Tag Archives: carers

Unpaid Carers

This page exists to support practitioners to work in partnership with carers and to achieve better outcomes. Much of the material in the other pages in Key Resources is also relevant to work with carers. You can find evidence supporting a focus on outcomes for carers in our Evidence section.


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
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. 


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
  • 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.

Carers are Individuals in the Act

Vic Citarella considers carers in the evaluation of Fulfilling Lives: supporting people with multiple needs projects

It is, perhaps, self-evident that people with complex needs frequently require correspondingly multiple and complex responses… wrote Henwood and Hudson in their 2009 CSCI study Keeping it personal. Now as Carers’ Week passes we have, in the Care Act, the strongest rights yet for carers. When put together with the duty of assessment for young carers, in the Children and Families Act, the legislative framework is suitably reflective of the very complexity identified for policy makers five years ago. It is a challenge for the Fulfilling Lives: supporting people with multiple needs evaluation to explore, understand and share how project investment resolves the problematic issues of real life complexity. Those involved in caring relationships shaped by homelessness, criminal behaviours, substance misuse and fragile mental health are potential benefiting contributors to making the most of that significant investment. The evaluation process has to identify both the benefits and contributions of carers to the success of Fulfilling Lives.

The Care Act refers to ‘individuals’ and so clearly covers both those with care needs and carers. It has a principle of well-being and includes duties to:

• Reduce carers’ needs for support (prevention)
• Provide information and advice (including financial advice)
• Assess carers on the appearance of need and that they may benefit from prevention, information or other support
• Apply eligibility criteria to carers’ services (yet to be defined in regulation)
• Provide services to meet carers’ assessed needs based on an entitlement
• Charge for carers’ support as applicable
• Prepare a support plan with the carer and help them choose how it is met
• Make sure there is no gap in services when people move home
• Promote diversity and quality in provision of carers’ services

There are also important new legal provisions regarding transition, delegated duties and safeguarding. The children’s legislation ensures that young carers have the same rights as adult carers based on the appearance of need.

The complexity kicks in when seeking to pinpoint who exactly is the person in need and who the carer is. Where the needs assessment applies and where the carers assessment? People, families, relationships, households and, indeed, communities characterised by multiple and complex need do not neatly fit into binary boxes. Such is the stuff of ‘gift’ relationships on which much of the system is founded. In fact relationships ebb and flow between cared for and carer, dependent and independent, care-giver and recipient, child and young carer – at one moment symbiotic and then parasitic, sometimes mutually beneficial and at others potentially harmful. That fluidity is equally a necessary feature of the evaluation process.

Whole System

Each Big Lottery, Fulfilling Lives project is measuring how well it is achieving its objectives. In so doing there is the overarching objective of providing tailored or bespoke support services that are personalised and unique to the needs of each individual. Those people will meet the given definition of complex need. The individual support will address all the issues faced from within the funded partnership. Because the legislation is about ‘individuals’ those people may or may not be in a caring relationship – the important thing is supporting them to tackle the complex need. Clearly a whole system approach to support is needed and equally to evaluation. That whether support is provided as a person in need or carer in need diminishes in the face of ensuring that the support system is built, maintained and becomes self sustaining – making change real.

The legislation allows for this in its founding principle of wellbeing, in its emphasis on prevention and its recognition of the individual with ‘an appearance’ of need whoever they are. Similarly the evaluation allows for this in giving even weight to input, activity, output and outcome. It uses case studies and formative approaches to learning as well as the more quantitative techniques – both are important. The research logic chain refers to individuals with multiple and complex needs rather than service users; just like with people being cared for and carers, it is not an either/or when it comes to the Fulfilling Lives evaluation. It is about capturing what works, identifying why and how so that others may learn and replicate success.

First published on the Fulfilling Livesblogging site

It’s Complicated – the Care Act and Multiple Needs

First published on Fulfilling Lives on May 28, 2014

The parliamentary ‘ping-pong’ is over, amendments agreed between the Lords and the Commons and the Care Act has Royal Assent. Everyone – local authorities, NHS bodies, public, voluntary and private organisations – are busy assessing the potential impact of the new law on what they do. How will it help/hinder; what are the gaps; what are the costs; what will we do now and what can wait; which clauses take priority; who is going to do what and how will we cope? The questions go on and the project and risk management training is put to the test. Projects will be making similar judgements themselves and the national evaluation team too will be considering how it might impact on our work on Fulfilling Lives; Supporting people with multiple needs.

Thinking positively, it is thus timely for a blog on the subject of the Care Act. If you are reading this then you are probably on the news and events section of our website dedicated to the national evaluation of Big Lottery Fund’s Fulfilling Lives; Supporting people with multiple needs. When you are done reading this, please do take a moment to look around the rest of the site and glean some more information about the anticipations of those involved.

It is certainly true that the Act, is a massive piece of legislation – both consolidating and creating law. For those of you seeking an understanding of the fledgling legislation see the government‘s explanatory notes. If you want to explore the extensive impact on those with multiple needs and their families then this and subsequent blogs will provide some thoughts and signposts that are intended to creatively provoke.

This is not simple stuff and the government has already published 19 factsheets and a glossary on the Act. It is not something that can be dealt with in a single blog. Even honing in on the Fulfilling Lives; Supporting people with multiple needs initiative doesn’t make things more straightforward. There are not many parts of the Act without significance to the initiative. To get an idea of the scale of effort involved have a look at the recent Adfam policy briefing. This, one of many that comes from an internet search, has the particular value of recognising that it is not just the Care Act but the Children and Families Act as well that requires attention.

So it’s complicated. But this blogger has a plan to trigger thinking about the Care Act. That plan has two elements which will feature in each blog:

• First, to share and comment on the approach of local authorities and other public bodies
•Second, to support learning and evaluation around the Big Lottery Fund’s Fulfilling Lives; Supporting people with multiple needs initiative

The blog plan will prioritise what is new in law and practice, alongside those aspects of the Act that are new in law but not in policy. Here we will focus particularly on considering how the Act might affect the national evaluation. The top half-dozen items of interest are:

1. Carer’s Assessments – clause 10
2. Eligibility – clause 13
3. Cap on care costs – clauses 15 and 16
4. Independent Personal Budget – clause 28
5. Care Account – clause 29
6. Advocacy – clauses 68 and 69

As an illustration, for one local authority, these are all in a project plan that contains 45 such high level items of which the risk RAG rating has 13 in the red – or lots of work to do and not yet ready – category. Their agenda seems like a worthy blogging schedule with the next being about Carers and Multiple Needs – what does the Care Act offer?