The Future of Adult Learning in Social Care – News | City & Guilds

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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. 

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.

A Rose by Any Other Name

Sue McGuire asks whether values matter 

I don’t know. Maybe I’m being a bit over sensitive here but I suspect anyone who reads this page will agree with me that it is wrong for a care home to change someone’s name. So why – if it’s so obviously wrong do people do it without the flicker of an eyelid?

When my mother in law went into a care home 7 years ago it was only after a couple of weeks that we realised that some of the staff were calling her Renee. Her name was Irene. She had never been called Renee and in fact (I’m not defending her stance just stating it) she would have considered it rather common and would have objected strongly – when she had been capable of making any objections. We asked them to stop and it didn’t happen again.

I had honestly (perhaps naively) thought that care staff training had moved on and that wouldn’t happen now. But a few weeks ago I visited the friend of an aunt in the care home she had just gone into. My aunt and I asked for Pat and staff looked blank. Eventually it clicked and they said ‘Oh Trish, yes her room is just down there’. Pat has never been known as Trish in her 88 years. Pat has the power to object but said that the staff had explained there were too many Pats so to distinguish her they would call her Trish. So she just let them – mind you she thinks she’s going home, which I very much hope she can but it will depend how good the social work is. I feel the urge to put several exclamation marks in here !!!!!! and one WTF.

Why do I think this is so wrong and yet the staff in the home can’t see anything wrong with it at all? Values. That’s the conclusion I come to. I believe I have a strong sense of individual worth, dignity and the respect that is due to someone. How does that get measured when care providers recruit? Pressure to recruit constantly is massive. Vacancy rates and turnover appear to be high everywhere in the country. According to the NMDS data turnover is 25.1% and vacancy rates across the country 6.7%. Pay is poor. Conditions worsening with zero hours’ contracts becoming more widely adopted. Having the right values may very well be going to the bottom of the pile or requirements.

But the aspirations of the Care Act 2014 will never be delivered by people without the right values. That is a big message for the social care workforce across all job roles and sectors. How can you be committed to ensuring someone chooses for themselves, grows in independence and has care personalised to them if you think that it’s OK to change their name – especially when they are already confused and vulnerable?

No answers here – just questions. Where does this casual lack of respect start? How can it be spotted? How can it be changed if this is the workforce we have? Maybe I have to ask as well – is it just me or doesn’t it matter?

Guest Blog from John Burton at The Association of Care Managers: In Defiance of Compliance

A care home that is run simply to be “compliant” is unlikely to be a good place in which to live or work. Compliance is alien to the ethos, principles and good practice of the social care profession and residential social work 

 

Compliance, the principal tool of measurement used by the Care Quality Commission, has no place or validity in the life and work of a care home. It is a negative and submissive concept. Nothing ever grew and developed, no initiative, no advance was ever made by compliance. Compliance is static and change is dynamic. The notion of compliance could only be of use to check important but secondary technical services to the home, and such checks should be made by suitably qualified and experienced technicians. For example, the lift must be properly maintained, medication managed well and accounted for, and food stored and prepared safely, but such compliance is not the primary purpose of a care home. 

 

Those of us who were trained and qualified as residential workers or residential social workers – trained to practise, manage and lead – received a thorough grounding in such areas as human growth and development, loss and change, social psychology, group processes, community and institutionalisation, leadership, ethics, ageing and society, social work methods, social policy, counselling, dependency and power relationships, family and individual therapy, etc. etc. We were encouraged to enquire, to challenge, explore, and debate ideas. We thought, read, and argued. We were not taught “compliance”. Courses differed and, of course some were better than others, but I very much doubt if any residential social work course ever mentioned “compliance”.

 

No, I’m wrong. In the early 70s, when I did my qualifying training, the word compliance described a worrying aspect of, for example, a child whose infancy and early years had compelled them to keep their heads down and to find a way of surviving the hostile and persecutory world around them. These days, we might take compliance in an eighty-year-old resident of a care home to indicate that they may be being abused, bullied or medicated, and they had attempted to avoid further pain and humiliation by withdrawing into themselves and being “quiet”, compliant and unnoticed. “No trouble.”

 

“The creativity that we are studying belongs to the approach of the individual to external reality . . . Contrasted with this is a relationship with external reality which is one of compliance, the world and its details being recognised but only as something to be fitted in with or demanding adaptation. . . in a tantalising way many individuals have experienced just enough of creative living to recognise that for most of the their time they are living uncreatively, as if caught up in the creativity of someone else, or of a machine.” D.W.Winnicott, Playing and Reality.

 

Care homes are caught up in what the machine of CQC has created – compliance. We will break free of the constraints of compliance only if we start acting like professionals and leaders of our care communities. We must stop acting like quiet, frightened, compliant children, anxious to please by fitting in with the rules and restrictions imposed on us. We must grow up, join forces in taking responsibility for our own profession, and lead the development of care homes as highly valued local centres of care and support.

 

Over ten years, the national regulators have turned social care upside-down. Instead of the needs of users instigating the form and operation of care services, and those services, led by the registered managers, being designed and managed at a local level to meet those needs, the regulators have imposed their misinformed and blinkered design for care. This top-down approach has in turn spawned a new layer of quality-assurance, management and consultancy which is now seen as essential to prove to the regulators that providers are compliant. And this self-perpetuating arrangement flourishes alongside the cosy pretence of personalisation. Compliance-centred is the very opposite of “person-centred” care.

 

It seems extraordinary that while those at the head of this appallingly wasteful and dysfunctional system have had the advantages of sophisticated management training and mentoring, they seem incapable of understanding their part in it.

 

According to Paul Hoggett (University of the West of England), social work/social care professionals need the capacity . . .

• to tolerate and contain uncertainty, ambiguity and complexity without resorting to simplistic splitting into good/bad, black/white, us/them, etc.
• for self-authorisation, that is, the capacity to find the courage to act in situations where there is no obvious right thing to do
• for reflexivity, that is, to take oneself as an object of inquiry and curiosity and hence to be able to suspend belief about oneself; all this as a way of sustaining a critical approach to oneself, one’s values and beliefs, one’s strengths and weaknesses, the nature of one’s power and authority, and so on
• to contain emotions such as anger, resentment, hope and cynicism without suppressing them and hence to be both passionate and thoughtful. 

What do we think Tom Kitwood would have made of this compliance culture? Would it not fit perfectly with his description of a “malignant social psychology”? Is it not understood at any high level in Government, Department of Health or CQC that the malignant effect of compliance does not merely “filter” softly down to the way residents in care homes are treated, it is – albeit unwittingly – aimed directly at them and blights their lives.  

 

When senior members of CQC are cornered, and when they cannot bully their way out of the corner, they resort to the excuse that they have no choice and are merely following the orders given them by government but are short of resources, and “give us time – we’re a young organisation”. Such excuses are a betrayal of professional ethics.  

 

As social care professionals and leaders, registered managers must take their cue from their own professional standards. We must support each other, learn from each other, and always put our clients first.  

 

John Burton, ACM

johnb225@btinternet.com