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Future Trends in Social Services: Lessons from the UK and Europe

Explore the key trends and challenges in the social services sector in an age of marketization, with insights from the UK and Europe. Topics include workforce development, demographic changes, welfare models, policy changes, marketization of care services, and the impact of personalization on the workforce.

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Future Trends in Social Services: Lessons from the UK and Europe

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  1. Dr Shereen Hussein Principal Research Fellow (Chair) King’s College London, UK A Workforce for the Future Trends and Challenges in an Age of Marketisation: Lessons from the UK and Europe Melbourne, Australia, August 2017

  2. Social Services Activities in Europe • A range of services and activities • From social work activities (children, families, mental health, older people etc.) • To personal care and support for adults and older people in need of care • Provided over a range of settings from people’s own homes to residential or institutional care • Personalisation agenda • Tendency to extend care into people’s own environment even when complex care is required • Marketisation of care • Increased role of for-profit providers and competitive markets: issues of productivity, maximising profits • Implications on the organisation and delivery of services Public Lecture, Future Social Service Institute

  3. Drivers for Further Developments • Demographic changes • Ageing populations • Growing diversity and complexity of needs • Globalisation and Migration • Social changes • Family structures, labour participation and proximity of living • Perceptions and expectations • Economic challenges • Broad and specific to welfare regime Public Lecture, Future Social Service Institute

  4. European Welfare Models • Most ‘welfare states’ developed post WWII • Initially (and many continued to) targeted the most vulnerable in society particularly • Contrast between the provision of health and social care services • European countries are usually divided into four main welfare models: • Corporatist model (e.g. Belgium, Germany, France, the Netherlands and Austria) • Family care model (e.g. Spain, Greece, Italy and Portugal) • Residual model (esp. UK) • Scandinavian model (more universal and comprehensive • Eastern and Central European countries rely heavily on informal care Public Lecture, Future Social Service Institute

  5. Policy changes • Differences between and within countries • Successive policy reforms • Evolving from a ‘social protection’ perspective • Agenda of personalisationand marketisation • Integration & interdisciplinary work • Convergence of welfare regimes towards mixed-economies of care • Regulations, training and qualifications Public Lecture, Future Social Service Institute

  6. Marketisation of Care Services • Promoted by the ‘New Management Approach’ in the 1980s • the approach argues for fewer input controls and a stronger focus on performance and impact • The market is stimulated by the state through commissioning and outsourcing policies • Service users are considered as customers and civil servants as service managers Public Lecture, Future Social Service Institute

  7. Some Criticism of Marketisation • Private sector methods such as standardisation may not reflect the individual circumstances • The aim to increase productivity can have a negative impact on service quality • Potential for increased risk of abuse/safeguarding issues • Impact on the workforce: wages; working conditions; job protection; stress Public Lecture, Future Social Service Institute

  8. Personalisation and Cash for Care • Evolved from concepts of tailored person-centred care • De-institutionalisation of care • Greater flexibility, choice and control (personalised purchasing) • Two ‘distinct’ approaches: person-centred care and personalised care • Enhance the involvement of families (family policy, e.g. Italy) • Neoliberal agenda of reducing public sector expenditure and increasing commercial transactions • Consumer choice vs. universalism ?? • Concerns about the use of unregulated, untrained workforce • Potential safeguarding complexities Public Lecture, Future Social Service Institute

  9. Impact of Personalisation on the workforce • Ability to provide more tailored services at short notice • Differences between concepts of person-centredness and personalisation • Variations in relation to ‘client’ group • Data from the Longitudinal Care Work Study (LoCS) identify four themes • Awareness of personalisation and understanding its potential impact; • Adapting services; • Contracting (moving away from block-contracts); • Impact on business viability Public Lecture, Future Social Service Institute

  10. Adapting services • Care homes • Concerns of decommissioning care homes, particularly for people with learning disabilities (deregistering homes to become supported living service- with practical and legal challenges) • Non-residential services • Fewer fundamental adaptations are required • Home care workers are permitted (and encouraged) to exercise more discretion in service delivery depending on users’ preferences Source: Stevens, M., Moriarty, J., Manthorpe, J., Harris, J., Hussein, S. and Cornes, M. (Forthcoming) Performing personalisation in Adult Social Care – the impact on care providers. Social Policy and Administration Public Lecture, Future Social Service Institute

  11. Fiscal Challenges • Increased demand • Population ageing • Choices and expectations • Growing diversity • Pressures to do more for less • Refocusing policies to support and facilitate informal care • Financing of social services are organised differently across Europe • Some care reforms have been delayed due to financial pressures Public Lecture, Future Social Service Institute

  12. Social Protection benefits’ expenditures (all functions) in Europe as % of GDP Public Lecture, Future Social Service Institute

  13. Impact of fiscal challenges Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017) Investing in the social services’ workforce: A study on how local public social services are planning, managing and training
the social services workforce of the future. Brighton: European Social Network. Public Lecture, Future Social Service Institute

  14. Decentralisation • Devolution of resources and competences at the local level • Integration • Financial pressures • Could be linked to tailored services (personalisaed) • Introducing new laws providing local authorities with more power Public Lecture, Future Social Service Institute

  15. Integrated Social Services • One-stop-shops • Smart, sustainable and inclusive • Potential for: • tailor-made, flexible and responsive services; cost effective and efficient; capacity building and innovation • Across Europe these are implemented either vertically or horizontally • The importance of the ‘political institution’ • The implementation is different in systems with ‘central’ governance (e.g. UK) or ‘federal’ structure (e.g. Germany) • One of the best examples is in Finland • Properly designed with clear allocated roles Public Lecture, Future Social Service Institute

  16. Other Developments • Technology • Service delivery • Workforce implications • Increased population/workforce diversity • Tailored services • Effective communications • Data and research • Use of evidence in decision-making • Privacy and data sharing Public Lecture, Future Social Service Institute

  17. The Social Services Workforce • A labour intensive and emotionally taxing line of work • Increases in demand are likely to require an almost equal increase in workforce supply (Fujisawa & Colombo 2009) • Burnout and stress issues and management strategies • Predominantly female • Both horizontal and vertical structural differences by gender • Wages, high turnover and vacancy rates; working conditions and structure & delivery of work • Flat hierarchy of work, little room for career development/progression • Supervision; training opportunities Public Lecture, Future Social Service Institute

  18. Structure of the workforce • Generally two tiers professional groups • Highly skilled – professional qualifications (e.g. social work; occupational therapy etc.) • Less skilled – lower threshold of skills requirement at point of recruitment • Variations in regulations, registration, training requirements and qualifications • Increased attention to the importance of regulating the ‘less skilled’ workforce; however, little progress and inconsistencies across Europe Public Lecture, Future Social Service Institute

  19. The European Social Service Workforce Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017) Public Lecture, Future Social Service Institute

  20. Governance & Workforce Planning • Regulatory bodies exist at various levels & might differ depending on the profession • Perceived to be responsible for ensuring the competency of the workforce; monitor quality and ensure professional development • Codes of (good) practice and ethics exist in most countries • 60% - employers use workforce planning tools • 48% never used such tools Public Lecture, Future Social Service Institute

  21. Education & Training • Most countries have recognised social work training programmes • 50% - social work an undergraduate qualification; 20%, postgraduate; 11% argued it could also be accessed through vocational training • Social work studies -generic or a mixture of specialist and generic modules • For 85% social care workers are required to have a minimum level of training and qualifications Public Lecture, Future Social Service Institute

  22. Improving social services’ performance Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017) Public Lecture, Future Social Service Institute

  23. Workforce Shortages: Recruitment and Retention • Offering on-job tailored training and qualifications opportunities • Initiatives to broaden the pool of recruits • Attracting more men; targeting younger people at school/college fairs; People with disabilities; those from second generation migrants or new communities of refugees) • Increase the contribution of migrant workers • Managed-migration routes in shortage areas of work) • Existing tool kits to improve recruitment to the sector • Create opportunities for current workers to act as ‘care ambassadors’ • Agency or bank workers Public Lecture, Future Social Service Institute

  24. Impact of Agency Workers Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017) shereen.hussein@kcl.ac.uk twitter: @DrShereeHussein

  25. The Role of Migrant Workers and Workforce Mobility • Large scale mobility within Europe • ‘Care chains’ and beyond • Large proportion of both the professional and less qualifies workforce are migrants in many European countries • Much higher prevalence in capitals and large cities (e.g. 40% in London) • European and country-specific immigration policies • Increased role of Central and Eastern European migrants • Skills, qualifications and language transferability shereen.hussein@kcl.ac.uk twitter: @DrShereeHussein

  26. Example: Migrant workers entering the English social care sector Source: Hussein, S. (In press, 2018) The English Social Care Workforce: The vexed question of low wages and stress. In Christensen and Billing (eds.) Research Companion to Care Work Around the World, Rutledge: London. Public Lecture, Future Social Service Institute

  27. Example: Migrant workers in the Norwegian care sector Source: Christensen, K., Hussein, S. and Ismail, M. (2016) Migrant intelligence shaping work destination choice: the case of long-term care work in the United Kingdom and Norway. European Journal of Aging. DOI 10.1007/s10433-016-0405-0, 28 November 2016. [Open Access] Public Lecture, Future Social Service Institute

  28. Stress & Burnout: Evidence & strategies • Some of the highest burnout rates • Especially with certain client groups • Emotionally taxing • Co-relates with motivations to work • Organizational factors are crucial in mitigating burnout • Adequate training • Supervisory and co-workers support • Development opportunities Public Lecture, Future Social Service Institute

  29. Social workers, job satisfaction and intention to leave Source: Hussein, S.et al. (2014) Organisational factors, job satisfaction and intention to leave among newly qualified social workers in England, Social Work Education. 33 (3): 381-396. Public Lecture, Future Social Service Institute

  30. Social service staff, Impact of job and personal characteristics on job satisfaction and intention to leave Source: Hussein, S. (Forthcoming) The role of job demand, control and support on job satisfaction and job quitting intention among British long-term care workers. Findings from the Longitudinal Care Work Study (LoCS) Public Lecture, Future Social Service Institute

  31. Factors associated with stress and personal accomplishments: children & families social workers Source: Hussein, S. (Submitted) Work engagement, burnout and personal accomplishments among social workers in England: Does the clients’ group make a difference? Public Lecture, Future Social Service Institute

  32. Strategies to reduce burnout and job quitting • Ensure adequate initial and ongoing training • Set up clear policies • Establish in-work support mechanisms • Quality and quantity of supervision • Opportunities for co-workers support • Facilitate informal support opportunities • IT and administrative support • Interactions with own teams and other professionals Public Lecture, Future Social Service Institute

  33. Technology and Workforce Implications • Increasing importance of assistive technology and digital platforms • Advantages and challenges • Training of workers and users • Sharing information (changing culture) • Changing work structure (remote working, reduced face-to-face working time) • Skills’ requirements? shereen.hussein@kcl.ac.uk twitter: @DrShereeHussein

  34. Service Users’ Involvement • Aspiration to be achieved • In both care delivery and training process; co-production and ownership • However, the reality that only 21 percent of a large European survey indicated that service users in the provision, recruitment or assessment of social work training • Good examples exist • Mental health peer-support; the Scottish Recovery Network • Homeless projects in the Netherlands Public Lecture, Future Social Service Institute

  35. Safeguarding Models and Personalisation • Evidence from England • Three main models • Dispersed-generic model • Limited or no specialist involvement in operational response to safeguarding concerns • Dispersed-specialist • Dispersed-specialist co-ordination for high-risk referrals • Dispersed-specialist co-ordination for all referrals • Centralisedspecialist operational safeguarding team- with various variations Public Lecture, Future Social Service Institute

  36. Key factors in safeguarding work • Care setting • Multi-agency responsibilities and responses • Multiple concerns (e.g. from the same provider or worker) • Local guidance and policies • Multi-agency safeguarding hub • Decision-making functions – independent chairing of case referrals Source: Graham, K.E., Norrie, C., Stevens, M., Manthorpe, J., Moriarty, J. and Hussein, S. (2016) Models of Safeguarding: identifying important models and variables influencing the operation of adult safeguarding. Journal of Social Work. Advanced access Public Lecture, Future Social Service Institute

  37. Ways forward • The concepts of personalisationand marketisation • Particularly with the NDIS and thinking of transition to ageing services • Innovative practice • Diversifying service structure and delivery • Maximise the use of evidence, data and research • Make best use of technology • Integration and multi-agency working • Especially between health and care but also benefits and employment services • Capacity building • Co-production • Involving informal cares and broader family policies VCOSS CEO & President’s forum

  38. Shereen.hussein@kcl.ac.uk @DrShereeHussein 00 44 2078481669 This presentation draws on a number of studies, most are funded by the Department of Health, Policy Research Programme. Public Lecture, Future Social Service Institute

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