, the ongoing recruitment crisis has currently no end in sight and the suggested increase of wages and improved conditions of work are necessary. The increased difficulties are also impacting on case management costs, which has further implications for funds and funding.

The 2023 Skills for Care report states that the workforce data set for this year did show some improvements in workforce capacity driven by international recruitment, more filled posts, fewer vacant posts, and lower turnover. However, “if the workforce grows in line with demographic changes, we are going to need an extra 440,000 roles by 2035 and we have 440,000 posts filled by people who will reach retirement age in the next 10 years”.

It is therefore vital that any Care Expert reports already obtained are up to date, to ensure that the hourly rates quoted are current and reflects what is being paid to support workers locally. 

In view of the increasing costs of care, Claimant’s solicitors are now more likely to seek periodical payments for case management and care, particularly where their client has substantial care needs. 

[ii] The State of the adult social care sector and workforce in England, published October 2022 (update published October 2023)


Additional authors:

Vanessa Brooks, Senior Associate

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