The importance of capturing workforce reflections when planning for the future of care
The social care sector is heading towards a period of reflection, that is not to say that the battle against Covid-19 is over for them and care homes in particular would tell you that they are still fighting on the front line. Managers and staff are understandably anxious over any reemergence of the virus and its impacts for their residents. Discussions are ongoing over the safest possible way to emerge from lockdown and to have that successful balance between safety measures and the real concern of the impact from lockdown and social distancing on those they care for.
However, we are starting to evaluate what care looks like now and how it will continue to be delivered in the coming months and years. The reflection that is needed is for policy makers to take the time to really understand the social care sector and its workforce which has been missing in the past when policies have been formed. This has resulted in the sector feeling that decisions are made that are not reflective of their experience, knowledge, and day to day roles. That is why it is imperative that this time the learning comes from front line staff and is shaped and formed by those who have already developed innovative ways of delivering care services within new and extremely strict guidance around infection control, wearing PPE and social distancing.
For many years we have talked about the importance of upskilling the workforce, creating new ways of learning and development and sharing of good practice which is of course extremely important however we must recognise that a great deal of that experience and knowledge is now held by the workforce particularly around dementia and palliative and end of life care. Managers of services, social care nurses and care and support workers who are providing care for those with complex dementia and with palliative care needs on a daily basis. They are hugely aware of the challenges of their roles and in their understanding of the individuals they support are able to provide high quality and tailored person-centered care.
We talk about care inductions and the wide variety of ways in which providers train and develop new staff members with the assumption that once an induction has been undertaken the staff member is then ready and able to work. Indeed, this is one of the qualifying reasons that the role of care worker sits on the Regulated Qualifications Framework (RFQ) at level 2. Unskilled staff are defined as those who require less than two to three months training prior to commencing a role and this is the definition that is used to describe front line care workers. This cannot be further from the truth which can be clearly evidenced in the staff mobilisation plans that have been developed in response to Covid-19.
Initially in March when a group was set up to discuss how best to support staffing levels and the social care workforce it was decided that SSSC would facilitate a recruitment portal alongside the portal being developed by NES for the NHS workforce returners. This was with a view to getting staff back into the sector quickly and to remove some of the difficulties and barriers of recruitment for providers while they were under huge pressure responding to the pandemic. This portal has been successful in that it set out to contact recent leavers of the sector, encourage them to come back into care, carry out the necessary preemployment checks and support the social care sector during the crisis. What was less successful was the ability of providers to access staff with the right levels of experience and knowledge that was required to fill these positions. The care home sector has seen the greatest impact of Covid-19 for a variety of reasons that I will not get into here however what has become clear is that it is not possible for staff to receive a short induction and commence work in a highly complex care setting such as a nursing care home.
The level of knowledge and skills that are required cannot be replaced with a week of training and the pathways that were subsequently created to deal with staff shortages came from bank staff at the NHS health boards and other care providers. Local networks provided much needed connections between care providers for example care at home staff were redeployed into care homes to provide the backfill support that was needed when staff were absent. This utilised staff who were already working in the sector and had a level of skill and experience that was required when supporting individuals with complex health needs and dementia support.
This lack of understanding of the social care sector and the assumptions that are made around the skill set of staff has been hugely detrimental to the recruitment and retention of the workforce that is needed. A lot of consideration has been placed on the difficulties of recruitment including the lack of decent pay, poor job security and poor terms and conditions all of which is true however this is also against a situation where the job itself is highly skilled with a great deal of responsibility which still goes unrecognised. SSSC data shows large numbers of new staff leaving the sector within the first six months as they realise that the role is complex and requires a great deal of learning and development. New staff coming into the sector must wait six months before applying to register with SSSC due to the recognition of a high percentage of leavers within that time frame.
The high level of staff vacancies and the pressure on care providers to recruit much needed staff has led to this message that individuals can walk into a care role and be ready for work shortly thereafter. This is clearly not the case and even when applicants can demonstrate the understanding and importance of person-centered values there is still a great deal of practical skill that must be learnt. This is actually the best case situation as practical skills take time but certainly can be taught, what is much more difficult is obtaining staff with the right attitude and emotional intelligence skills such as motivation, compassion and empathy that are vital for this role. In addition, as providers are taking on staff who require greater support and development this requires increased supervision and mentoring from experienced staff to ensure that the quality of care being delivered remains high.
The nature of care and the complexities of individuals needs often mean that care staff work in pairs and this enables the employer to match new staff with experienced staff to give that ongoing support and learning while recruiting the workers they need. This demonstrates the ways in which care providers have maximised the use of their existing staff to support new staff and provide ongoing mentoring to pass on experience where possible. If the sector is going to become more attractive to younger workers and grow the workforce to the numbers of people that we will require to work in care in the future this must be taken into account and the necessary support and development should be available along with the funding required.
The Fair Work report gave five dimensions that are important to individuals when contemplating and choosing their work and career. These include; effective voice, opportunity, security, fulfilment and respect. Previous labour market surveys have shown that social care employees give fulfilment as one of the main reasons they work and remain in the sector. We can also see from SSSC intelligence that there are huge opportunities for career progression within the sector and a great deal of staff movement between the different areas of the register show a high percentage of upwards promotion with care workers moving on to become supervisors and supervisors becoming care managers. However, we also know that the workforce in general feel that they do not have a voice, their contributions to policy making that would work for them is low and they certainly on many occasions do not have job security or are treated with respect in their professional capacity.
It is these areas that must be changed in order to build the social care workforce of the future. Those who are in positions of making policy and decisions must revaluate and speak with the workforce providing the care and learn from their experience if we wish to reach the highest level of care possible.
It is imperative that we find a structured way in which to define the so called “softer skills” that we have seen are so important particularly during the confines of lockdown and social distancing where care and support workers have provided that much needed end of life support and comfort when families have been unable to do so. That is a skill and it is something that many would be unable to do effectively to give that comfort when needed. We must also ensure that in the decisions being made for the future around keeping individuals safe that we do not lose sight of the importance of caring for that individual and what makes their life worthwhile to them.
Therefore, we come to the new normal that faces social care workers, the restrictions on movement, the additional personal protective equipment requirements that are affecting both staff and service users and the increased infection prevention control measures now in place. As a result of the pandemic there is a greater understanding of the role of social care and its impact and benefits on communities and the people being supported within them. This must now be taken forward and with that greater respect in mind it is imperative that the workforce is involved in these important conversations. Staff need to be asked what has been helpful and what has worked during the crisis and then time should be taken to understand these measures so that we can replicate these where possible. These conversations must be meaningful, we cannot ask staff to give of their even more precious time for a tick box exercise and so that people can reassure themselves that they did consult with the sector and involve front line workers. These must be conversations where real change is going to be actioned, where respect for the skills and knowledge of the workers must be acknowledged and the changes be driven by the workforce. We can do this by reviewing what changes to practice have already been implemented to look at what has been working for both staff and those they support. It is very clear that while policy makers have been talking the social care workforce has been creating changes that they can work within and is still in line with the many iterations of “helpful” guidance that has been published for them to follow.
Social care has certainly increased its number of allies and supporters over the last three months including individuals from within the NHS and our wider communities that can see the amazing work that goes on both in care homes and in people’s homes where they are supported. The general public has had a greater understanding of social care and what is actually required in the role due to the increased profile the sector has been experiencing. We must not lose this opportunity to build on this now, to amplify the voice of social care and to build on the promises that have been given to these essential key workers of their importance and contribution to society and the economy that has been for so long overlooked.
Workforce Policy & Practice Lead