Shifting policy attention to the social care workforce

Dr Shereen HusseinDr Shereen Hussein is Principal Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (956 words)

The year 2014 has seen growing attention given to the social care workforce, with a number of high profile reviews being published, including the Kingsmill Review ‘Taking Care’, the Unison report into home care ‘Time to care’, the Demos review of residential care and, launched today, the Burstow Commission review on the future of the home care workforce, ‘Key to care’.

The question of how to maintain a high quality social care workforce has received academic scrutiny for many years, with research highlighting the lack of career progression, low pay and status, and the inability of the sector to attract young and diverse groups of workers as some of the key issues. There are many reasons why we are in this state of ‘crisis’ but at the core is the assumption that care work is something that can be performed by ‘anyone’—it does not require a vast amount of skills and we can always find a willing worker to do it. While these assumptions go unspoken, they underline how the sector operates and derive from the perception of care work as ‘women’s’ work that comes ‘naturally’; if the family can do it why do we need a skilled professional to do it? Continue reading

What social care support is provided to family carers? What support do family carers want?

Jo Moriarty Nov 2014bJo Moriarty is Research Fellow and Deputy Director of the Social Care Workforce Research Unit in the Policy Institute at King’s. This month sees the publication of the Research Findings of a project she led on Social care practice with carers. (736 words)

 

I’ve lost the man that I fell in love with and I now just feel like a full time nurse. (Nicola-Jane, Carer08)

Research about family carers often focuses on the problems they face. However, at a time when increases in social care funding are not enough to meet the additional demand for services and when it is expected that the gap between the number of people needing support and the number of people able to support them is widening, we need to focus not just on problems but on finding better ways to support the six and half million people providing unpaid help to members of their family and friends in the United Kingdom. Continue reading

The challenges of medical workforce migration between the UK and New Zealand

Prof Robin GauldOn 29 October 2014 the Social Care Workforce Research Unit at King’s hosts a seminar examining workforce migration in health and social care (places still available). Prof Jill Manthorpe, Director of the Unit, is joined by Prof Stephen Bach, Department of Management at King’s: they will be the formal respondents to a presentation given by Professor Robin Gauld who is the 2014 NZ-UK Link Foundation Visiting Professor. Here, Robin Gauld introduces his work, which focuses on health workforce migration between New Zealand and the UK. (531 words)

The week of 6 October saw significant media coverage in the UK of the 2014 State of Medical Education and Practice report by the General Medical Council. This indicated that around half of all migrating doctors are departing for the shores of Australia and New Zealand. One newspaper summed it up as: ‘…They cost us £610,000 to train – but 3,000 a year are leaving us for a life in the sun…‘. Continue reading

What can the city banks learn from social care?

The Registered Managers’ Programme from The National Skills Academy for Social Care aims to better equip Registered Social Care Managers to meet the challenges they face, to reduce their isolation by networking them at local and national level, and to enable them to recognise their leadership role. As part of the Programme, they are funding Local Networks to support Registered Managers on the ground, either where demand has been identified but no Network exists, or to strengthen and expand existing ones.

One such network has recently been established in Cumbria with support from the Social Care Workforce Research Unit at King’s College London, and it builds on earlier work around communities of practice. For more information contact michelle.cornes@kcl.ac.uk

This post was written by the members of the Cumbria Registered Social Care Managers’ Network following their meeting last month.

The focus of this meeting (4 June 2014) was celebrating the work of the huge number of social care workers who do a great job every day and make a really positive difference to the lives of people who need care and support. Inevitably though, the conversation moved to discussing the recent Panorama programme (Behind Closed Doors, 30 April 2014) on abusive care, and the impact programmes like this have on staff in the sector. That led to us thinking about what registered social care managers can do to raise the profile of care that is caring and compassionate?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

For the front-line care workers in attendance at this meeting, programmes like Behind Closed Doors are far removed from their day-to-day experiences of delivering care. A good day for some starts with crumpets, toast and jam and a chance to catch up with each other (called a ‘hand over’ in the jargon). There are enormous challenges in delivering good quality carefor example how to be personalised, compassionate and ‘quick’ (in your 15 minute time slot with each resident). Work is often stressful, physically demanding (12 hour shifts) and emotionally draining. Needless to say, the situation is not helped by the current climate of austerity and chronic underfunding. However, the job brings with it enormous rewards and a great sense of personal satisfaction. At the heart of the work is your team, like a family almost, and all the emotional benefits which flow from being collegiate.

Added to this, is the sense that you are making a very real and positive difference to people’s lives. In this business it is the ‘smiles and the thank yous’  that count for most… The six figure bonuses, pay rises, company cars and expenses said to be absolutely essential to recruit and retain the ‘best’ staff in the more compassionate(less) industries are seemingly not so important in social care. Maybe the city banks have something to learn from social care managers in this respect?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

Where programmes like Panorama can have a particularly detrimental impact is that they can work to undermine the confidence and integrity of some social care managers. The desire to ‘protect’ the public from abusive care often sees the inspectorates and commissioners of services imposing further layers of monitoring and regulation. However, unless carefully implemented as part of a wider culture of learning and improvement, this can quickly lead to a ‘them’ and ‘us’ scenario in which there is a lack of trust and authentic partnership working. While the ‘best managers’ will follow the rules and regulations, reporting ‘poor practices’ or any ‘safeguarding’ incidents as they are required to do, they can be left feeling demoralised and ‘brow beaten’ by the response. ‘Poor managers’ meanwhile will keep their heads down; they will not engage externally and will remain largely hidden from view, that is, until the television cameras go in.

How to engender trust and authentic relationships (the ‘smiles and the thank yous’) between commissioners and providers of social care services is a question we shall return to in future meetings. Celebrating the role of the social care worker and raising the profile of ‘good care’ has just been a first step.

For more information about this post please contact Michelle Cornes, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. The Unit is part of The Policy Institute @ King’s.

Recognising the value of people who are paid to care

Katie Graham, Research Associate at the Social Care Workforce Research Unit, reports on care workers taking strike action in Doncaster.

During the last few months many care workers in Doncaster have been on strike. A three day strike ended on 22 April and union members have now started a further two weeks of action. UNISON members are taking action against changes to pay (including reducing weekend enhancements), sick pay and holiday entitlement. These planned changes are being implemented following the NHS loss of its contract to provide supported living services in the area. Given the rarity of unionisation and action within care work and the precedent that the proposed contract working terms and conditions would set (as more and more previously public sector services are transferred to the for-profit sector), it is curious that there has been such limited national coverage of the ongoing strike action.

In other parts of England social care providers and local authorities (the commissioners or funders of much social care) are subject to sharp criticism over the poor contractual conditions of care workers within commissioned services. Some home care workers have to endure zero hours contracts (Joseph Rowntree Foundation report) and non-payment of travelling time leading to below minimum wage payment. It has been confirmed by Care Minister, Norman Lamb, that there are 307,000 care workers on zero hour contracts (Community Care, 2013); work by this Unit has indicated that at least 150,000 workers in the social care sector may be getting paid less than the minimum wage (Hussein, 2011). And in 2013 the Low Pay Commission expressed its concern that social care workers are particularly vulnerable to poor pay and conditions of employment. The situation has been highlighted in the press and the House of Commons in part due to a recent court verdict in late 2013 (Whittlestone v BJP Home Support Limited) which ruled on the illegality of the non-payment of travelling time.

A recent review of the implications of adult social care budget cuts by Community Care (McNicoll & Stobart, 2014) illustrated the strategies councils are using to manage their limited budgets.  These included increasing the eligibility criteria (threshold for public funding entitlement), strict limits on care packages (e.g. no overnight care and reduction in the length of calls), increasing charges to service users, a ‘cap’ (upper limit) on council expenditure on social care, with budgets allocated to care managers to ensure they ‘understand fully the implications of their decisions’ on finances.  In spite of the government promising guidance for local authorities to address these concerns within the commissioning process another strategy seems to be the outsourcing of previously public run services and the re-negotiation of existing contractual arrangements with voluntary and for profit organisations. These may potentially reproduce the very conditions that have lead the care workers in Doncaster to take decisive action and the difficult decision to strike.

The Joseph Rowntree Foundation (Carr, 2014) recently released a summary of three major research projects looking at care work and low pay. These suggest that the evidence that connects low pay and poor quality of service is inconclusive.  However, it is emphasised that a combination of pay and working conditions including supervision, training, appropriate amount of time to fulfil tasks, need to be considered to ensure ‘job quality’ for the care worker and a quality service.

Historically there has been limited unionisation of care workers working in residential and community services, therefore there has been limited collective response to poor working terms and conditions. The policy of personalisation is leading to the development of a more dispersed and fragmented workforce. This makes the struggle, by those in a position to organise and collectively campaign, particularly difficult and important. By whatever means, there needs to be a wider recognition that ‘care work’ in its multiplicity of forms including practical tasks, assisting, prompting, skill development as well as relationship building, emotional support and developing trust in often intimate domestic situations, should be valued both financially and socially.

Care workers have always experienced low pay for demanding work so little has changed. In recent years we have seen undercover reporters exposing shocking images of abusive practices in residential settings and recently the BBC televised further instances of abuse and neglect of older people in residential care homes by care workers. Many such instances have been rightly responded to both by the criminal justice system as well as the regulator, the Care Quality Commission (CQC). However, there is a problem in individualising the blame (on a ‘bad apple’) rather than seeking to understand and address the systemic failings in how we organise and value front line social care. The combination of dismay at the regular practice of organisations creating savings by non-payment of care workers’ travel time and the ongoing strike action by UNISON members in Doncaster for commensurable terms and conditions of employment in an outsourced service, highlights the need for research and policy to take a holistic view of our care industry, recognising how the material and working conditions of the workforce must be directly connected to the quality of our care services.

Dr Katie Graham joined SCWRU in early 2013 and is working on a NIHR School for Social Care Research funded project comparing the costs and benefits of different models of adult safeguarding.

A new approach to social work recruitment in the United States

Dr Mary Baginsky

Dr Mary Baginsky

Mary Baginsky, Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s and an expert on the UK Step Up to Social Work programme, reports on a New York initiative, the Children’s Corps.

I have also come to learn the difference between ‘feeling unsafe and just feeling out of place’. There have been many times when I feel out of place but I am getting over that.—A Children’s Corps Programme member

There is an increasing interest in the United States (US) in trying to ensure that those who are employed in children’s welfare services know what is ahead of them. What have been called ‘realistic job interviews’ attempt to give applicants a deeper insight into what the job entails. They are proving to be reasonably effective where the job is complex or difficult and where there are high turnover rates early on in careers, as well as where aspects of the work may not be fully understood by applicants. By giving them a real idea of the challenges the chances of retaining good staff increase. In the UK many of those recruiting onto social work programmes already do this explicitly or implicitly. We are also seeing some targeting of resources (such as the bursary) at people with prior experience with the idea that this will pay dividends in quality and retention.

The UK Step Up to Social Work programme has now recruited its third cohort. It is targeted at those with a good degree (defined as a first or upper second) as well as significant experience with children and young people. Time will tell what the retention rate is like but the feedback from trainees indicated that their prior experience was invaluable, even if they felt it was not always recognised by the universities or agencies where they were based. On the other side of the Atlantic another similar initiative has also just recruited its third cohort. Once again experience is at the heart of the thinking about how to attract and retain good social workers of the future.

Based in New York, Fostering Change for Children recruits college graduates as well as existing professionals on to the Children’s Corps programme. They all have to be prepared to commit to work in foster care and preventive services in New York City (NYC) for two years. The hope is that many of those who are accepted onto the programme will go on to qualify and practise as social workers. In fact some of those in all three cohorts already have a Bachelors degree in Social Work and see the programme as a way of gaining experience before embarking on a Master’s course. Since 2011, 88 Children’s Corps members have been placed in jobs in foster care agencies and preventive programmes across NYC. The receiving agencies are not expected to provide any additional support and the Corps members are no different from any other employee.

The Children’s Corps programme was inspired by Teach for America and shares its hallmark traits of emphasizing selection, training and support. Its message is that child welfare work is rewarding, but is also complex and demanding; it takes a strong and motivated individual to succeed in the field. The application and recruitment process is rigorous and involves realistic interviewing techniques and resilience testing to try to ensure they get people prepared for tough work in difficult environments. The programme starts with a five-week intensive summer school, but there is no funding to support the participants so they must have or need to find the resources to survive in New York without a stipend. The staff of Fostering Change for Children realise that there is a danger that it will therefore tend to attract those who have enough funds or supportive parents to see them through.

In May I was fortunate enough to be able to spend time with four Corps members while I was in the US as part of my Churchill Fellowship. Two of the four did not fit this profile. One had come to the US from the Caribbean when she was eight and said she had always been encouraged by her mother to give back to the society where they had made their home. She had recently married and the couple was able to live on one salary until she started earning. Another member had borrowed money from her family that she paid back when she started to receive a salary.

While the summer school was said to be excellent they all admitted that they had faced a steep learning curve when they joined their agencies. The average turnover in fostering agencies in NYC is 40 per cent, which meant that those coming towards the end of their second year had seen almost all their original colleagues leave. To say they were dealing with very difficult cases is an understatement and, at times, they had all wondered if they could go on. The quality of the supervision they received in the agencies had varied as this person told me:

For the first nine months of my job when all these workers were leaving it was a very negative work environment – it was not supportive and you were very much on your own. You had seven families assigned to you – I had 19 children assigned as a result. Sometimes I wouldn’t even know what I was supposed to be doing. I had some really old cases that were very hard. I thought about quitting every other day – may be at one point every day. I used to come home late at night after working a 12-hour day and I would cry – I was so exhausted. I did not know how I’d be able to go back the next day. It was very hard.

This person did not quit and is now studying for a MSW. But, as with her colleagues, she attributed her survival to the support she received from Children’s Corps. Not only does each member have a mentor whom they can use as much or as little as they want, the organisation provides monthly training sessions that also offer the opportunity for peer support as well as additional training. The retention level has been good across the early cohorts. Of the four Corps members I met three intended to qualify and practise as social workers and the fourth is deciding between that and going on to become a clinical psychologist, where she admitted she would earn more and probably attract more professional respect. The experience they have gained means that those going into the profession do so with a very realistic expectation of what the work is like. They have also learnt that if they are to stay in the profession they will have to seek out support if it is not immediately available.

Mary Baginsky is Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. She is author, with Claire Teague, of Speaking from Experience: the views of the first cohort of trainees of Step Up to Social Work (Department for Education, June 2013). Follow Mary on Twitter: @abbotsky

Go to the Fostering Change for Children websiteChildren’s Corps blog

Is the care worker perspective still overlooked in disability research?

Professor Karen Christensen

Professor Karen Christensen

A long time ago – at least as it is defined in the academic world – in the 1990s, the British professor of social policy Clare Ungerson published an article: “Give them the money: Is cash a route to empowerment?” In this article she forecast many of the challenges arising from welfare policies intended to empower disabled people in their everyday lives by means of cash payments. The idea was that instead of letting disabled people receive traditional services such as home help they should receive money to employ their own care workers and this should be “a route to empowerment”. The important contribution that Ungerson made with this early article about these cash payments was to point to the care worker’s perspective within a welfare scheme that aimed at providing services on the user’s terms. If she was critical of disability writers in this and later articles, and she was, so she was subject to criticism herself by disability writers such as Jenny Morris and others.

Since the late 1990s cash-for-care schemes have developed in different ways in many European countries and there is a growing literature investigating this form of welfare. However, this basic tension underpinning the field remains and also, reflecting this tension, the care worker perspective remains the perspective that is under-researched within the disability research field. Although currently ‘multidimensional aspects’ and ‘inter-disciplinary studies’ are keywords for new research projects, many networks and associated research areas are specialized or restricted within limits and this may take some of the research on ‘care’ – actually an unpopular concept within the independent living ideology, which has pushed forward welfare schemes that could empower disabled people – out of disability research. Interestingly, this does not seem to be the case with research on long-term care for older people, where studies about the care of older people are a central part of the research area.

I am currently working on a study about welfare, migration and care work, which is empirically based on life histories of migrant care workers in Norway and the UK, and these questions around disability research arise in the project for two reasons. One is empirical and concerns the life stories: in all of them care work, and particularly personal assistance work for disabled people, plays a role, though the role varies in relation to the different life projects of the migrants. The second reason is that migration is no longer an issue only for countries like the UK with its colonial past and long traditions of bringing migrant workers into the workforce; it has also become an issue in Nordic countries. So here, for example, the health and care sector is one of the main employment areas attracting migrants, in particular women. In the UK, migrants have played a role in the cash-for-care scheme since its start, while this is a more recent phenomenon in Norway. The difference is due to the different timing of the migration waves in the two countries; in the UK starting after the Second World War, while in Norway significant numbers of migrants first started coming after the EU extension in 2004, opening the borders to citizens from several East European countries. In other words: migration is now an issue for the cash-for-care system and for the discussion of disabled people’s empowerment in both countries.

Due to the ageing population in both countries there is a growing need for workers in the health and care sector. However, in the UK, and Norway (as well as the other Nordic countries), this sector is experiencing a recruitment problem, in particular regarding direct care jobs. This type of work is stigmatized as female low status work and, particularly in the UK, is associated with very low wages. Therefore the work is often seen as unattractive to indigenous workers and the shortages caused by this contribute to the explanation as to why the work appeals to migrant workers. Among the multiple motivations for migrants taking up this work are, for example, the lack of recognition of their qualifications and the necessity therefore to take the kind of jobs that are available and the flexibility of these kinds of jobs (part time, no fixed hours, live-in options etc.) which may appeal to their specific life situation. Overall, the structural point of departure, however, is of a reserve workforce situation which raises issues regarding, for example, the risks of developing working conditions which are below the general standards in these countries. Another risk, particularly in the UK, concerns the widespread use of private agencies supporting disabled people in their employer role, but often for a price that reduces the care workers’ wages significantly. Both disabled people and care workers are vulnerable groups under such circumstances.

What I am trying to say is that empowerment for disabled people is not only a disability project, but also still – and maybe even more so now, due to the new groups of workers entering the labour market – a care work issue. Care work is increasingly globalized: labour markets are no longer restricted to localities or countries. New worldwide job seeker web sites have been established and the rapid development of technology makes it possible to keep in contact with families in the home country. Including these changes in the discussion requires paying attention to the ways migrant care workers themselves handle their work situation as part of their lives. The life history perspective affords us a way of understanding this as an ongoing process of balancing individual preferences with the structural conditions set by immigration policies and the way in which the welfare scheme is implemented, as well as enabling us to examine concrete interactions with disabled people about the assistance they need and want to control in their everyday lives. Without knowledge of the care worker side, future discussions on how to empower disabled people will lack insight. These future discussions will benefit from opening the borders between disability and care work.

A version of this piece, together with the photograph of Prof Christensen, was originally posted on the blog of Nordic Network on Disability Research, 12 December 2012.

Karen Christensen, Professor of Sociology at the University of Bergen, is Visiting Research Fellow at the Social Care Workforce Research Unit at King’s College London. Her co-authored report on the marketization of older people’s services in Scandinavia is forthcoming. She took part in the Invisible Communities conference here at King’s. For more of Professor Christensen’s work on the Norwegian context see the Research On Workforce Mobility network, of which she is a member.