No baton changes: We must start from what people want

Featured article - 01 July 2020
By Oonagh Smyth, Chief Executive, Skills for Care

We are still in the middle of the pandemic, which is impacting so many lives, directly and indirectly, and causing so much pain. While the pandemic is not over, it is important that we can take a step back and think about the changes that we have to see for the 1.49 million people who work in adult social care. Without their skills and commitment, the 1 million people who access care and support every year will not get the support they need.

• Skills for Care
• SCIE: COVID-19 support for social care
• Other opinion articles in this series

Deep and historic issues in social care

There were deep issues the 18,500 organisations who offer social care services were wrestling with before the virus. A high turnover rate of 30.8% and increasing year on year. This is compounded by a high vacancy rate which means that on any given day before the pandemic there were 122,000 vacancies that need to be filled.

Those realities make it more expensive for employers who have to pay to recruit constantly. It can have a negative impact on people accessing care and support who have to keep building and rebuilding relationships with new faces.

We must start from what people want

We must start any conversation about the future of the adult social care workforce from the perspective of the person who accesses care and support who is the person with lived experience. We must start by listening to what they want. This will be different for different people in different contexts and it is not our role, or the system’s role, to assume that we know what this support is or should be. We must always make sure that people have choices and options.

This means that we need the right people, in the right roles, with the right skills and core values that we can build on to make that aspiration a reality.

No baton changes

People should not feel the baton change between different systems. People want their health and care delivered by flexible, digitally aware people with the right skills, who are kind, skilled and treat them with respect. They do not care whether the support delivered is commissioned by health, or social care.

We know that social care roles are highly skilled and now finally the public do too as they have seen for themselves the value of what the workforce has contributed through their sacrifice, skills and commitment.

We also know people are living longer with more chronic health conditions, so developing a more complex set of skills, and understanding the breath of models of care and support in both social care and health is going to be critical.

We are seeing this during this crisis – social care staff have done many tasks which would typically have been the role of health staff. They have stepped up; they have been trusted and have shown every day that they are worthy of that trust. We have to build on this and have more of a fusion of care and health skills so people can have a seamless integrated experience locally.

We also need to recognise that for a significant number of people who access care and support do not currently have health issues. They may be more likely to need integrated experiences between social care, housing, leisure, transport and all the community services we take for granted.

Joined up workforce plan and reform

This leads me to believe that we need to have one, joined-up national workforce plan, and developing effective local plans.

The social care workforce will need to change and grow in different ways according to population growth and changes to needs. The plan must include flexibility and long-term strategic planning to ensure we have the right people, with the right skills, in the right place now and in 15 year’s time.

We must plan for the interaction of social care with health and with other systems. The plan must include more integrated local approaches and learning from them what works.

The average hourly rate for care staff is £8.10 an hour with only 10% of care workers on the real living wage. This plan must include improved pay and terms and conditions of care staff.

There is only 15p per hour difference between the most and least experienced care worker and this has been narrowing over the years. The plan must include clear career pathways.

We know that people often leave managers and not organisations. Our managers are under extreme pressure – even before COVID. One quarter of Registered Managers leave every year and the vacancy rate of Registered Managers is 4% more than the average vacancy rate in social care. The plan must include continued investment in our leaders and managers.

These are the things which impact on people’s desire to come in to care roles and as importantly stay. It is the least we can do to recognise the central role that people working in adult social care have played during this pandemic.

Building trust

We need to build on the trust in adult social care that has been shown during this crisis. We have heard that the crisis has resulted in increased trust, between commissioners and providers, employers and employees, health and care. We must trust our colleagues in social care to make decisions using their skills and judgment. We must support them to have the right skills in order to do this. Families and people who access social care trust us every day and we need to build this as a value deep in every part of social care.

Change needs to be deep and it needs to last

Social care helps people to live the lives that they choose. To build and keep relationships. To live independently. To live. The need for social care is changing and growing as people live longer, with more chronic health conditions. If we take the most conservative projections, we will need an extra 580,000 jobs in social care in 15 years.

We have an opportunity now to think about the changes we need to make, and what sort of workforce we will need in the future. If we do then people who access care and support will be able to live the lives they want to.

• Oonagh tweets @oonaghsmyth