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Workforce inequalities in health and adult social care

A report examining how discrimination and unequal treatment affect staff across health and adult social care, and the impact on care quality, staff wellbeing and service delivery.

Key statistics 

  • the employee voice survey received 832 responses, of which 646 were included in analysis after data cleaning 
  • 41% of survey respondents reported personally experiencing and or observing race or ethnicity-related inequities, 32% reported sex or gender-related inequities, 22% physical disability or condition-related inequities, and 18% mental health condition or illness and nationality-related inequities 
  • more than two-thirds of respondents reported experiencing and or observing two or more types of inequities 
  • 77% of respondents identified attitudes of leaders or managers as a condition driving workforce inequities, 66% identified attitudes of staff or colleagues, and 62% identified organisational culture 
  • more than 80% of respondents reported feeling upset or distressed due to experiencing inequities, and over half had considered leaving their job as a result 
  • 54% of respondents said robust procedures to ensure complaints are acted on were effective, but only 31% said these were available in their organisation 
  • 45% said senior leadership engagement was effective, but only 28% said it was present in their organisation 

Key messages 

  • The report uses the term inequalities; however, many of the differences described reflect avoidable and unfair patterns, and can therefore be understood as inequities. 
  • race and ethnicity-related workforce inequities were the most commonly reported form of unequal treatment across health and adult social care 
  • combined or intersectional discrimination was common, with many staff reporting overlapping inequities linked to more than one protected characteristic 
  • workforce inequities were linked to distress, anxiety, social exclusion, reduced career progression and intentions to leave work 
  • inequities were shaped by both interpersonal factors, such as attitudes of managers and colleagues, and structural factors, such as organisational culture and systems 
  • workforce inequities can affect care quality, staff willingness to speak up, and interactions with people using services 
  • common EDI activity such as staff training and celebrating diversity was widespread but often seen as less effective than strong complaints procedures and visible senior leadership engagement 

Policy implications 

  • set clear and measurable workforce EDI targets and link them to accountability and progress monitoring 
  • expand collection and use of workforce EDI data across all providers, not only NHS trusts 
  • strengthen complaints, grievance and speaking up systems so staff can report inequities safely and with confidence 
  • make senior leaders clearly responsible for workforce equality and embed this into regulation and assessment 
  • move beyond tick-box EDI activity and support more practical action on everyday discrimination, harassment and exclusion 
  • strengthen the evidence base linking workforce inequities to care quality and outcomes for people using services 

Gaps 

  • the report identifies a need for more research on disabled staff, sector differences, and the underlying causes of some reported experiences such as isolation and exclusion 

Commentary 
This report looks at workforce inequities across health and adult social care and shows that these are not only staff issues. They also affect how care is delivered. The report was commissioned by CQC and combines survey data, interviews, literature review and case studies to understand what workforce inequities look like, what drives them and what helps reduce them. 

A central finding is that race and ethnicity-related inequities were the most commonly reported. Staff also reported inequities linked to sex or gender, disability, mental health conditions and nationality. Many respondents described overlapping forms of discrimination, which matters because people do not experience these issues one at a time in real life. 

The report makes clear that workforce inequities are shaped by both workplace culture and wider systems. Staff most often pointed to managers’ attitudes, colleagues’ attitudes and organisational culture as key drivers. That matters for care equity because staff who are excluded, ignored or treated unfairly may be less able to progress, less likely to stay, and less likely to speak up when something is wrong. 

The findings also show a clear link between workforce inequities and the quality of care. The report says staff experiencing inequities reported negative effects on service quality, care quality and interactions with people using services. In particular, more than 40% of respondents experiencing or observing race or ethnicity-related inequities reported poor interactions with patients or people using services. 

From a care equity perspective, this is important because inequities affecting staff can feed through into inequities affecting people who use services. If some parts of the workforce are more exposed to bullying, poorer progression, low pay or unsafe speaking up cultures, that can affect continuity, trust and service quality. It can also be worse in parts of the system already under pressure, including adult social care, smaller providers and areas facing recruitment and funding problems. 

Another useful finding is that the most common EDI activity was not seen as the most effective. Staff training and celebrating diversity were common, but respondents were more likely to value strong complaints systems, transparent data and visible senior leadership action. This suggests that tackling workforce inequities needs practical follow-through, not just awareness activity. 

Overall, the report shows that workforce inequities are part of wider structural problems in health and adult social care. Improving care equity means paying attention to how staff are treated, who is heard, who progresses, and who feels safe at work. Without that, inequities in the workforce are likely to continue affecting inequities in care. 

Quality of working life in health and social care during COVID-19

A mixed-methods study examining the quality of working life, wellbeing and coping strategies of health and social care workers in the UK during the COVID-19 pandemic.

Key messages 

  • many health and social care workers reported poor mental health and wellbeing 
  • burnout and emotional exhaustion were widespread 
  • job insecurity and low pay contributed to stress and dissatisfaction 
  • staffing shortages increased workload and pressure on remaining staff 
  • workplace inclusivity influenced how workers experienced support during the pandemic. 

Policy implications 

  • workforce wellbeing should be a central focus of recovery planning 
  • addressing pay and staffing levels may reduce burnout 
  • inclusive workplace cultures can support resilience 
  • mental health support for staff remains essential beyond crisis periods. 

Gaps 

  • the study focuses on experiences during the COVID-19 pandemic 
  • challenges beyond the pandemic period are not directly examined 
  • findings rely on self-reported experiences 
  • longer-term workforce outcomes are not assessed. 

Commentary 
This study provides a detailed account of how the COVID-19 pandemic affected the working lives of health and social care staff. It documents high levels of burnout, declining mental wellbeing and the cumulative impact of sustained pressure during crisis conditions. Participants described how staffing shortages and job insecurity intensified workloads and reduced the capacity of services to meet demand. These pressures also affected morale and the ability of workers to provide the quality of care they aspired to deliver. 

From a care equity perspective, the findings highlight how workforce strain can deepen inequities within care systems. Workers in lower-paid or less secure roles faced greater exposure to stress and burnout, while service users experienced variable support depending on staffing levels and workforce stability. These dynamics risk reinforcing uneven experiences of care across settings. 

Overall, the study stresses the importance of workforce wellbeing as a foundation for equitable care. Addressing mental health, pay and staffing issues is essential not only for supporting workers, but for sustaining fair and reliable health and social care services in the longer term.

Safe staffing, wellbeing and intentions to leave among social workers 

A study examining perceptions of safe staffing, mental wellbeing and intentions to leave the profession among UK social workers.

Key statistics 

  • around 65% of social workers reported insufficient staffing to adequately support people drawing on care and support 
  • workers aged 30-39 reported the highest sickness absence and strongest intentions to leave 
  • intentions to leave were not strongly associated with region, gender or job role. 

Key messages 

  • perceptions of unsafe staffing levels are widespread 
  • workload and burnout negatively affect mental wellbeing 
  • increased administrative demands reduce time for direct practice 
  • reliance on agency staff reflects workforce instability 
  • wellbeing concerns are closely linked to intentions to leave the profession. 

Policy implications 

  • safe staffing standards are needed to support practice quality and worker wellbeing 
  • reducing administrative burden may help retain staff 
  • addressing burnout could reduce sickness absence and turnover 
  • workforce planning should consider age-related risk of exit from the profession. 

Gaps 

  • the sample is weighted towards respondents from Northern Ireland 
  • findings rely on self-reported data 
  • further research on safe staffing thresholds is ongoing. 

Commentary 
This study highlights the relationship between perceived staffing adequacy, wellbeing and retention among social workers. Many participants described feeling unable to meet the needs of people they support due to insufficient staffing, alongside growing administrative demands. 

The findings show how workload pressures translate into sickness absence and intentions to leave, particularly among mid-career workers. Dependence on agency staff was described as both a symptom and a driver of instability, adding complexity to team functioning and continuity. 

From a care equity point of view, the study illustrates how workforce shortages affect both workers and service users. Where staffing levels are inadequate, social workers have less capacity to provide timely and consistent support, increasing the risk of uneven access and outcomes for people drawing on care and support. At the same time, burnout and poor wellbeing disproportionately affect those in high-pressure roles. 

Overall, the paper highlights that safe staffing is not only a workforce issue but a care quality issue. Improving staffing levels and working conditions is essential to sustaining an equitable social care system that supports both practitioners and the people they serve. 

Staff retention in intellectual disability social care services

A qualitative study exploring factors that influence job retention among social care staff working in intellectual disability services.

Key messages 

  • relationships between care staff and individuals drawing on support were central to job satisfaction 
  • pay was an important factor influencing decisions to stay or leave 
  • job fulfilment was linked to feeling valued and able to provide good care 
  • some staff actively sought alternative employment due to working conditions 
  • retention was shaped by a combination of relational, financial and organisational factors. 

Policy implications 

  • retention strategies should recognise the importance of relationships in care work 
  • pay and conditions remain key levers for reducing turnover 
  • interventions to improve job satisfaction may support workforce stability 
  • intellectual disability services may require tailored retention approaches. 

Gaps 

  • findings are based on qualitative data 
  • the study focuses on intellectual disability services only 
  • limited insight into the impact of specific retention interventions 
  • further research is needed on how organisational change affects retention. 

Commentary 
This study highlights the complex reasons why social care staff choose to remain in or leave roles, within intellectual disability services. While pay emerged as an important consideration, the quality of relationships with individuals receiving support was equally influential in shaping job satisfaction. 

Participants described care work as meaningful when they felt able to build trusting relationships and provide consistent support. Where organisational pressures limited this relational aspect, motivation to stay diminished, even when staff valued the work itself. 

Considering care equity, the findings point to how workforce instability can disproportionately affect people with intellectual disabilities. High turnover and staffing instability disrupts relationships that are central to continuity and quality of care, potentially leading to uneven experiences. At the same time, low pay and poor conditions reflect broader inequities faced by a workforce that is often undervalued. 

Overall, the study suggests that improving retention requires attention to both material conditions and the relational nature of care. Supporting staff to remain in post is essential not only for workforce sustainability, but for delivering equitable and person-centred support to people with intellectual disabilities. 

Organising among paid care workers

A qualitative study exploring the priorities, experiences and progress of paid care worker organising in England, with a focus on pay, conditions and worker voice.

Key messages 

  • care workers identified pay and working conditions as central concerns 
  • systemic and structural issues shape everyday experiences of care work 
  • participants highlighted limited influence over decision-making processes 
  • organising was seen as a way to make care workers’ experiences more visible 
  • informal practices and collective action were used to address workplace issues. 

Policy implications 

  • decision-making in social care should better reflect frontline experience 
  • mechanisms to support worker voice could strengthen workforce sustainability 
  • pay and conditions remain key levers for recruitment and retention 
  • engagement with care worker organisations may improve policy relevance. 

Gaps 

  • findings are based on qualitative interviews 
  • the study does not assess the impact of organising on outcomes 
  • experiences may vary across regions and care settings 
  • longer-term analysis of organising efforts is needed. 

Commentary 
This study provides insight into how paid care workers in England understand their working conditions and the role of organising in addressing long-standing challenges. Participants described organising as both a response to low pay and poor conditions and a way of asserting professional identity within a marginalised sector. 

The findings show that care workers often feel disconnected from decision-making structures that shape their work. Organising activities were framed as efforts to make everyday realities visible to employers and policymakers, rather than solely as formal union activity. 

Considering care equity, the study highlights how unequal power within the workforce affects both workers and the people they support. When care workers’ voices are excluded from policy and practice, inequities in pay, security and conditions are sustained. These workforce inequities have downstream effects on continuity and quality of care, particularly in a sector employing large numbers of women and people from marginalised groups. 

Overall, the paper suggests that supporting care worker voices is not only a labour issue but a care issue. Strengthening avenues for collective input may contribute to fairer working conditions and a more equitable and stable care system. 

Wellbeing and staff turnover in the adult social care workforce

This study examines social workers’ perceptions of safe staffing levels and correlate these perceptions with standardised measurements of well-being in the UK

Key Stats: 

  • Almost two thirds of social workers stated that their service did not operate with a ‘staff-to-service ratio’. 
  • over 75% staff who have taken between 11 to 20 sick days from work are respondents who stated they do not work in a safe ‘staff-to-service’ ratio work environment. 

Key Messages 

  • England has the highest proportion of staff working in unsafe staff-to-service ratios, followed by Northern Ireland. 
  • Staff in unsafe conditions are twice as likely to leave their organisation compared to those in safer environments. 
  • Workload pressures are increasing, with insufficient staffing to meet care needs, leading to unsafe working conditions. 
  • Staff report compromised practice, poor decision-making, and inability to follow procedures due to being overstretched. 
  • There is no capacity to cover absences or annual leave, resulting in frequent overtime. 
  • Staff are forced to prioritise administrative tasks over direct care, reducing time with those they support. 
  • Wellbeing is impacted: staff feel burned out, less resilient, and overwhelmed by unmanageable caseloads. 
  • Post-COVID pressures persist, with unreasonable demands from management and lack of understanding of burnout. Staff feel ignored by managers, with delayed responses and insufficient support from senior leadership. 
  • High turnover and intentions to leave the profession are driven by daily pressures and feeling unheard. 

Commentary 

This paper highlights the increasing pressures faced by the social care workforce due to limited capacity and insufficient administrative support. Staff report burnout from covering understaffed shifts, receiving low pay, and being unable to take annual leave without burdening their colleagues. These conditions compromise staff wellbeing and restrict their ability to move beyond crisis management, limiting opportunities for training, skill development, and career progression. While staff remain committed to meeting the needs of those who draw on care and support, the current staff-to-service ratios are unsustainable. Many report having less time to provide personalised care, with the shortfall directly impacting people who are drawing on services. This is recognised as a national issue, not just an organisational one, with widespread capacity challenges across the sector. 

This article calls for urgent action to address workforce capacity, improve training, and support newly qualified social workers, who experience particularly high turnover rates. Current practice falls short of BASW’s guidance, which recommends 80% of time spent engaging with service users and 20% on administration. Limitations of the study include a homogeneous sample in regards to ethnicity and an overrepresentation of respondents from Northern Ireland. Additionally, authors note that findings may not be representative of all social workers, as those who responded to open-ended questions likely held strong views on the issues discussed.