Adult Social Care Briefing
Issue 016 | 16 October 2026
A slightly later briefing this week while I’m away, bringing together the developments I think matter most for leaders of adult social care services for older people in England.
This week’s focus is workforce stability, delegated healthcare activity, a National Patient Safety Alert affecting blood ketone testing, and what recent CQC findings tell us about the difference between having assurance systems and knowing whether they are effective.
This Week’s Headline
Skills for Care Publishes Its 2026 Workforce Report: Retention Needs More Than Recruitment
Skills for Care published The state of the adult social care sector and workforce in England, 2026 on 14 October, using data from 2025/26.
The report examines workforce size and structure, recruitment, retention, pay, training and qualifications, international recruitment and factors associated with both staff turnover and CQC ratings.
What Has Changed?
The wider workforce picture has improved in some respects. Skills for Care reports that the adult social care vacancy rate fell to 6.2% in 2025/26, equivalent to around 96,000 vacancies on any given day and the lowest vacancy rate recorded in a decade. Filled posts increased by 1.4%, or approximately 22,000, although Skills for Care describes this as the slowest workforce growth in four years.
The more interesting findings concern retention.
Skills for Care identified five employment and development factors associated with lower turnover among care workers:
competitive pay;
guaranteed hours;
training;
relevant qualifications; and
full-time employment opportunities.
Where all five factors were present, care-worker turnover was 15.3%, compared with 34.3% where none were present. Management experience was also associated with workforce stability. Skills for Care reports that care-worker turnover reduced from 28.3% to 20.6% as registered-manager experience increased.
The report also found associations between stronger CQC ratings and workforce characteristics including staffing ratios, pay, training opportunities, Care Certificate uptake and lower vacancy rates. These are associations rather than evidence that any individual factor causes a particular outcome.
Why It Matters
Recruitment remains important, but the findings strengthen the case for looking beyond vacancy numbers.
Repeatedly replacing staff who leave is expensive, disruptive and can affect continuity for people receiving care. Workforce assurance should therefore consider whether experienced staff and managers are staying, not simply whether vacant shifts are being filled.
For boards and senior leaders, workforce stability and quality improvement should not sit in completely separate conversations. Skills for Care’s analysis suggests there is value in considering employment conditions, training, leadership stability and quality outcomes together.
Actions for Providers
Review workforce information beyond the overall vacancy percentage. Look at turnover by service, role and length of employment, including how many people leave within their first year. Consider whether pay, contractual arrangements, training, qualifications, progression and management support are contributing to retention.
Review registered-manager stability and succession arrangements. Where management turnover is high, consider whether the organisation understands the reasons rather than treating each vacancy as an isolated recruitment problem.
Clinical Governance
Delegated Healthcare Activities Are Now Being Measured Across Adult Social Care
One of the notable additions to this year’s Skills for Care report is national data on delegated healthcare activities. Skills for Care reports that non-nursing staff undertake delegated healthcare activities in 59% of responding CQC-regulated services. An estimated 46% of direct-care workers in those services undertake delegated healthcare activities.
What Has Changed?
This is new workforce intelligence.
Skills for Care defines delegated healthcare activities as activities that a regulated healthcare professional delegates to a colleague working in a non-regulated role.
The figures provide a clearer indication of how significant these activities have become within adult social care delivery.
Why It Matters
For providers, the numbers reinforce the need to know what clinical activity is actually being undertaken across services. A competency document alone does not demonstrate that delegation remains safe. Governance needs to be clear about which activities are delegated, who made the decision to delegate, whether the individual remains competent, what supervision is available and what happens when the person’s condition changes. The issue is particularly important where care workers are supporting increasingly complex health needs outside traditional healthcare settings.
Actions for Providers
Identify the delegated healthcare activities currently being undertaken across your services.
Confirm who holds professional responsibility for each decision to delegate.
Review how competence is assessed, maintained and reassessed.
Make sure staff understand when they should stop an activity and seek clinical advice.
Consider whether incidents, changes in condition or concerns trigger review of the delegation arrangement.
Patient Safety
National Patient Safety Alert Issued for Nova Biomedical StatStrip Blood Ketone Test Strips
A National Patient Safety Alert was issued on 13 October concerning Nova Biomedical StatStrip blood ketone test strips. The alert, NatPSA/2026/007/NSDR, was issued following quality issues affecting specified lots, associated quality-control failures and the manufacturer’s recall of affected stock. It was issued through the Central Alerting System to a range of organisations including social care providers registered with CAS.
What Has Changed?
The alert follows MHRA Device Safety Information issued on 9 October.
Nova Biomedical has paused distribution of affected lots and advised that affected stock should not be used. The alert states that further lots failing quality-control testing should also be withdrawn. At the time the alert was issued, Nova expected new product to become available for shipment to the UK during the week commencing 26 October. This is an expected supply position rather than a guaranteed resolution date.
The National Patient Safety Alert set:
an action-underway deadline of 15 October 2026; and
an action-complete deadline of 20 October 2026.
Why It Matters
Not every adult social care service undertakes blood ketone point-of-care testing.
Where the equipment is used, however, the issue is potentially significant because affected stock should not be used and alternative testing arrangements may be required. This may be particularly relevant to nursing services and other settings where blood ketone testing forms part of an agreed clinical pathway or delegated healthcare activity.
Actions for Providers
Establish whether any service uses Nova Biomedical StatStrip blood ketone testing.
Where it is used, ensure the responsible clinical lead has reviewed NatPSA/2026/007/NSDR and the manufacturer’s affected-lot information.
Affected stock should be removed from clinical use in accordance with the alert, and alternative testing arrangements should be clear where blood ketone monitoring is required. Where the alert applies, ensure completion of the required actions by the specified deadline.
Regulation and Quality Assurance
CQC Findings Show Why Assurance Needs to Look Beyond the Dashboard
Two CQC publications this week provide useful, contrasting examples of how staffing, culture and governance translate into people’s experience of care.
Acer Court Care Home in Nottinghamshire was rated Requires Improvement in an assessment report published on 13 October. On 14 October, CQC announced an Outstanding rating for Assist Care Group – Surrey, a homecare service supporting adults including people living with dementia.
What Has Changed?
These are individual CQC findings.
At Acer Court, CQC found that staffing levels matched the dependency tool being used to determine safe staffing. Despite this, people were sometimes left without staff oversight in communal areas or remained in their rooms for prolonged periods without safety checks. CQC also identified poor infection-control measures, damaged pressure-care equipment, medicines not always being administered as prescribed, including time-specific medicines, a culture in which some staff did not feel able to speak up, and governance systems that had either failed to identify or failed to address the concerns found during the assessment.
CQC had served a warning notice on the provider on 15 September in relation to safe care and treatment, staffing and good governance.
The Assist Care Group findings provide a useful contrast.
CQC reported an average staff length of service of seven years and described leaders as monitoring day-to-day service activity and performance to drive improvement.
When an increase in reported falls was identified, leaders sought staff views on potential causes and worked with them to make changes. CQC also found that staff had access to a support team while working in the community so that changes in people’s condition could be addressed in real time.
Why It Matters
A staffing tool can demonstrate that the calculated number of staff are rostered. It cannot, on its own, demonstrate that staff are deployed effectively or that people receive the supervision and support they require.
The same principle applies to audits and dashboards.
Their value lies in whether they identify emerging risks, support professional challenge and lead to improvement.
The Assist Care Group findings also show the other side of assurance: using information such as falls data to understand why something is changing and involve staff in improving the response.
Actions for Providers
Review how staffing deployment is assured, not only whether rostered numbers match dependency calculations.
Look at high-demand periods such as medicines rounds, mealtimes, evenings and shift handovers.
Check whether time-specific medicines are being administered at the required times.
Consider how confidently staff can raise concerns and what evidence exists that those concerns lead to action.
Test whether audits and dashboards identify risks already visible to people receiving care, relatives and frontline staff.
Where trends change, such as an increase in falls, examine whether governance processes move beyond counting incidents to understanding causes and evaluating action.
Leadership Reflection
Workforce Stability Is a Quality Issue
One of the strongest messages from this week’s workforce report concerns the relationship between staff experience, employment conditions and the quality of care people receive. It is easy for workforce discussions to become dominated by recruitment numbers, vacancies and agency expenditure. Those figures provide only part of the picture.
A service may have few vacancies while experiencing repeated changes in its workforce. Another may have a stable and experienced team but limited development opportunities or increasing clinical responsibilities that are not fully recognised.
The findings concerning registered-manager experience are particularly important.
Leadership develops through experience, professional judgement and an understanding of the people, staff and services involved. Repeated changes in management can disrupt continuity and make sustained improvement harder.
There is therefore an organisational responsibility to create the conditions in which good managers can remain effective.
We frequently talk about supporting and retaining care staff. We should be equally interested in what enables good managers to stay, develop and lead well.
Five Things I’d Be Thinking About This Week
Workforce retention: Are we looking closely enough at why people leave during their first year, and what encourages experienced staff to remain?
Management stability: Are we supporting good managers to stay and develop, or repeatedly rebuilding the same management teams?
Delegated healthcare: Could we clearly identify which activities are delegated, who authorised them and how competence and clinical oversight are maintained?
Patient safety: Have we established whether the StatStrip blood ketone alert applies anywhere in our organisation?
Governance: Are our staffing, audit and incident systems telling us what is actually happening in services, or mainly confirming that expected processes have been completed?
Sources
The state of the adult social care sector and workforce in England, 2026. — Skills for Care. Published 14 October 2026; data period 2025/26.https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/workforceintelligence/Reports-and-visualisations/National-information/The-State-of-report.aspx
New Skills for Care report identifies factors linked to better retention of care workers and higher quality of care — Skills for Care. Published 14 October 2026.https://www.skillsforcare.org.uk/news-and-events/news/new-skills-for-care-report-identifies-factors-linked-to-better-retention-of-care-workers-and-higher-quality-of-care
Adult social care vacancy rate falls to lowest level in a decade as workforce grows — Skills for Care. Published 24 June 2026. Used to verify the 2025/26 vacancy and workforce figures carried forward into the October report.https://www.skillsforcare.org.uk/news-and-events/news/adult-social-care-vacancy-rate-falls-to-lowest-level-in-a-decade-as-workforce-grows
Supply disruption for Nova Biomedical StatStrip blood ketone test strips – NatPSA/2026/007/NSDR — National Patient Safety Alert, National Supply Disruption Response. Issued 13 October 2026.https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103281
Nova Biomedical StatStrip ketone test strips: risk of disruption to blood ketone testing due to quality-control failures and supply interruption DSI/2026/013 — Medicines and Healthcare products Regulatory Agency. Published 9 October 2026.https://www.gov.uk/drug-device-alerts/nova-biomedical-statstrip-ketone-test-strips-risk-of-disruption-to-blood-ketone-testing-due-to-quality-control-failures-and-supply-interruption-dsi-slash-2026-slash-013
Acer Court Care Home – Assessment report AP28981 — Care Quality Commission. Published 13 October 2026.https://www.cqc.org.uk/location/1-319747838/reports/AP28981/overall
CQC rates Surrey home care service outstanding — Care Quality Commission. Published 14 October 2026.https://www.cqc.org.uk/press-release/cqc-rates-surrey-home-care-service-outstanding
Editorial Note
This briefing reviews material developments published or substantively updated between 9 and 16 October 2026. This edition is being published one day later than usual. Official material from CQC, NICE, NHS England, GOV.UK, including DHSC and MHRA, and relevant sector sources was reviewed. Items have been included according to their practical relevance to providers of adult social care for older people rather than simply because they were published during the period.
The Skills for Care findings about employment conditions, management experience, turnover and CQC ratings identify statistical associations. They should not be interpreted as proving that individual workforce factors cause a particular retention or regulatory outcome.
NatPSA/2026/007/NSDR is a National Patient Safety Alert with an action-complete deadline of 20 October 2026. It applies specifically to the Nova Biomedical StatStrip blood ketone testing issue described in the alert.
The CQC findings relate to individual registered services and are included for learning and assurance purposes.
The Why It Matters, Actions for Providers, Leadership Reflection and Five Things I’d Be Thinking About This Week sections contain professional interpretation and practical considerations based on the cited evidence.
Looking Ahead
22 October – Adult Social Care Finance Report
DHSC has confirmed that Adult social care finance report, England: 2025 to 2026 will be published on 22 October 2026.
The report will provide official statistics on adult social care expenditure and income across councils with adult social services responsibilities in England.
This should be useful next week for understanding the wider financial and commissioning context, although national and local authority expenditure statistics should not be treated as evidence of the actual cost of delivering an individual care service.
29 October – Adult Social Care Survey
DHSC has confirmed that Adult social care survey, England: 2025 to 2026 report will be published on 29 October 2026.
The publication will provide official statistics on the outcomes and experiences of people aged 18 and over receiving long-term adult social care services in England.
The findings will be worth reviewing once published, particularly for what they tell us about people’s experience of care, quality of life and the impact of services, rather than drawing conclusions before the data is available.
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