top of page
Lay Summary
The association between staff retention and English care home quality
Stephen Allan and Florin Vadean, August 2021


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. Some evidence from the USA suggests that staffing factors impact on quality outcomes, but there is little evidence for the UK.


This study explored the influence that various measures of workforce composition, including staff retention, had on the quality of English care homes. Quality was measured using the national health and social care regulator’s – the Care Quality Commission (CQC) – quality ratings. The CQC monitors a provider’s quality of care according to five key questions, asking if the care home is: safe, effective, caring, responsive and well-led. Based on monitoring and inspections around these questions, homes are given a rating of either ‘Inadequate’, ‘Requires improvement’, ‘Good’ or ‘Outstanding’.

Using a national dataset of care home staffing for 2016, we examined the relationship between care home quality and the following workforce composition measures: job vacancies, staff turnover and retention, temporary workforce (e.g. agency staff), resident to staff ratio and the nursing staff ratio (the number of nurses to other direct care-giving staff, for nursing homes only).


We found that care homes with higher levels of job vacancies and staff turnover were more likely to have lower quality ratings, while homes with high levels of staff retention were more likely to have better quality ratings. The size of the negative relationship between job vacancies and care home quality was larger for nursing homes compared to residential homes. We further found no influence of temporary staff, resident to staff ratio or nursing staff ratio (for nursing homes) on quality. 


Our findings suggest that care home providers could significantly improve the likelihood of a ‘Good’ or ‘Outstanding’ quality rating by improving staff recruitment and retention. Conversely, a large negative change in a care provider’s staffing circumstances could have an adverse influence on their CQC quality rating. 


These results are a first step in assessing how staffing impacts on quality in care homes in England and provide support for national policies aimed at improving recruitment and retention of the workforce in social care. Future work could look to assess employee-level factors such as wages and training and their relationship with care quality.


Stephen Allan,

bottom of page