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

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