The impact of workforce composition and characteristics on English care home quality

February 8, 2018

By Stephen Allan and Florin Vadean

Quality of care is a fundamental goal for policymakers in the social care sector. At the same time, the social care sector is highly labour intensive and so it is likely that care home staff will have a large bearing on the quality of care that residents will receive. There is some evidence from the USA that suggests that staffing factors impact on quality outcomes, but there is little evidence for the UK. We have explored the impact of various measures of workforce composition and characteristics on the quality of English care homes in 2016.

Quality is measured using the national health and social care regulator’s – the Care Quality Commission (CQC) – quality ratings. These can rate a care home as inadequate, requires improvement, good or outstanding.

From a national dataset of care home staffing we examine the following workforce composition measures and characteristics: job vacancies, staff turnover and retention, temporary workforce (e.g. agency staff), and the nursing staff ratio (the number of nurses to other direct care-giving staff, for nursing homes only).

We find that care homes with higher levels of job vacancies are less likely to have higher quality and homes with high levels of staff retention are more likely to have better quality ratings. We further find that there is no impact of temporary staff, staff turnover or nursing ratio (for nursing homes) on quality.

The size of the impact of job vacancies and staff retention on the likelihood of having a good or outstanding quality rating could be quite large for a care home provider that improves recruitment and retention policy or where the provider suffers from a large negative change in staffing circumstances.

These results are a first step in assessing how staffing impacts on quality in care homes, but more work is required.

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