New landscapes in social care workforce planning
The adult social care workforce is facing a time of unprecedented and sustained change. Arguably the Care Act 2014 is the most significant piece of legislation to impact on the social care workforce since the establishment of the welfare state. It marks a shift from local authorities’ duty to provide services to meet people’s needs, to defining their primary responsibility as the promotion of individual wellbeing. This is set against a backdrop of relentless and challenging financial pressures.
In the new briefing I have recently authored for RiPfA on workforce development, I have divided this backdrop into four areas:
- Social care workforce landscape
- What works?
- Workforce planning.
Social care workforce landscape
A key theme in the workforce landscape is integration and the Care Act 2014 makes it a statutory requirement for local authorities to collaborate, cooperate and integrate with other public authorities. The integration of health and social care services has long been an aspiration for government but despite widespread support, there have been real difficulties in achieving it. The Health and Social Care Act 2012 established health and wellbeing boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. The briefing examines national initiatives designed to support service integration such as the pooled funding arrangements in the Better Care Fund, or the development of innovative practice through the Vanguards sites and Integrated Care Pioneers.
By 2025 there will be an additional 1.5 million people and as more people live longer, the need for social care and support as well as health care is increasing. Spending on social care has been falling since 2009 and fewer people are receiving publicly funded services. There is mounting concern about the impact of these cuts on individuals and families and on the NHS.
In this turbulent environment for adult social care financial resources are not the only answer and there are signs that the sector is showing the ability to adapt with many new roles arising from the pressures. Evidence of these roles can be seen emerging in innovative services across the country. These can be divided into four categories:
1. Specialist - focusing on a particular specialist area or task. These can be found in Suffolk in the social enterprise Sensing Change, which supports people with sight and hearing loss. Sensing Change has also generated income by running sensory awareness and British Sign Language courses for clients including a national retailer.
2. Facilitator - working in partnership with and alongside service users. In Thurrock they have adopted a co-production approach to recruit and support local area coordinators to provide long-term, community-based support. A recent evaluation found that they had been successful in finding practical solutions to problems that would otherwise require social services-funded support.
3. Organiser - facilitating and arranging support from different resources. Shropshire’s People2People is a social enterprise trying new ways of assessing older people and those with physical and/or learning disabilities and their carers. As well as assessments, People2People arranges support and services for those it works with and allocates personal budgets.
4. Integrator - working across services or user boundaries.In North East Lincolnshire the entire adult social work function, including safeguarding, was moved out of the NHS and local authority and into Focus, a fully independent company. Most of Focus’s 150 staff was transferred to the company under TUPE rules retaining their local authority/NHS pay and conditions. Staff also form the bulk of the company’s Board.
In order for social care services to ensure the quality and safety of the care they provide, they must find ways to encourage innovation and creativity, while keeping the quality of care for people who use services at the centre of their work.
Responding to this challenge requires three key elements:
1. Leadership: The social care environment has been changing rapidly, presenting remarkable challenges and opportunities for leaders. One result of this has been the blurring of organisational and professional boundaries as services are integrated, resources pooled and staff deployed more flexibly. Collaboration across health and social care is widely recognised as an essential approach to secure better outcomes for people at an optimum cost. The term ‘Systems Leadership’ describes a method of managing problems that cannot be solved by one organisation and is characterised by two interrelated attributes: collaboration and working across boundaries. Great systems leadership requires a particular mindset and approach to the role, including being able to give up and share power.
2. Mindset: Well-led services have a positive organisational culture that is open and transparent and where the vision and values are embedded and understood by staff across the service. Where there is pride and enthusiasm amongst both staff and people using the service, this is often indicative of good leadership and a safe culture. Similarly, the best managers welcome feedback and are open to challenge and willing to take on suggested changes. When communicating ideas to the workforce it’s vital to have examples of how they work in practice. It is not enough to have written polices merely stating values etc. To develop positive mindsets, workers need to see these policies role-modelled by their managers, or they can feel undervalued and disempowered.
3. Commissioning: The RiPfA briefing highlights the need for a more refined approach to workforce commissioning and analysis of choices made by people using services aiming to make clearer links with other sectors. An effective workforce strategy helps to enable joined up care services and summarises how local organisations will work together, making certain everyone is committed to collaborative working and producing better outcomes.
Adapting and evolving
It is fair to say that the social care workforce faces significant challenges. However it is also beginning to adapt in difficult times. The evolving roles are starting to have a positive impact and could be part of a more confident future for the sector. There are common themes and issues emerging as the number of roles increases. To ensure that workers understand each other’s functions there is a need for strong systems leadership on all levels with the ability to communicate across organisational boundaries.
For the most part those who work in social care are trying to achieve the same thing - better outcomes for people who use their services. Leaders need to instigate a positive mindset and shared language across different professions and roles, so the workforce can clearly understand each other and positively work together. Many of the changing roles and the skills associated with them arise from pressures being placed on social care but this is not the whole story. The examples highlighted show that the innovations often come from the hearts and minds of those who work in or receive services. The challenge for those who plan and commission the workforce is to coproduce a strategy in such a way as to enable grass roots innovation to flourish.
About the author(s)
Robert is a former Director of Health and Social Care and has 25 years’ experience across the full range of Adults’ and Children’s Services. He is currently the Independent Chair for Cheshire East and Portsmouth City Safeguarding Adults Boards and founder of a newly established social enterprise ‘Well Street Better Care and Health’.