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THE SOCIAL CARE NETWORKBy Richard Berry

compassDIRECTION FOR THE

DEMOCRATIC LEFT

The Social Care Network• Context

• Analysis

• Prescription

“Training has beenshown to have adirect benefit forservice outcomes,but it is the indirectbenefit of increasingretention that couldprove even morevital. ”

Compass publications are intended to create real debate and discussion aroundthe key issues facing the democratic left - however the views expressed in thispublication are not a statement of Compass policy.

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The Social Care NetworkBy Richard Berry

Compass Thinkpiece 16

Context

Social care is the National Health Service’s poor relation. Where the NHS is free at the point of delivery, the provision of social careis means-tested. It is used almost exclusively by society’s marginalised groups - looked-after children, older people and people withlearning disabilities - for whom the need for care is not defined in medical terms. It is delivered by local authorities rather than centralgovernment, and occupies much lower prominence in the public consciousness. Where the Labour Government trumpets thenumber of nurses and doctors recruited since 1997, corresponding figures on social care assistants are nowhere to be found.

This despite the fact that, among the over-65 population alone, there are currently 1.2million people relying on publicly funded socialcare services. And in our ageing society, this figure will grow dramatically in the coming decades. While the overall population willgrow by ten per cent in the next 20 years, the number of people aged over-85 will grow by two-thirds. Furthermore, increases in lifeexpectancy are not being matched by corresponding increases in healthy life expectancy: the proportion of our lives that we canexpect to be in good health has fallen since the 1980s.

To manage the consequences of these trends, the capacity of our social care system will need to grow significantly. The workforce ofthe sector will be absolutely crucial in achieving this. However, the present workforce in the sector is failing to meet existing levels ofdemand for quality social care, let alone equipped to carry the burden of future need.

Analysis

The sector suffers chronically from the shortage and instability of staffing. Vacancy rates are currently estimated to be 11%,representing 110,000 unfilled posts, with an annual staff turnover rate of 14%. Pay is clearly a major factor in this, with levels farbelow the average wage (Wanless, 2006).

Also a factor - and a problem in its own right - is the low level of training in the sector.Training has the key benefit of improvingretention rates, but not enough staff are being trained to make a significant difference. Just 29% of all care staff possess some level ofNVQ, although this figure can be as low as 10% among private homecare providers.

Training has been shown to have a direct benefit for service outcomes, but it is the indirect benefit of increasing retention that couldprove even more vital. This was a key finding of a comparison of the mortality rates of two groups of elderly long-term hospitalresidents, one of which had experienced continuity of care staff and the other instability.

However, the drivers to increasing training levels are largely absent from the sector. This can be understood at the organisational andthe individual level, as well as in terms of positive and negative incentives. For an organisation - a social care provider in the public,private or voluntary sector - the benefits of a highly-trained workforce represent a positive incentive, but the costs of trainingemployees to a competent level in what is a labour-intensive industry are high. Supplementary public funding can be accessed, but thestreams for this are complex and multiple. In the case of care homes, a negative incentive exists in that the National MinimumStandards for care homes state that 50% of an organisation’s workforce must be trained to a level at or above NVQ2: however, this isa regulation that is still to be implemented in a large proportion of homes.

At the level of the individual employee, a positive incentive to training would be the improved career prospects afforded byqualifications. However, social care is marked by a lack of visible career paths, and there is an absence of graduated pay structureslinked to qualifications. Furthermore, staff will be expected to contribute to the cost of their own training. The sector’s skillsregulator has said they should expect to contribute 15% of the costs, although in reality it can be much more: with current wagelevels, this can be prohibitive.

The latest attempt at creating a negative incentive for individuals and providers to pursue training is represented by the policy thatnow stands out as the Government’s flagship initiative on the social care workforce: the registration of social care workers.

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Following establishing legislation in the Care Standards Act 2000, the Government asked the General Social Care Council in July 2005to introduce a register of all domiciliary and residential social care workers. A register of social workers – a higher status and lessdiverse workforce than that of the social care sector – is already in place. The coverage of the new register is estimated to be750,000 workers, incorporating all care staff employed in care homes (residential), homecare providers (domiciliary) and agenciessupplying these organisations, as well as staff in fostering and adoption agencies.

Despite the huge size of this endeavour, it does not cover the entire social care workforce: the most significant omission are theemployees of day centres. The inclusion of the entire workforce would take the number of registered workers closer to one million.

The main potential benefit of the registration system for both staff and users lies in the training requirements staff will have to meet inorder to enter and remain on the register. However, this is where the detailed proposals recently announced by the GSCC are mostdisappointing.

The training requirements come in three main forms. Firstly, there is induction training for all new staff: satisfactory completion of aninduction period will be a pre-condition of entry to the social care register. This is a welcome move in that the provision of inductiontraining currently is either non-existent or, at best, widely varied between organisations, ranging from hands-on training from skilledinstructors in good providers to sitting in front of a video for two days in others. The way to correct this inconsistency would be tointroduce common, national induction standards: such standards have been devised by the skills regulator and are awaitingimplementation. However, the GSCC does not propose to implement these until an undetermined future date, leaving open theprospect of service users being cared for by staff who have received only minimal preparation.

Secondly, there is the requirement for staff who already possess a care qualification to undertake an average of five days of trainingand development every year to remain on the register. This appears the strongest of the GSCC’s proposals. The five days rule is on apar with most other caring professions, raising hopes of a more serious approach to social care workers. However, a devastatingcaveat to this is found in the third form of training requirement.

This requirement states for staff who do not possess a care qualification at the time of their registration must acquire one within theirfirst period of registration. But the length of the initial registration period is to be set at six years. And unqualified staff will only beobliged to begin their training toward the qualification ‘within the first three years’ of the six-year period. This provides an incredibleamount of slack in the registration system. The high costs and low rewards of training mean employers are unlikely to send their staffon training courses until they are compelled to do so: that is, after three years. But because of high turnover, a high proportion ofstaff in most organisations will be in their first few years of service. Therefore, the new rules are likely to create a situation wherelong-serving staff are trained but there is a permanent section of the workforce that has received no training whatsoever beyondbasic induction.

Prescription

The ultimate goal of this discussion is to improve standards across social care. The main route through which this will be achieved isby enhancing the quality of the workforce. Raising the entry requirements to a social care career – so they are level with nursing, forinstance – is a direct way to do this, but will most likely only diminish the number of available employees. Training the existingworkforce is the more attractive option. This will have the combined benefits of developing the skills of workers and, equallyimportantly, encouraging higher staff retention.

Of course, increasing pay levels would be perhaps the simplest and most effective way of raising workforce standards: by attractingmore and better-qualified entrants and keeping them in the profession for longer. Pay levels certainly needs to be addressed, althoughwith low unionisation in the sector it is difficult to see how this will be done immediately. It can only be hoped that higher trainingrequirements will, in turn, promote calls for higher pay and create a virtuous cycle of improvement.

In pursuing this agenda, the Government can make several immediate moves. In its flagship policy of worker registration, theregulations must be tightened significantly. Common, national induction standards must be introduced, with their implementation byproviders to be rigorously monitored by the Commission for Social Care Inspection. The requirement for employees to acquirequalifications must come into effect as soon as they enter the profession, not after three years: in this amount of time, it should beexpected that a new member of staff will have actually achieved the necessary qualification. Any training must also take into accountthe main client groups that the employee is engaged in caring for : a child with learning disabilities and an older person with dementiarequire different care skills, for example, with generic training simply insufficient.

To augment the registration system, the overall obligation on providers to employ trained workers should be increased. The 50%

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target for how many staff must possess at least NVQ2 should be replaced by a far more ambitious goal – 90% by 2015, for instance –again with thorough monitoring of implementation.

Direct public expenditure is required to increase the amount of money available for training, with simplified funding streams. Relatedto this, the Government could consider relaxing the stringent restrictions faced by immigrant workers. Like the NHS, social careproviders rely heavily on overseas staff, but these workers are denied access to Government-funded training activity for the first threeyears of their residence. Even for those workers with considerable care experience from their home countries, the denied access tolanguage courses is a major barrier to the provision of high quality care.

A final reform could be the most effective all. And, as New Labour moves more and more towards the ‘commissioning’ model inBritain’s public services, its introduction would symbolise the Government’s determination for this to be a progressive process. Thereform in question would be that local authorities – who are responsible for delivering social care – must give preference to thoseproviders with the highest workforce standards when they commission services. If there is to be competition, let it be on the basis ofquality rather than cost.

Richard Berry is a Policy Officer at the Alzheimer’s Society.

References

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