What Workforce for
Personalised Care?
Martin Stevens
10 October 2012
Introduction
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Personalisation policy
Workforce characteristics
Pay and conditions
‘Traditional’ services
Personal assistants
Recruitment and Retention
Risk and safeguarding
Social workers and social work roles
Personalisation policy
• Personalisation is achieved when a
person has real choice and control over
the care and support they need to
achieve their goals, to live a fulfilling
life, and to be connected with society.
– Caring for Our Future 2012 p18
• ‘Councils should provide personal
budgets for everyone eligible for
ongoing social care , preferably as a
direct payment, by April 2013.’
– Vision for Adult Social Care, 2010, p 19
• A caring, skilled and valued workforce
delivers quality care and support in
partnership with individuals, families
and communities.
– Caring for Our Future 2012 - p18
Social Care Personalisation History
Direct
payments
legalised
Direct
payments
always
offered
Individual
Budgets
piloted
1996
2003
2005-8
White Paper –
Personal continued focus on
budgets - personalisation,
transform transformation of
social work and
ation of
safeguarding
social care
2008
2012
Workforce characteristics
• 1.6 million workers (20,000 social
workers)
• ‘Dual labour market’ - One set of
pay and conditions for
professionals/paraprofessionals
and another for frontline and
ancillary workers
• Care workers continue to have
high job satisfaction - Much
better than shop workers or
waiters/waitresses
• However, workers see
demanding nature of work and
low status as barriers
Pay and conditions
• In 2009, median hourly rate for a
care worker was £6.47 (Hussein,
2010)
– Living wage’ outside London is
£7.20
(http://www.livingwage.org.uk/aboutliving-wage )
• Many agencies do not pay travel
time or petrol
• Personal assistants may earn less
• Migrant workers earn less (Hussein,
2011)
‘Traditional’ – CQC registered – services
• Purchasing patterns - many older
people prefer to have their personal
budget managed by local authorities
• Moving from block to spot purchasing
– increased flexibility or more uncertainty
for providers and therefore older people
• Differential rates of pay
• Less regulation of personal assistants
• Will there be an expansion of mutuals
and co-operatives?
• Will (and how) will services adapt to
meet new expectations? (Baxter et al
2011)
Personal assistants
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Shortage of personal assistants (and care workers)
Low level of qualifications
Mainly female, white and spread across ages
Paid workforce may include family members/adult
fostering/shared lives (just under half known to individual
employer
• Workers able to move between agency work and directly
employed
– implications for continuity of care?
– Poaching agency staff
• Pay, conditions and careers?
Working for personalised care: A framework for supporting personal
assistants working in adult social care (DH 2011)
Recruiting Personal Assistants
• Level of support critical:
from peers, local authorities,
Age UK etc – Personal
Assistant Registers
• Job Centre Plus advisers –
need for increased
understanding
• Checks – Criminal Records
Bureau/ISA/Disclosure and
Barring Service
• Developing skills over time
(Aksey and Baxter, 2012)
Retaining care workers
and personal assistants
• Over 40% plan to leave in the
next 5 years – on a par with
other care workers
• Lack of training
• Quality of relationships with
employers – role boundaries
• Low pay and status of social
care
• Support - from peers,
employers, social workers,
unions. PA networks and
organisation
(Personal Assistant Framework- DH 2011)
Risk and safeguarding
If there’s a problem they can’t just ring
us up and say, ‘Sort it’. Because if
they’re actually employing the person,
they’ve got to sort that out with
whoever it is that’s supporting them to
employ that person (Team manager
people with learning disabilities team:
IBSEN – Glendinning et al 2008)
• Unregulated personal assistants
• Using PBs inappropriately and
unproductively,
• Poor quality and poor outcomes,
• Creation and attraction of crime,
• Risk of losing public support
"Safeguarding Marblehead”
Training
• Positive impact of regulation in
improving access to training
(Gospel, 2008)
• BUT limited access to training in
specific areas such as dementia
care (NAO, 2007)
• Needs reinforcing to maintain long
term impact (Moriarty et al, 2010)
• Apprenticeships for care workers
• Induction training standards for
personal assistants?
• On the job versus trainer led
training?
• But who pays?
Image from Elite Social Care
Professionals Website
Social work and social workers:
mixed messages?
• Chief social worker to be appointed
• Social work practices – independent of local
authorities
• Role to: ‘focus on promoting active and inclusive
communities, and empowering people to make
their own decisions about their care’ (Caring for
our Future, DH 2012)
• Division of roles – assessment, support planning
and brokerage
• But - local authorities are aiming to reduce the
numbers of social workers (Lymbery, 2012)
The future?
The Nightmare (Fuseli)
The Golden Age (Cortona)
• Ongoing austerity –
dominant issue – much
more to come
• Choices between limiting
amount of support you have
and paying workers fairly
(NAO Care Markets report,
2011)
• Will we transfer structural
problems onto people using
services and family carers?
• Will apprenticeships
improve recruitment and
skill levels?
• Will personalisation lead to
increased job satisfaction
and retention?
• Communities and families ‘in it together
• Increase in ‘intermediate’
occupations (e.g.
brokerage/advocacy)
Thank You
Martin.stevens@kcl.ac.uk
020 7848 1860
Social Care Workforce Research Unit, King’s College
London, Strand, London WC2R 2L
www.kcl.ac.uk/schools/sspp/interdisciplinary/scwru/
The views expressed in this presentation are those of
the author and not necessarily those of the
Department of Health