‘Who cares about skills?
The impact and limits of statutory regulation on
qualifications and training in the social care sector’
Howard Gospel and Paul Lewis
Management Department, King’s College London
DH, 17 November 2009
Outline
•
Context
•
Methods
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Impact of regulatory framework
training
OPH, PLDH, CH
•
Continuing impediments to training
•
Significance and discussion
•
Conclusions
Context: the social care sector
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1990 Health Services & Community Act
quasi-market in social care
purchasers and providers
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The regulatory framework
2000 Care Standards Act and NMSs
Inspection regime – NCSC, CSCI, CQC
Registration regime – GSCC
NMSs
Training central – for managers and workers
Training targets – 50%/80% 2005
•
Classic quality assurance model
service standards
internal quality control procedures
external monitor
Context: the social care workforce
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1.6 million, circa 5% of UK labour force
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2/3 of whom care workers
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85% women, 50% part-time, 65% 35+,
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High turnover and vacancy rates
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International recruitment 
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Labour costs 80% of total costs
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Training limited
Research methods
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Replication study – 2003 DfES; 2008 DH
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7 case studies
4 OPHs, 1 PLDH, 2 CHs; spread of types
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Interviews with key organisations
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Examination of various statistical databases
The impact of training targets
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2003, 1 met NMSs; 2008 all met NMSs
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All registered managers compliant
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Managers attributed higher qualifications to NMSs
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See also CO 2008 study: ‘Everyone we spoke to
believes that far fewer employees would have been
trained in the absence of regulation’ (16)
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Representativeness?
The impact of targets – flow measures
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Table. New registrations (levels 2 and 3)  each
year 2000-05; tails off in 2006
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Biggest increase in 2003 and 2004
•
Same story with registered managers
The impact of targets – stock measures
1.
Staff
2003 20% at level 2 or above
SfC NMD 23%
CO 30%
Some, but limited, progress to 50%
SfC NMD registered managers 57%
2.
Homes
OPH 48% compliant in 2002/3; 78% in 2006/7
HPLD 63%, 80%
CH 46%, 70%
Significant , but still considerable work to be done
The impact of targets – other
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Induction standards – in place in all case studies
Induction training  in length, breadth, formality
Better integrated into subsequent NVQ
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Minimum number of days training – all compliant
Used for mandatory training e.g. h&s, POVA etc.
Built into routines
•
Conclusion: Significant positive effect, but still
considerable scope for improvement
Impediments to achieving NMSs:
employers
1.
Costs of training / funding
2003 direct costs covered, but not indirect
2008 more state money
Constraint 
2.
Assessment
2003 cost and time of assessor
2008 move to external assessment
Constraint 
3.
Turnover
Fear of poaching in both 2003 and 2008
But fears not well grounded – turnover not 
Perceived constraint continues
Impediments to achieving NMSs:
employees
1.
Time constraints
NVQ study 1 – 2 hours per week
Still a constraint
2.
The academic demands of NVQ
Tho’ practical, on-site, on-the-job
Still fear of ‘going back to school’
2008 constraint : older workers have quit; more
of a tradition; smaller portfolio; in-house
assessment
3.
Deficiencies in basic skills
literacy and numeracy
immigrant labour
Still a constraint
Impediments to achieving NMSs:
employees
4.
Weak financial incentives
no or very small increment
But HPLD £1 / 15%
5.
Limited career prospects
Little scope for progression to 3 (or 4 in CH)
a. barriers to gaining experience
b. paucity of senior positions
c. blocked by professional requirements
e.g. nurse, DipSW
Discussion 1:
NVQs - training or certification of existing skills?
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Improvement, caused by regulatory framework
but still NMSs still not fully met.
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But scepticism about NVQ
assessment, not training
certification of existing competencies
formal compliance as opposed to real commitment
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Some agreement with this
But most think real advice and training – better
underpinning knowledge, more reflective
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Would like more technical training
Discussion3:
broader HRM linkages
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Is training being integrated into a broader set of HRM
practices – pay, job design / team work, job security,
career, better information, voice?
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None had moved much towards integrated strategies
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However, genuine training; integrated (induction,
NVQ, mandatory)
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Also, job security – little use of agency work
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Also, team working
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But, only a minority had aligned qualification and pay.
Discussion: broader HRM linkages
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Only limited granting of more discretion
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Progression a problem
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Despite fact that most workers desired.
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Lessons to be learnt from NHS (Cox 2007)
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May have to change in future
a. demand for more multi-skilled workers may 
domiciliary care ; older on entry
b. pool of labour may shrink
higher educational and aspirational levels
Conclusions
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2000 regime was a major development: ‘brave new
world of social care’
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Some improvements under this regime.
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But a long way to go.
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Managers and employees supportive of present
framework and would like to see a tightening up.
•
However, re-fashioning of the system / regime
- ‘lighter touch’ regulation – ‘risk-based’, ‘output-driven’
- revision of NMSs – targets likely to go - ‘personalisation’
– direct payments, individual budgets
‘Who cares about skills?
The impact and limits of statutory regulation on
qualifications and training in the social care sector’
Howard Gospel and Paul Lewis
Management Department, King’s College London
DH, 17 November 2009