We read, seemingly daily, of the demands placed by an ageing population on the domiciliary care services that support older people in sustaining effective lives in their own homes and, sadly, of the widespread failures in these services. Care scandals have become almost commonplace in the UK and policymakers face ongoing pressure to increase funding to ensure delivery of high quality care. Increased funding is indeed vital and it is encouraging to see parties across the political spectrum addressing this in their election manifestos. Yet extra funding is not the panacea to all ills in a sector beset by ongoing recruitment and retention crises and wider action is needed to assure the skilled and stable workforce needed to deliver high quality social care.
Radical public sector reform in recent decades means the majority of domiciliary care is now purchased by Local Authorities from independent (private and voluntary) sector providers. Their commissioning practices, impacted by government funding and austerity programmes, deliver insecure and inadequate funding streams to these providers. Providers have responded by offering inferior employment conditions, which are in the main subject only to standard UK employment. As we outline below, the consequences for domiciliary care worker recruitment and retention have been catastrophic. There are three main reasons for this:
- Lack of funding for workforce development, despite regulation that emphasises the importance of a skilled workforce and promotes induction and ongoing training, together with acquiring (at least) a Level 2 Qualifications and Curriculum Framework diploma (QCF2).
- Low pay, with were few benefits and ongoing difficulties over (lack of) payment for travel time.
- Problematic employment conditions with widespread use of zero-hours contracts and non-payment for waiting times between peak periods of demand, meaning care workers work ‘full time hours for part time pay’. Coupled with an increased use of very short visits, high levels of strain and fatigue resulted.
In combination, these factors reduced care quality by compromising its continuity, flexibility and reliability. They are compounded another important issue, the status of care work, which is generally considered to be low-skilled and low-quality and not an attractive occupation. Most care workers enter the sector motivated by a desire to help and make a difference to the lives of others; they want to be supported in delivering good care. Some are prepared to tolerate poor employment conditions because of this caring motivation. Yet many workers are deterred from entering or indeed leave the sector because of these poor conditions and their negative consequences for both themselves and the care that older people received. Combined with an outdated perception of care workers as low-status ‘home helps’, perhaps relating to a female-dominated workforce, and ongoing negative media coverage of the sector, recruitment and retention becomes exceptionally challenging.
Urgent action is needed to deliver the well-trained, well-paid and secure workforce with appropriate working patterns needed to recruit and retain care workers and to deliver high quality care. Increased funding is important, but not the whole solution and more robust regulation is needed to ensure that, in the independent sector, increased funding flows to enhance the workforce offer via:
- Improved workforce development that also recognises the higher skilled nature of care work, perhaps adopting a German model with higher and lower-skilled care worker roles to attract entrants to the sector and create career paths.
- Enhanced pay structures to reflect the skilled and demanding nature of the work, reward acquisition of skills/qualifications and underpin career paths.
- Better employment conditions with a routine offer of guaranteed hours contracts, with zero-hours contracts used at the margins to deliver flexibility, pay for travel time and adequate visit lengths.
The challenges are wide ranging and addressing them will require commissioning practice that delivers not only increased and more secure funding, but also more robust workforce regulation and the positioning of domiciliary care jobs as good quality. Recent government attention is welcome but only the beginning of a long road towards creating the skilled and stable workforce required to deliver high quality social care.
Carol Atkinson is Professor of HRM in the Centre for People and Performance at Manchester Metropolitan University Business School. Here she reports research undertaken with Dr Sarah Crozier on employment practice in Welsh domiciliary care and its negative consequences for care quality.
Full details can be found at http://gov.wales/statistics-and-research/factors-affect-recruitment-retention-domiciliary-care-workers/?lang=en
Full article can be found in the latest issue of Public Sector Focus: