It is difficult to predict accurately how the public services workforce will need to change in the long term, and yet it is necessary to prepare now for the future. What is an appropriate approach to long-term planning for workforce needs and demand in public services, and how should current training adapt, not just at the point of employees’ entry into the workforce but throughout their careers?
The sector urgently needs significant investment to improve pay and conditions for its workforce who provide such a valuable service and yet who are among the lowest-earning workers in the country[1]. An improvement in material conditions must be the foundation on which increased prestige, visibility and professionalisation of social care work is built.
Strategic planning should also diversify its approach to training and recruitment so that it reflects the variety of support options which are providing excellent outcomes for people but at too small a scale. For example, Shared Lives is consistently rated as the highest quality form of social care by the Care Quality Commission (CQC), and yet it accounts for just under 1% of social care provision in England by numbers of people supported, and 0.5% by workforce.[2]
In Shared Lives, a person with support needs moves in with or regularly visits an approved Shared Lives carer who works from their own home. Together, they share home, family, and community life. People with a spare room, who have the right attributes to provide a more personalised type of care, are plentiful and yet currently represent a huge untapped potential – most people don’t realise that there are caring roles they can do from their own home and in which they can form a real connection to the person they support.
Conventional approaches to training have not enabled enough professionals to enter the public services workforce to meet demand. How might training change to maximise the number of public services professionals and improve their skills?
Any changes to training must be part of an holistic approach to workforce which provides fair conditions and meaningful progression routes. Training should highlight the diversity of types of work and future management roles available. It should seek to develop person-centred, relational skills based on mutuality, respect and problem-solving as well as those focussed on practical care needs. Helping people to live good lives should be the outcome care professionals train for, and care providers need the funding to be able to provide training to that end.
For Shared Lives carers specifically, a central framework of training with transferrable, optional modules exploring a wide range of topics relevant to supporting people with social care needs to live a good life would be appropriate. These modules could be adopted as individual situations dictate to provide a bespoke, person-centred skillset.
What are the hurdles to joint training between services? Do siloed approaches to attaining professional qualifications prevent joint training? How might better data-sharing improve joint training?
Data-sharing alone is not sufficient, training should be standardised and based on a shared, values-based philosophy so that different providers in the sector can be confident of quality and unity of purpose when they overlap with one another and recruit from one another. Joint training requires an immense amount of time and co-ordination and capacity for this simply doesn’t exist in the sector currently. A joint, standardised approach to training must also account for the fact that each Local Authority population’s care needs are unique and currently commissioning reflects this – so flexibility is key.
How might the public sector become more attractive as an employer, particularly in comparison with the private sector? How might it become attractive enough to retain workers throughout their careers while maintaining a level of turnover that brings fresh ideas to organisations?
As mentioned previously, a commitment to investing in increased pay and conditions for all social care workers is the foundation of making the sector more attractive to potential employees. Social care employment terms need to be fundamentally changed – from basic wage increases down to addressing specific inequities such as the fact that many carers have to pay their own travel costs and are not paid for the significant time they spend travelling between calls.[3]
The visibility and prestige of social care as a career option needs to improve – and part of that includes in raising awareness of the full range of what is possible in social care. Showing that it is about supporting people to live a good life - to grow, learn and have fun together. The advertising campaign Every Day is Different had some success in demonstrating this. Such a campaign could be improved by showing explicitly the variety of work arrangements and, in particular, by showing that people can work from their own home in a Shared Lives match
The question here belies the fact that, although social care provision is a statutory obligation of local authorities, the majority of this provision is outsourced to independent bodies and private, profit-making organisations.[4] Many large provider organisations are in extreme financial difficulty following their acquisition by predatory private equity companies[5], while many smaller providers lacked the resources to invest in expansive recruitment and training in the first place.
People in Shared Lives have often had prior experience of another type of social care support which has been either inadequate or inappropriate, receiving too little support or else having their freedom, human rights and opportunities to live a good life restricted by overly interventionist institutional forms of care. People from lower socio-economic groups, those with support needs and those from marginalised communities are less likely to have the ability to research, advocate, and broker the support they really need.
The postcode lottery of provision[6] and a general lack of quality and personalised care offers people who need support too little personal choice. It also results in a lack of consistency of care to individuals, breakdown in relations with their family and community and in most extreme, but sadly not uncommon cases, higher levels of abuse and safeguarding instance.[7]
How can providers of public services recruit a more diverse workforce? How should they improve their recruitment of BAME people, people with disabilities, older people and people who use public services and live in the communities that providers serve?
Any approach to recruiting a more diverse workforce must understand that the groups listed are less likely to be able to access opportunities. Therefore, a more pro-active strategy, which knows “where to look” actively at interfaces appropriate to the different groups, is needed. Providers should be supported to work together with groups whose aim is to increase opportunities for people in marginalised communities.
There are also ways in which social care services could engage those people it serves to communicate about opportunities in the sector – in Shared Lives, for example, people with lived experience often become integral to the delivery of a service as part of the panel which assesses new Shared Lives carer applicants. This points the way for an approach which includes people with lived experience in all aspects of service design and delivery and recruitment.
What role can digital tools play in increasing the accessibility of public services workers to service users, and in improving the quality of their work? How might we anticipate and mitigate any inequalities of access to public services that may arise from the expansion of such technologies?
People with a learning disability are just one group who are less likely to have access to the internet and other communications technologies and devices.[8] There is no evidence to suggest that the digitisation of services necessarily improves outcomes for people using them, and any expansion of digital interfaces must make sure that technology does not replace real, dedicated, face-to-face support. Where digital technologies can make a positive impact is in the tabulation and visualisation of data.
Preventative and early intervention services can improve the ability of the public services workforce to respond to users’ needs. How might such services be embedded within any public services workforce strategy?
Preventative services should be an integral part of the service provision landscape and receive parity in planning and funding to interventive branches. Planning should recognise that a blended approach can work for many people, including a combination of preventative and interventive, informal and regulated services.
Homeshare, which is not a regulated form of social care but which is based upon the principles of the restorative power of relationships and matching strengths and needs, can have an excellent preventative effect in communities. In Homeshare, an older person with a spare room opens up their home to someone younger needing a place to stay in exchange for a set number of hours of practical support per week. Both parties share home life, swap stories and skills and benefit from the unique companionship afforded by an intergenerational friendship.[9]
As well as tackling the loneliness epidemic and the housing crisis - both of which have well-documented impacts upon health and wellbeing and consequently huge implications for interventive services - Homeshare matches have been shown to be effective in helping older people live at home for longer and maintain their health and wellbeing so that their need for acute and clinical services is less. [10]
What have been the effects of the COVID-19 pandemic and Brexit on the public services workforce? Have these events created opportunities for workforce reform?
One of the key effects of the pandemic has been to put tremendous pressure on, and consequently highlight the importance of, short-term day support services. Firstly, Shared Lives carers – 20% of the total - who provide short-term support, in the form of either day arrangements or short breaks, were forced to stop working altogether because the measures implemented to mitigate the pandemic made such arrangements unworkable.[11]
Secondly, with short-term social care provision significantly reduced, many Shared Lives arrangements became full-time, with no break for the carer or the person supported. The need to invest in shorter term provision is urgent, and there is no reason why Shared Lives could not form a greater proportion of that provision given it proved its resilience as a model throughout the pandemic.
Focus on tackling the pandemic has hampered the wider reform agenda, and in many cases the government’s authoritarian response has had drastic implications for the wider workforce. We are pleased that the government looks set to reverse its policy of mandatory vaccination, which could have led to the loss of nearly 10% of care workers from the sector, yet there are many staff who have left in anticipation of the mandates who will be difficult to replace in a sector already suffering an acute workforce problem.
Integrating public services can mean that they are delivered more effectively to users. What would be the outcomes of better integration between public services workforces?
Integrating services effectively – between health and care systems, between those delivering care and those in referral, planning and co-ordinating roles - can facilitate the flow of information and raise awareness within the system of the potential of its various branches. If professionals providing interfaces to the public are fully aware of the wider landscape of service provision and what it can do, they will be more likely to refer people seeking support to an option that really works for them.
Greater integration would also result in a more holistic, joined-up provision which users would experience as less complicated, inconsistent and stressful to navigate. People would not need to repeat their stories and go through the same processes over and over again.
As stated above, these workforces are already providing a majority of existing social care. They should be considered as key partners and involved in planning and delivery at national and local level – not least because of their expertise and experience in working collaboratively with people who use health and care services. Planners should adopt the recommendations in the VCSE review of 2019[12]
What are the barriers to achieving better workforce integration (including integration with the voluntary and private sectors), and how can any such barriers be overcome? How can leaders of public services drive and incentivise any cultural change necessary to achieve integration between organisations? Are there any examples of best practice?
Just one way in which health and social care integration has proven difficult to achieve in practice is in the mechanism for funding individuals’ care. Health and social care funding are delivered through different channels which means that attempts to integrate services can be hamstrung by a lack of clearly defined imperatives to release funding from distinct “pots”.
For example, Shared Lives Plus has long known that Shared Lives can support people with health needs as well as assessed social care needs. NHS England recognised this and partnered with Shared Lives Plus in a project to develop this type of Shared Lives provision. The project achieved good outcomes in establishing infrastructure and raising internal awareness but did not mandate a clear method for releasing funding for individuals referred into Shared Lives for health needs. In practice, representatives of both health and social care commissioning on the joint panels deciding care pathways for each individual often felt that it was the responsibility of the other service branch to fund the match, and there was no guidance to resolve the matter. [13]
Most services experience a serious lack of capacity, leaving little time and resource to commit to meaningful integration with other service branches. That capacity must be afforded and built in by central, strategic planning. From within the Shared Lives sector there are a number of examples of coordinated planning and joint leadership between organisations and sectors.
Northeast ADASS, the 12 directors of social care in the Northeast of England, have partnered together with Shared Lives Plus specifically to grow, develop and diversify Shared Lives provision across the whole region, benefitting from a centralised approach to sharing best practice, training and resources – but retaining the flexibility to design services that suit the unique needs of people at the level of place.
Shared Lives Plus also pioneered a project to develop Shared Lives provision for survivors of domestic abuse which featured a partnership between two expert voluntary sector organisations and six different Shared Lives provider services which delivered positive outcomes for a number of survivors. [14]
What tools do good leaders use to incentivise and challenge their workforces to transform service delivery? Are there any examples of best practice?
Leaders in all services must listen to, and involve, those with lived experience in designing services and planning. They should stay informed about, and communicate with, the full community of service provision in all its diversity so as to share best practice and discover new approaches and ways of thinking. TLAP’s recommendations for an “asset-based area” approach are extremely relevant to this topic.[15]
The Northeast ADASS work referred to in the previous answer also provides an excellent example of how leaders can focus on whole communities of practice to introduce the change needed across all sectors and aspects of communities.
To what extent is public services workforce planning managed better at regional, sub-regional and local levels, rather than at the national level, and what mechanisms might enable more effective devolution of workforce planning? How can the Government train workforces to deliver more effectively those public services that are coordinated at the national level?
There must be a balance between the national and local approaches, recognising the strengths of each. National-level resources, planning and implementation are needed for policy frameworks and recruitment campaigns with the ability to really cut through, but with a remit for flexibility at local level so that policy and recruitment can be based on local population needs and workforce base.
In the Shared Lives sector, for example, recruitment of new carers happens primarily via word of mouth and Shared Lives Plus supports Local Authorities with targeted, demographic-focused digital recruitment campaigns. We would welcome government support so that we can continue to offer this to local authorities. We would also welcome another large-scale, centralised recruitment campaign like Every Day is Different - a local campaign approach would be unable to marshal the necessary resources.
Our previous inquiries have shown that public services are failing to deliver joined-up support that is centred on the user. What workforce barriers need to be overcome to bring about a more user-focused approach to public services delivery?
Service planning must adopt principles like asset-based thinking in earnest and not simply nominally, and that must include a willingness to commit greater material resources as well as shifts in ways of thinking. In general services should shift away from a restrictive focus on risk and begin to think of the ways they can facilitate a person to live a good life. These ideas should exist at the heart of training programmes and there must be significant funding to enable care professionals to act on them meaningfully - it is very difficult for underpaid, under pressure workers to deliver genuinely person-centred care to too many people in fifteen-minute blocs,
Users’ expectations of public services are changing rapidly. How, in your experience, have their expectations changed? What are the best ways to involve users in the design of public services, and what skills will public services workforces need in order to respond? For example, what skills will employees need to support users who expect more choice in the public services that they use?
In time we hope more people will view social care as something that can help them live a good life. Their expectations will be of a more flexible and responsive system which has the ability to grow into the shapes needed at an individual level - more intensive in some cases and lighter touch in others.
People using services should be formally integrated into every aspect of service planning and delivery – people using Shared Lives being part of panels recruiting new carers are just one example of good practice in this area. People using services should have open lines of communication to all levels of service planning and delivery, and there should be investment in creating such forums.
Workers will need to have skills and values around personalisation of care, and the asset based approach already mentioned– focusing on what people can do and want to do, rather than on what they can’t or shouldn’t.
February 2022
[1] https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/Topics/Pay-rates.aspx
[2] https://sharedlivesplus.org.uk/2022/02/02/report-the-state-of-shared-lives-in-england-in-2020-2021/
[3] https://www.litrg.org.uk/tax-guides/disabled-people-and-carers/caring-someone/issues-facing-paid-care-workers
[4] https://www.kingsfund.org.uk/audio-video/key-facts-figures-adult-social-care
[5] https://cusp.ac.uk/themes/aetw/wp26-careless-finance/#1579557747983-bfc4b6a4-fd4ccb6c-f99e05cc-4874
[6] https://www.homecareinsight.co.uk/social-care-postcode-lottery-fully-funded-care-six-times-more-likely-in-some-areas/
[7] https://sharedlivesplus.org.uk/shared-living-and-human-rights/#:~:text=Shared%20Lives%20and%20Homeshare%20are,age%2C%20health%20and%20social%20care.
[8] https://www.ofcom.org.uk/__data/assets/pdf_file/0026/132965/Research-summary-learning-disability.pdf
[9] https://homeshareuk.org/
[10] https://www.nhsconfed.org/articles/homeshare-model-preventative-approach-help-older-people-remain-independent-longer
[11] https://sharedlivesplus.org.uk/2022/02/02/report-the-state-of-shared-lives-in-england-in-2020-2021/
[12] https://vcsereview.org.uk/
[13] https://sharedlivesplus.org.uk/news-campaigns-and-jobs/growing-shared-lives/health/
[14] https://sharedlivesplus.org.uk/news-campaigns-and-jobs/growing-shared-lives/domestic-abuse/
[15] https://www.thinklocalactpersonal.org.uk/Latest/The-Asset-Based-Area-/