Nursing Workforce, Pay and Retention in Social Care: 2025 Review

Registered nurses remain essential to safe, effective care in nursing homes across England, supporting medication management, complex needs, clinical decision-making and end-of-life care. In 2025, the nursing workforce in adult social care continued to grow, but retention remained fragile as providers balanced cost pressures, pay competition from the NHS and wider labour market and changing immigration conditions.

For nursing home operators across the West Midlands, workforce planning is now a commercial priority as well as a quality imperative. Vacancy levels have improved but turnover and pay competitiveness still determine whether homes can sustain stable rosters and consistent clinical leadership.

Workforce overview: more nurses in social care, but demand still outpaces supply

Nursing homes with nursing: capacity has strengthened but vacancies remain

Skills for Care’s 2025 workforce reporting indicates that in 2024/25 CQC-regulated care homes with nursing had around 290,000 filled posts and 13,000 vacant posts (around 305,000 total posts), with an estimated 4.7% vacancy rate, across 4,186 CQC-regulated locations. The same summary highlights that around 10% of the workforce in care homes with nursing were employed on zero-hours contracts.

Registered nurses: vacancies are down, but still material

Across adult social care overall, Skills for Care reported a registered nurse vacancy rate of 6.7% in 2024/25, continuing a multi-year improvement from the peak period earlier in the decade.

CQC’s State of Care (2024/25) also points to improved staffing metrics in care homes generally, noting that care home vacancies have continued to reduce and that turnover has fallen compared with 2021/22, but remains elevated relative to the wider labour market.

Retention in 2025: improving at sector level, but nurse turnover remains high

Turnover fell overall, yet registered nurse churn is still significant

Skills for Care reports that overall turnover across adult social care decreased year-on-year, but registered nurses remained an outlier. In 2024/25, estimated turnover for registered nurses was 32.8%, materially higher than many other roles.

This matters operationally: high nurse turnover increases agency reliance, destabilises clinical governance and places additional load on remaining nurses and managers.

What providers said in 2025: pay competition is the biggest driver

The Department of Health & Social Care's Adult Social Care Workforce Survey (published April 2025, based on Aug–Sep 2024 responses) found recruitment and retention pressures were heavily linked to better pay outside the sector. Providers most commonly cited  “better pay outside adult social care” as the leading reason for increased recruitment and retention difficulty. 

In practice, this aligns with what we see in nursing home recruitment: where pay is only marginally above minimum wage for non-registered roles, internal pay differentials compress and progression incentives weaken, which can affect retention across the whole team.

Wider pay context: the National Living Wage continues to shape care economics

Although registered nurses are not paid at NLW levels, nursing home cost bases are heavily influenced by NLW because the majority of roles in a home are care and support roles. The National Living Wage rose to £12.21 per hour from April 2025.

Working patterns: stability and flexibility are becoming a retention lever in nursing homes

For nursing homes, retention increasingly depends on predictable rotas, realistic nurse-to-resident expectations, and reducing “always-on” pressure for senior nurses who carry clinical accountability. National reporting also links turnover with employment conditions, including the use of variable-hours arrangements, and shows that more stable terms can support retention. 

2026 outlook: what we expect nursing homes to prioritise next

1) Cost pressure will continue as NLW rises again in April 2026

The UK Government has confirmed the National Living Wage will rise to £12.71 per hour from April 2026. For nursing homes, this is likely to intensify “wage drift” expectations across senior carers and nursing associate pathways and it may also increase pressure to lift nurse pay to protect differentials and reduce attrition.

2) Fair pay reforms move closer, but implementation risk remains

Policy attention is increasingly focused on formal pay-setting mechanisms in adult social care.

The  government plans on  establishing an Adult Social Care Negotiating Body in 2026 as a public body through secondary legislation, using powers provided by the Employment Rights Bill. It will bring together trade unions and people representing employers to negotiate on pay, terms and conditions, and related matters.  

3) Retention will be the differentiator, not just recruitment

Vacancy rates have improved, but high nurse turnover is still disruptive and expensive. In 2026, providers who reduce churn through clearer clinical career pathways, stronger supervision, funded training and rota stability are likely to outperform those relying on reactive hiring. 

What’s keeping nurses in social care roles?

Drawing together national data and market conversations, nursing homes that retain nurses best tend to offer:

• Competitive, transparent pay and protected differentials
• Predictable rotas and fair workload distribution
• Supportive clinical leadership and stable registered management
• Funded training, progression routes and strong onboarding
• Values-led culture where nurses feel respected and listened to

How Flourish Medical supports nursing homes in the West Midlands?

We support nursing homes and social care providers across Birmingham, Wolverhampton, Worcester, Walsall, Dudley, Solihull, Coventry and the wider region with:

• Targeted permanent recruitment of registered nurses aligned to your service model and shift pattern
• Reliable short-term cover to protect occupancy and compliance during sickness, vacancies and growth
• Local market insight on pay expectations, availability and retention drivers so you can position roles competitively
• Hiring support including role profiling, advert wording and interview planning to reduce time-to-hire and improve fit

What nursing homes should do now for 2026 workforce stability

• Benchmark nurse pay and differentials ahead of the April 2026 NLW increase
• Review rotas and escalation expectations to reduce burnout-driven turnover
• Build a visible development pathway (preceptorship, dementia competency, clinical lead steps)
• Put a plan in place for agency reduction by strengthening your “bank” and pipeline

Talk to us

If you are a nursing home in the West Midlands planning your 2026 staffing strategy or a registered nurse exploring a move into social care nursing, Flourish Medical can help.

Contact our friendly team today.