Contradictions and conflicts in the policy towards the social care workforce

1. Contradictions and conflicts in the policy towards the social care workforce Jill Rubery and Peter Urwin European Work and Employment Research Centre Manchester Business School University of Manchester

2. The Research Project Dynamics of National Employment Models (DYNAMO) Elderly Care Sector Research • Data from reports (CSCI, DWP, Wanless) • Interviews with national actors in the sector - Regulators (CSCI, GSCC) - Providers (UKHCA, RNHA, ‘large independent provider’) - Local authority association (ADSS) • On-going local case studies - Local government officers (with responsibility for purchasing care services, monitoring quality and providing remaining in-house service) - Local independent providers (private and not-for-profit, residential and domiciliary, big and small)

3. UK system of elderly care: state commissioned but not state provided Entitlement: Based on needs assessment by local authorities. Subsequent means-test determines liability for fees. Around 80% of care is commissioned through local authority channels – privately initiated spending remains quite low (13% of personal social services spending in 1999/2000, Smithies 2005) The UK is viewed as having a substantial level of socialised care provision Local authorities retain the statutory duty to ensure that assessed needs are met

4. UK system of elderly care: state commissioned but not state provided Provision: Residential care: 76% private, 14% voluntary, 10% local authority • 1985-93: explosion of private provision, encouraged by benefit arrangements, ‘social care millionaires’ • 1993- : decline in LA provision due to cost and requirement to purchase 85% of residential services from independent sector. Process: some selling of public assets and TUPE transfers. Domiciliary care: 70% of state-financed hours provided by independent sector • From mid/late 1990s: cost pressures on LAs and the expense of in-house provision (increased after single status) led to the on-going shift to independent provision Process: natural wastage in in-house operations – TUPE avoided

5. Central government Budgets/care regime Local Authorities National minimum wage Care national minimum standards Alternative employers LA single pay spine Independent providers In-house provider Individual care providers Users as direct budget holders

6. The four dimensions to UK policy Demand- continued universal right to receive care, - growing demand expected Costs- contain costs through tight and non hypothecated budget- rising costs due to nmw in private sector and single pay spine in LAs-leading to increased outsourcing Quality- Diversity of providers subject to enhanced regulation (Training targets, Criminal records checks, Inspections – also the NMW) Choice- User choice agenda being introduced-direct payment and individualised budgets - further fragmentation

7. Contradictions and Conflicts in UK policy • Problems of quality and availability of labour supply exacerbates by policies to deal with costs • Efforts to regulate / improve independent sector employment conditions ineffective/contradictory • Evasion of superior and improved in-house employment conditions • Increased regulation of service quality but inoperative in more fragmented sector • Introduction of choice agenda without reference to issues of ensuring quality and availability

8. Labour supply constraints: High vacancy and turnover rates in some areas of the country – particularly affecting independent providers Problems in staffing unsocial hours, in a context of growing demand for this service Declining supply of women returnees due to women’s improving job opportunities and greater likelihood of being continuous employees. Employment in alternative sectors such as retail has also become more attractive with the declining pay differential Inappropriate responses: Contracting out more domiciliary care services to the independent sector on the basis of reduced cost which translates into lower pay for carers The removal of unsocial hours payments LAs are creating conditions in which carers are not paid for their travel time, in a context of greater use of short visits – making elderly care less attractive 1. Labour supply shortage- remedy is deteriorating employment conditions?

9. National minimum wage Improved level of pay in private sector but improved pay in competitor areas even more- e.g. retail NMW applies to travelling time but LAs do not include travel time in contracted hours - supposed to be funded out of gap between NMW and hourly rate paid to providers - not supposed to be sliced from visit time -ambiguity in responsibility for meeting standards. Training Target- 50% trained to NVQ standard Missed target- problem of high turnover, delivery of training, incentives to train, etc. Higher level NVQ training for managers- but increasing shortage of managers because less of an outflow from NHS to social care. 2. Efforts to regulate / improve independent sector employment conditions ineffective or in contradiction to commissioning policy

10. Provider commitment to training? DfES/DH document ‘Options for Excellence’ calls for “greater training opportunities and higher standards in staff training at all levels” (p. 4). BUT: a senior manager in a large independent provider organisation regards care skills as ‘natural’ or ‘normal’ attributes : “To be a good carer you don’t really need any skills at all, other than having a caring personality and a willingness to help. We’re not looking for rocket scientists, …we’re looking for normal people who want to help others and care for them, and that’s almost human nature, you don’t need to have a qualification in that”.

11. 3. Evasion of improved terms and conditions for in-house employees Improved pay for care staff in LAs through single pay spine agreement In-house managers have improved their recognition of skill, pay unsocial hours premia to staff, and are restricted to a maximum working week below that of the Working Time Regulations Extra in-house costs met/avoided through increased outsourcing - no attempt to spread improvements to private sector unlike NHS Strategies to avoid TUPE transfer as would lead to limited reduction in costs and problems for private providers- reliance on voluntary turnover but improvements in pay may reduce turnover.

12. Unaffordable in-house employment costs? ‘Options for Excellence’ calls for a “highly valued” care workforce (p. 6) BUT: funding regime leads councils to avoid high-cost in-house provider options – where terms and conditions are superior In the North East Case study: In-house domiciliary care staff given option of guaranteed hours contracts “We have given carers a better career and more security of income, but three years later, due to funding shortfalls, its become too expensive to maintain… So we’ve shot ourselves in the foot”. In-house domiciliary service manager

13. 4. Weak implementation of quality regulation Criminal records checks Tighter regulation in principal of those involved in care work Evidence suggests that checks not being made- high turnover- need to deploy staff quickly etc. Issue of how CRBs on migrant workers operate- some agencies provide checks but recognise that the quality of checks depends on home country's standard of record keeping.

14. Quality Professionalise care work New minimum training standards (50% NVQ level 2) Expand range of care services provided Stress on importance of continuity/reliability of care Choice User involvement – but users stress reliability/ attitudes/ flexibility that come with employment stability Choice reduces opportunities to turn multi- client jobs into stable continuous employment –users are an unstable population so patterns of demand and preferences for types of workers vary so difficult for individual to put together a stable working week. Direct payments/ individual budgets may enhance flexibility of content of care but further stage of fragmentation may be problem for reliability/attitudes Promotes domestic employees or use of agencies- not a framework for enhancing training or creating career ladders 5. Promotion of both quality and choice: incompatible objectives?

15. Concluding remarks Poor employment conditions are embedded in the contracting system The universal right to care is based on cheap labour Attempts to improve service quality through regulation, training and choice are undermined by the fragmented supply system Result is a low and deteriorating quality of employment in elderly care