What Workforce for Personalised Care?

1. What Workforce for Personalised Care? Martin Stevens 10 October 2012

3. Introduction • Personalisation policy • Workforce characteristics • Pay and conditions • ‘Traditional’ services • Personal assistants • Recruitment and Retention • Risk and safeguarding • Social workers and social work roles

4. Personalisation policy • Personalisation is achieved when a person has real choice and control over the care and support they need to achieve their goals, to live a fulfilling life, and to be connected with society. • Caring for Our Future 2012 p18 • ‘Councils should provide personal budgets for everyone eligible for ongoing social care , preferably as a direct payment, by April 2013.’ • Vision for Adult Social Care, 2010, p 19 • A caring, skilled and valued workforce delivers quality care and support in partnership with individuals, families and communities. • Caring for Our Future 2012 - p18

5. Social Care Personalisation History White Paper – continued focus on personalisation, transformation of social work and safeguarding Personal budgets - transformation of social care Direct payments always offered Direct payments legalised Individual Budgets piloted 1996 2003 2005-8 2008 2012

6. Workforce characteristics • 1.6 million workers (20,000 social workers) • ‘Dual labour market’ - One set of pay and conditions for professionals/paraprofessionals and another for frontline and ancillary workers • Care workers continue to have high job satisfaction - Much better than shop workers or waiters/waitresses • However, workers see demanding nature of work and low status as barriers

7. Pay and conditions • In 2009, median hourly rate for a care worker was £6.47 (Hussein, 2010) • Living wage’ outside London is £7.20 (http://www.livingwage.org.uk/about-living-wage ) • Many agencies do not pay travel time or petrol • Personal assistants may earn less • Migrant workers earn less (Hussein, 2011)

8. ‘Traditional’ – CQC registered – services • Purchasing patterns - many older people prefer to have their personal budget managed by local authorities • Moving from block to spot purchasing • increased flexibility or more uncertainty for providers and therefore older people • Differential rates of pay • Less regulation of personal assistants • Will there be an expansion of mutuals and co-operatives? • Will (and how) will services adapt to meet new expectations? (Baxter et al 2011)

9. Personal assistants • Shortage of personal assistants (and care workers) • Low level of qualifications • Mainly female, white and spread across ages • Paid workforce may include family members/adult fostering/shared lives (just under half known to individual employer • Workers able to move between agency work and directly employed • implications for continuity of care? • Poaching agency staff • Pay, conditions and careers? Working for personalised care: A framework for supporting personal assistants working in adult social care (DH 2011)

10. Recruiting Personal Assistants • Level of support critical: from peers, local authorities, Age UK etc – Personal Assistant Registers • Job Centre Plus advisers – need for increased understanding • Checks – Criminal Records Bureau/ISA/Disclosure and Barring Service • Developing skills over time (Aksey and Baxter, 2012)

11. Retaining care workers and personal assistants • Over 40% plan to leave in the next 5 years – on a par with other care workers • Lack of training • Quality of relationships with employers – role boundaries • Low pay and status of social care • Support - from peers, employers, social workers, unions. PA networks and organisation (Personal Assistant Framework- DH 2011)

12. Risk and safeguarding If there’s a problem they can’t just ring us up and say, ‘Sort it’. Because if they’re actually employing the person, they’ve got to sort that out with whoever it is that’s supporting them to employ that person (Team manager people with learning disabilities team: IBSEN – Glendinning et al 2008) • Unregulated personal assistants • Using PBs inappropriately and unproductively, • Poor quality and poor outcomes, • Creation and attraction of crime, • Risk of losing public support "Safeguarding Marblehead”

13. Training • Positive impact of regulation in improving access to training (Gospel, 2008) • BUT limited access to training in specific areas such as dementia care (NAO, 2007) • Needs reinforcing to maintain long term impact (Moriarty et al, 2010) • Apprenticeships for care workers • Induction training standards for personal assistants? • On the job versus trainer led training? • But who pays? Image from Elite Social Care Professionals Website

14. Social work and social workers: mixed messages? • Chief social worker to be appointed • Social work practices – independent of local authorities • Role to: ‘focus on promoting active and inclusive communities, and empowering people to make their own decisions about their care’ (Caring for our Future, DH 2012) • Division of roles – assessment, support planning and brokerage • But - local authorities are aiming to reduce the numbers of social workers (Lymbery, 2012)

15. The future? The Nightmare (Fuseli) The Golden Age (Cortona)

16. Ongoing austerity – dominant issue – much more to come • Choices between limiting amount of support you have and paying workers fairly (NAO Care Markets report, 2011) • Will we transfer structural problems onto people using services and family carers? • Will apprenticeships improve recruitment and skill levels? • Will personalisation lead to increased job satisfaction and retention? • Communities and families - ‘in it together • Increase in ‘intermediate’ occupations (e.g. brokerage/advocacy)

17. Thank You Martin.stevens@kcl.ac.uk 020 7848 1860 Social Care Workforce Research Unit, King’s College London, Strand, London WC2R 2L www.kcl.ac.uk/schools/sspp/interdisciplinary/scwru/ The views expressed in this presentation are those of the author and not necessarily those of the Department of Health