The Social Care Commitment and the Care Quality Commission

The raison d’etre of Bettal Quality Consultancy is to support managers to achieve high quality services. In this blog, I take a look at the Social Care commitment which aims to support people to deliver high quality services.

The Social Care Commitment was launched in 2012 by the Department of Health along with Skills for Care. It is the adult social care sector’s promise to provide people who need care and support with high quality services. It has been designed by people working in the sector, so it is easy to do and will have a real impact in workplaces. It’s also seen as a key way of increasing the public’s confidence in social care services.

Social Care Commitment Statements

The Social Care Commitment is made up of seven statements, with associated ‘I will’ tasks that address the minimum standards required when working in social care. Seven statements for employers, seven statements for employees – for each statement there is guidance which explains clearly what is and isn’t meant by the statements.

Employers Statements

Statement 1: I will take account of potential employees’ values, attitudes and behaviours when recruiting new staff.
Statement 2: I will provide thorough induction for all new staff and for those changing job roles.
Statement 3: I will provide timely, appropriate and accessible education, learning and development opportunities to enable my employees to develop and strengthen their skills and knowledge.
Statement 4: I will encourage everyone I employ to sign up to the Social Care Commitment and to commit to any codes, standards or registration systems applicable to their job role.
Statement 5: I will take responsibility for the values, attitudes and behaviours that my employees display at work, including upholding and promoting equality, diversity and inclusion.
Statement 6: I will regularly monitor the skills and behaviour of everyone I employ, ensuring that feedback is encouraged from anyone they support or have direct contact with, including families and carers.
Statement 7: I will work to ensure a positive culture and working environment where all employees are supported to do what they’ve said they will as part of their Social Care Commitment.

Employees Statements

Statement 1: I will always take responsibility for the things I do or don’t do.
Statement 2: I will always promote and uphold the privacy, dignity, rights, health and wellbeing of people who need care and support.
Statement 3: I will work co-operatively with others to ensure the delivery of safe, high-quality care and support.
Statement 4: I will communicate in an effective way to promote the wellbeing of people who use care and support.
Statement 5: I will respect people’s right to confidentiality, protecting and upholding their privacy and dignity.
Statement 6: I will improve the quality of the care and support I provide by constantly reflecting on and updating my own knowledge, skills and experience.
Statement 7: I will promote equality, diversity and inclusion by treating all people fairly and without bias.

When providers sign up to the commitment they are given a development plan that records the tasks and activity they have promised to complete as part of their commitment. This development plan can be used by the manager as evidence during CQC inspections.

Efforts to improve quality of care are always to be commended. The employer’s statements represent could practice and are closely linked to the Care Quality Commission Fundamental standards. What is different is the drive towards commitment to quality.

Evaluation of the Social Care Commitment

Skills for Care commissioned an evaluation of the Social Care Commitment in 2014. At that time almost all of the signed up employers had, at the time they were consulted, made some progress towards the tasks they had selected. Around half of these employers had experienced barriers to completing their tasks, citing a lack of manager time, difficulties in releasing staff from their day-to-day duties and financial constraints as the main issues.

These were more prevalent in domiciliary care providers than their residential counterparts.
The group of reputational benefits included in the survey were cited by the vast majority of employers. 85% of employers have also experienced, or expect to experience, quality of care related benefits as a result of the Commitment, while 83% said that it has led, or will lead, to improvements in how staff are trained and developed.

Commercial benefits (costs, sales and profits) were cited less often, although this is not surprising given that commercial improvement was the least frequently cited motivation for engaging with the Commitment.

There is a modest level of additionality associated with the Commitment, with many of the employers saying that they would have undertaken the tasks anyway. However, the added value of the Commitment is in the structured approach to workforce development that it provides. It is repeatedly helping to focus their efforts, is providing a framework and is ensuring that they are working towards an appropriate standard which is consistent with the rest of the sector.

Some barriers were identified to progressing the commitment. Half of the employers that had signed up had not experienced any barriers to progressing and, where applicable, completing their tasks. For the remainder, the main Evaluation of the Social Care Commitment barriers, none of which came as a surprise, were a lack of manager time to take the tasks forward, difficulties in releasing staff from their day-to-day duties and financial constraints. The results suggest that domiciliary care providers are more likely to experience these barriers than their residential counterparts, especially a lack of financial resources and difficulties releasing staff from their jobs.

Summary

The Social Care Commitment can be seen as a driving force to encourage managers to focus on elements of best practice that are requirements of CQC Fundamental Standards. The evaluation found the process to be generally very positive and, as such, they found relatively few obvious areas for remedial action or intervention. However, employers were keen to stress that the added value of the Commitment is in the structured approach to workforce development that it provides. It is repeatedly helping to focus their efforts, is providing a framework and is ensuring that they are working towards an appropriate standard which is consistent with the rest of the sector.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Employee Satisfaction in care homes and domiciliary care services

All managers of social care services have become aware of the increasing difficulty of recruiting and retaining staff. Given the high level of staff turnover rates, the manager views each new appointment faced with the dilemma of how they are going to keep them. Some people will say they only work for money, but there is a great deal of evidence that employee satisfaction plays a major part in staff deciding to stay in their job.

What is employee satisfaction
Employee satisfaction is the terminology used to describe whether employees are happy and contented and fulfilling their desires and needs at work. Many measures purport that employee satisfaction is a factor in employee motivation, employee goal achievement, and positive employee morale in the workplace.

Factors contributing to employee satisfaction include treating employees with respect, providing regular employee recognition, empowering employees, and positive management within a successful framework of goals, measurements, and expectations.

The critical factor with employee satisfaction is that satisfied employees must do the job and and contribute to the provision of the service that the manager and the service user needs.

Measuring Employee Satisfaction
Employee satisfaction is often measured by anonymous employee satisfaction surveys that are administered periodically to gauge employee satisfaction. In an employee satisfaction survey, employee satisfaction is looked at in areas such as:
• management
• understanding of values and ethos of the service
• empowerment
• teamwork
• communication
• co-worker interaction

A second method used to measure employee satisfaction is meeting with small groups of staff and asking the same questions verbally.

Depending on the culture of the service, and whether staff feel free to provide feedback, either method can contribute knowledge about the degree of staff satisfaction to managers and employees.

Exit interviews are another way to assess employee satisfaction but the problem here is that satisfied employees rarely leave the service.

Employee satisfaction surveys
A satisfaction survey may be used by care home or domiciliary care services to measure the liking and approval of staff. Normally, in relation to the work environment, culture, or conditions of their employment.

A satisfaction survey is a series of questions that employees answer to inform the manager about how they feel about or how they experience their work environment and culture. The questionnaire usually offers both questions that ask employees to rate a particular aspect of the work environment and open-ended questions that allow them to express opinions.

With carefully chosen questions that do not lead to particular answers, an employer can get the feel for the happiness, satisfaction, and engagement of employees. When a satisfaction survey is used at specific intervals, such as annually, an employer can track employee satisfaction over time to see if it is improving.

Management response
If a manager decides to use an employee satisfaction survey, the employer must commit to making changes in the work environment based on the employee responses to the survey. This is the bottom line for employers who are considering administering a survey to staff.

The manager who chooses to use a satisfaction survey with employees must be committed to reporting the results to employees. Additionally, the manager should be committed to making changes to the work environment, with the help and involvement of staff.

Communicating transparently about the changes, their impact, and future plans are all part of a positive satisfaction survey process. Without the transparent communication, results reporting, and employee updates, employees will not trust the employer’s motives in collecting survey data.

The involvement of employees in improving the work environment based on survey results creates an environment of shared responsibility for workplace culture and improvements.

The manager should avoid leading staff into believing that satisfaction at work is the sole responsibility of the manager. Employee satisfaction is a shared responsibility. So, is the response to an employee satisfaction survey.

Summary
The difficulty in recruiting and retaining staff in care homes and domiciliary care services will continue to challenge managers in the foreseeable future. We all know how difficult it is to compete on the wages front where supermarkets are paying higher wages than care staff for stacking shelves.

However, if managers are to have more chance of retaining staff they must invest in ways that keep staff happy and contented. Managers need to know what staff think about the service they work in. One method of finding out is the use of employee satisfaction surveys. The surveys will provide useful information which if acted upon the manager can lead to a satisfied staff team and a higher level of staff retention.

Here at Bettal we have recognised the importance of employee satisfaction surveys and included them in our Cared 4 Quality Management System.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Why care home providers need clear transparent resident’s contracts

Whether and for how long after the death of a service user, a care home should be entitled to charge fees, is a vexed and sensitive question which has troubled the sector for very many years.

The issue has come to a head again following families’ complaints to the Competition and Markets Authority that they have been charged fees for ‘extended periods’ after the death of a loved one.

Some care homes are charging families for weeks after the death of an elderly relative in some instances, prompting a string of complaints to the competition watchdog that is investigating the sector. Families are being charged for sums that can amount to thousands of pounds to cover for the time it can take before a room can be used again.

Caroline Abrahams, director at Age UK, said it was “wholly unfair” to charge for rooms after someone had died and their room became vacant. “This is a really difficult and distressing time for relatives and the last thing they need is to be worried about money in this way.”

Some care homes charge the relatives of a deceased resident for a week so there is time to clear their belongings, but the CMA was told in submissions that families were being charged fees for “extended periods” after their relative’s room had been cleared.

One submission from the wife of a resident said: “The emotion in moving a close relative from home to a care home is complex – guilt, feelings of failure, tragedy at the loss of the person you once knew and their transition into a person who can no longer understand anything or help themselves.

“People are very much at the mercy of availability, location and affordability. The demands on relatives are substantial. They have not got rid of their responsibilities, but developed other, different ones. “I firmly believe that this dishonesty in charging and it must be dealt with.

The view of providers
Care homes have defended their contracts and said local authorities were not paying enough toward the cost of care. Others said it necessary to charge families when a room was unoccupied.

Charles Taylor, who runs two care homes in Oxfordshire, tries to address the issue of charging for rooms after the resident has died.

He said: “We charge families for a one-week period post the death of a resident. Family members are suffering from a bereavement at this time and often take this week to remove personal items from an individuals’ room, and to say goodbye to the person in the place of their passing.

“The alternative is for the care home to fill the bed the day following the death and to pack up the individuals’ belongings to be collected, which does not allow the family the time to grieve properly.”

Care England, the trade body for care homes, said arrangements for paying for rooms after the death of a resident were stipulated in the contracts. Its chief executive, Martin Green, said: “This will of course depend on the contract, and like many other agreements, the payments do not stop the moment you die, rather there are contractual arrangements which the person’s estate is responsible for.”

What providers need to consider
There are several issues here that need to be considered by providers:

• The public relations damage caused by perceptions of unfairness
• Clear acceptable reasons where reasonable charges could be made
• The importance of clear transparent contracts.

There is little doubt that the general public will take a dim view of excessive charges for accommodation following the death of a resident. However, providers need to specify in the residents contracts the period of notice and reason for the notice period. It is not sufficient to say it will take a week to clear a resident’s bedroom for example. Nor is it acceptable to expect families to pay for preparation of a room for the next resident.

Managers should review resident’s contracts for all new residents to ensure that the notice period is stipulated and there is justification for the notice period. In addition, they should ensure that the contract including the notice period is clear and transparent and explained to families at the stage of admission and following the death of a resident.

Summary
The issue of excessive charges for bedrooms following the death of a resident will continue to run. The Competition and Markets Authority say they are very keen to hear from care home residents and their relatives who have experienced issues such as unexplained or ‘hidden’ charges, unexpected fee increases or occasions when they feel that complaints have not been handled fairly.

Providers will do well to get their house in order and ensure residents contracts state clearly the period of notice which can be defended as being reasonable, because of what they are required to do. A great deal of bad publicity could be avoided by clear transparent contracts that are explained to families at a most difficult and distressful time.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Recruiting and retaining staff in care homes and domiciliary care services

There are few social care providers who are not faced with the ever-increasing challenge of recruiting staff let alone keeping them.

Last month, a care home in Leeds was forced to close its nursing wing, not because of funding cuts or lack of demand, but because of staff shortages. Donisthorpe Hall’s chair of trustees, Robert Ross, released a statement at the time citing “the current climate of nursing shortages”, which meant they had been forced to rely on a “constant turnover of short-term” agency staff. Days later, Hawkesgarth Lodge care home in Whitby also had to shut as a result of the “national shortage of trained nursing and care staff”.

And last August, the social care regulator, the Care Quality Commission (CQC), found that a care home in Derbyshire was so short-staffed that residents had resorted to caring for each other. Local papers are littered with stories like these. The main cause of these shortages is the sheer number of unfilled vacancies, although sickness absence and failure to cover parental leave are also factors. Latest figures from the Office for National Statistics show that of the 751,000 externally advertised job vacancies in the UK for the three months to January 2017 across the whole economy, more than 15% – about 117,000 – were in the health and social work sectors.

On any one day, there are 90,000 vacancies for social care jobs in England, according to Skills for Care, And NHS Jobs has more than 15,000 vacancies on its website.

Last year’s report by Skills for Care on the state of the adult social care sector and workforce in England estimated that just under 340,000 social care employees leave their jobs each year. On average, in care homes there are about 2,800 unfilled manager jobs at any one time while, despite concerted recruitment drives, vacancy rates for social workers in the statutory sector have jumped from 7.3% in 2012 to 11% in 2016, and turnover rates continue to climb.

Sharon Allen, chief executive of Skills for Care, says: “Recruitment and retention is without a doubt the biggest issue for adult social care employers because to have sufficient levels of the right people with the right skills is absolutely fundamental to providing quality care and support. It is a big concern for everybody and we’re trying to help promote careers in social care, but there are many challenges.”
With 80% of all jobs in adult social care held by women, something is clearly making women want to leave the sector.

Last month’s report on the public-sector workforce by the Reform think tank is blunt about the impact of staffing problems. “Public services fail when employees fail,” it concludes. “This is the dramatic lesson from a number of high-profile errors in recent public service delivery. In many instances, quality is compromised, not because of individual incompetence, but the way the workforce is structured and organised.”

According to the Trades Union Congress, recruitment and retention issues have not only been exacerbated but caused by the cap on public sector pay rises. NHS staff and local government workers both have their pay rises capped at 1% a year, which is typically below the rate of inflation. The TUC calculates that some public sector employees, such as midwives, nurses and social workers, will see their real pay, which accounts for the impact of inflation, drop by more than £3,000 by 2020 if the government sticks with the 1% limit on salary increases. Adjusting for inflation (CPI, 2016 prices), a nurse, for example, would have earned £30,929 in 2010, but only £28,462 last year.

“We could talk about money until the cows come home, but it’s not all about that,” says Sue Evans, the president of the Public Service People Managers’ Association and head of HR at Warwickshire county council. “Here the government are not just taking away the funding – they don’t speak very highly about the public sector; they don’t value it. The reputation of the public sector as a whole has taken such a colossal knock, and then they wonder why we’re finding it hard to recruit people.”

What can be done to improve the situation?
We need to adopt several approaches that could form part of a strategy to improve recruitment and retention of staff in care homes and domiciliary care services. I would suggest:

• We need to promote the value of staff who are employed in the services.
• We need to recognize the importance of social care staff to peoples wellbeing and pay them accordingly.
• We need to attract young people to the profession by offering apprenticeships, working with careers services in schools.
• We need to provide innovative quality training with recognized qualifications.
• We need to develop a staffing structure with opportunities for promotion.

Summary
The penny has at last began to drop and a growing realization that all the problems faced by providers of social care services cannot be put down solely to the crises in social funding. There is growing concern among providers who face increasing difficulties in recruiting and retaining staff. The figures produced by the office for National Statistics and last year’s report by Skills for Care on the vacancy rates in adult social care make stark and alarming reading.

If we are to stem the tide we need a strategy that places greater emphasis on attracting young people to the work, and recognize the value of all those who provide a service to people and pay them accordingly.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy