Going to market

Vic Citarella, Director CPEA Ltd, looks at the economics of social care and suggests marketing is more than immediate sales but is integral to every provider’s longer-term business strategy.

 

Describing a market portrays how buyers and sellers do business. There are many kinds of market and several types of player. Social care is a market with changing characteristics and an evolving cast of participants. Knowing and understanding how it works is central to successful transactions – now and into the future – between customers and service provider. In this respect, social care is like any other business.
 
In economics, it is usual to identify five types of market:

• Perfect Competition
• Monopoly
• Oligopoly
• Monopolistic Competition
• Monopsony

Applying the associated features of each to the social care market, it appears that not to be perfect competition because there are not an infinite number of buyers and sellers. There is one buyer who can alter the prevailing price in the market and that is the local authority. Nether buyers nor sellers have infinite alternatives and choice is a chimera.

Patently nor is there a monopoly with just a single supplier of social care and no reasonable substitute. If there were the supplier would be able to charge whatever they wanted and their income would only be limited by whether the customer was prepared or able to pay.

Neither is there an oligopoly in social care where there are just a few dominant providers. If there were they would be able to collude to set prices and to the customer it would seem just like a monopoly.

If the social care market were monopolistic competition there would be numerous competitors but the differences between each would allow them to charge different prices. Whilst each provider may be different there are usually substitutes available.
Lastly the monopsony market in social care would just have a single buyer. If this were the case they could dictate the price.

Two markets
So, what types of market are there is social care? On a national level, there are two markets. Firstly, the public market – about 40% – which is a monopsony. Here the purchasing local authority can keep the price to the lowest level feasible. The only controls are if there is intervention from a regulator or there are unlawful actions. Both forms of intervention are currently being tested. 

Secondly the private market which displays aspects of all the other types excepting monopsony. Several providers are seeking to differentiate their social care offer. For example, this is the case at the luxury end of the market and in terms of specialism or niche. There are signs of an oligopoly-like cluster emerging as smaller businesses are squeezed and consolidation takes places through mergers and acquisitions. If this trend continues there will need to be a strong regulator to prevent price fixing between providers and the eventual emergence of a monopoly. There are further signs in some parts of the private market that there is genuine competition (if not perfect) which offers the customer some choices at affordable prices.

Questions and Challenges
Selling to the monopsony provider – the local authority – is becoming untenable. Home care providers are handing back contracts and residential care homes are closing or ceasing to operate for the public-sector customer. The return on investment is insufficient to sustain a business even for a not-for-profit provider. There is little scope to attract and retain a skilled workforce. Much vaunted innovation will not take root in a climate of survival of the fittest. Social care is not a business field where rebuilding or paradigm shift can come out of chaos because of the lives at stake. Such change is much needed but careful incubation is a safer approach.
Residential home providers are either shifting to the private market and/or charging in a way that means private customers are subsiding the shortfall on income from the public customers. The former leads inextricably to a two-tier service with characteristics akin to the airline industry where actual customer service is increasingly for the first class only. Whereas the latter seems duplicitous under consumer legislation.
Inevitably providers are cutting costs – some say ‘corners’ – and seeking ways to raise income from extras – some say from ‘basics’. There are too many services not reaching the minimum standards required by the regulator. The regulator is not well enough resourced to enforce standards. And policing a service that cannot comply brings the system into disrepute with a fall-back position that colludes to allow the standards to lapse.

Knowledge and Expertise
In short – two markets, two tiers of service, falling standards for the have-nots and a get what you pay for service for the haves. The scenarios are last business standing takes the chaotic market into a monopolistic new order or the state intervenes to prop up a failing market and a centralised monopsony is (re)institutionalised with a choice and/or means tested opt out. Not a pretty picture for providers or genuine investors. Not encouraging for the social care entrepreneur unless jeopardising quality and safety are an acceptable risk for permitting the entry of a cohort of more ‘disruptive’ investors.
Markets and marketing are vital areas of knowledge and expertise for social care providers. In social care, both involve individuals with needs, transactions between organisations and purchasers as well as a strategic understanding of the local and national (and indeed international) business environment.

Ask yourself:

• How well do you know your market – where are the gaps?
• Who are the key players in your market – the service users, families, the workforce, the commissioners, brokers, agents or regulators – how well do you know them and do you need support in mapping and understanding your stakeholders?
• What are the emerging opportunities – do you need assistance in developing them?
• Who are the customers and why should they buy from you? What’s your plan?

Vic Citarella, Director CPEA Ltd, www.cpea.co.uk 07947 680 588

Lynden Consulting has a proven track record in implementing successful strategies to achieve excellence and tangible results for providers in health and adult social care. Get in touch to find out how we can help.

This blog first appeared on April 20, 2017 at http://www.lyndenconsulting.com/blog/going-to-market 

Developing effective commissioner–provider relationships

Vic Citarella – a post that first appeared on RiPfA website on the 9th March 2017

 

As everyone seeks to squeeze more out of the social care system, how can strong and positive relationships lead to improved and more cost-effective working practices?

I have recently authored a Strategic Briefing for RiPfA on effective commissioner-provider relationships and facilitated a workshop on the same topic. I will also be leading their upcoming open access webinar ‘developing effective commissioner-provider relationships’ (28 March, 12-1pm, online). As part of my approach to gather evidence relating to this work, I began by asking some initial questions. I found it helpful to test out some of the underlying assumptions, namely that:

• there is a problem
• the relationship that matters is the one between the commissioner and the provider
• such relationships have character – effective, strong and positive – which can be improved
• there is an answer to the problem.

Problem – what problem?

Clearly social care is experiencing unprecedented financial pressures which is characterised as a problem or even a ‘crisis’. RiPfA identified this as a key issue back in 2012 in the publication: How to maintain safe, effective and quality services with reducing resources.

The underlying assumption is that integral to the problem are poor relationships between commissioners and providers. Community Care and the Guardian certainly think so. The guidance and toolkits say so. If only commissioners and providers got on better, they could make the money go further and people in need would get what they want. Implicit in this assumption, and reinforced in the Care Act 2014 guidance (Chapter 4), is that it is for the commissioner to do something about this problem. They have the money, the power and are the public authority.

But is this in fact the case? Does the responsibility lie at their door? The forthcoming webinar offers an opportunity to check this out.

A many-faceted relationship

Perhaps a more worrying assumption is that the relationship we are talking about involves just the two parties – commissioner and provider. But social care is patently a more complex system involving lots of people, organisations and stakeholders. Relationships between two people are hard enough. Imagine how much more convoluted relationships are in the multi-agency, multi-professional and multi-faceted world of social care.

The webinar session will try to unpick some of these relationship interactions and dynamics, and look at common purpose, co-production and role clarity. We will look at ideas around stakeholder mapping, user-led approaches and person-centred coordinated care.

The character of a relationship

That a strong relationship is a positive one and leads to more effective services is another assumption we can test. From there we can explore what steps can be made to build strength in relationships. How we turn our social care values into commissioning and service providing practice is the proving ground for the customers.

Clearly trust and communication are at the heart of all kinds of relationship building – but what do you actually do to make these things happen? The webinar will also look at how the behaviours of the participants in the commissioner-provider relationship can be (positively) developed, drawing on examples that have been tried involving individuals, groups and organisations in a variety of settings and formats.

A problem demands a solution

Lastly there is an assumption that there is an answer to the problems of poor commissioner-provider relationships. There is no sure-fire formula for success. Like personal relationships, those in business and between organisations require continuous work (and as with personal relationships there are online quizzes to evaluate the partners’ starting point and where they want to go with a business relationship, for example: http://www.growthink.com/content/finding-business-partner-take-quiz). In fact, the similarities between the advice offered by relationship counsellors and business gurus is quite remarkable. Writ large are trust, open communication and respect.

What we will examine during the webinar is ways for commissioners and providers to work together, how to make the time, and some methods that have been found to work. We will consider approaches to procurement and contracting as procedural processes to cement relationships, to record agreements where the players may change and to cater for endings and failures as well as success.

Join the webinar

If you are a commissioner or service provider (of any kind – registered/not registered/large/small/private/voluntary), please do join us at the webinar on 28 March. As we are looking at relationships between commissioners and providers in social care then it would be beneficial if people who have worked together in these roles could participate jointly (although this may of course not be possible). People who use services and/or directly commission for their own needs are very welcome to attend.

If you have any thoughts or questions, please email me in advance at vic.citarella@cpea.co.uk– although I am not offering relationship counselling!

---

About the author

Vic Citarella is a qualified social worker and a former Director of Social Services. He now works with local authorities, NHS bodies, private and voluntary social care providers, to help them improve standards and quality of services.

---

Related resources

Developing effective commissioner and service provider relationships: Strategic Briefing

Developing effective commissioner provider relationships: Webinar (28 March 2017, 12-1pm, online)

Workforce retention?

Richard Banks looks ahead to this year’s Skills for Care conference where the focus will be on recruitment and retention of the social care workforce.

David Mowat MP, the Parliamentary Under Secretary of State for Community Health and Care, voted as did most Conservative MPs, against guaranteeing EU citizens rights to stay in the UK ahead of the ‘Article 50’ negotiations. If passed the amendment would have ensured that all EU citizens legally living in the UK on 23 June 2016 (the date of the EU referendum) would have their right to stay and work protected.

Across the UK EU nationals comprise around 4.95% of the staff in NHS trusts and Clinical Commissioning Groups, and 5% of the UK social care workforce[1]. In England, there are 1.43 million people in the social care workforce[2] – The Cavendish Coalition[3]estimate that there are 90,000 EU nationals in employment – this is around 7 % of social care workforce. [4]

So, 90,000 people working in England in social care are now uncertain of their future as social care workers and as residents, along with their families, of the UK.  Horrible for them and how can any of us imagine how we might reassure our relatives supported and cared for by these people?

The social care sector in England has difficulty in recruiting and retaining staff; there are about 90,000 job vacancies[5].  All indications are that the need for increased levels of social care support will require a continued growth in the workforce.

Dodging responsibility

Respect and support for the social care workforce might be the least one might expect from the Parliamentary Under Secretary of State for Community Health and Care sadly this has not been the case.  Recently, in attempting to dodge responsibility for the Government’s social care funding crisis, David Mowat blamed uncaring families. In doing so he not only insulted families but also implied that social care was an unskilled occupation that any family member might do.  With the EU amendment vote last week he went further and completely dismissed the importance of 90,000 social care staff.

So, it will be interesting to hear what messages David Mowat will have when he speaks at the Skills for Care Conference entitled Recruitment and retention: the road to success (Thursday 9 March in Liverpool).  Social care conference participants are remarkably unmoved by banal government representatives (almost as if they expect no better). Let’s hope that on this occasion David Mowat can explain how he has a plan to support social care recruitment and retention. He might even manage to show some respect for the social care workforce who surely are an example for the Conservative slogan of being for ‘hard working people’ 

---

[1] researchbriefings.files.parliament.uk/documents/LLN-2016…/LLN-2016-0039.pdf

[2]http://www.skillsforcare.org.uk/NMDS-SC-intelligence/NMDS-SC/Workforce-data-and-publications/State-of-the-adult-social-care-sector.aspx

[3]http://www.nhsemployers.org/media-centre/2016/09/new-coalition-of-health-and-social-care-experts-on-mission-to-guarantee-status-of-eu-staff

[4]Evidence to the SUBMISSION TO HOUSE OF LORDS EU INTERNAL MARKET SUB-COMMITTEE https://www.adass.org.uk/media/5653/cavendish-coalition-house-of-lords-inquiry-eu-internal-market-sub-committee.pdf

Of the overall percentage, the detailed breakdown shows geographical variances:

·         22,000 staff in London – 12% of workforce;

·         23,000 in the south east – 10% of workforce.

·         There are a higher proportion of EU nationals in regulated professions, e.g. nursing, than managerial posts.

[5]Skills for Care 2017 Conference information

Support the workforce don’t blame the families

Richard Banks makes the case for investment in the social care workforce

David Mowat the Parliamentary Under Secretary of State for Community Health and Care recently questioned why it was that care of older people is not seen as naturally the role of families in the same way as care of children is viewed.  Whilst this raises several issues, it particularly appears to show limited understanding of the nature of social care for older people. Actually, social care is provided only to people with very particular needs that for the majority of families are beyond their capacity to deal with.  David Mowat seems under a delusion that social care is in crisis because resources are spent on simple support tasks.  The reality is of physical frailty and dementia that are beyond the capacity of even the most dedicated and caring family.   He did go on to show some understanding of the numbers of ‘informal’ carers and their position particularly in relation to employment.   Clearly the comments were based on his struggle to say some thing, any thing, in the face of the government created crisis facing social care and the NHS. 

Defending the Indefensible

The demographic issues of our population, the lack of any proper response to the resource needs and the position of carers have been known for the last two decades. David Mowat MP for Warrington South occupying a post that has been down-graded from Minister of State is the current defender of the indefensible.  

Part of this problem is that government(s) in England has resisted any attempt to recognise the social care workforce. If he had any knowledge or respect for the skills, knowledge and understanding of social care staff he would not have made such a crass statement. 

Things are not perfect in other parts of the UK but at least the importance of the workforce is recognised The Welsh Government have announced that social care workers will register from 2020, Northern Ireland have confirmed similar plans and Scotland made it compulsory for care home staff to register, with a register opening for domiciliary care workers in 2017.  The administrations of the other parts of the UK clearly see registration as an import part of establishing social care work as a valued professional activity.  Sadly in England social care has remained as a low skill, low pay occupation not worthy of registration and as a result it struggles to recruit and retain staff.  While employers and programmes promoted by Skills for Care (such as apprenticeships) are making progress in recruiting people they do so against a background of confused and incoherent policy from Government that leaves staff underpaid and cut off from establishing a professional status. 

It is now more than 16 years since the Care Standards Act 2000 provided for the registration of social care staff in residential and home care services for children, adults and older people.  England now stands as the only part of the UK that does not use registration to support the professional competence of care staff and to contribute to the safeguarding of people who depend on care staff.  Labour, Conservative-led coalition and the Conservative administrations have all failed to create a registration system for the 1.7 million staff working in social care. Yet the Government has just announced a spend of up to £16m between now and 2020 on what will be the third registration authority in 20 years for the 90,069 (01/12/16 HCPC) social workers 

Social care is a big employer.  It employs more people than construction, the food and drink service industries and several recognised large sector employers.  It is strange then that the workforce is either ignored or patronised by government.  Even stranger since it is one of the few areas of growth in employment.  The social care sector has about 6.4% of total English workforce and staffing demand is set to rise over the next 30 years.  The debate about the rise in the minimum wage (and change of name to ‘Living Wage\’) and effect of social care again illustrate the complete lack of understanding in government about how social care is organised.  They make no provision for the increased wage bill only latterly allowing local authorities to increase local tax in two piecemeal fuddled policy changes. That increase will not cover the existing funding gap identified by the Local Government Association or the increasing costs of supporting the NHS that fall on to social care budgets. 

Recruitment crisis warning

There is a warning from the last decade when there was a narrowly avoided crisis for adult social care. Recruitment of staff became almost impossible in some areas due to better conditions offered by other industries.  Residential care homes could not fully open and home care services could not recruit or retain sufficient staff to cope with demand. Services to people in need began to suffer as they are again currently. The availability of staff from the new members of the EU saved the day in terms of numbers (there were issues about skills and language).  There were additionally staff from overseas recruited by employment agencies (that had previously provided staff to the NHS).

By 2009 the redundancies related to the economic crisis had ‘freed’ more people looking for work and the crisis of recruitment subsided. There is now again a crisis of recruitment but this time amplified by the start of the well-predicted increase in need as our population ages. This time with Brexit related fear about the status of EU nationals working in this country and other tighter restrictions on immigration there may be further collapse of social care provision due to lack of staff. 

In parts of London over Christmas the home care sector was unable to support the discharge of older people from hospital. The predicted social care crisis preventing the discharge of patients and the lack of support services to prevent the need for hospital care in the first place is now happening.  The problem is not just of numbers but of skills – it takes time and investment to train and qualify social care staff able to work safely and to create personalised support for people.

All of the problems with social care funding and workforce have been communicated to Government over many years but there has been no policy and no action. Rather than attempting to shift responsibility David Mowat needs to start working to invest properly in the social care workforce. This requires proper pay, funded training and setting up a register that ensures we have a safe and competent workforce for the future. 

Marketing your health and social care business

It’s a question of the frontline

Posted on September 7, 2016 by VicCitarella at the mcnevaluation blog site of Fulfilling Lives

In the first of a series of blogs, Vic Citarella considers the crucial role of the workforce in Fulfilling Lives for people with multiple and complex needs. Vic is keen to start a dialogue with projects on this topic. You can get in touch with him using the details below.

“The CFE and University of Sheffield 2nd annual report into the national evaluation of Fulfilling Lives: Supporting people with multiple needs programme has chapters on ‘interventions and approaches’ and on ‘working the frontline’. The report says it raises as many questions as it answers but without doubt it pinpoints the workforce and what they do as the mission critical factor in the projects. More is promised by way of research and future evaluation. That means, among other things, dialogue with the practitioners, the managers, the stakeholders and the customers of the services.

What better way to exchange views than by identifying some themes in a Blog?

A question of purpose
The evaluation reports that users of the services value the ‘sense of purpose’ that the project workers share with them. Clearly we need to know how that ‘purpose’ is articulated and shared. What is it about the mission statements, vision, values and principles that motivates and convinces the workforce that they are doing the right thing? There is a saying that: if you lose your ‘why’ then you lose your ‘way’. Well, we have to know why.
There are a number of big pointers in the annual report and perhaps foremost among them for the workforce is a purpose which includes:

• Meaningful service user involvement
• The concepts of open-endedness and persistence
• Psychologically Informed Environments (PIEs)
• Systems change

These are themes that need further probing for workforce implications.

A question of detail
Few people remember the second half of the quote: The Devil is in the details. It goes on to say: so is salvation. The problem with specifics is sorting out what is important and what gets in the way. There are some clues in the annual report that will warrant further exploration.
The projects all work through some variation of keyworkers. We know from the report that this means in practice both personal, relationship-based support and service coordination or navigation. Knowing the detail of how these twin roles are demarcated and overlap will help prepare operational job descriptions and person specifications, make for effective values and skills based recruitment and ensure appropriate support and training for the workforce.
Knowing what types of people that you want to perform what roles and tasks is about sorting through the specific details to make clear statements of what is important.
So for example it appears from the annual report that service user involvement and peer support are both important. Quite right, but what are the important details?

A question of pragmatism
Everyone wants to know how to do things – a handy guide, top tips or a readiness checklist. There is no shortage of these on the web to encourage best practices for the workforce and their managers. They may not be exactly useable off-the-shelf but a lot of general policies and procedures can be customised to the multiple and complex needs project scenario. What may be challenging is undertaking the customisations.

The annual report spells out that pragmatism, practicality and perseverance are the order of the day in projects. It flags up a number of workforce issues that will need further evaluation. Among them are:

• People with lived experience on the frontline as volunteers and/or employees
• Caseload management
• Navigation and systems brokerage as emerging job roles

A question of curiosity
The annual report makes it very evident that members of the workforce are at the heart of evaluating progress with the projects. It is they who complete the two measuring tools – Homelessness Outcome Star and the NDT Assessment – with the service beneficiaries. One of the features that workers enjoy about the projects is the move away from target driven approaches. We need to know how, without the target driver, projects capture the imagination and creativity of practitioners in working alongside beneficiaries in getting as full an evaluation picture as possible.
So for example projects could share views and opinions on:

• The skills and training required to make good use of the tools
• The amount of time it takes to collect the data and information
• What helps and what hinders in using the tools
• How the data and information is useful to them in their work
• What makes data collection less challenging

The continuing evaluation must be inquisitive about the interventions and approaches. The more we know about what works and why the better. In this way the best workforce can be recruited, trained, supported and retained. What follows is an effective service. As Einstein said: \”The important thing is not to stop questioning. Curiosity has its own reason for existing.”

Vic Citarella
Company Director CPEA Ltd. 07947 680 588| vic.citarella@cpea.co.uk

If it’s good enough for Mo Farah!

Guest Blogger Cedi Frederick, former social care Chief Executive and now Managing Director of Article Consulting Ltd challenges the sector to invest in coaching for Registered Managers 

 

                                                                            

It’s generally accepted that the job of the Registered Manager is the toughest in social care bar none! No other job comes with the relentless pressure, the ever increasing expectations and in real terms the ever decreasing resources; be that people or money!  At its best it’s hugely rewarding, but at its worst it can break even the most resilient of individuals.  In 2013 in a response to the growing number of Registered Manager vacancies, the CQC imposed tough penalties on organisations who failed to fill the 2,439 Registered Manager vacancies that existed and miraculously between November 2013 and April 2014, 1395 manager vacancies were filled, with 470 registration applications lodged with the CQC.  I wondered then, as I wonder now how many of those appointments were really up to the toughest job in social care and how many of those managers appointed then are still Registered Managers today?

I have led many management and leadership workshops and training sessions for Registered Managers and there’s a slide I always use to illustrate the expectations placed on them.  It shows the faces of Oprah Winfrey, Mahatma Ghandi, Margaret Thatcher, Anita Roddick, Winston Churchill, Richard Branson, Albert Einstein and……Paul Daniels! So, the ideal Registered Manager needs to have Oprah’s empathy, Ghandi’s wisdom, Thatcher’s toughness, Roddick’s entrepreneurial spirit, Churchill’s leadership, Branson’s business savvy, Einstein’s brains and like Paul Daniels, a Manager needs to be able to pull rabbits out of hats!  A lot to expect of one person?  Yes, it is, but we’ve seen how a great Registered Manager can turn a failing care home around, but we’ve seen how a home that was previously well run and delivering great outcomes can slowly fail following the appointment of a Manager who is not up to the job!

Skills for Careand the National Care Forum are doing great work to support Registered Managers to improve their management and leadership skills and knowledge.  They are to be applauded for their efforts, as are the organisations that invest in their Managers training and support.  But it’s not enough.  Care providers need to invest as much, if not more in Managers’ emotional and psychological well-being as they do in their managerial competencies.  I believe that thousands of Managers are burnt out and struggling to get through each day in a job that has changed beyond all recognition.  Many are of an age where they’re just holding on, hoping to see out their careers without a major incident in their homes that would threaten their future employment at a time when they believe that changing career would be virtually impossible.

 

So, how should organisations respond?  By providing every Registered Manager with a Personal Performance Coach.

It would be inconceivable that a top sportsman or woman could maximise their performance and achieve the highest success without a coach.  More and more executives including CEO’s are benefiting from coaching, so why aren’t organisations who are increasingly recognising that their success rests on the shoulders of their Registered Managers considering the benefits of coaching for this crucial group of staff.  The guaranteed return on that investment?  More resilient, more confident, less fearful and less stressed Managers, better able to handle the constant pressure they face, more likely to become better leaders, better able to manage change and deliver transformation.  Personal coaching, alongside more formal management and leadership training will improve a Manager’s performance which will lead to greater staff engagement, greater trust and confidence between a Manager and their staff which in turn leads to lower staff turnover and sickness and ultimately better service delivery.

Depending on the needs of the individual Manager, a coaching programme could take from a few weeks to a year or more.  These 1-1 sessions could be held face-to-face, over the phone or even online with Managers expected to undertake some personal work between sessions. A coach is a catalyst for change in an individual.  They don’t do the work, but they hold their client to account for doing the work themselves. 

Providing a Registered Manager with a coach may save an organisation thousands of pounds per home each year.  Why wouldn’t they do it?

Social care work – at the butt end of downward mobility

Vic Citarella postulates that investment in the social care workforce will improve social mobility

One factor that contributes to divisions or unity between people is the nature of the labour market. Work features large in how we see ourselves and how others see us and our families. It is integral to our identity. It is about the pay-off from hard work that politicians talk of when they use the language of social mobility. They usually mean better paid and more secure jobs lead to the \’good things\’ in life. It is those jobs that enable mobility and which, for politicians, can only go one way – upwards. When people identify themselves as downwardly mobile, it is then that they get angry and lash out at governments, officialdom, the establishment, outsiders and eventually each other. When a majority of people who perceive themselves as downwardly mobile are given any plebiscite the result is predictable. In the case of the referendum on membership of the EU an outcome exacerbated by the perceived comparative upward mobility of many immigrant workers. 

My understanding is that employment in the UK post the crash of 2008 is strong and has recovered. Today, after the recent turmoil, there remain a growing number of work opportunities and a shortage of applicants in many sectors. However my view of the labour market is of one that has polarised in many parts of the UK. Polarised between the low paid, low skilled often temporary and part-time workforce and the higher skilled and permanent, full-time workforce. The former characterised by the largely female social care workforce and the latter by ICT professionals. Jobs and opportunity in the middle range of skills and reward are evaporating – in manufacturing, construction and critically the more clerical professions. The consequence is that workers have to set their sights higher or accept supposed lower status work. 

Such divergence in the labour market is one root of the current discontent and in my view social care is at the butt end of it. Much of social care is seen as unpleasant work, poorly paid and not requiring skills. It is viewed as work for women and girls not worthy of more than minimum pay. Social care – along with flipping burgers, waiting tables, cold-calling and stacking shelves – is what the displaced workforce in the middle, who are unable to attain higher, see before them and they don\’t like it. They recognise themselves as being downwardly mobile and will vote accordingly in their droves.

The current social care workforce is upwards of 1.5 million and the demand will soon exceed well over 2.0 million people. This is a significant number and nearly doubles when the NHS equivalents are added in. This is not work that can easily be automated or undertaken off-shore like much clerical work. It is work that requires hands-on skills, heart in the right place attitudes and an astute awareness of context and circumstances. In short it is not low skilled work at all but, nonetheless, has the low skills status. It therefore seems to me that there is a win-win for the country in a concerted effort to up the status of social care work. A first win in that we have the workforce that befits all our aspirations for ourselves and our families that need social care. Our willing dependency on family care would be supplemented, enhanced and supported instead of stretched to breaking point. A second win in that the schism in the wider labour market is repaired as people increasingly seek social care employment as a route to upward mobility. Having social care jobs with status, reward and recognition will go a long way towards reconciling social discontent. There is a third win around the reliance of some social care employers on an immigrant workforce – their contribution would be valued at the same time as the dependency reduced. 

How does a country boost the standing of a workforce you may ask? 

• Political leadership – lets have a Department of Health and Social Care with a minister to make real the paper policies of integration
• Professionalisation – lets demand a social care workforce that is competent, qualified and aspirational
• Personalisation – lets either commit fully to a consumer/user-led approach to the social care market or parallel the NHS with a National Care Service as suggested in 2009. The alternative is that market forces will entrench a two tier workforce. The privately funded care workforce having just low status over the very low of the publicly funded one.
• Pay – lets be honest and openly evaluate the rewards allotted to a care worker in respect of what they do. Lets challenge traditional job evaluation criteria that determine pay rates.
• Prices – let the market do its work and limit the local authority to inducing variety and policing local standards. We could move more rapidly towards a position where a local authority only makes the social care purchases when they have permission from the Court of Protection. Otherwise the actual purchase is undertaken directly by the customer or their agent albeit, in full or part, with public money.
• Public relations – lets get more media savvy about working in social care.

One way or another this will cost the service user more money in fees. Government will need to do more than the current tinkering around the edges that has gone on since at least 1990 when the country moved decisively away from a municipal model of social care provision. It will need to pull levers and apply brakes. The cost to us all will either be more tax or different use of current taxes. The incentives though are substantial:

• People being able to purchase a safe social care service at transparent levels of quality and affordable price
• Protection for those lacking capacity
• A motivated workforce recognised for its skills
• Social care work as a badge of upward mobility and a unifying force in communities. 

The time is right for the social care workforce to move from butt end to front end of labour market thinking. If not we are destined to have a social care workforce that churns within itself, is riddled with self-deprecation and is scorned by the upwardly mobile. It will remain at the wrong end of an unequal society to all our detriment.

WORDS MATTER

Vic Citarella attends a Belinda Schwehr workshop

Last week I attended a day workshop put on by Community Living Magazine led by Belinda Schwehr. It was entitled Adult Social Care Legal Developments. I had forgotten how much Belinda can pack into a day and I am not going to make any real attempt to relay the contents. If you or your organisation want to learn about social care law then Belinda must be the go to trainer.

To give a flavour here are just a few extracts from my notes before I stopped writing and concentrated on listening. You are always sure of a gargantuan handout from Belinda and note taking is superfluous. She is protective with her intellectual copyright but generous to her customers.  So here goes:

• Legal literacy can only come from realising that every word matters. Hear here.
• Social work is a surreal sector. Don\’t we know it – not.
• Grey hair is good in social work. What goes round comes round.
• It is not legally true that social services is for everybody. Its legally untrue then?
• Providers can just stay firm and say \”no\”. If only
• You can\’t moan about fees if you keep taking them and hide the true consequences. Easy to say.

On carers

• Assessed eligible unmet need. It is people\’s carers who really give them choice. It is what carers are prepared to do. To work this out social workers need to be able to have grown up conversations for which they need to be legally literate. Who is doing carer\’s assessments? Anyone who provides any free support of practical or emotional use is a carer and eligible for assessment. Respite services are users services. Don\’t drive carers into assessment it is daft. Prevention makes more sense as only a few will give up. Necessary care what does it mean? There is no obligation to care. People cannot be made to care. Carers will not stop caring unless they think their loved ones will be alright.

On assessment, care planning and charging

• Three things that would make your life better – in priority order. Simple advice for being assessed
• People who know their rights will get more. Squeaky wheel.
• When care is being \”mediaevalised\” then the law matters. This applies beyond care.
• The care plan is the bedrock of the clients rights. You better believe it.
• Outcomes-based planning without inputs gives away clients rights. Its the workers – how many, how long, how competent – that matter.
• You can\’t charge for something you are not providing. Some will try it on though
• Local authorities cannot charge the user more than services costs. Charging is not to be used to redistribute wealth.
• People must not be left without support whilst a dispute is resolved. Shout it from the roof tops

Finally

• Just because it shocks you don\’t think it will shock a judge. Shocking
• Never say never…say usually. Words matter
• Social services managers need to be good at the law in order to be strategic leaders. Or know someone who is?

Belinda runs regular webinars if you can\’t get to one of her workshops. Have a look at http://www.schwehroncare.co.uk/

A Major Oxymoron

Vic Citarella remembers the days before there was social care

Listening to former premier John Major sounding off about Europe on TV this week prompted a memory – one that could be completely incorrect, but nonetheless its mine. The recollection being that he was credited to be the first senior politician to publicly use the term ‘social care’ back in the 1980s. Anyway this was what was said back then amongst those promoting the standing of residential, day and domiciliary care workers. Those arguing for investment in status, training and recognition and the professionalisation of social care as distinct from social work. 

It is now 30 years since Major was Minister of State for Social Security – the most likely time when he would have made a speech about the care sector. In that time since 1986 the cause of professionalising social care has made little progress. It probably peaked with the creation of the General Social Care Council in England in 2001. The code of practice was about social care and the intent was to register domiciliary care workers straight after social workers. By the time the GSCC was closed in 2012 the idea of registering any social care workers was long buried under burgeoning bureaucracy and costs. It remains alive and flourishing in the rest of the UK.

Why is social care in retreat in England? Why did the former Social Care Association struggle with membership? Why do the one and a half million people who work in what we call social care still have low skill, low pay and low esteem standing? Listening to Major again something about his stance on Europe and the NHS made me consider the possible oxymoronic juxtaposition of the words social and care. Like, as in, was he a ‘caring Conservative’?

Consider how far social care is a truth particularly in our times of personalisation and individual care planning. Most people want their care to be private rather than social I suspect. Consider the contradictions in the need for companionship and activity alongside the need to go to the toilet, go to bed, get up, wash, dress and be fed. The one involves groups of people and the other is – or should be – just you and the care worker. Consider many people’s preference to have support rather than care.

Perhaps, with hindsight, it was a mistake to coin the term ‘social care’. Residential, day and domiciliary care had the benefit of less ambiguity, more exactness.  It still does – people know what you mean if you say you work in a care home, a children’s home or if you are a Home Help or work in a day centre. Precision in terminology can put pressure on politicians, be understood by the public and attract investment.  With that comes professional respect and standing for the practitioner.  So out with the Major minor oxymoron of social care and let’s think about the major key alternatives.