The recent report from the All-Party Parliamentary Group (APPG) on Acquired Brain Injury (ABI) laid bare the scale of the work that must be done to ensure brain injury patients are properly cared for.

To truly meet demand, it said, the UK needs 14,600 neuro-rehab, in-patient beds to meet an annual caseload of around 300,000 ABI admissions. Currently, there are just 4,600 beds nationwide.

While this increase will undoubtedly add vital specialist resource to a sector which is badly in need, the report also acknowledged the growing shortage of neuro-rehab personnel.

Although the recruitment of care professionals is a problem affecting the care industry as a whole, with an estimated 100,000 vacancies at any given time, it is particularly prevalent in roles involving patients with long-term care needs.

Amid pressure to more than triple the amount of dedicated neuro-rehab beds, the necessity to address the root causes of the crisis and find a way forward is intensifying.

Professionals point to the difficult nature of the job and poor pay that have long been the nature of many care roles as being an ongoing issue, particularly in the care of brain injury patients with their associated complex needs.

The changing nature of society is also a key factor, with many young people reluctant to consider care as a career. Nicola Lowery is a specialist health and social care recruiter, who has worked in the industry since 2007. She has noticed a big change in the quality of candidates applying for roles.

“Care work used to be staffed by genuine, passionate and supportive people. People who choose the job because they are naturally caring people. While there are still some absolute gems out there who see care work as a vocation rather than just a job, the ‘old school’ qualities are increasingly hard to come by among people coming into the profession.

“The pay is poor, the hours are long. It can be physically demanding, and often with high risk of violence and aggression, and it’s often thankless too,” said Nicola, head of health and social care at Nineteen Recruitment Services.

“Rates of pay continue to be pretty appalling, considering the nature of the work. I have seen candidates who administer life saving medication paid just above minimum wage. Staff who have been bitten, kicked, punched on a daily basis, all for minimum wage.

“Care can be an easy job to get into due to providers’ constant ongoing need for staff, it often requires minimal education and qualifications and, as training and supervision will be provided on the job, experience is not always essential. This, however, can result in unsuitable people working in the sector; those who can’t manage the challenges, or aren’t necessarily genuinely passionate about supporting others. This results in high turnover and the process repeats.”

Karolina Gerlich, chief executive and founding director of the National Association of Care and Support Workers (NACAS) agrees. Having worked as a care worker herself for the past nine years, she sees first-hand many of the issues, and has been critical of the current campaign by the Department for Health and Social Care for “sugar coating” the realities of care work.

“I think retention is a bigger issue than recruitment. One of the most common problems faced is that often rotas aren’t feasible and people are told at short notice what hours they have to work, and holidays are taken away, which makes it difficult to have a life outside of work.

“One big problem is that new people constantly leave, there is a very high turnover of staff, and this puts pressure on the existing care workers. Plus, many people who have worked in social care for a long time are quitting because they burn out,” she said.

“We need to make people aware of the job and not attempt to glamourise it, as people quickly realise that this is not the reality and there are hard times in this job. This is absolutely a job worth doing but we need to be be realistic. Care is an extremely valuable and important profession that can break your heart and body. The strength of those who do this every day needs to be celebrated, but not sugar coated.

“The new government campaign with its hashtag, #Everydayisdifferent, is a great banner under which to show the variety of tasks, skills, people and jobs that social care involves, but new recruits have to come to the industry with realistic expectations.

“The campaign seems to lack balance, creating misperceptions about the realities of the job. Many of the responses I have heard from care workers are about the fact that the role is not – despite what the campaign suggests – all about dancing, bird feeding and going out together.

“Working in care is not seen as being glamorous in an age where young people want to be big social media stars. [TV journalist] Stacey Dooley recently made a documentary where five teenagers spent two days working in a care home for elderly people. They went in with the attitude that old people smell and are dying, but they finished their time there having really enjoyed their work, and that was very nice to see.”

Angela Kerr (pictured), chair of the British Association of Brain Injury Case Managers (BABICM), also believes there is a big problem in the levels of young people wanting to come into the profession.

“Currently, the younger generation are, by and large, no longer wanting to do jobs like working as a carer. The millennials, as they’re called, are setting their sights on higher paid jobs or particularly ones that involve media, so being on TV or YouTube or other social media,” she said. “I saw something that said this is now the career ambition of 70% of young people these days – their energies are going towards that rather than a career in care. When we are placing care roles, it is not generally young people who are filling these roles, it is the older people who have been in care for a long time.

“Working with neuro patients can be very complex and is not attractive for everyone – it’s something you can do or you can’t, there seems to be no middle ground. You have to really engage your brain to deal with [the job] and have to be creative in the ways you do things. It’s a more complex care role but is very rewarding, although it is challenging.”

But with the pressure to create extra neuro- rehab beds, clearly this situation needs to change. The APPG report also highlighted the regional disparities in brain injury care provision, with some parts of the North, East and South West having little or no access to neuro-rehab services or specialist providers. Angela confirmed she and fellow BABICM members see this on the ground.

“There is a big difference between regions, more people are now living in our cities and with those big populations of people it is more likely there will be people to fill vacancies in care. So, for example, in Birmingham or Manchester, the situation is easier than in say Lincolnshire or Derbyshire. I have a client in the Peak District who is having to look to Sheffield for recruitment, and even then, the people we are finding are the older generation as there are few young people coming into care.”

While much has been made of the likely impact of Brexit on the existing recruitment crisis, Angela believes this will not impact on specialist neuro care.

“While Brexit might be blamed as having some role in the wider care recruitment situation, from a neuro carer or support worker point of view, so those who are working with people with quite complex communication problems, it won’t make as much difference,” she said.

“Traditionally, this area of work has never fully utilised people with strong accents, such as from other European countries, as often they are working with people with quite complex communication problems. Unless their command of English is excellent and they know the fine details and nuances and they are clear and understandable, this would not be an area in which they would work.

“For that reason, it has never been common practice to recruit heavily from within European countries. So while the wider ‘crisis’ may be influenced by Brexit, within neuro it is a different situation.”

While there is clearly a huge amount of work to do in regard to young people’s changing career choices, Nicola is seeing some positive trends among young graduates and students wanting to go into care.

“We have got some fantastic young people who want to work in care and specialist care, as a result of them studying in that area. They’re very passionate about it and they want to put into practice some of the qualities they’ve learned.

“Admittedly we don’t have a huge bank of young people coming through who are suitable for many of our vacancies, as, to many people, care is just a job, and once the reality of it kicks in they leave, or they contact us because the Job Centre told them they have to. But there are still some super young people out there with the right ethics and personalities who give me confidence,” she said.

Angela, too, believes there is a place for graduates in helping to stem the recruitment crisis, as well as considering other more innovative ways of ensuring brain injury patients are supported.

“It is very good that we have involvement from graduates, such as from psychology or occupational therapy, who are looking for practical experience. I think that could have a growing role to play. It may not be a career choice, but they can have a big impact during their placements. While that is a short-term measure rather than a long-term solution, I do think closer working and links with universities will be increasingly important,” she said.

“Going forward, while of course they can’t entirely replace the human contact and capability, we do need to make use of alternatives where we can. We use automation and AI like Alexa and Siri already, and the use of robots is also something we should explore further.

“Assistance dogs are incredible and are a huge support to people, as well as providing that nurturing contact, so they can play an increasing role too. We have to be innovative and creative in looking at solutions or part-solutions.”

Karolina concluded: “Care staff’s hard work goes hand in hand with job satisfaction, the pride of making people smile and helping them live fulfilling lives – but the reality is that there is a huge level of vacancies to fill and a lot of work to be done. It is a job in a sector desperate for more funding at every level of provision, as well as better training standards, pay and working conditions, so these are the fundamentals that need to be addressed.”


Despite staff shortages in the care sector, people power has enabled rapid growth at Exemplar Health Care in recent years. Here Lynne Waters, HR director, shares the complex care provider’s retention and recruitment secrets.

Lynne Waters, Exemplar

Our focus as an organisation is on striving to deliver the highest quality of care; and central to this is what we call a ‘Our People Plan’, rather than an HR strategy.

This puts people at the heart of everything we do and ensures everyone understands the importance of their role in the lives of our residents.

Another minor shift in vocabulary, which actually makes a big difference, is the use of the word ‘colleague’ instead of member of staff or employee.

To do their best work and deliver an excellent level of care, colleagues must be totally engaged and motivated and have the opportunity to continually develop their skills.

They must also have clear lines of communication with other people across the business, including executives.

We achieve this through forums, leadership blogs and initiatives such as ‘Listening Groups’, which encourage colleagues to discuss, and share ideas and suggestions about, their roles, the home and improvements.

Although there are clearly different wage and management levels, the company does not feel hierarchical. This is by design. We want all colleagues to know how equally valued they are.

This starts when they first join the company and undergo an intensive induction process over a week. Whether you are a director or a carer, you will complete the same induction process with your fellow new starters.

This helps to give a full and detailed picture of the entire business and explain where individuals fit into our wider plans.

As part of Our People Plan we are operating a programme called ‘Happy, Healthy, Here’ to develop colleagues as wellbeing champions.

These champions support fellow colleagues in all aspects of wellbeing from mental health support to healthy living. This is supported by an annual wellbeing calendar with focus on specific topics to give colleagues hints and tips to stay healthy.

Creating a culture based on positive values is important in both attracting and keeping hold of vital personnel. We aim to create an inspiring, vibrant place to work in what can be a challenging sector, and we want everybody we work with to be part of that.

In terms of recruitment, we have had great results by working closely with job centres that are able to tap into local communities on our behalf.

Recruitment open days are also a fantastic way of uncovering suitable candidates and meeting people. Our current colleagues do a fantastic job at open day events, talking about what it’s like to work at Exemplar with real passion and enthusiasm, as well as portraying a realistic picture of life in a complex care setting.

This gives people a really good preview of what the jobs entail. But also, the enthusiasm of colleagues in talking about resident environments can be infectious and encourage people to think ‘this is for me and I really want to work for this company’!

We look for candidates from an array of sectors. Our Dearnevale home, for example, has a number of ex-miners who’ve forged successful care careers. Other recruits include former police officers and business people. With five new homes confirmed to open this year – in Leeds, Castleford, Liverpool, Preston and Hull – we look forward to welcoming more new faces as colleagues in the coming months.

Exemplar Health Care provides specialist nurse-led care to adults with complex needs and currently has 26 homes across the UK. Areas of focus include neuro- disability, brain injury, spinal injury, stroke, mental health conditions, complex dementia and learning disability.