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

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.

On Both Sides Now

Sue McGuire takes a look at ‘the grass on the other side’

The other side of the fence is a place where you can learn a lot… even if you were the sort of person who didn’t know there even was a fence – or who thought they’d been pretty good at looking over it but who often found on the actual other side of it that it’s not just ‘there,’ it’s a lot bigger and denser than you thought it was!

I know this for a fact in my own case – as after about eighteen months of retirement from 23 years in Health and Social Care services I’ve been involved in supporting relations through three continuing health care assessments, none of which looked or felt anything like I thought they were supposed to look or feel when I worked; and believe me, I should have known what they were like.

What I am saying is that I thought I knew it all… but there is always more to learn, as there always is when you think you know it all. I’m willing to give the benefit of the doubt and believe that most local authorities, CCGs or Health Trusts aren’t deliberately trying to hide much. But I do think they are awful at making information as accessible as it really should be to the public. Try entering any local authority website and just finding out who the main people responsible for Safeguarding are, for instance – and you are likely to find yourself having to wend your way through several pages to get to a place where you can download some minutes of a committee or an annual report to find some actual names.

For contact details it’s even harder; the Wooden Spoon award has to go to Birmingham City Council, which you might almost believe had made a deliberate decision not to reveal any management names below the Chief Executive – unless it’s the courageous people responsible for the library service. Grr Come on people; if you want to be paid to be responsible for something as important as Safeguarding, put your name on it! Gold award would go to Coventry who bravely publishes an easily accessible and fabulous list of all its senior managers with their job titles and salaries, which makes it a snap to spot immediately who has safeguarding in their title.

When I was a busy middle manager, I remember the air turning blue when a Freedom of Information (FOI) request came through and had to be added to my seeming never ending list of ‘Things to Do’. To be fair, many such requests did not feel like they were citizens trying to find out what they needed to know to negotiate a tricky system; many were from businesses really wanting to know what systems and products we used and thus who they should rugby-tackle to try to get a foothold for their own brands (or they were from researchers for MPs or political parties wanting to ask awkward questions to score points).

The thing is, now I have found a use for ‘Freedom of Information’ information and bless their cotton socks, our fellow citizens who have been beavering away at getting information suddenly seem very useful. Specifically, I have been trying to gather a list of safeguarding lead names for the West Midlands but the varying quality of local authority, heath trust and CCG websites means that while some have excellent information almost immediately discoverable by very simple searches, others are like searching for the proverbial needle in the vast haystack. Luckily, great website called \’Whatdotheyknow\’ as come in very handy for my purposes; if I want to know it, you can bet someone else wanted to know it before me. WhatDoTheyKnow is run and maintained by UK Citizens Online Democracy, a group that wants to help enable people to frame their FOI requests in a brief note and then they send the request to the relevant public authorities.

And it’s a job it is doing very well, let me tell you; plus, any response received is automatically published on the website for all to find and read. So I recommend you have a go yourself – go onto the Whatdotheyknow website and type in a search for Safeguarding. You will immediately see how many requests begin with a desire to know who the responsible person for Safeguarding is. The website makes the requests and the answers as accessible as they really ought to be.

A lack of consistency between councils in respect of naming senior managers is not really excusable and likely to be just another thing that feeds anxiety and distrust. This I can see, now I am on ‘the other side of the fence;’ maybe if it was all easily accessible some busy middle manager might not have one more thing to add to their list…?