‘The author then decamped to Blackpool to work in that fecund and oxymoronic sector, “caring”…twenty minutes per visit, maximum. The carers had trained themselves to use loaded questions to speed visits along… “You don’t need any shopping today, do you?”. The elderly client, not wishing to cause bother, would invariably answer the questions, “No”. That’s the care industry for you.’
This is Rod Liddle – not someone I often quote – reviewing James Bloodworth’s recent book documenting what it’s like to work in low-wage sectors in Britain.
Many of us would object to such a description. But it’s how the sector is commonly portrayed.
Media coverage of the workforce
In March, University College London published a large-scale study of staff in care homes – more than 1,500 staff across 92 homes. The vast majority of the feedback, as reported in the study, related to acts of kindness and compassion that staff had seen. What was the headline? ‘Half of care home staff have seen the elderly neglected.’
It could be argued that the sector has resigned itself to this view of social care.
Earlier this year, when abuse of residents with learning disabilities was revealed at Mendip House, a residential care home run by the National Autistic Society in Somerset, there was not nearly as much of an outcry in the sector, a sense of red lines being drawn, as there had been over Winterbourne View.
I think it’s matched in some areas by a sense of wanting someone else, some deus ex machina, to come in and rescue the sector.
In March, Secretary of State for Health and Social Care, Jeremy Hunt MP’s speech on social care was pored over for signs of hope for the workforce. They are there. ‘A valued, respected and nurtured workforce’ is one of the seven principles that will underpin the forthcoming Green Paper. Mr Hunt called the social care workforce, ‘Our society’s modern-day heroes’, noting that although they were often highly-skilled, they were typically the lowest-paid, and that the value of social care work should be recognised.
The speech committed to publishing an ‘aligned’ 10-year workforce strategy for both the NHS and social care later this year. Personally, I’m hoping for something daring and dramatic: for example, to open up the NHS Graduate Scheme to people in social care with and without degrees, along the lines of the Open University, with a view to professional recognition for registered managers.
Also, I hope it’s backed by real money. At the moment, as the National Audit Office (NAO) noted in its recent review, The Adult Social Care Workforce in England, the sector spends just £14 per person on training and development.
Lack of money is a major issue: both providers and commissioners told the NAO that funding constraints meant they prioritised provision of care in the short term over training and development in the longer term, although both said better training would be a priority if more funding were available.
Valuing the workforce
Whilst we’re waiting for the radiant future, that doesn’t mean we can’t value the social care workforce and nurture and develop them in the here and now. This is valuable not just in itself, but in order to foster a sense of self-worth and belief across the workforce – which in turn will help develop a workforce-led push for recognition.
What we need is more of the attitude set out in a report from the House of Commons Communities and Local Government Committee in March 2017, which quoted one care worker as saying, ‘I am often frustrated to hear people conflate low pay with low skill and low value. Most people working in adult social care are undertaking very skilled roles and they need high skills and personal attributes and high levels of resilience to be able to do what they do.’
When it comes to valuing and developing your staff, if you’re an employer, I think the first thing is to see training and development as something that actually saves you money. In February, the NAO review noted, ‘The widespread public perception [is] that care work offers limited opportunities for career progression, particularly compared with health.’ This then acts as a barrier to recruitment and retention.
Staff retention is a key issue in the sector, with annual turnover of all care staff amounting to 27.8% in 2016-17, and turnover being especially high in homecare, across the south of the country, and amongst care workers and registered nurses. Overall, turnover has been increasing since 2012-13 which creates an issue for providers because high vacancy rates and turnover can disrupt the continuity and quality of care for service users. The Care Quality Commission (CQC) has also found a link between high vacancy and turnover rates and poorer levels of care being provided.
High turnover leads to providers incurring regular recruitment and induction costs. It’s estimated that the cost of recruiting one new member of staff, taking into account time of senior staff in interviewing, selection and induction, amounts to £2,000 to £3,000 per individual.
If money is tight, and if net migration continues to fall so that the pool of potential workers is smaller, you can save significant sums by addressing turnover and, therefore, not needing to recruit as many replacement frontline workers. This means there is an opportunity cost here: why not put the money you use on recruiting new people towards retaining the good people you’ve got? Thus, reducing the number of new recruits you’ll need in the future.
Role of leadership
Once you have the people you want to retain working with you, being a good leader will help you to keep them. This involves exhibiting the behaviours in the Leadership Qualities Framework for Adult Social Care (LQF), which sets out what good leadership looks like at all levels of a team or organisation and is intrinsic to being a good employer.
Continuing your personal development and that of your staff is one of the four components of leadership around Demonstrating Personal Qualities that are set out in the LQF.
It says that good leaders:
- Actively seek opportunities and challenges for personal learning and development.
- Acknowledge mistakes and treat them as learning opportunities.
- Participate in continuing professional development activities.
- Change their behaviour in the light of feedback and reflection.
When looking at training and development, it is important not to see it as something ancillary to people’s day-to-day jobs, but as part and parcel of their values and their everyday leadership behaviours, because care work, by definition, is highly-skilled work.
Implementing training also doesn’t always mean external training courses. For example, frontline workers – care assistants, care workers or apprentices – can be, in the words of the LQF, ‘Open to learning from others and willing to share knowledge and experience’. As such, buddying with co-workers, or using coaching approaches can constitute forms of development.
There is plenty of advice available on low-cost and innovative ways to develop yourself and your teams. The King’s Fund, in its recent report on Enhanced Health in Care Homes, mentioned many creative approaches to training.
One extract is, ‘We did some training for activity co-ordinators. We developed a Facebook page off the back of that where homes can see live feeds and we share information through there, we also use Twitter. Some homes are agreeable to open their doors up and share with other care homes, so…we might go into a home that’s not doing so well on something just down the road from one that’s got it sorted and we’ll pair them up. Or if we’re doing training with them we’ll help them to contact local homes in the area because the more training places get booked, the cheaper it is per person, the more you can share the cost.’
Getting it right
All this said, social care employers must be doing something right. In its last State of Health and Social Care report, CQC stated that the proportion of adult social care services rated ‘Good’ had increased from the previous year, with 78% achieving the rating versus 71% in 2016. Moreover, strong leadership played a pivotal role, with good leaders characterised by individuals who actively sought out best practice to steer improvements.
The report also explicitly stated that good managers truly valued their staff, supporting them to maintain their knowledge of best practice and person-centred care through training and establishing ‘champions’ in different areas of care. It added that leadership was not restricted to registered managers: everyone could play a leadership role through exhibiting good everyday behaviours.
Despite everything, training and development is happening, and it’s showing through in excellent care. How about we make some more noise about what we do? We don’t need Rod Liddle to define social care for us.
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