Employment Practices and Performance: Rewards
and incentives and their relationship to recruitment,
retention and quality of service in adult social care in
England
Part 1 Literature review and statistical analysis
Authors: Dr Carol Atkinson, MMU Business School
Joe Godden, Independent Consultant
Professor Rosemary Lucas, MMU Business School
Statistical Analysis:
conducted by Aidan Kelly
Synopsis
In Section 1, the literature search aims to examine the relevant literature regarding
issues relating to employment of staff in the social care sector in England. More
specifically there is an exploration of the literature regarding rewards and incentives in
the sector and the possible impact of rewards, incentives and other employment issues
on the quality of service for people that use social care services.
In Section 2, the second stage of the research used statistical techniques to examine
two large data basis concerning the social care sector, the first on is called the NMDS –
SC and the second one is a compilation of CSCI inspection material. Multivariate
analysis of the correlations within and between the data basis was undertaken.
Date:
April 2008
1
Contents
Section 1 Literature review
1
2
3
4
5
6
7
8
9
10
11
Introduction
Terms used in social care
The social care workforce in context
Size of the social care market and characteristics of the
sector
The impact of the National Minimum Wage
Workforce issues: perceptions and views
Workforce realities: a study of care workers.
The link between employment practices and
performance
Summary and conclusions from the literature survey
References
Appendices
Page 3
Page 5
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Page 17
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Page 36
Page 40
Page 45
Section 2 Statistical Analysis
1
2
3
4
5
6
Introduction
Terms of reference
Details of method and analysis
Findings
4.1 Establishment data
4.2 Employee data
4.3 CSCI outcome data
4.4 HR practices
4.5 Analysis using constructed indices
4.6. Modelling NMDS – SC variables and CSCI
inspection outcomes
4.7. Subset of establishments where expected
relationships are found
Page 2
Page 3
Page 5
Conclusions
Recommendations
Page 25
Page 27
Page 9
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1 Introduction
Skills for Care commissioned the writers to research the important area of rewards and
incentives and the relationship of these to recruitment, retention and quality of service in the
social care sector.
The overall aim of the project is: “To examine the links between rewards offered in the sector,
recruitment and retention difficulties and outcomes for service users.”
The project outcome to: “input to guidance for employers.” (A report will be provided to
employers in a user friendly format).
The aim of the research is illustrated in Table 1 below

Pay

Other rewards &
incentives
Terms &

conditions of
employment
Training &
qualifications
Other factors





Vacancy and
turnover rates
Recruitment and
retention problems

Outcomes for
service users
(quality and
continuity of care)
Table 1 Exploring the relationship between pay, reward and other factors and outcomes
The first stage of the project is described in Table 2
Review of
existing
information
Desk based research of research into recruitment and retention and related
issues in the social care sector in the UK. Contextualization within the context
of theoretical frameworks
NMDS1
analysis
Discussion with stakeholders, particularly client, about key variables. Trial run
and review of findings. Completion of analysis using SPSS. Report on
findings. Liaising with client and reference group
Matching
with CSCI2
reports
Analysis of compatible data from CSCI to SPSS3, to integrate with NMDS.
Writing up of findings, liaison with client and reference group.
Table 2: Stage 1 of the rewards and incentives research
Stage 1 is divided into two sections:


Section 1 of the report covers the review of the literature
Section 2 covers analysis of the NMDS data and the matching of the data with CSCI
data.
An explanation of the terms used and acronyms is found in “2” below.
CSCI stands for Commission for Social Care Inspection.
3 SPSS Statistical Package for Social Sciences.
1
2
3
The literature review focuses on a number of areas. Firstly, the context of social care is
described, which includes both the policy context and information about the economic market
place. Comparison with other industries is touched on to contextualize the social care sector in
terms of information about pay and other terms and conditions of employment.
Secondly, information about the workforce is detailed. There has been a great deal of published
information regarding the social care workforce, much of it stating that the sector has
considerable problems, particularly in relation to recruitment and retention of staff. This is
followed by an exploration of information about the size of the social care market and
iinformation on turnover and destination of leavers. Data regarding the impact of the National
Minimum Wage is explored as this provides valuable information about the sector and
information about the impact of a significant change.
It is demonstrated that much of the information about the workforce has limitations in terms of
the accuracy of the information. The National Minimum Data Set – Social Care (NMDS – SC)
holds the prospect of more accurate information and some of the data that is currently being
analysed is beginning to provide useful and accurate information. It is noted, however, that the
NMDS – SC is intended to be a “minimum” data set and that further more in depth studies will
be needed to understand the workings of the social care labour market.
The next section explores the literature regarding perceptions and reports of workforce issues.
The predominant impression of the social care sector workforce is that the sector has major
recruitment and retention issues and that these will grow worse unless drastic action is taken to
address the problem. The literature search indicates that although there may be significant
problems in parts of the sector, that other parts or locations do not experience the same degree
of difficulty. Until the NMDS – SC is more complete it will be difficult to analyse the sector in
detail and discover what the variations are or the causes of the variation. Variations could be
geographical, due to different management practices, or due to the funding of the social care
market. An in depth study of 500 care workers is referred to, as is information that is arising
from the development of the National Minimum Data set.
The link between employment practices, (which includes rewards), and performance at the level
of individual organisations is then explored. Reference is made to literature that seeks to
demonstrate the link between employment practices, for example how staff are recruited,
management practice and performance. The concept of High Performance Work Systems
(HPWS) is introduced – a process of creating teams that are given autonomy, good quality
training and that seek to value employees. The applicability of the concept to social care is
explored by looking at the research literature.
The final section of the literature review summarises the findings of the literature review and
proposes exploring the issues further in the second stage of the research – the case studies.
Stage 1 section 2.
In parallel to the literature review a detailed statistical analysis of data from NMDS – SC was
undertaken. The analysis sought to explore internal correlations of the data. As well as internal
data correlations an examination of correlations between the NMDS – SC data and CSCI data
Details of this aspect of the research are given in section 2 – analysis.
Stage 2.
The second stage of the project will use the information from stage one to inform the
methodology for an in depth study of 254 social care organisations regarding aspects of their
human resource practices, particularly their use of rewards and incentives and possible links
with outcomes for service users.
4
Six of the case studies will be of residential homes, six of residential homes with nursing care and six
domiciliary care organisations. There will also be seven case studies that provide a brokerage service for
people who employ their own staff under direct payment or individual budget arrangements.
4
Stage 3.
The third stage of the project will be to provide an academic report and a shorter version that
aims to inform employers of the outcomes of the research.
5
2. Terms used in social care.
Social care, in common with any other sector of industry has its own terminology.
This section identifies the key terms, which are later referred to in this report.
2.1 Social care
The term ‘social care’ has been used to include all aspects of paid social care including social
work. This research only applies to services to adults (age 18 to 64 and to older people 65 and
over). Services for adults that come under the term social care include the following: residential
care, home care, respite care and day services. It is becoming increasingly difficult to define the
boundaries of social care and to see where social care ends and where health- care, or other
community services begin. However, the vast majority of social care services can still be defined
by the sources of funding, which for the significant majority of people who use services is
financed in part or fully by local authorities.
2.2 Carer
The term ‘carer’ is used to describe people who provide care unpaid, for family or friends. Paid
care staff are referred to as ‘care staff’ or ‘care workers’.
2.3 National minimum data set for social care (NMDS – SC)http://www.nmds-sc.org.uk/
The NMDS – SC was developed by Skills for Care5 in partnership with other organisations in
order to provide workforce intelligence for the industry. The NMDS – SC6 was launched in 2006
and aims to have comprehensive data about the social care workforce within a few years.
Previous information about the workforce was incomplete and based on a variety of sources,
with concerns expressed in the sector about its validity and reliability. Two data sets were
established. One is for employers to complete, which captures information about the
organisation. The data is completed by a manager in the organisation, usually an operational
manager. It is not possible to identify whether the organisation is part of a larger organisation
i.e. whether the organisation is part of a multi unit organisation. The guidance states “The
organizational level at which NMDS-SC data applies is the ‘establishment’. This is the single
location (even if it comprises more than one building) at which care is provided or from which it
is organized.” For CSCI-registered activities the establishment is the registered care home,
domiciliary care agency, adoption agency etc. http://www.nmdssc.org.uk/viewNMDS.asp?section=5
The second data set is called an employee survey. This is again completed by the
organisational manager, with the guidance stating that this should be completed with the
employee (www.skillsforcare.org.uk). This research used data from 2006 and 2007. The details
are explained in the analysis section (section 2). A degree of caution however must be shown
with the NMDS figures, because the data from May 2007 represents only about 30% of the
estimated total number of organisations and the 30% may not be representative of the whole
sector. As the proportion of employers and employees completing the NMDS increases the
information will become more accurate.
2.4 Service provider.
The term ‘service provider’ is used to define an organisation that provides social care services.
This includes residential, day services and domiciliary care services. The main focus of this
research relates to services for older people and adults with a physical disability, mental health
needs, or a learning disability.
2.5 Individualised budgets and direct payments
A relatively new development in the care sector has been the introduction of direct payments
and individual budgets. Individualised budgets and direct payments are a mechanism whereby
the purchase of social care support passes from the local authority to the individual needing
5
Skills for Care is the sector skills council for social care
There is widespread agreement that social care must improve massively its collection and analysis of
data if it is to win its case for preferential government funding in either the pending comprehensive
spending review (CSR) or, much more likely, the one three years down the line. (Skills for Care NMDS –
SC Briefing Issue 1.)
6
6
services. The individual purchases services from where ever and from who ever they want.
Individualised budgets and direct payments, however, account for less than 2% of care
purchased (CSCI, 2006). The data in the NMDS – SC does not contain information about
people who purchase their care directly themselves.
In order to support people who wish to purchase social care themselves a number of
organisations have been established. They have different names, but commonly are referred to
as “care brokerages”. The care brokerages provide a number of support functions, such as
helping with recruitment of staff, payroll, advice on employment issues and advice on training.
The brokerages do not directly employ care staff, rather they introduce potential staff to the
direct payment recipient. The direct payment recipient is free to employ the person or not. Many
recipients of direct payments and individualised budgets find staff themselves, including
employing friends, neighbours or family. Individualised budgets and direct payments are a key
mechanism for government policy of aiming to make services more individual and to give more
control and power to people that use services.
2.6 Commissioning
The term commissioning, in social care, refers to the process whereby the budget holder –
usually a local authority – commissions social care services for the population that it serves. The
commissioning process also involves a detailed procurement and contracting process. The
social care market receives most of its funding via local authorities, however individual providers
may also provide care services direct to individuals – either as private individuals, or via direct
payments or individualised budgets. The price that the care provider is able to obtain from the
purchaser varies. The price clearly has an impact on how services are delivered, including
possible impacts on terms and conditions of employment. This impact is referred to in several
documents and will be referenced further on in this review.
3. The social care workforce in context
3.1 The policy context.
The main policy driver for social care in the last few years is “Our Health, Our Care, Our Say: a
new direction for community services” (DH, 2006). This White Paper describes in detail the
vision for health and social care for the next decade. Within the White Paper there is reference
to workforce issues and these are explored in more detail in subsequent department of health
sponsored documents. Of particular significance is the Options for Excellence review of the
social care workforce. The review states “The social care workforce is integral to delivering the
vision for the future set out in the White Paper Our Health, Our Care, Our Say. In order to
ensure good outcomes for people, steps are being taken to address a range of workforce
issues, including workforce skills, recruitment and retention. (DH, Oct. 2006). The review also
highlights the need for a strategic approach to workforce planning and strategy and makes a
wide ranging series of recommendations. The recommendations include ideas for addressing
problems with recruitment, retention and the need for organisations to align their human
resource policies to organisational outcomes. The review was asked to bring forward
recommendations in order to:





increase the supply of all workers within the sector, such as domiciliary care workers
residential care workers, social workers and occupational therapists
look at measures to tackle recruitment and retention issues
improve the quality of social care practice
define the role of social workers in the wider context (including training and skills
requirements)
develop a vision for the social care workforce in 2020 and a socio-economic case for
improvements and investment in the workforce (DH, Oct 2006).
The recommendations from the review fell into two categories – short term, with quick potential
gains, and longer term ones, which have fed into the Comprehensive Spending Assessment.
This research into rewards and incentives is one of the short term recommendations.
7
3.2 Inspection of services.
The majority of social care services have to be registered and inspected. The responsibility for
inspection lies with the Commission for Social Care Inspection (CSCI). CSCI have created a set
of standards by which service providers are inspected, utilising national minimum standards,
including key standards. These standards are based on national minimum standards which
were identified in the Care Standards Act of 2000. The Care Standards Act set out a broad
range of regulation making powers covering, amongst other matters, the management, staff,
premises and conduct of social care and independent healthcare establishments and agencies.
These standards include requirements about minimum staffing levels, competence of the work
force including their suitability, experience and qualifications. Each registered care service has
to have a registered manager who is responsible for the service and the many resources
including staff that are required.
CSCI report that residential services for older people are now meeting 79% of standards,
compared with 59% in 2003. Services for younger adults are now meeting 82% of all standards,
compared with 63% in 2003. However they report that only 66 % of homes are meeting
standards relating to recruitment practices (CSCI, 2006). 7The issue of inspection and how
much they measure quality is the subject of much debate in the social care world. The
standards have been criticised for concentrating on process issues, rather than outcomes and
as a result CSCI have developed the inspection process to include more outcome measures.
Part of the first stage of this research was to examine whether there were any correlations
between the CSCI inspection reports and the data obtained from the NMDS – SC. Details of the
methodology and description of the standards are found in section two.
At the time of writing there are plans to merge the organisations responsible for health and
social care inspection. From 2008 there will be a bringing together of the regulation of NHS and
adult social care services, including the mental health act commission. This new body will be
called the Care Quality Commission and will commence regulation in April 2009 (DH, Oct 2007,
DH, Nov 2006). The details of what this will mean in terms of inspection regimes, standards and
regulation have not been announced. In addition the Government is undertaking a review of the
National Minimum Standards, expected to take effect from 2008-09. CSCI have introduced a
scoring system for social care that gives a star rating. Three stars is regarded as excellent, two
stars as good, one star as adequate and no stars as poor. (www.csci.org.uk)
3.3 Regulation of the workforce
Until relatively recently the social care workforce was unregulated. The General Social Care
Council (GSCC) is responsible for setting standards of conduct and practice for social care
workers and their employers, for regulating the workforce, and for regulating social work
education and training. The GSCC is a non departmental public body established in October
2001 under the Care Standards Act 2000. To date only a small proportion of the social care
workforce is subject to regulation – social workers and residential child care workers. However
there are plans to extend the regulatory requirement to domiciliary care workers and other social
care workers. The driving force behind the implementation of regulation is the desire to improve
standards. http://www.gscc.org.uk/Home/
3.4 Training and qualifications within the social care workforce
A further part of the strategy to improve standards in the social care sector is the introduction of
a training and qualification framework for the industry. The strategy is lead by Skills for Care, for
the adult sector workforce. A considerable success has been achieved in implementing the
qualification and training strategy. Information about the extent of this success is found in
several sources, including the NMDS – SC. The National Care Forum (NCF) annual personnel
statistics survey for 2006-07 report the following for the not for profit sector8
7
For a list of the CSCI standard see Appendix 1
The term “not for profit sector” refers to organisations that are not private organisations, or not public
sector organisations. The term “independent sector” refers to both the private and not for profit sector
combined. The public sector refers to organisations that are part of a local authority or part of the NHS.
8
8


NVQ 2 up from 59% last year to 67%
Managers with NVQ 4 up from 90% to 97.6%” (NCF 2006-7)9
An in depth survey of 500 care workers, commissioned by Skills for Care reported that 40% of
care workers have achieved NVQ 2, or 3, however 20% had no qualifications. The qualifications
most often achieved were an NVQ Level 2 (23%), in Care, or Health and Social Care (Skills for
Care, November 2007).
The overall number of care sector NVQ registrations increased by 22.4% and NVQ certificates
rose by 42.7% from June 2005 to June 2006 (DH, Oct 2006).
Information from the NMDS - SC for the North West region reports 66% of direct care staff are
working towards a relevant qualification. The data from the research, using national data from
the NMDS are similar.
3.5 The future of the social care market.
The social care market has seen a lot of change over recent years, both in terms of policy and
in terms of the way that the market operates. At present the market is dominated by small to
medium size providers, who derive a large part of their income from local authorities via
contracts. The impact of local commissioning strategies may in fact have a significant impact on
performance and measures taken to improve performance and HR practices.
There are indications, however, that the market is consolidating. Figure 1 below illustrates the
probable direction of travel and it is reported that the move to the right hand part of the diagram
is already significant. What the impact in terms of employment will be is not known.
Small owner /
manager
financed by
mortgage
Equity capital specialised
Private equity, stock
market and
specialist groups
Figure 1 Direction of travel in the social care market
Laing and Buisson (2005) report the following regarding the residential care sector:






39.7 % of provision is by organisations who own three or more care homes
the four largest organisations have 18.7% of the market
care home concentration is low compared with other more mature sectors of the
economy and other segments of healthcare provision
the only care organisation listed on the stock exchange is Care UK
Consolidation is being driven forward by private companies
Continued decline in no. of homes. 580 closed in year to April 2005
9
The NCF report survey covered a total of 32,878 staff drawn from 27 not-for-profit care providers within
NCF membership
9

Demand and capacity have continued to decline, although fall in demand is less than the
fall in capacity. Now occupancy rates are running at an historic high of 91.9% (Laing and
Buisson, 2005).
Reid is of the view that commissioning behaviour favours larger providers. He argues that the
process of winning tenders is complex and increasingly demanding. Preferred provider lists
mean that it is difficult to break into this, again larger providers are favoured. The equity and
share market are wanting to invest in the sector. The larger the group, e.g. Southern Cross, the
higher trading values (per capita). They buy small to medium and then this translates into higher
capital values after consolidation (Reid Care and Health Conference, 2007).
Wanless and others forecast increasing needs for social care over the next 20 years. It is
projected that there will be a rise in the number of older people with some care needs of 53%;
and a 54% increase in those with a high level of need (Wanless, 2006 a). In summary, Wanless
anticipates that there will be an increased demand for health and social care services, albeit the
way that these services are provided will change, as will the way that they are funded. The
increase in demand will need to be met by an increase in the number of people employed in the
sector.
3.6 Summary of section 3.
Section 3 has sought to describe the regulatory system that the majority of social care services
operate under. The industry is subject to national minimum standards regarding quality of
provision and workforce issues such as staffing levels, recruitment practices and qualification
levels. Organisations are inspected by CSCI to ascertain the degree that the national minimum
standards are met.
The majority of provision is purchased by local authorities, who are driven by a best value
agenda and commissioners seek to obtain quality services at best value prices. Commissioning
practice appears to have a significant impact on the market for social care.
4.0 The size of the social care market and characteristics of the
sector, particularly in relation to workforce.
4.1 Size of the sector
There are various sources of information about the sector and the sources look at different
things. For example, the sector can be measured by looking at the number of organisations, the
number of staff and other information about staff, financial data and number of people receiving
services. This section briefly identifies some of these characteristics. The following provides
some of that data:

During 2004-05, approximately 1.7 million adults received social care services.


Expenditure on adult services was over £14 billion.
98,240 households received intensive homecare in 2005 and 267,240 people were
supported by councils to live in residential care. In addition the purely private market is
estimated to account for another 20 to 30% (Laing and Buisson, 2005).
Spending by older people alone, on residential and home care, is estimated at more
than £3.5 billion a year (CSCI, 2006).
As at 31st March 2006, there were 18,718 registered residential care homes for adults,
with 441,335 places. The average size of homes that were registered for people over the
age of 65 stood at 34 places. On the same date there were 4,623 registered home care
agencies and 859 nursing agencies. The majority of these services were run by the
independent sector (CSCI, 2006). It is not known how many of these organisations were
part of a larger, multi unit organisation.


10



CSCI report that in 2005 – 6, 98,240 households received intensive home care, an
increase of 6% from 2004. The number of people supported by councils to live in
residential care decreased from 277,950 in 2003-04 to 267,240 in 2004-05 (CSCI,
2006). The CSCI figures do not give an indication of the impact on employment, or
people who are privately purchasing care.
The numbers of people using direct payments had increased significantly, but direct
payments were still used by only a small minority of people. Individual budget pilots were
already demonstrating that some people are looking for very different services to those
traditionally commissioned by councils (CSCI, 2006).
The Low Pay Commission surveys of employers (LPC, 2001a, 2003, 2005, 2007)
illustrate from a reasonable sample size, some characteristics of the sector. The median
number of employees is 25, and 72 % of organisations are small to medium size
enterprises (SMEs10) (Table 3 below).
Sample size
Response
1999
3800
760
2002
3600
684
2004
4660
699
2006
3795
721
Total employees
Median employees
Mean employees
1-49 employees
50-249 employees
250+ employees
39900
24
53
75%
21%
3%
29802
20
44
81%
18%
1%
34833
23
83%
14%
3%
41579
25
72%
24%
4%
Table 3 Low Pay Commission reports regarding employment in the social care sector
To date, the size of the independent sector workforce has relied on estimates, mainly based on
sample surveys of the individual employers. There is more accurate information available about
the social care workforce employed by local authorities (LGA, 2005). (See 4.3.2 below).
The following information gives an indication of the size of the overall social care workforce:

There are approximately 1.25 million to 1.5 million employees in social care, with over
25,000 employers, providing a service to around 1.7 million adults at any one time (DH
2006, collaborative recruitment solutions in social care).

Laing and Buisson report that 892,000 employees work in the independent social care
sector (private and voluntary) and 440,000 employees work in the public sector (Laing
and Buisson, 2006).

The Low Pay Commission report that in 2006 there were 1,098,000 jobs in social care,
134,000 more than in 1998 (LPC, 2007). Jobs rose by 16,000 in 12 months to
September 2006. The number of those in employment in low paying occupations also
rose by 41,000 to 49,000 over the same period. There has been a decline in
employment in residential care but a substantial rise in employment in non-residential
care (LPC, 2007).
The number of jobs in the care sector has been rising in the past seven years, with a
shift towards full-time jobs (Laing and Buisson, 2004). The fall in the number of
domiciliary care workers (121,500 to 97,500 between 2000 and 2004) has been
compensated by each worker working on average 25% more hours (LPC, 2005).

10
SME stands for small and medium size enterprise. These organisations employ fewer than 50 people
11
4.2 Information on turnover and destination of leavers.
The following details information from various sources regarding turnover and destination of
leavers from the social care sector and some comparative information from other sectors:







The CIPD undertake a benchmarking survey of employers each year11. In 2007
information from the survey reported: “The labour turnover rate in the overall economy of
18.1% remains almost the same as the previous year’s 18.3%. The private sector
reports the highest labour turnover rates 22.6% (CIPD, 2007).
International comparisons of labour turnover place the UK mid-way between a fluid
North American pattern of labour churning, and a lower Continental European one.
Recent UK evidence indicates that a typical new job lasts just 15 months, although the
average length of a job in progress is over five years, as most workers eventually find a
long-term job match. Seventeen per cent of new jobs end within three months, and 42
per cent within one year. (Atkinson and Williams, 2003)
A Skills for Care analysis of the NMDS – SC in June 2007 found the overall turnover rate
for all categories of social care staff was 19.3%, rising to 25.9% in domiciliary care. For
care workers it was reported that the turnover rate was 22.2% (over one in five
workers leaving in a year). Senior staff have a lower vacancy rate of 2.4% with a
turnover rate of 10.9%. Registered managers have a turnover rate of 11.7%. (Skills
for Care, 2008). The 2007 report stated that human resources information states that
a turnover of 15% presents a problem and that one over 20% is a major deterrent to
a quality service. This is all the more so in our sector where relationships are key
and the tasks are personal and intimate. (Skills for Care 2007) http://www.nmds-sconline.org.uk/content/Research.aspx
CSCI (2007). Skills for Care (2007) report that high turnover is particularly problematic in
the sector where relationships are key and the tasks are personal and intimate.
An analysis of the NMDS Skills for Care Eastern Region Hampshire found a turnover
rate of 16.5% (Skills for Care 2007, Eastern Region).
An analysis of the NMDS North West found only 5% of staff stated pay as their reason
for leaving, in line with the national figure. 6% stated the nature of work, and 2%
conditions at work. By far the largest at 19% left for personal reasons. 18% of staff left to
go to another adult care provider, 6% left to go into health and 2% going to the retail
industry. The turnover rate for all categories of social care staff was 19.3% with 25.9% in
domiciliary care (Skills for Care North West, NMDS, 2007).
The above two data sets show that only a very small percentage of staff left to go into
the retail sector and a significant proportion remained in the care sector.12
4.3 Other information about the workforce
4.3.1 A survey of 5,000 apprentices found that the average apprenticeship pay in health and
social care was £130 per week. This placed it well ahead of hairdressing and child care, and
ahead of retail and business administration. Traditional male apprenticeships, such as motor
trade (£136) and engineering (£167) paid more (Ullman and Deakin, 2005).
11
12

Hairdressing £90 a week



Early years & education £95; 97%
Retail £123; 61%
Business admin £126; 76%
The CIPD survey included social care employers.
Further reference to workforce statistics is found in section 6.0 below.
12

Health & social care £13013; 89%
4.3.2 Local Government Workforce Survey Staffing (LGA, 2005; IDEA, 200614). This thorough
survey of the social care workforce directly employed by local authorities reports the following:
the highest vacancy rates were for:

care staff in children’s homes (15.1%)



occupational therapists (13.6%)
care staff in homes for other adults (homes for adults with physical disabilities, mental
health problems or learning disabilities) (12.3%)
Managers in elderly people’s homes (8.5%)

Home care staff (9.4%) had the lowest vacancy rates.
Information from the survey reported that male public sector care assistants earn more than
their private sector counterparts but the gap appears to be closing. Female public sector care
assistants earn below both their male public and private sector counterparts but more than
female private sector care assistants By the long-term cost measure, however, the (Local
Government Pension Scheme) LGPS is over three times as valuable as a typical private sector
defined contribution scheme (i.e. so-called ‘money purchase’ schemes).While the LGPS is
undoubtedly a valuable benefit, many low-paid workers are not in membership and hence
receive no benefit from the scheme. A survey by the EO of 20 authorities found that just over
50% of male part-timers and 34% of female part-timers were not in the scheme. For many parttimers the cost of membership while at work is not worthwhile (Local Government Pay
Commission, 2003).
It is notable that compared to the independent social care sector and the wider workforce that
the vacancy rates in home care and care staff are not that high. Indeed there are reports that
the destination of staff in the independent care sector is often the local authority because of
preferential terms and conditions of employment (Yeandle et al., 2006).
4.3.4 Children’s workforce.
Although not part of the brief of this research the early years and children’s workforce share
many characteristics with the social care workforce15. This workforce will be using a version of
the NMDS-SC and this will enable comparisons to be made. Recent research about the
children’s workforce reports similar issues in relation to the workforce – turnover and recruitment
issues. For example, the private children’s nursery sector is reported to have a turnover of 25%.
Nursery nurses average pay is reported to be £6.00 per hour, compared to the cited £6.20 per
hour for care assistants and home carers. However, it is acknowledged that coverage of data on
pay levels over the entire children’s workforce is incomplete and of variable quality, due to the
diversity of workers and employers and a lack of consistent data collection (CWDC, 2006).
Nursery nurses and care assistants enjoy higher earnings in the public sector than the private,
although in both cases there has been a recent closing of the gap.
4.4 Summary of section 4
Section 4 has attempted to give an overview of the sector in terms of size and workforce issues.
13
It should be noted that the category included health as well as social care. It is not known what the
impact of including apprenticeships in health in the same category are.
14 To date the NMDS data regarding the public sector is relatively scare, however early indications
confirm other data that there are greater problems regarding workforce in the independent sector than in
the public sector.
15 The social care part of the children’s sector was counted as part of the social care workforce up until
the separation of the Children’s Workforce Development Council from Skills for Care in 2005.
13
The sector is a significant one in terms of economic value, the number of people it serves and
the size of the workforce. There are various sources of data about the sector, with the NMDS –
SC beginning to have a real impact in terms of the quality and detail of information. There is
evidence of significant turnover in the sector, particularly in the independent sector, and
particularly at the front line level. High turnover is particularly problematic for quality of care,
however the negative picture appears to be somewhat ameliorated by evidence that the
destination of many leavers is other parts of the social care sector.
5.0 The impact of the National Minimum Wage
5.1 Another source of information regarding the social care workforce is the research on the
impact on the introduction of the National Minimum Wage. There is a wide body of research on
the impact of the National Minimum Wage (NMW) on jobs, earnings, wage structures, pay
differentials, accommodation provision, quality of care, recruitment and retention, staffing levels,
productivity and firm performance (profits, prices, government funding) from Low Pay
Commission reports and economic studies by Machin and others. The LPC commissions a
survey of all low paying sectors every two years and the social care sample is around 700. This
information provides some useful information about the social care sector.
5.2 Impact of the national minimum wage on jobs
As reported above, the size of the social care market has continued to grow during the period of
the national minimum wage.
5.3 The impact on earnings of the national minimum wage
Before the NMW, 1 in 3 firms paid below the NMW, so the NMW had huge potential impact on
non-unionised small firms doing a very homogenous activity in geographically concentrated
labour markets. NMW raised the wages of a large number of care home workers causing a very
big compression of the lower end of the wage distribution, thereby strongly reducing inequality.
Wages rose by 24p per hour (6%) (Machin, Manning and Rahman, 2003).
The main gainers were women (mainly care assistants and domestic assistants), the greatest
impact was on the private sector and the cost of compliance gave rise to concerns about the
public funding of fees in social care (LPC, 2000). The proportion of workers earning the new
NMW of £3.60 in private care homes more than doubled after the NMW was introduced, but
there was a negligible effect in the public sector. Over 40% of care homes had to raise some
pay rates to comply (LPC, 2001b).
The government accepted the funding recommendation made in LPC (2001b). The publication
of Building Capacity and Partnership in Care (2001) was accompanied by £300m extra funding
to the end of 2003. Other changes led to £1 billion support for older people’s social care by
2006.
The proportion of adult employees paid the NMW did not increase after the 2003 uprating,
suggesting that the impact of the NMW was reducing (LPC, 2005). The issue of non-cash
benefits and salary sacrifice schemes has been considered but no sectoral breakdowns are
given (see IDS, 2005a). Table 3 below shows that very few firms have cut non-wage benefits to
pay for NMW increases.
More recently, fewer than 8% of social care employees (all three age groups) held jobs paid at
or below the NMW (by low paying occupation). Fewer than 9% social care employees (all three
age groups) are paid at or below the NMW (by low-paying industry). These are Low Pay
Commission estimates based on the Annual Survey of Hours and Earnings (Office of National
Statistics, April 2006) and minimum wage jobs are defined as those jobs that in April 2006 paid
the equivalent to the forthcoming October 2006 minima (£5.35 at age 22+, £4.45 at 18-21 years
and £3.30 at 16-17 years) downrated by the growth in average earnings back to April 2006. The
Low Pay Commission report indicates that there are considerably fewer low paid jobs by both
sets of analysis than in cleaning, hospitality and hairdressing and that social care is performing
well compared to most low paying sectors.
14
5.4 Differentials
When the NMW was introduced compliance at the lower end was accompanied by tapered
increases higher up (LPC, 2000).
The UK Home Care Association argued that the NMW removed the sector’s pay advantage
over the lowest paying sectors and removed the differential between unskilled and the lowest
paid, making recruitment more difficult (LPC, 2001b). Pressures on wages includes competition
with other sectors e.g. retail, statutory obligation for a proportion of staff to hold NVQ 2 or above
and the need to maintain pay differentials (LPC, 2007).
Maintaining pay differentials may be becoming more difficult (IDS, 2006), often exacerbated by
inadequate levels of fee income received from local authorities. Two sizeable hikes in the NMW
in 2001 (by 40p) and 2003 (by 30p) required a higher percentage of firms to increase the pay of
higher graded staff, than when the NMW was introduced. BUPA Care Homes reported a
growing number of staff receiving the NMW, which had eroded differentials for higher paid staff
and had deterred staff from undertaking NVQs
5.5 Impact of the NMW on quality of care
Care providers have a requirement for minimum staffing levels and they also have standards
which stipulate the level of staffing that should be qualified. Care providers also derive much of
the their fee income from local authorities and the sector claim that the income from local
authorities does not necessarily reflect the full and rising costs of care, including the uprating of
NMW (LPC, 2007). This may explain why increased or decreased use of unskilled labour is only
marginal (Table 4).
5.6 Impact of the NMW on recruitment and retention
Some care home managers said the NMW was now outweighed by other factors, particularly
funding arrangements, the new care standards and local labour market conditions. There is
significant regional variation with the greatest impact of the 2001 increase on the less affluent
areas of the country (Laing, 2002).
According to the Low Pay Commission, the NMW has not helped to lower labour turnover,
increase staff motivation or enable the faster filling of vacancies in most firms (Table 4).
1999
2002
2004
2006
Lower staff turnover
Significant
Slight
3%
11%
3%
10%
2%
11%
1%
14%
Higher staff motivation
Significant
Slight
1%
17%
2%
17%
2%
14%
1%
12%
Faster filling of vacancies
Significant
Slight
2%
6%
1%
9%
0%
7%
0%
10%
Increased productivity
Significant
Slight
1%
4%
-
-
-
Any benefit
27%
28%
-
-
Table 4 Benefits from the NMW
LPC, (1998, 2003, 2005, 2007.)
5.7 The impact of NMW on staffing levels.
When the NMW was introduced most firms adopted tighter controls on working practices and
non-pay items, though some made reductions to staff numbers and hours (LPC, 2000; Machin
et al., 2002). Initial employment /hours effects were not sizeable given how heavily the wage
15
structure was affected (Machin et al., 2003). These trends have more or less continued but have
become less perceptible (Table 5).
In terms of wages Grimshaw and Carroll state that pay for care home care assistants competes
with other sectors paying higher rates, where jobs are seen as less demanding and stressful
(Grimshaw and Carroll, 2002).
As minimum staffing ratios are set as a legal requirement, there are limits to firms’ ability to
reduce staffing levels or to increase prices due to reliance on public funding. Although public
funding has increased, evidence shows continued problems of public funding failing to meet to
extra costs of the NMW (Independent Care Organisations Network (ICON), in particular, firms
that had modernised to meet more demanding physical standards set for ‘new’ homes first
registered since April 2002. Significant drops in workers aged 50 or over may reflect a
reluctance to undertake further training to acquire further qualifications (LPC, 2005).
Overall staffing levels
Decrease
Increase
Basic hours
Decrease
Increase
Overtime hours
Decrease
Increase
Overtime rates
Decrease
Increase
Non-wage benefits
Decrease
Increase
2002
2004
2006
20%
6%
22%
5%
16%
4%
18%
5%
16%
4%
12%
3%
18%
5%
19%
5%
18%
2%
12%
10%
12%
10%
11%
6%
9%
10%
7%
4%
5%
0%
Table 5: Has the NMW increase caused you to makes changes to the business?
(LPC, 2001a, 2005, 2007.)
5.8 Impact of the national minimum wage on productivity and firm performance.
There appears to be little economic effect of the NMW on firms’ performance in the care
sector.16 This is surprising because the NMW appears to have a significant effect on wages but
only a limited impact on jobs so it is conceivable that there must be a stronger impact on other
aspects of firm behaviour. Draca et al. consider the effect of a NMW on firm profitability,
showing that its introduction reduced profitability significantly (and wages increased
significantly) both in care homes and a range of private sector firms (Draca et al., 2006). This is
also confirmed from LPC surveys in Table 6, which also shows that measures were more likely
to be implemented to control non-labour costs than labour costs. Although social care firms may
have chosen not to use new technology and/or processes or to introduce innovations, low take
up is more likely to relate to the limited opportunities that exist for making these changes in care
work.
Overall the NMW has had a significant effect in the social care sector, and a number of
technical issues create complexity and need to be kept under review. The role of local
authorities as purchasers of care is crucial and society needs to provide the additional
resources required if workers’ wages are to rise (LPC, 2005).
Profits
Decrease
Increase
16
2002
2004
2006
90%
2%
88%
4%
76%
2%
Performance here is measured as profits.
16
Prices
Decrease
Increase
Measures taken to control labour
costs
Decrease
Increase
Measures taken to control non-labour
costs
Decrease
Increase
3%
55%
6%
55%
3%
46%
6%
22%
6%
30%
4%
23%
11%
35%
9%
35%
6%
30%
Use of new technology/processes
Decrease
Increase
7%
13%
5%
10%
3%
14%
Quality of goods and services
provided
Decrease
Increase
10%
8%
8%
10%
5%
7%
Introduction of new products and
services
Decrease
Increase
13%
6%
9%
7%
5%
5%
Use of unskilled/unqualified labour
Decrease
Increase
5%
6%
3%
8%
4%
6%
Table 6: Has the increase in the NMW led to any business changes?
(LPC, 2003, 2005, 2007).
5.9 Summary of section 5 – the impact of the introduction of the national minimum wage
in social care.
Over 40% of care homes had to raise some pay rates to comply with the introduction of the
NMW. The economy of the social care market is, to a significant degree, determined by the
behaviour of local authority (and latterly health) commissioners. Care organisations have
complained that commissioners have not sufficiently recognised the impact of the NMW in terms
of higher fee income. The high degree of regulation in the sector has meant that there is little
scope for productivity savings, for example introducing new technology to replace staff. The
main area where economies have been made have been in non-labour costs, but again there
are restrictions in savings that can be made. (See also section 6.5.1).
6.0 Workforce issues – perceptions, solutions and pay and reward.
6.1 Perceptions and reports of workforce issues
This section reports on information and reported perceptions of information concerning the
social care workforce. Reports that propose solutions to workforce issues in the sector are
reported on. The last parts of section six detail information about the link between pay and
rewards.
6.2 Problems regarding the workforce
Nearly all the reports about workforce issues in the social care sector stress the problems within
the sector in terms of recruitment, retention and overall labour supply. Certainly the expansion
of social care will have had an impact, particularly in the context of labour shortages within the
overall economy. Yeandle et al. (2006) reports that the IER has estimated that from 329,000
personal service jobs in the social and health care sector in 2004, employment will grow to
around 530,000 jobs – a very large net increase of over 200,000 jobs – by 2014. This estimate
17
includes about 68,000 new ‘expansion demand’ jobs, and 134,000 ‘replacement demand’ jobs.
Given other labour market projections (which show increased demand for labour in a number of
other sectors), this is likely to be extremely challenging for employers in the social care sector.
The following references are intended to give a flavour of the commentary concerning workforce
issues:

The care sector struggles to maintain a qualified and experienced workforce. Pay and
conditions are poor, and there is high staff turnover (Training Standards Council, 2000a).

Perceptions of working in social care are of a vulnerable underclass working in small
workplaces employing 16-17 workers who are predominantly female with an average
age of 40 and working 25 hours a week (Machin et al., 2003).

Social care: the growing crisis; report on recruitment and retention issues in the
voluntary sector by the Social Care Employers Consortium London: Social Care
Employers Consortium, 2004. 20p (SCIE).
While the quality of the data remains at best uneven, in the case of recruitment
difficulties for particular occupations, much of it does appear to point in the same
direction and we are in no doubt that local government does face difficulties in a number
of areas. (Report of the Local Government Pay Commission, 2003).
There is a considerable degree of consensus amongst stakeholders at national and local
level, based on consistent evidence, that there are specific, national recruitment
difficulties for some occupations where local government is the main employer. For
example social workers and occupational therapists. (Report of the Local Government
Pay Commission, 2003).
Recipe for retention. “As any inspector knows, a good indicator of the quality of care
provided in a care home is staff turnover. Regulatory alarm bells should be chiming if
staff turnover is frequent (as indeed should no change over a long period, which ups the
possibility of institutionalised practice or, worse still, a collusive regime). It is disruptive,
prevents residents from building up relationships and has a demoralising effect.”
(Community Care, 2004).
Care assistants (and hairdressers) are the lowest paying occupation in the National
Earnings Survey (Machin and Manning, 2004).
“In many parts of the country, there are significant problems recruiting and retaining care
workers. These appear to be associated not only with the low pay in this sector, but also
with terms and conditions that often do not compare well with other sectors such as the
retail” (CSCI, 2007).
The role of local authorities as purchasers of care is crucial and society needs to provide
the additional resources required if workers’ wages are to rise (LPC, 2005).








A national survey of adult placement schemes in England: Recruitment and Retention of
Adult Placement Carers. Barnard et al. (2006) reported significant problems in recruiting
and retaining care staff. The report states that the care work sector is widely
acknowledged to be facing a crisis of recruitment and retention.
However sophisticated the commissioning, there are significant pressures that are
hindering progress. These include financial pressures in the social care and health
system; an underdeveloped care market; continuing recruitment and retention problems;
and organisational turbulence (CSCI, State of Social Care 2005-6)
18








Competition from employers in other low-paying sectors, e.g. retailing, is now a more
important determinant of wage rates (LPC, 2005 see page 9). UNISON claimed low pay
was having a direct impact on the sector’s ability to recruit and retain staff (LPC, 2007).
“In many parts of the country, there are significant problems recruiting and retaining care
workers. These appear to be associated not only with the low pay in this sector, but also
with terms and conditions that often do not compare well with other sectors such as the
retail trade” (CSCI, Oct 2006).
The picture with regard to current vacancies was also mixed. While 42% of providers did
not have any current vacancies, more than one in 5 (22%) said that 25% or more of their
current domiciliary care posts were unfilled, and in 9 cases (out of 64) 75% or more of all
posts were reportedly unfilled (Yeandle et al., 2006).
A project was undertaken over an 18 month period to build quality and sustainable
capacity within the local home care market. Components of the project comprised:
developing a ‘fair rate’ for care based upon realistic cost drivers; improving the terms
and conditions of care workers to aid recruitment and retention; and making payments
for travel time to promote better quality service provision (CSIP, March 2006).
Definitely, high quality care workers will be more easily attracted and retained by a
service which allows them to care in an autonomous, creative and personalised way.
There are widespread problems in recruiting care staff (Fitzgerald and Chandler, 2006).
Pay and conditions need to be good enough to attract and retain high quality staff. While
pay is rarely the prime motivation of high quality home care staff, interviewees made
clear that reward at independent agencies is sometimes so poor that it can deter good
workers. Problems were noted concerning low pay rates, minimal weekend premium
rates, no guaranteed hours, no mileage pay and no pay for non contact time such as
travel and training. Exactly which of these elements matters most probably varies locally
(CSIP, March 2006. Caring for the whole person).
Wanless identified that there are significant financial problems in the sector which impact
on the quality of provision including recruitment and retention (Wanless, 2006 b)
The SPRU home care research suggests that a pre-condition for person-centred care is
that each customer has at least one regular worker who gets to know and care about
them. If staff rewards are insufficient to retain a regular workforce, the style of care
sought by the Green Paper cannot begin. Staff retention is affected both by pay and
conditions and by job satisfaction, as was repeatedly affirmed during this research
(Patmore and McNulty, 2005).

Commissioners need to analyse whether the volume of home care commissioned
through spot contracts is helpful in dealing with known capacity and fragility problems in
the market. Providers often complain that this approach hampers their ability to plan on a
longer-term basis, which in turn has implications for recruitment and retention of staff, a
major influence on market capacity problems and quality of care for people (CSCI,
2006).

Factors that have been held responsible for the absence of dignity in care include
bureaucracy, staff shortages, poor management and lack of leadership, absence of
appropriate training and induction and difficulties with recruitment and retention leading
to overuse of temporary staff (SCIE 33, Practice Guide 9 Dignity in Care; SCIE, 2007).
Staff retention is one of the biggest challenges facing many social care organisations
(SCIE, 2005).

19




Workers are motivated by the intrinsic nature of the work to enter into and stay in the
field. Job burnout is as important as low pay in forcing workers out of the field.
Administrators, however, perceive money to be a major factor motivating workers to
enter the field and perceive external opportunities as forces that pull them away. Thus,
administrators must address their workers' needs if their agencies are to offer quality
services (Blankertz and Robinson,1997).
The research and reports about the early years sector – which has a lot in common with
the social care sector report similar issues to the social care sector. Recruitment is seen
as particularly problematic (DHhttp://www.everychildmatters.gov.uk/resources-andpractice/IG00038/ The Government response has been to develop a workforce strategy
(DfES Feb 2006) http://www.cwdcouncil.org.uk/projects/rrr.htm
A recent development that indicates recruitment issues is the significant presence of
migrant labour to fill labour market shortages (Table 7) The Office for National Statistics
report that for care assistants and home carers 16% are non-UK born (ONS, 2006) with
68 % of staff in London being born overseas.
Yeandle et al. (2006) reported that the near certainty that reconciling supply and demand
for domiciliary care will continue to be an important challenge well into the future means
that efforts at all levels will need to be strengthened. They did however note from their
study of the domiciliary care sector in six localities that there was considerable variation
in the six localities that they studied and within those localities a lot of variation of the
views of employers. 17
2006
Employ migrant workers
Started employing them in last 12
months
No. has increased
No. has decreased
No. unchanged
Reasons
Labour market shortages
Their efficiency
More qualified/skilled
Control wage costs
Other
Social care
35%
20%
All firms*
28%
23%
35%
4%
38%
44%
3%
33%
71%
12%
6%
6%
15%
64%
23%
6%
6%
12%
Table 7: Migrant workers
6.3 Positive reports regarding the workforce.
The previous section summarised numerous comments regarding recruitment and retention
being problematic in the care sector. More positive reports about recruitment retention and
rewards in the sector are more difficult to find. The following are examples of more positive
reports.
6.3.1 A recent report from the voluntary care sector reports an improvement in the last few
years in turnover, showing a stepped improvement on the last few years. This is the fourth year
that NCF has produced the survey which covers a total of 32,878 staff drawn from 27 not-forprofit care providers within NCF membership. The survey shows:
17
The picture with regard to current vacancies was also mixed. While 42% of providers did not have any
current vacancies, more than one in 5 (22%) said that 25% or more of their current domiciliary care posts
were unfilled, and in 9 cases (out of 64) 75% or more of all posts were reportedly unfilled.
20

NVQ 2 up from 59% last year to 67%


Managers with NVQ 4 up from 90% to 97.6%
Staff turnover (residential care for older people) has reduced from to 21.2% to 16%

The proportion of staff with 5 years of experience has risen to 20% (14% in 2006) (NCF,
2007).
6.3.2 Local Government Pay Commission. (www.lgpay.org.uk)18
This report explores issues to do with recruitment and retention in the local authority workforce.
This report states that there are certainly local and service recruitment ‘hot spots’ when it comes
to occupations at the lower end of the pay spine, however problems are not universal. One of
the reasons given for this is that care assistants enjoy higher earnings in the public sector than
the private, although there has been a recent closing of the gap.
6.3.3 As part of the consultation for this research regional Skills for Care committees were
consulted regarding recruitment and retention issues. Each of the regional committees are
employer led and have the majority of members on the committees. A number of employers,
including domiciliary care providers, reported that they did not have significant recruitment and
retention problems.
6.4 NMDS – SC and workforce data.
The reports about perceptions of recruitment, retention and rewards vary in quality in terms of
the accuracy of their data. It is hoped that the NMDS - SC information will enable more accurate
analysis of workforce data. Of particular interest will be variation between regions and subregions and between types of employers. It is likely that the information from the NMDS – SC
will confirm that some regions and some sectors are experiencing greater recruitment and
retention issues than others.
A wide range of recommendations and approaches have been suggested in order to tackle the
recruitment, retention and workforce issues, including raising the quality of the workforce.
Section 6.4 identifies some of these recommendations.
6.5 Proposals and guidance to tackle workforce issues in the social care sector.
This section details some of the major responses to the reported workforce problems.
6.5.1 Options for Excellence.
The Department of Health commissioned a study to consider the future of the social care
workforce entitled “Options for Excellence” (DH, Oct. 06).
Options for Excellence recommendations included:

publicity campaigns to raise awareness of the work that the social care sector does and
to improve its image

creation of a more diverse sector by supporting workforce development in private and
third sector providers


roll out of Care Ambassador Schemes
promoting the role of people who use services in shaping and delivering services


support for informal and formal carers (including foster carers)
an initiative to ensure safe and ethical international recruitment
18.
The Local Government Pay Commission however report that while at national level in local
government and the public services there is a considerable amount of information being generated by a
range of bodies, the value of these data can be questioned. A considerable amount of data on
recruitment and retention difficulties in relation exists but it has often generated more heat than light.
21


research into the links between rewards offered in the sector, recruitment and retention
difficulties and outcomes for service users (of which this research is part of the
recommendation)
measures to reduce reliance on temporary staff.
6.5.2 Collaborative recruitment solutions in social care (DH 2006).
Department of Health report (DH, 2006) looks at what individual organisations are doing to
address homecare recruitment and retention. It highlighted the importance of collaboration
across statutory and non-statutory providers in a fragmented sector where many small
organisations struggle to compete. Case studies explain how collaboration in various guises can
offer a range of benefits and meet specific objectives. The report outlines ways employers have
successfully overcome barriers to recruitment, sometimes by taking a fresh approach to existing
activities. A traditionally limited labour pool can be expanded by targeting younger people,
overseas workers and marginalized groups. But attracting workers is only part of the challenge
– keeping them can be just as hard - turnover of domiciliary care staff is 75% in some areas. So
the report looks at how to make workers feel valued and stop ‘leakage’ of new recruits.
“We must ensure that health and social care employers are good employers. Evidence is
growing that the highest-performing organisations have good employment practices. This
includes local organisations fulfilling statutory duties on race, disability (from December 2006)
and gender equality (from April 2007). Yet, being a good employer is more than simply meeting
legal requirements: supporting a good work–life balance, flexible working, childcare provision
and healthy workplace policies are important to ensure that staff can perform to their full
potential. The Department of Health will work with the Department for Work and Pensions and
the Health and Safety Executive to promote healthy workplaces in health and social care, and
model employment practices that attract and retain the best staff with the best skills”(DH, 2006).
6.5.3 SCIE people management web site retention: best practice
The guide explains how to understand the real problem posed by staff turnover and covers best
practice strategies for staff retention. The guide states that staff retention is one of the biggest
challenges facing many social care organisations. While a low level of employee turnover can
be beneficial in bringing in 'new blood' and allowing existing staff to take on new and more
challenging roles, too high a level of turnover can be costly and have serious effects on other
staff and on service users. Hence it is vital to understand why staff leave, and to put in place an
employee retention strategy including:

Recruitment and selection



Pay and conditions
Training and development
Work-life balance (SCIE 2005).
6.5.4 Building quality and sustainable capacity within the local independent sector home
care market (CSIP March 2006)
A project was undertaken by CSIP (March 2006) over an 18 month period to build quality and
sustainable capacity within the local home care market. Components of the project comprised:




developing a ‘fair rate’ for care based upon realistic cost drivers
improving the terms and conditions of care workers to aid recruitment and retention
making payments for travel time to promote better quality service provision
care workers’ roles may become more satisfying if their customers become more
satisfied through a customer-centred approach and hence more rewarding to work with
Pay and conditions need to be good enough to attract and retain high quality staff
22


problems were noted concerning low pay rates, minimal weekend premium rates, no
guaranteed hours, no mileage pay and no pay for non-contact time like travel and
training. Exactly which of these elements matters most probably varies locally
commissioners need to analyse whether the volume of home care commissioned
through spot contracts is helpful in dealing with known capacity and fragility problems in
the market. Providers often complain that this approach hampers their ability to plan on a
longer-term basis, which in turn has implications for recruitment and retention of staff, a
major influence on market capacity problems and quality of care for people.
6.5.5 There is widespread agreement that the competence, performance and fitness to practice
of the social care workforce are the main influence on the quality of people’s experience when
using services, and the effectiveness of practice and provision (ADASS, 2007). As already
noted, while pay is rarely the prime motivation of high quality home care staff, interviewees
made clear that reward at independent agencies is sometimes so poor that it can deter good
workers. Problems were noted concerning low pay rates, minimal weekend premium rates, no
guaranteed hours, no mileage pay and no pay for non contact time like travel and training.
Exactly which of these elements matters most probably varies locally. (CSIP, 2005 Caring for
the whole person).
6.5.6. The Care Ambassador Project is a scheme to promote social care careers. Skills for Care
have been heavily involved in the development of care ambassador schemes. They have
produced a toolkit to support the development of schemes (Skills for Care 2007).
6.6 The link between pay and reward and recruitment and retention.
At a common sense level one would conclude that there is a direct link between pay, reward
and recruitment and retention. However establishing the link is complex. There are many
reports that factors other than pay influence people’s decisions regarding employment. These
issues are discussed more fully in section 7. Factors impacting on recruitment and retention
include reward factors such as pensions, guaranteed hours, sick pay, holiday entitlement,
flexibility of working patterns and other factors such as quality of management and as reported
in 6.5.1 factors such as status and negative perceptions of the sector.
6.6.1 One report that directly attempts to explore the links between pay, reward and recruitment
in the social care sector is the report of the Local Government Pay Commission (LGPC)
(2003).19 The Commission was asked: “To establish the extent and causes of recruitment and
retention difficulties in local government, and to advise on their relationship to pay and rewards.
The report stated that an understanding of the relationship reflects consensus on the fact that
the provision of high quality services is inevitably dependent on the ‘right’ employees being
present at the ‘right’ place at the ‘right’ time. The report was clear that recruitment and retention
difficulties in local government defy easy analysis, one of the main reasons for this being that
even in local government – where workforce data is more easily available - that there are
considerable methodological problems with the data. The impact of local factors is highlighted
as of key importance – “The relationship between regions and recruitment and retention
difficulties remains at best uneven and limited. Indeed, such difficulties are often associated not
with regions but local ‘hot spots’ within a region which reflect the distinctive features of its local
economy” (LGPC, 2003).
The LGPC report states that in the case of recruitment, attempts to assess the situation have
often relied on asking local authorities to highlight ‘problems’ or ‘difficulties’. This is the approach
adopted by the EO in its regular survey on this topic and by IDS in research commissioned by
the Union side. Other indicators fare equally poorly. For example, information on job vacancies,
perhaps a more robust measure, is logistically difficult to collect. There is no government
agency with this role, leaving the EO to rely on voluntary returns, inevitably generating patchy
data.
19
It needs to be stressed that this report only refers to the directly employed workforce of local authorities.
23
The LGPC report states that potentially retention data finds a ‘harder’ measure in turnover,
although here as well there can be certain inconsistencies in definition. These inconsistencies
limit the possibility of comparison as well as the scope for debate over what level of turnover
constitutes a ‘problem’.
The LGPC report states that while the quality of the data remains at best uneven, in the case of
recruitment difficulties for particular occupations, much of it does appear to point in the same
direction and we are in no doubt that local government does face difficulties in a number of
areas.
There was some consistency of view amongst stakeholders in local government that the
recruitment difficulties for certain occupations were particularly acute in London and the South
East.
The Commission made an important point about the issue of turnover where it is not too difficult
to replace staff. The report recognised that an ability to replace such staff lessens the negative
consequences of high turnover; however the Commission was concerned about the
consequences of such turnover. High turnover may well have an affect on the continuity and
quality of service provision. Where personal service provision is concerned (as in home care)
turnover can pose particular problems for service users.
In terms of the contribution which pay and rewards have made to these difficulties, the supply
side shortages in a number of these professions cannot be completely dissociated from pay in
that one might expect higher salaries to attract a larger number into the profession. As well as
the important issue of pay, there are additional factors which may underlie these supply-side
problems. These relate with varying degrees of directness to pay. A number of them concern
the less tangible aspects of reward. For example the esteem and status associated with these
professions (notably social work) has been eroded over the years by hostility from the media
and public policy makers; the roles undertaken are hugely complex and difficult which, while a
possible attraction, can generate uncertainty and imbalance in the risk-reward ratio; there are
an increasing number of alternative careers in the public services, for example in regulatory
bodies, the independent sector and indeed the private sector, for those who might otherwise
have gone into these professions and even after training for those who initially chose the
profession.
The Commission reported that pay is significantly related to the supply of individuals willing to
enter local government professions and young people prepared to embark on general careers in
the sector. In addition to concerns about pay, the Commission stated that other issues need to
be addressed to encourage and keep quality employees including issues of esteem and status;
quality of working life and workforce/HR planning.
As noted above employers almost all felt that while pay rates were a potentially valuable tool in
retaining staff, they had very limited room for manoeuvre in the area of employees’ rewards and
benefits, because of the very tight costing and pricing regimes operated by local authority
commissioners of domiciliary care (Yeandle et al., 2006). They also asked employers what other
factors apart from pay were considered important. They state that most employers emphasised
the importance of flexible working arrangements and of offering part-time positions. Others
stressed that the supervisory and managerial support given to employees, and especially to
new recruits, was critically important and other non contractual benefits, such as creating a
welcoming and supportive working environment.
6.6.2 Evidence regarding the link between recruitment, retention and pay and rewards in
the children’s workforce.
The children’s workforce shares many characteristics with the social care workforce and until
recently information about both workforces were collected together. In a report commissioned
by the Children’s Workforce Development Council on workforce issues it was concluded that
generally “the evidence does not indicate that there is a direct link between the levels of pay
and rewards, and recruitment and retention across the children’s workforce” (CWDC, 2006).
24
The report stated that there are other influencing factors, including non-financial rewards and
the satisfaction or work/the enjoyment derived from working with children. Other benefits
include, for some jobs, flexibility, home-working, non-financial rewards, variety of work, location
of job and the team environment. The overall package is what will contribute to an individual's
contentment within a job and each individual will place a different emphasis on different
aspects. However, the report stated that lower pay is regarded as a factor in the high turnover of
staff in some occupations, with individuals regularly moving in search of higher pay. This issue
is not restricted to lower paid jobs. There is some evidence to directly link pay and qualification
levels, for example CAFCASS workers, and child and family social workers. (CWDC, Oct
2006).20 As with the social care workforce it has been reported that low value and lower pay of
the workforce must also be considered in relation to high levels of satisfaction with work. In
comparison to other groups of workers, workers within the children's workforce have been found
to be the most satisfied with their jobs.
6.7 Summary of section six.
This section started with descriptions from a variety of sources about the state of the workforce.
The majority of these reports state that there are significant problems in recruiting and retaining
people in the sector and this situation is likely to get worse with the anticipated expansion of the
sector. However, there are some reports that state that for some the situation is improving.
There are numerous reports that suggest solutions to the reported workforce problems, many of
these link to commissioning.
At a common sense level it would be anticipated that there would be a link between pay, reward
and recruitment and retention. Detailed research concerning this is limited. The LGPC report on
rewards and incentives in the local authority sector reported some evidence of links between
pay and reward and recruitment and retention, but stated that the situation is complex and many
factors need to be taken into consideration.
7.0 In depth information about the workforce.
7.1 Survey of 500 care workers.
The NMDS - SC contains valuable information about the workforce, including important
information about turnover and destinations of leavers. However, the NMDS, at this point, does
not contain much in depth information about the perceptions and views of the workforce. In
order to address some of this information deficit Skills for Care commissioned an in depth study
of 500 care workers, using representative sampling techniques (Skills for Care, Nov 2007).
The study of the 500 care workers included workers’ views on satisfaction with their jobs and
duties and views about their future working intentions. The sample was collected using the
nationally representative Omnibus surveys of the general population to identify care workers in
England. Using the Omnibus screener, care workers were found to be about 3.4% of the
working English population. 21 The following points are considered as of particular relevance for
the rewards and incentives research:




Nearly two thirds (63%) worked full time, and 65% had been doing care work for less
than 10 years.
49% had been working in their current job for up to 3 years, 14% for 4-5 years and a
further 22% for between 6 and 10 years.
The average hourly wage was £6.87 and approximately two-thirds of jobs did not pay
extra for any shift work or night work.
Nine out of ten care workers’ jobs made them happy (88%).
20
The DfES research cites the Labour Force Survey (LFS) 21 and comments that the" coverage of data
on pay levels over the entire children’s workforce is incomplete and of variable quality, due to the diversity
of workers and employers and a lack of consistent data collection.
21
The survey reports that a small proportion of those were later screened out as being ineligible.
25


83% of care workers would recommend their job to a friend, because they enjoy the
work, it is rewarding and enjoy working with the clients.
84% said that their work fits in well with their other responsibilities.

The majority of care workers were qualified to at least a Level 2 qualification, however
20% had no qualifications at all. The qualifications most often achieved were an NVQ
Level 2 (23%), possibly in Care, or Health and Social Care.

Just 15% of care workers were seeking promotion in the next 2 years, either as there
was no structure in place to progress (27%), or because they did not want the extra
responsibility (24%).
Most care workers said they were unlikely to change jobs or leave the sector in the next
5 years, but of those that intended to leave the sector, this was most likely in order to
retire (48%).


63% of care workers thought the public did not understand much about the work they do,
and just 39% thought their work was valued by the public. (Skills for Care, Nov 2007).
7.2 Summary of section 7
The in depth study of the views of 500 care workers supplies very useful information about the
sector. The picture painted was of a relatively stable workforce, who had a very high degree of
job satisfaction.
8.0 The link between employment practices and performance
Pay
Other rewards &
incentives
Terms & conditions of 
employment
Training &
qualifications
Other factors
Vacancy and turnover rates
Recruitment and retention 
problems
Outcomes for
service users
(quality and
continuity of care)
The literature search had as one of its aims to explore the link between employment practices
(which includes pay and other rewards and vacancy and turnover issues) and performance, with
performance specifically being considered as the outcome for service users. (Performance can
be considered in a number of ways, for example profitability of business is a common outcome).
It would be, for example, of considerable interest if it was found how an organisation can “get it
right” in terms of achieving high quality by utilising human resource policies and strategies. The
research from other employment sectors identifies that the process is poorly understood. The
evidence explored demonstrates that the process is not simple, indeed if it was it is likely that
industry would have uniformly adopted the necessary practices. Section 8 explores these
issues.
8.1 References to employment practices.
In addition to the references in section 6 regarding employment practices a number of other
references have been found that relate employment issues and performance. This section
attempts to explore the academic literature in order to better understand the relationship
between introducing various changes in the social care sector and outcomes. Outcomes can be
examined in three broad categories:
1. improved services for the end user, or service user
2. improved experiences of work for the employee
3. improved outcomes for the employer, in terms of financial factors.
26
It was reported in section 6.5.2 above that “Evidence is growing that the highest-performing
organisations have good employment practices.…... yet, being a good employer is more than
simply meeting legal requirements: supporting a good work–life balance, flexible working,
childcare provision and healthy workplace policies are important to ensure that staff can perform
to their full potential, to improve understanding of the affect of introducing changes in terms and
conditions of employment or changes in management practice”. Research in the health sector
reports more than 30 studies carried out in the UK and US since the early 1990s that leave no
room to doubt that there is a correlation between people management and business
performance, that the relationship is positive, and that it is cumulative: the more and the more
effective the practices, the better the result" (CIPD, 2001)
There are extensive reports in the literature of the desirability of introducing changes in
employment practice, commonly referred to as HR changes, how to implement such changes
and also some research on the mechanism that takes place in order to make the changes.
However, no formal academic studies of the relationship between implementing changes in the
social care sector were found in the UK literature. (These changes are referred to henceforth as
Human Resource Management (HRM) changes.) Nevertheless, we can refer to the wider
academic literature and identify relevant studies that address linking pay, recruitment and
retention to performance outcomes that may resonate to social care in the UK context. The next
section attempts to explore the link. In simple terms, if the mechanism for introducing changes
can be understood and can also be linked to the outcome of introducing changes, then there is
the potential for improvement in improved services, improved experiences of work for the
employee and improved profitability for the employer.
8.2 The elusive quest to explain the Human Resource Management (HRM) and
performance link
8.2.1 “High road” or “low road”?
A wide ranging general literature has developed on how firms approach the management of
human resources by pursuing either ‘high road’ (innovative quality-led ‘soft’ HRM) or ‘low road
(cost-minimising ‘hard’ HRM) policies (Grimshaw and Carroll, 2002). ‘Situational contingency’
theory suggests that product market innovation is associated with employment practices that
foster commitment to quality, improve investment in training, encourage autonomy, whereas a
cost-minimisation approach is associated with practices that encourage. The use of simple,
routine work practices, minimal training and intensive monitoring (Schuler and Jackson, 1987).
Much evidence points to high commitment or innovative HRM being associated with increased
productivity and profitability (e.g. Huselid, 1995; Ichniowski et al., 1996). However, it may be that
the scope for some industries to introduce such changes is more restricted than others. If there
was a simple positive causal effect of introducing “high road” practices leading universally to
improved performance, we would expect to see a major take up of this approach among
employers, rather than the small minority take up that is currently observed (Boxall and Purcell,
2003).
8.2.2. “Best practice” or “best fit”?
Much of the debate on HRM and its relationship to performance has focused around “best
practice” or “best fit” models, with the majority of studies defining HRM in terms of HR practices
or bundles of practices. The notion of bundles reflects the fact that individual practices cannot
be seen in isolation from each other and are interdependent, for example pay levels and
recruitment practices are strongly influenced by product and labour markets (Gilman et al.,
2002).
Boxall and Purcell (2003) reject the ‘either-or’ choice of HR strategy. Rather, they acknowledge
that employee development, employee involvement and high rewards are universally successful
27
practices22, whereas the actual design of overall HR practice depends on unique organisational
contexts. Thus the nature of the firm’s production system might militate against team-working
and performance-related pay. An example applicable to social care could be that the mode of
service and a need to optimise one-to-one care may militate against the use of highly flexible
working practices. Equally the external context, such as legislative constraints, might similarly
restrict the way in which optimal HRM design can be achieved. Obvious factors that apply in
social care are the impact of the National Minimum Wage and funding arrangements, which limit
the scope of employers to consider implementing costly measures.
Of the three main theoretical frameworks used to underpin most research studies, ability,
motivation and opportunity to participate (AMO) theory is now most widely used, rather than
strategic contingency theory or the resource-based view23. AMO theory focuses on High
Performance Work Systems (HPWS) (Appelbaum et al., 2000). Batt (2000, 2002) suggests that
because HPWS are more expensive to introduce, they are most likely to be implemented in
high-value segments for high-skilled workers engaging in complex service provision, whereas
low-skilled workers are likely to be subject to more traditional approaches to labour
management.
8.2.3. Linking inputs to outputs
Although the added value of HRM to enhanced performance is widely accepted, the
relationships are often statistically weak and the results ambiguous, raising unanswered
questions of how and why this occurs (Paauwe and Boselie, 2005). Put simply, we do not know
how HR inputs are translated into performance outputs and outcomes (see also Purcell et al.,
2003).
It is also conceivable that the same HR practices may lead to different and unforeseen
outcomes; enhanced workplace performance may not only improve employees’ work
experiences but also diminish them where work intensification occurs and job quality remains
low (Ramsay et al., 2000; also Harley, Sargent and Allen, 2007 below). As Fleetwood and
Hesketh (2008: 129) note ‘Research that lacks a theory also lacks an explanation of what the
selected HR practices actually do to influence organisational performance, and is, thereby,
guilty of treating the workplace as a “Black Box” (see 8.3 below).
8.2.4. Problems of interpretation
The majority of studies rely on managerial evidence and may be biased by managers seeking to
justify and defend their own intentions, rather than demonstrating successfully implemented
policies. It is conceivable that studies of HR specialists might produce even more positive
findings than those involving line managers. Line managers may resent the imposition of the
demands placed upon them or be less than convinced that centrally-driven organisational
initiatives are workable (Guest, 1999). In addition, we do not know how far the failure of HR
initiatives arises from managerial incompetence in implementing and maintaining HPWS or from
inherent limitations within the model itself (Ramsay et al., 2000).
The point being made here is that it is very important to distinguish between policies (the
organisation’s stated intentions for managing employees) and practices (actual, functioning,
observable activities, as experienced by employees), with an emerging literature arguing that
the success of HR can only be measured by employees’ experiences of organisational practices
(Gibb, 2000). There is also recognition that the very different priorities and needs of different
employee groups may call for tailored group-specific HR practices (Paauwe and Boselie, 2005).
22
The top four (of 26) different practices are training and development, contingent pay and reward
schemes, performance management (including appraisal) and careful recruitment and selection (Paauwe
and Boselie, 2005).
23 Strategic contingency theory, among other things predicts a link between HRM and external business
strategy and the environment. For example, Miles and Snow (1984) link HR strategy to competitive
strategy by identifying three types of strategic behaviour. Thus ‘defenders’ with a narrow and relatively
stable product market aim to succeed through efficiencies, while ‘prospectors’ continually search for new
markets and aim to compete through innovation rather than efficiencies. The resource-based view holds
that competitive advantage can be maintained or sustained through unique, rare, scare, inimitable and
valuable internal resources (Barney, 1991).
28
In other words, we need to distinguish between managerial intentions, the actual
implementation of HR practices and employees’ perceptions of them (Wright and Nishii, 2004).
8.3 Opening the black box
The elusive problem of how to open the ‘black box’ and explain the link between HRM and
performance necessitates us to consider different performance outcomes.

Financial outcomes, such as profits, may be influenced by a range of factors, such as
funding arrangements and have nothing to do with employees’ skills or human capital.

Organisational outcomes such as productivity, quality and efficiencies may be
particularly affected by investments in capital and new technology, but they are less
important than employees’ skills and human capital in contributing to service user quality
in care work.

HR-related outcomes in terms of employees’ attitudes and behaviours e.g. satisfaction,
commitment and intention to quit are also important considerations in care work.
Nevertheless, establishing causation has not been addressed in the majority of studies (Wright
and Haggarty, 2005).
Here the application of Appelbaum et als.’ (2000) model (Figure 2) may be of interest, even
though it has been developed in a manufacturing context. Unlike many other models, it does not
take strategy as a starting point but focuses on the importance of three sets of practices
designed to improve employee discretionary effort that will link to improved firm performance.
Nevertheless, the model is beset by four different sets of problems, as we now explain.
High performance work systems
Opportunity to participate
Skills
Effective
discretionary
effort
Firm performance
Incentives
Source: Applebaum et al, 2000
Figure 2 Conceptual model linking HRM to performance
8.3.1 A critique of Appelbaum et al.
1. Timeframe and measuring success
The first problem with this model is that it does not take account of timescale, and this raises
issues about how we can measure tangible success. It is suggested that the majority of HR
interventions, such as training and development and participative teamwork, have a longer-term
effect (2-3 years) on performance and may even fail to have any effect at all. Other
interventions, such as performance incentives, may have a more, direct short-term effect (Guest
et al., 2003). Additionally, the direction of causality is difficult to address. Do innovative HRM
practices inspire worker commitment and induce higher effort and higher productivity or does
high productivity enhance the stability and security of the firm or increase its ability to pay for
costly investment in innovative HRM policies (Grimshaw and Carroll, 2002)?
2. Neglect of institutional context and conflicting demands
29
The second problem with this conceptual model is its neglect of institutional context and
conflicting demands (Paauwe and Boselie, 2005). Care work is quite heavily regulated, for
example, the NMW and minimum staffing levels. This may give rise to conflicting demands from
interest groups outside the workplace. For example, the onus on commissioners to provide best
value for money maybe at odds with the demands of regulators, and indeed service users, for
high quality. Another area of potential conflict of interest is the regulation associated with health
and safety and the person centred approach, or best practice approach, which places the
wishes of the people who use services at the centre. Time spent away from direct working with
service users may be seen as detrimental to service users’ interests, yet regulation and good
practice demands that staff receive formal supervision away from interruption from operational
issues. With the perceived burden of regulation, HRM might emerge as part of an invasive set of
practices devised by non-care-centred managers. These pressures might give rise to conflicting
outcomes where managers’ desire to increase productivity subjects employees to work
intensification and increased levels of stress and anxiety.
‘Emotional labour’ is frequently required of care staff, on a near constant basis (Hochschild,
1983). This is not simply a ‘display’ of a felt state, such as kindness, compassion and cheer, but
an ability to behave and complete tasks patiently, gently and with tolerance, even if under
physical or verbal attack. Real attachment and emotional dissonance combine in these jobs.
Korczynski (2000) notes how nurses undertaking patient-centred work, rather than task centred
work, can be caught between the need to be efficient and a strong desire to give meaningful
care to patients. The consequences of delivering inadequate care due to work overload, erodes
nurses’ self-esteem and causes real anguish. The same argument could be applied to care
workers.
3. Employer behaviour, labour markets and product markets.
A third problem with the model is that it overlooks the importance of studying employer
behaviour in the context of complex product and labour market conditions. Positive and
negative market influences define important limits to employers’ ability to effect transformative
change (Grimshaw and Carroll, 2002).

The absence of data on product market strategy makes it difficult to assess the
sustainability of a new route.

Innovative HRM objectives may be productivity improving but designed to meet shortterm cost objectives to the detriment of longer-term quality objectives. For example,
delayering in the name of fostering employee communication leads to the breaking up of
career ladders and endangers the capacity of employees to develop skills along a
natural job hierarchy (Grimshaw et al., 2002).

The HRM and product market strategy link may be distorted by a range of other factors
that are internal and external to the firm. One example is employer perceptions of the
motivation and capacities of particular groups of workers (Hoque, 2000; Lucas and
Keegan, 2008, forthcoming). Employers might combine cost-reducing with qualityenhancing where there is an attempt to exploit particular groups of workers, such as
students who are cheap to employ but perceived to have the added-value of superior
education and other personal qualities compared to other groups of younger workers
(Lucas and Keegan, 2008, forthcoming). In these circumstances, new HRM practices
might tend to segregate workers by building on differential pay and conditions.

The adoption of quality enhancing employment practices is not a sufficient condition for
entry into or survival in quality-led markets. Care homes operate in a price-led
marketplace, which may hamper innovations. Narrow profit margins, competitive
conditions and difficulty in accessing capital or labour (cost and availability) in price-led
product markets make it difficult for many care homes to experiment with a qualityenhancing approach, regardless of incentives for change (Grimshaw and Carroll, 2006).
4. Applicability to other firms
30
A fourth problem is that the Appelbaum model may not transplant to other firms. We know from
recent studies that firm size and sector are both important determinants of employment
practices (Arrowsmith et al., 2003), who identify two prevailing views of small firms.

The first suggests that small firms provide ideal sites for the development of an HRM
approach because of direct communications, flatter hierarchies, directly observable
employee contributions to performance and the immediate ability of the owner/manager
to bring about change (Bacon et al., 1996: 98). In these circumstances there is little
pressure from employees for higher pay because it might eliminate the slack or
responsiveness in terms of supervision, work organisation or patterns of working time
currently enjoyed.

The second view of small firms is that employment is likely to be harsh as result of
exposure to more competitive markets and dependence on large firms as customers
(Rainnie, 1989). In these firms wages are low, and a regulatory shock such as the NMW
might force some employers to resort to illegal practices rather than encourage HRM
innovations.
Many care homes are owner/managed and small, where an informal, idiosyncratic approach to
employment is more likely to prevail (Gilman et al., 2002; Ram, 1994). Employment practices
strongly influenced by the ideology and values of owner-managers (Wagar, 1998) and may
inhibit a ‘high road’ approach if management philosophy is authoritarian and autocratic.24 Where
managements’ opportunity to exercise discretion is strong, employer perceptions of the
motivation and capacities of particular groups may limit the choice of HR approach (Hoque,
2000). As noted above, it is thus possible to combine cost-reducing HRM with a qualityenhancing product market strategy where labour market conditions enable employers to exploit
particular groups of cheaper workers, such as students.
Interestingly, Arrowsmith et al. (2003) are able to demonstrate that pay is not a key factor in the
retention and motivation of employees in small firms, citing the example of two guesthouses in
adjacent streets. One paid its employees the NMW (£3.60) but qualitative factors at work,
meals, breaks and flexibility over working time were important incentives to staying with the firm
because workers were female, secondary earners with children. The other paid its employees
£4.20 with 25 days’ paid leave, but less accommodation over hours and tighter work supervision
contributed to higher turnover.
8.3.2. The way forward
Business strategy may be seriously limited by a number of factors, including lack of skilled
labour, lack of management skills, increased competition, and the availability and cost of
finance for expansion. Service quality improvement initiatives may not necessarily be ‘high road’
(innovative quality-led ‘soft’ HRM) if they rely on work intensification and minimal change to
traditional methods, rather than the introduction of new technology and HR initiatives. Hence we
need to guard against considering ‘low road’ options if we are to improve firm capabilities in the
ways they manage and improve quality of care in social care, in the knowledge that the scope
for costly new initiatives may be limited by factors such as funding arrangements.
The way forward may be to develop HR practices that embrace flexibility and agility (focusing on
the customer rather than market needs) that reflect organisational climate and culture, and aim
to align individual values, corporate values and societal values (Paauwe and Boselie, 2005; see
also Eaton, 2000 below). While this might be developed at a firm-specific level, its wider
application may be more problematic. Recent research suggests that we have to guard against
over formalizing HR in small firms, because this may work against the interests of employers
and employees alike. There is evidence that employee satisfaction declines the greater the
formality of HR initiatives, notably, the presence of an HR professional, formal newsletters and
the presence of a formal dispute procedure (Storey et al., 2008). The implication here is that
24
Management style and competence is now assessed by CSCI, which should make it more difficult for
such behaviour to go unchallenged. See Appendix 1
31
firm-specific informality needs to be acknowledged more fully and used to the benefit of
employers and employees.
Finally, it should be noted that defining the "best practice" evidence base is one thing, but
translating this into widespread application of the appropriate bundle of HRM interventions is
another. Buchanan (2004) citing Richardson and Thompson and Guest highlighted the issue of
the relative lack of "take up" of HRM good practice: even when it has been verified by the
studies quoted above, it is not evident in day-to-day practice in many organisations. This
highlights an important issue for any sector wishing to improve HRM practice: deciding how best
to disseminate good practice in HRM is as important as determining how to identify and
evaluate it.
8.4 Lessons from comparative studies in social care
Section eight so far has detailed theories about the implementation of HPWS and other HR
theories from the general literature. This section explores the evidence of the impact of
implementation in the research literature in the social care sector. The only examples that have
been found that is specific to the social care sector are Australian and American and these are
detailed below.
8.4.1 Implementing High Performance Work Systems (HPWS) to care workers in Australia
This section explores the academic research literature on the impact of implementing “good”
work practices, or HPWS, for example implementing some, or all of the following, to personal
care workers in Australia (Harley, Allen and Sargent, 2007):
Good work practices
1. Work organisation – designing work so that it is interesting, particularly around the
development of team work
2. Sophisticated employee selection – ensuring as far as possible that the right people are
recruited for the job
3. Performance management, for example appraisal systems and supervision
4. Pay - How pay is linked to individual performance and ensuring that pay is competitive
relative to other organisations
5. Training – ensuring that employees have the skills and qualifications for the job
6. Consultation with staff about decisions
There are two perspectives on HPWS:
1. Mainstream – HPWS are associated with overwhelmingly positive outcomes by
contributing to autonomy, commitment and satisfaction that leads to superior
organisational performance (Becker and Huselid, 1998).
2. Labour process theory (LPT) view – HPWS practices take place through work
intensification and the shifting of responsibility to employees that leads to heightened
workload and stress (Ramsey et al., 2000).
As noted earlier, HPWS and more humanistic HR practices are more likely to apply to high-skill
workers where employers see benefits from increased autonomy and flexibility, but not to lowskill workers operating in mechanistic environments (Boxall, 2003).
The study
The Harley study is the first study to compare two types of worker within the care sector: The
survey covered registered nurses (RN) and personal care workers (PCW) using a random
sample of 3,136 workers drawn from the membership roll of the Victorian Branch of the
Australian Nursing Federation, the trade union that covers both groups. 1318 useable answers
32
(42%.) were returned. (It is notable that the research covered a highly unionised sector, which
is very different from the UK).
The study was concerned with the perceptions of staff, as opposed to managers, in the
knowledge that managers tend to overstate the extent of HR practices (Guest, 1999). While
managers may point proudly to the existence of a formal policy statement of good practice,
employees measure these HR policies in the way that they are affected by them and not by how
they are formally articulated. Individual employees are best able to describe HR practices,
whereas managers are unable accurately to describe HR practices (Wright et al., 2005).
Positive outcomes from HPWS
Data from the Harley study showed that HPWS have positive outcomes for both the personal
care workers and the highly skilled nurses and, in some cases, HPWS are associated with more
positive outcomes for low-skilled workers. There was no support for the labour process view of
work intensification, such as heightened workload and stress. Team membership was seen to
be associated with a positive experience of work for personal care workers but not registered
nurses.25
The Harley study contrasts with findings of a generally negative association between HPWS
and employees’ experience of work (Berg and Frost, 2005), whose central finding was that
HPWS do not work unless management systems based on work that is low skill, routine and
unrewarding are changed. High levels of trade union membership help workers to resist
employers’ attempts to establish clear divisions between workers in terms of job quality. It also
prevents employers from applying HPWS to one segment where both groups work closely
together. While teams may provide PCW with a means to control their work, in effect greater
empowerment, RNs do so by virtue of higher skill and position within organisational hierarchies
8.4.2 Linking HRM to patient quality outcomes in Australia
A second aspect of the work conducted by Harley and others is the use of a novel measure of
service quality as an indicator of organisational performance. This is based on respondents’
assessment of the quality of care provided to residents in their organization (Harley, Sargent
and Allen, 2007). Quality of service is a key indicator of how an organisation is performing. In
elder care service quality is a central indicator of effective service provision, as it captures a
measure of performance that employees can be expected to have direct influence on. In these
circumstances we should expect to see changes in the quality of care to residents from HPWS
initiatives that have been designed to enhance employee skills, improve motivation etc.
Although quality of care may be a subjective measure, it is about how care organisations deliver
their main service.
Good jobs
Components of a ‘good job’:
 task identity (extent to which employees complete a whole piece of work)

skill variety (extent to which employees have a range of skills)



task significance (significance of job within work context)
feedback (how much feedback built into job)
task discretion (amount of discretion involved in the job)
Mixed results
25
The ‘Disciplined worker’ thesis (Edwards et al., 1998) provides a plausible explanation for the findings.
Practices may be welcomed by workers if they enhance the orderly and systematic performance of work.
They get predictability and order by making performance appraisal systematic and by linking rewards to
performance in a clear manner and this is perceived by workers as enhancing their experience of work.
From this perspective one can accept that where HPWS lead to a stable and orderly, work environment,
this can deliver benefits to workers.
33
The research shows HPWS practices are positively associated with the employees’ assessment
of quality of resident care for employees in high quality ‘good jobs’. Associations are mediated
by employee commitment, discretion and work effort; hence performance gains arise from
positive employee outcomes. HPWS had a direct effect on quality of care probably because
careful selection, attention to performance management, training etc. have the effect of
selecting the right employees to get the job done and provide them with the skills and incentives
to perform well. HPWS are associated with commitment and discretion and through these, to
enhanced performance. HPWS are also associated with reduced workload, and helping
employees to work ‘smarter not harder’; which flowed through in terms of quality of care for
residents.
In low quality ‘bad jobs’, where work is low-skill, routine and unrewarding, the position is not so
positive. HPWS impacted on commitment but this did not work through to enhanced experience
of work and resident care; impact on commitment was weak compared to those in ‘good jobs’.
So although HPWS practices appear to ‘work’, they work in ways that deliver clear benefits to
those in “good jobs” by enhancing their experience of work. As there is no enhanced experience
of work in “bad jobs”, the only benefit they deliver here is increased commitment to the
organisation, but this is probably more a benefit to the organisation than to the employees.
8.4.3 Linking HRM to patient care quality in American long-term care
8.4.3.1 Management philosophy, work organisation and front-line care
An earlier study exploring the link between HRM, work organisation and patient care quality in
US long-term care proposes a key role for both management philosophy and improved front-line
staffing arrangements in delivering consistently higher quality care, defined to include both
physical and psychological outcomes (Eaton, 2000). This study focuses on relationships and
people management to identify mechanisms that lead from a particular work process design to
specific quality outcomes for residents. It also noted that studies have not examined customers,
in this case residents, who lack a voice and whose satisfaction is not a major goal of the
industry (the provider is paid by third parties whether residents satisfied or not). Quality of care
can hinge on small decisions made by workers such as the appropriate food to give to an
individual. Pleasant and positive relationships and feelings and attitudes between staff and
residents are crucial to quality of life and care but rarely occur. Hence this study fills an
important gap by focusing on the details of actual work organisation and carers’ interactions
with residents, using direct observation, interviews, intensive case studies.
8.4.3.2. Changing attitudes and behaviours towards elders
Eaton’s study seeks to challenge the poor care and ‘places to die’ attitude of longer-term care
that leads to higher mortality, depressed residents, and ill-effects, such as bed sores. Rather,
the study underpins the importance of encouraging elders to continue their psycho-social
growth and development, to ‘age in place’ and to remain in control of their lives, in the
knowledge that some facilities record lower mortality for residents cared for in simple, different
ways. It is argued that social and informal interaction are as important to the quality of residents’
lives as medical and clinical care. This arises because experienced workers accumulate stores
of ‘tacit knowledge’ from doing ‘invisible work’, such as how to turn patients safely, how to cheer
them up, who has grandchildren, who prefers warm water for bathing and when someone needs
their glasses. The problem is that this work is not considered productive because it is not
routinely measured and consequently, the work of carers is socially devalued and marginalised.
8.4.3.3 Three models of care:
1. Low-quality (medical-custodial).
The majority of firms in American long-term care pursue a traditional, low-quality approach
where there is no supervision to help workers do tasks, no feedback, no information, minimal
training, and a lack of equipment and essential supplies. Managers do not trust their workers,
perceiving them to have limited skills, abilities and capacities. In spite of poor education, many
nursing aides care deeply for patients and deliberately choose this work, despite poor working
conditions.
34
Staff turnover is typically 100% and recruitment and selection poor and staff and patients are
sometimes abused. The public reimbursement scheme, which funds two-thirds of patients,
simply requires a written commitment to correct deficiencies found in an annual survey to the
detriment of more qualitative improvement measures. Firms can only increase profit margins by
seeking private paying residents in addition to those on Medicaid. With occupancy levels high,
managers do not have to improve quality to attract patients.
2. High-quality (medical-rehabilitative).
In this more semi-skilled, semi-autonomous model, firms’ philosophies of management and
work organization, and not their profit status, yield higher quality outcomes. Firms are not
understaffed and use teams and care pairs to support and assist each other in difficult
emotional and physical work. Team meetings occur at the beginning of a shift and starting
wages are 50% higher than in low-quality care. There are more nurses per shift, more
gerontological training, greater information sharing, team-work, and continuity of care.
Measurable differences in resident outcomes include lower incidence of bed sores, less
frequent use of restraints, and fewer hospitalisations because there are fewer infections and
falls. Observable differences are the lack of odour and higher resident activity levels and social
engagement between residents, visitors and aides. Patient-specific knowledge is crucial in
ensuring quality of life and management’s HR strategies are values-based. One religious home
with a 70% Medicaid population was able to raise 14% of its budget through the community so it
could maintain higher standards of care.
3. Regenerative community.
The basis for this new semi-skilled, semi-autonomous, approach draws from the experience of
two nursing homes in Connecticut. In one, residents were given a choice of house plants to care
for and to make small decisions about their daily routines. Eighteen months later residents were
more cheerful, active and alert and more remained alive (less than half had died) than in the
other one (Langer, 1989:1).
Example 1 the Eden Alternative
Using initiatives including keeping pets, having plants, working in the garden, visits from school
pupils and story telling sessions, the firm’s motto was to ‘Give care to others and to each other’.
Statistically significant reductions in mortality, illness, including depression, and drug use were
observed.
Aides were asked to make their own schedules which improved attendance because people
were better able to manage their home and work responsibilities, and also had training in
‘holistic’ care. Ongoing costs were no higher than before. ‘Capitalisation’ costs of pets, plants
etc. of $100 a bed worked out at less than 1/300th of facility’s annual budget for a bed.
Example 2 Sisters of Providence
In this example, care and service delivery were redesigned to provide dignity, choice and
growth for residents and employees. Several ‘neighbourhoods’ and ‘families’ of residents, with
helpers were created. Each comprised five residents supported by one resident aide. Residents
were able to choose their getting up and bed times and what and where to eat. More of their
time was spent interacting with others.
Aides’ job descriptions now included talking with residents, attending to requests for
companionship and helping them eat at times of their choice. Aides were cross-trained and
licensed as food handlers. Housekeeping staff were assigned to a ‘neighbourhood’ and crosstrained as nursing assistants, so they could help with toileting and bathing when residents
preferred, and not to an imposed schedule. The facility became resident-centred not nursecentred and began hiring people never previously trained in long-term care.
35
There were no additional costs, aside from initial remodelling and research and documentation
efforts, which was funded by a grant. Even if we assume some start-up costs, rebuilding units
and staff training, longer-term costs were reduced by an overall improvement in residential
health status. However, family support was not always forthcoming and strong leadership was
required.
8.4.4 Management implications
Rather than beginning with HRM reforms, these models are based on philosophical or religious
approaches to residents which require changes in work organisation and HR to be
implemented. Eaton maintains that high-performance models from other industries are
insufficient where there is care in a physical and emotional sense. High labour costs (70%) in
nursing homes and a psychological-emotional context, where ageing, dying, dignity, choice and
families are critical, differentiating factors. In these circumstances, quality can consist of caring
conversation, combined with gently performing hard physical tasks of lifting, feeding and
cleaning residents.
The key to an alternative model:
1. Develop an ideology or culture of production of care that encourages the growth of
residents rather than one which assumes inevitable deterioration; this is not grounded in
market niche choices. Philosophy is crucial in guiding managers’ and the co-producers
of cares’ choices. Different structures may be appropriate to suit particular workplaces
e.g. small family type units or multi-generational units with animals.
2. Recognise that close links between high-skilled labour and improved quality of life for
residents are not easily measured in productivity terms and must embrace value and
nature of relational work and emotion at work. Some crucial work is not measured in
current regulatory or reimbursement systems and is devalued compared to bed making
and record-keeping. Basic care activities and related outcomes of psychological and
physical health need to be measured and considered productive.
3. Multi-layered cross-functional teams are crucial, as is sustained interaction between the
lowest-skilled and more highly trained workers who must share information e.g. why
nursing decisions are necessary and what carers know about patients’ needs and wants.
Future research must specify nature of management’s philosophy of care more carefully, as well
as relevant environmental factors. A clear definition of quality needed; key features include
resident voice, social engagement, freedom of choice and traditional medical outcomes.
8.4.5 Significance of the Australian and American research for the UK.
There are clearly significant differences between the research samples in the Australian and
American studies and the care sector in the UK. For example, the sample in Australia is highly
unionised, whereas union membership in the care sector in the UK is low, particularly in the
private sector. The Australian study also looked at what are classed in the UK as nursing
homes. In nursing homes there is a clear hierarchy based on nurses being in charge and care
staff reporting to nursing staff. This applies to the nursing home sector in the UK, but not to the
residential care sector, or domiciliary care sector. It may be, for example, that within the UK’s
residential sector there is scope to regard and treat care assistants as having “high quality”
“good” jobs.
It is therefore not possible to draw any firm conclusions about whether it is possible to
generalise the information from the Australian and US studies to the UK, although it provides
some valuable ideas that are worthy of consideration. However, the research does appear to
demonstrate in these contexts that there will be pay-offs for organisations adopting HPWS
practices and this suggests that performance gains of service quality can emerge partly through
positive employee outcomes.
One might argue that employees’ perceptions of the quality of patient care are flawed, because
they do not account for patient outcomes, a point we address in the next section. Managers who
implement HPWS practices are likely to see performance gains regardless of job quality, with
heightened commitment resulting alongside performance gains. The research also indicates
36
that innovations in HR practices can contribute to raising commitment, even in jobs that remain
“poor.” It is, however, unfortunate that they do not help improve the experience of work in low
quality jobs. The challenge may be to move “poor” jobs into the “high” category, by for example
implementing the components of “good” jobs – autonomy, skill variety, task significance,
feedback and task discretion. The qualitative research of 500 care workers in the UK
demonstrates very high levels of job satisfaction. It is not clear whether the satisfaction derives
from the intrinsic nature of the work, or whether job satisfaction is overtly influenced by “good”
HR practice (Skills for Care, Nov 2007).
9. Summary and conclusions from the literature review.
1. Introduction
Skills for Care commissioned the writers to research the important area of rewards and
incentives and the relationship of these to recruitment, retention and quality of service in the
social care sector. The introduction aimed to identify the issues that would be explored in the
literature review.
2. Terms used in social care.
Social care, in common with any other sector of industry has its own terminology.
This section identifies the key terms, which are later referred to in this report.
3. The social care workforce in context.
Section 3 sought to describe the regulatory system that the majority of social care services
operate under. The industry is subject to national minimum standards regarding quality of
provision and workforce issues such as staffing levels, recruitment practices and qualification
levels. Organisations are inspected by CSCI to ascertain the degree that the national minimum
standards are met.
The majority of provision is purchased by local authorities, who are driven by a best value
agenda and commissioners seek to obtain quality services at best value prices. Commissioning
practice appears to have a significant impact on the market for social care.
4. The size of the social care market and the characteristics of the sector
Section 4 has attempted to give an overview of the sector in terms of size and workforce issues.
The sector is a significant one in terms of economic value, the number of people it serves and
the size of the workforce. There are various sources of data about the sector, with the NMDS –
SC beginning to have a real impact in terms of the quality and detail of information. There is
evidence of significant turnover in the sector, particularly in the independent sector, and
particularly at the front line level. High turnover is particularly problematic for quality of care,
however the negative picture appears to be somewhat ameliorated by evidence that the
destination of many leavers is other parts of the social care sector.
5. The impact of the National Minimum Wage
Section 5 explored the impact of the introduction of the national minimum wage. The impact of
the introduction and subsequent up ratings of the NMW are as follows:

The NMW has had a major impact in social care by raising the pay of substantial
numbers of workers.

The main impact was from its introduction, and there is now evidence that pay in social
care compares favourably with other low paying sectors, although it remains relatively
low.
Larger hikes in the NMW have necessitated that the restoration of the differentials of
some higher paid workers.
There has been no negative impact on jobs in the sector, which have continued to grow.



Compliance has been achieved mainly by a drop in profits, and to a lesser extent a rise
in prices.
37


There has been a marked effect in the increase of labour cost and non-labour cost
controls.
There has been a relatively minor effect on lowering staff turnover, higher staff
motivation, the faster filling of vacancies and the use of new technology.

There has been a small effect on reductions in staffing levels, basis hours, overtime
hours and overtime rates, and a marginal effect on the reduction of non0-wage benefits.

There has been a minimal effect, either positively or negatively, on service quality,
innovation and firm performance.
6. Workforce issues: perceptions and views and the link between rewards and
incentives and recruitment and retention issues.
This section started with descriptions from a variety of sources about the state of the workforce.
The majority of these reports state that there are significant problems in recruiting and retaining
people in the sector and this situation is likely to get worse with the anticipated expansion of the
sector. However there are some reports that state that for some the situation is improving.
There are numerous reports that suggest solutions to the reported workforce problems, many of
these link to commissioning.
At a common sense level it would be anticipated that there would be a link between pay, reward
and recruitment and retention. Detailed research concerning this is limited. The LGPC report on
rewards and incentives in the local authority sector reported some evidence of links between
pay and reward and recruitment and retention, but stated that the situation is complex and many
factors need to be taken into consideration.
7. Workforce realities: a study of care workers
This section reported on an in depth study of the views of 500 care workers supplies very useful
information about the sector. The picture painted was of a relatively stable workforce, who had a
very high degree of job satisfaction.
8. The link between employment practices and performance
The key points are as follows:
 The performance outcome of service quality is three-dimensional. It is important for the
service user, the work experience of employees and the financial success of the
employer. Ideally, its measurement is best achieved by gathering evidence from all three
parties.




Employment practices are best seen not as individual practices, but as bundles of
practices. A way forward may be to combine bundles of “best practice” HR (employee
development, employee involvement and high rewards) with bundles of other practices
that recognise the nature of the firm’s production and service modes.
Bundles of practices will also need to reflect and take account of the institutional context
in which social care functions, the way individual employers choose to behave in
response to labour market and product market conditions, and the conflicting demands
that managers and employees have to contend with in carrying out their work.
High quality practices should seek to achieve high quality outcomes, without being
unduly costly. These should enhance, rather than diminish, the work experience and
self-esteem of employees and the quality of life for those being cared for.
Good work practices and good jobs based on job redesign, work reorganisation,
information sharing, fair treatment, showing respect for others, some flexibility,
empowerment and working smarter are not necessarily costly.
38




Good policies on their own are useless unless they are implemented effectively and
have the desired effect.
Setting and appropriate timescale and establishing success criteria are important to
ensure that the achievement of short-term gains does not work to the detriment of
longer-term gains.
Measures of what is productive work needs to reflect qualitative measures as well as
quantitative ones.
Employment practices need to be sensitised to the organisation’s culture, climate and
value systems. Over formalisation of employment practices may be damaging if the
benefits of informality are lost.

Enlightened management philosophy and attitude to social care, leadership and vision
are important prerequisites to semi-skilled, semi-autonomous ways of working.

The social care sector is a sizeable and growing sector of the economy and is likely to
grow in the next 20 years in line with demographic changes.
Conclusions
There is a considerable amount of information in the literature that reports workforce issues in
the U.K. social care sector. The validity and reliability of the information will be put under
scrutiny in coming years as the NMDS – SC generates more data.
The literature reports the sector stating that there are considerable problems in the sector with
recruitment, retention and turnover, and that there were problems with the introduction of the
National Minimum Wage.
It needs to be remembered that the industry has changed considerably over the past decade
and that many of the changes are a result of external influences, such as commissioning and
legislation regarding regulation. The majority of the sector is publicly funded, albeit delivered by
private sector providers. This has implications for the way that the market operates, in that in
many ways the market does not operate in a free market, competitive environment. This in turn
may have implications for the way that the sector behaves, for example funding is clearly a
major issue for the sector, yet the majority of funding comes from government sources. One of
the ways that the sector can influence the supply of funding is by exerting pressure on
government. It is likely that genuine perceptions of rewards and incentives are being used to try
and influence the government agenda. It is also likely that the commissioning decisions of the
major funders – local authorities –are a significant determinant of decisions at the level of the
individual organisation relating to rewards and incentives. This complicates analysis of the
relationship between HR factors, such as rewards and incentives and performance at a whole
industry level.
There is little conclusive evidence of the impact of applying variable rewards and incentives in
the sector. This is not surprising given the complexity of possible causal relationships, coupled
with current limitations in the quality of the data. There is, however, much discussion about what
could and should be done.
Information from research outside of the social care sector indicates that the process of
introducing HR reforms can have a negative as well as a positive affect on employee
performance, less is known on the impact on overall performance. A key feature of
implementation of strategies relating to rewards and incentives and other HR issues would
appear that HR practices should not be introduced in an over formalised way, otherwise they
can be seen as a bureaucratic burden that distract operational managers and staff from direct
work with people who use services. The opportunities within the care sector to get the
implementation right appear to be good as many of the organisations are small and locally
managed.
39
The literature search found that hard evidence about the scale of recruitment and retention
difficulties and the success of solutions for them is somewhat limited. Undoubtedly there are
“hot spots” in the sector where there are considerable problems. The literature also raised the
important point that the impact of turnover on service users will be greater than in other sectors
of the economy because of the value that service users place on continuity of care. It also
appears that domiciliary care experiences as a whole greater problems of recruitment and
retention than the majority of the sector, this has particularly challenging implications as this is
the area that is likely to experience most growth.
There is not enough information about the causes of the recruitment and retention difficulties in
detail, the development of NMDS information should go a long way to help solve this. For
example, to see if there are correlations between commissioning decisions of local authorities
and outcomes in terms of employment and quality.
The research in Australia and the US indicated that “good” HR practices can have an impact on
both organisational performance and employee satisfaction. The specifics of the research
however mean that there are limited lessons for the UK, unless the research was replicated and
adapted to the England context.
The case study approach, which is stage 2 of this research, will explore at the level of individual
organisations the impact of various HR practices. These factors will include an exploration of
how the organisation is run, including management and HR practices, as well as the economic
context of the individual organisation. Case studies will be selected by using indicators from the
statistical analysis, with a particular emphasis on firms that score highly or poorly on CSCI and
NMDS – SC indicators.
40
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Appendix 1
CSCI standards for residential care for older people.
Choice of Home (Standards 1–6)
Health and Personal Care (Standards 7-11)
Daily Life and Social Activities (Standards 12-15)
Complaints and Protection (Standards 16-18)
Environment (Standards 19-26)
Staffing (Standards 27-30)
Management and Administration (Standards 31-38)
1.Prospective service users have the information they need to make an informed choice about
where to live.
2. Each service user has a written contract/ statement of terms and conditions with the home.
3. No service user moves into the home without having had his/her needs assessed and been
assured that these will be met.
4. Service users and their representatives know that the home they enter will meet their needs.
5. Prospective service users and their relatives and friends have an opportunity to visit and
assess the quality, facilities and suitability of the home.
6. Service users assessed and referred solely for intermediate care are helped to maximise their
independence and return home.
7. The service user’s health, personal and social care needs are set out in an individual plan of
care.
8. Service users’ health care needs are fully met.
9. Service users, where appropriate, are responsible for their own medication, and are protected
by the home’s policies and procedures for dealing with medicines.
10. Service users feel they are treated with respect and their right to privacy is upheld.
11. Service users are assured that at the time of their death, staff will treat them and their family
with care, sensitivity and respect.
12. Service users find the lifestyle experienced in the home matches their
expectations and preferences, and satisfies their social, cultural,
religious and recreational interests and needs.
13. Service users maintain contact with family/ friends/ representatives and the local community
as they wish.
14. Service users are helped to exercise choice and control over their lives.
15. Service users receive a wholesome appealing balanced diet in pleasing surroundings at
times convenient to them.
16. Service users and their relatives and friends are confident that their complaints will be
listened to, taken seriously and acted upon.
17. Service users’ legal rights are protected.
18. Service users are protected from abuse.
19. Service users live in a safe, well-maintained environment.
20. Service users have access to safe and comfortable indoor and outdoor communal facilities.
21. Service users have sufficient and suitable lavatories and washing
facilities.
22. Service users have the specialist equipment they require to maximize their independence.
23. Service users’ own rooms suit their needs.
24. Service users live in safe, comfortable bedrooms with their own possessions around them.
25. Service users live in safe, comfortable surroundings.
26. The home is clean, pleasant and hygienic.
27. Service users’ needs are met by the numbers and skill mix of staff.
28. Service users are in safe hands at all times.
29. Service users are supported and protected by the home’s recruitment policy and practices.
30. Staff are trained and competent to do their jobs.
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31. Service users live in a home which is run and managed by a person who is fit to be in
charge, of good character and able to discharge his or her responsibilities fully.
32. Service users benefit from the ethos, leadership and management approach of the home.
33. The home is run in the best interests of service users.
34. Service users are safeguarded by the accounting and financial procedures of the home.
35. Service users’ financial interests are safeguarded.
36. Staff are appropriately supervised.
37. Service users’ rights and best interests are safeguarded by the home’s record keeping,
policies and procedures.
38. The health, safety and welfare of service users and staff are promoted and protected.
46