A strategy for improving recruitment and retention of staff in social care services


The difficulties faced by providers in attempting to recruit staff for social care services continues to present significant challenges. Low wages, conditions of service and lack of career opportunities are often cited as major reasons why it has become increasingly more difficult to attract people to work in social care.

In December last year, Health Education England published Facing the Facts, Shaping the Future: A Health and Care Workforce Strategy for England to 2027.

  • The adult social care workforce is larger than the NHS workforce but has lower average pay, fewer qualifications and more part time staff.
  • Turnover is high and there are 88,000 vacancies.
  • Required growth of between 14% and 31% is forecast by 2030.
  • 18% of the workforce is from overseas with regional variation.
  • 20,300 independent organisations provide care in England.
  • The government is consulting on changing aspects of the system.

The report highlights that the majority of the care workforce is likely to earn at or near the National Minimum Wage. The workforce is 82% female with an average age of 43 and nearly half work part time including 54% of care workers. Zero-hour contracts cover 24% of all staff and 33% of care workers. Turnover is high at over 25% with around 347,000 staff leaving roles during 2016/17, 33% of those leaving the sector altogether.

The sector faces recruitment and retention challenges at all levels, in both regulated and unregulated professions. Vacancy rates are higher than the general economy at 6.6% compared to 2.5%, with approximately 88,000 vacancies. Workforce diversity, as with the NHS, means a combination of interventions are needed to support an adult social care workforce for the future. The government has recognised pressures on the social care system with an additional £2bn, however a number of factors such as pay, large numbers of small employers, contract status and retention and recruitment make workforce issues challenging for the sector.

Increasing demand for adult social care

Demand is growing as people live longer with more comorbidities leading to more complex health and care needs. According to “Horizon 2035: health and care workforce futures”, by 2025 unconstrained demand for lower skilled direct care staff is likely to increase by 12%, (around 120,000 more jobs), and an overall workforce demand increase of 14% (190,000 jobs). Skills for Care suggest that need might be as much as a 31% increase or 500,000 jobs by 2030. Factoring in vacancies approaching 90,000 and the challenge of the current staffing model to meet these demand projections is clear. It also has implications for the wider economy, with labour used to meet this increase not being available to other sectors. There are interventions that can alleviate some of this increasing demand whilst meeting peoples’ desire to remain independent and well at home for longer. These include social care staff supporting prevention and public health interventions; better join up between health and care; more support for carers; and new technology.

Maximising recruitment

There are two focus areas for ASC recruitment. The first is training and skills development. Roles tend to have low entry requirements with around half the workforce having no formal social care qualifications. This is especially true of the vast majority of staff providing direct care and support. The regulated professions tend to perform more supervisory roles. There are no standard training requirements across large parts of the sector with too many staff not receiving training or professional development, despite providing direct care for vulnerable adults whose dignity and quality of life is dependent on the quality of their work. The Care Certificate, developed by HEE, Skills for Care and Skills for Health, provides a standard induction framework across social care and health. There is no mandated skills training or development across employers.

The second recruitment challenge is overseas staff. UK nationals make up 83% of the ASC workforce; 7% (around 90,000), are non-UK EEA nationals and 11% (about 140,000) are from the rest of the world. Direct care staff form the biggest group of EEA staff with about 67,000 workers

The majority of roles have low entry requirements and limited career structures. The 20,300 employers separately determine job titles and structures, which makes demonstrating career pathways challenging meaning staff often seek career progression by leaving the sector. Increases in the National Living Wage have driven up pay for those on the lowest wages but also narrowed pay differentials thereby reducing the attractiveness of seeking promotion or progression in some cases.

Summary

The Health and Care Workforce Strategy for England to 2027 has involved consultations with those who have a vested interest across the care industry and was due to be completed last month. Any new strategy will need to take into account that if we are to recruit and retain more staff, we cannot continue to have over 20000 care providers determining staff job titles and career structures. We need a national set of employment conditions that give staff encouragement to seek career progression with available training, that is recognised and financially rewarded.

If staff can be supported to gain satisfaction in their work through training that leads to improvement of skills, career opportunities and financial rewards, then we have the basis for a thriving, consistent and high-quality workforce. We may then begin to see an improvement in recruitment and retention of staff in the social care industry.

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

 

Support for providers to comply with the General Data Protection Regulation


Given the amount of information available to increase awareness, most providers will now be aware that GDPR comes into force on the 25th May 2018. That being said, if readers carry out a trawl of the internet, they will find that apart from the Bettal GDPR Compliance Tool there is no other company advertising support with compliance designed and tailored specifically for social care services.

The purpose of this article is to give readers an overview of the requirements of the General Data Protection Regulation and how the Bettal GDPR Compliance Tool can support providers to achieve compliance.

Essentially, the responsibilities of managers are contained in the GDPR Principles.

GDPR Principles

Article 5 of the GDPR requires that personal data shall be:

(a) processed lawfully, fairly and in a transparent manner in relation to individuals;

(b) collected for specified, explicit and legitimate purposes and not further processed in a manner that is incompatible with those purposes; further processing for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes shall not be considered to be incompatible with the initial purposes;

(c) adequate, relevant and limited to what is necessary in relation to the purposes for which they are processed;

(d) accurate and, where necessary, kept up to date; every reasonable step must be taken to ensure that personal data that are inaccurate, having regard to the purposes for which they are processed, are erased or rectified without delay;

(e) kept in a form which permits identification of data subjects for no longer than is necessary for the purposes for which the personal data are processed; personal data may be stored for longer periods insofar as the personal data will be processed solely for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes subject to implementation of the appropriate technical and organisational measures required by the GDPR in order to safeguard the rights and freedoms of individuals; and

(f) processed in a manner that ensures appropriate security of the personal data, including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measures.”

Article 5(2) requires that:

“the controller shall be responsible for, and be able to demonstrate, compliance with the principles.”

Care Services will need to register with the Information Commissioners Office(ICO).

As can be seen the data controller will need to have systems and documentation in place to address the principles and requirement of GDPR.

Data Controllers will need to demonstrate that:

  • they have a legal right to hold information on service users;
  • they are aware of the kinds of information they hold on services user’s staff and volunteers;
  • the information they hold is accurate and up to date;
  • personal data collected is adequate relevant and limited to the purpose for which it is being processed;
  • people are aware of their rights to access information that is being held about them;
  • appropriate security measures are used with the processing and storage of people’s personal data.

Bettal GDPR Compliance Tool

The Bettal GDPR Compliance Tool designed specifically for social care services has taken months to develop. The Tool draws heavily on the GDPR Principles, compliance guidance produced by the Information Commissioners Office and their own Self-assessment (ICO).

The Tool is designed to:

  • Enable managers to understand their obligations to the GDPR.
  • Provide you with the documentation you require and guidance to meet the GDPR.
  • Audit and check your compliance to GDPR.

The Tool includes:

  • An Implementation Plan.
  • Data Processing Audit Register (Form).
  • Example Privacy Impact Assessment (Form).
  • Example Privacy Impact Assessment (Form).
  • Obtaining Consent (Policy).
  • Information Governance (Policy).
  • Data Breech (Policy).
  • Security of Personal Data (Policy).
  • GDPR Staff Training (Policy).
  • Duties of senior Person Responsible for Compliance to GDPR (Guidance).

Overall the contents of the Bettal GDPR Compliance Tool includes over 30 documents.

Please click here for further information on the Bettal GDPR Compliance Tool where you can download free samples and purchase the full package.

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

Managing Malnutrition in care homes


At a time when some care homes are being criticised for having service users who have suffered from malnutrition, it is pleasing to hear of a new innovation to prevent the problem.

A care home in Shrewsbury has won an award for the innovative and fun ways it encourages residents to eat well. Briarfields in Raby Crescent, a residential home for older people run by Coverage Care, scooped the 2018 Think Food award from the NHS Shropshire Clinical Commissioning Group.

Think Food is a practical pathway to signpost care homes in the treatment of malnutrition with everyday food and drinks.

Older people can suffer from malnutrition for a variety of reasons from ill-fitting dentures, a poor swallow, having difficulty feeding, a medical condition, or their mental state.

Briarfields has introduced a number of initiatives to ensure that residents who are identified to be at risk of under eating can up their calorie intake in a healthy way.

Home manager Denise Morris said: “The Think Food pathway has become a key pillar of our care and all our staff are aware of how it fits in with our day to day operation.

“We always have fruit and cake available and residents can also visit our ‘shop’ to buy a range of snacks. We have a hydration trolley in the summer offering smoothies and fruit, which is a novelty for residents and encourages them to take on extra fluid. We also do special activities like film afternoons where they can have ice cream and popcorn.

“For those people that have specific dietary needs we create individual plans to ensure they are eating enough. For instance, we have one resident with dementia who was burning off a lot of calories, as she was very active walking around the building. She liked to stop in reception so we placed a special jar of treats for her there which helped her to take on the extra food she needed.”

Coverage Care Chief Executive David Coull praised the Briarfields team for its win.

He said: “Denise and her team are to be applauded for the proactive and innovative way they are tackling potential dietary issues among residents. Eating well is crucial if older people are to stay as fit and as healthy as possible and everyone at Briarfields is working hard to make that happen.”

The home was presented with a food hamper for residents and staff for the way it has adopted the Think Food approach.

Managing malnutrition

While malnutrition can refer to either over or undernutrition we are referring here specifically to undernutrition; a deficiency of energy, protein and other nutrients that causes adverse effects on the body (shape, size and composition), the way it functions and clinical outcomes. Most malnutrition is disease-related, although some social and mechanical (e.g. dentition) factors can also have an impact.

Malnutrition can be identified using a validated screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’) – see www.bapen.org.uk.Healthcare professionals using screening tools should have appropriate skills and training.

In most cases malnutrition is a treatable condition that can be managed using first line dietary advice to optimise food.

Managers can obtain The Malnutrition Pathway that is a practical guide to support healthcare professionals in the community to identify and manage individuals at risk of malnutrition and particularly disease-related malnutrition, including the appropriate use of oral nutritional supplements (ONS)

 Summary

I guess we would all subscribe to the notion that you are what you eat. But just as food is essential for health strength and well-being, eating should also be a sociable and enjoyable occasion.

Briarfields Care Home in Shrewsbury has shown a novel but practical way of engaging service users in the importance of food by following the Think Food Pathway as a means of preventing malnutrition.

In most cases malnutrition is a treatable condition that can be managed using first line dietary advice to optimise food. Managing malnutrition should be at the heart of a service users care plan where there is identified risk of malnutrition. The Malnutrition Pathway will provide care home managers and their staff with a practical guide on the management of malnutrition.

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

MPs concern about the standard of quality in care homes

A recent poll commissioned by Independent Age survey found that more than half (51%) of Tory MPs and four in five Labour MPs (83%) were concerned that the quality of care homes would deteriorate over the next year without Government action.

Janet Morrison, Chief Executive of Independent Age, the older people’s charity, said: “MPs in England are strikingly pessimistic about the quality of care homes in their constituencies.

Older people who need residential or nursing care need to be given a meaningful choice when it comes to their care, so it is worrying that so many MPs expect the quality of care homes in their area to get worse next year if nothing is done.

“This is a stark reminder of the challenge facing Jeremy Hunt in his new expanded role as Secretary of State for Health and Social Care. The quality and cost of all types of care must be addressed in the forthcoming social care Green Paper for both the long and short term. With so many MPs seemingly having lost faith in their local care homes market, it’s time to get on with finding a solution.”

Prime Minister Theresa May is facing increasing pressure from Tory MPs to address the growing health and social care crisis.

Sarah Wollaston, who heads the Commons Health Committee, said: “We need a clear understanding from PM that NHS, public health and social care are inextricably linked and urgency of the need to review current and long-term funding as a single system.”

More than four in five (82%) Conservatives and nine in 10 (92%) Labour MPs said older people should be given the choice of at least one Good or Outstanding CQC rated home.

More than one third (37%) of Tories and over two-thirds (68%) of Labour MPs do not believe the care home market is functioning well in their constituency.

Two-thirds (66%) of MPs believe that elderly people should be offered legal protection from being only offered homes that are ‘Requires Improvement or Inadequate’.

Independent Age’s research found councils are not routinely taking into account CQC ratings when arranging care home visits.

A Which? survey published last week revealed that one in four English care homes are rated Requires Improvement or Inadequate.

Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “This telling survey is further evidence that the social care crisis is rising up the worry list of MPs of all parties and cannot be ignored. It follows the recent publication of the Competition and Markets Authority report on the care home market, which further underlined the significant funding shortfall facing the sector.

“MPs are rightly concerned that the quality and choice of care homes will get worse unless immediate action is taken to tackle social care underfunding.”

Independent Age is calling for the social care Green Paper to set out clear solutions for a fairer, more transparent and sustainable care system that will instill confidence in MPs across all parties, as well as older people and their families, to show that the government has fully comprehended and taken on board all the issues surrounding social care.

About the survey

ComRes interviewed 119 MPs with constituencies in England online and by paper self- completion questionnaire between 14 th  November and 11 th  December 2017. Data was weighted to be representative of the House of Commons by party and region. ComRes is a member of the British Polling Council and abides by its rules.

Summary

This survey is one of many that highlights concern about the standard of quality in care homes. The views of the MPs who took part in the survey should be taken seriously, in the hope that they will bring pressure to bear on the government about the needs of social care with the forthcoming Green Paper.

The notion at long last of an inextricably linked NHS, public health and social care service appears to be gaining momentum. This can only be good for those who require services along with those who provide them.

The survey also raised concern about the choice available for those requiring a care home placement. MPs are concerned that some local authorities are only offering placements in care homes rated ‘Requires Improvement or Inadequate’ the MPs believe people should be offered legal protection when only offered homes with this rating.

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

Is staff burnout in care homes leading to neglect?


A study, published in PLOS ONE, following a survey carried out by University of London Psychiatrists of responses from care home staff who had witnessed positive or negative behaviours in their daily work. Care home staff were asked anonymously about positive and negative behaviours they had done or had witnessed colleagues doing.

Dr Claudia Cooper (UCL Psychiatry), the study’s lead author, said: “We found low rates of verbal and physical abuse; the abusive behaviours reported were largely matters of neglect.

“These behaviours were most common in care homes that also had high rates of staff burnout, which suggests it’s a consequence of staff who are under pressure and unable to provide the level of care they would like to offer.”

From 92 care homes across England, 1,544 care home staff responded to the survey. The staff were asked whether they had, in the past three months, witnessed a range of positive and negative behaviours. Their responses were linked to data from each care home describing a measure of burnout in care home staff.

Some negative behaviours were categorised as ‘abusive’, using a standard definition, and based on the behaviour reported, rather than the intention of the care home staff. The most common abusive behaviours were:

  • making a service user wait for care (26% of staff reported that happening);
  • avoiding a service user with challenging behaviour (25%);
  • giving service users insufficient time for food (19%);
  • and taking insufficient care when moving service users (11%).

Verbal abuse was reported by 5% of respondents, and physical abuse by 1.1%. At least some abuse was identified in 91 of the 92 care homes.

Positive behaviours were reported to be much more common than abusive behaviours, however some positive but time-consuming behaviours were notably infrequent. For instance, more than one in three care home staff were rarely aware of a service user being taken outside of the home for their enjoyment, and 15% said activities were almost never planned around a service user’s interests.

“Most care homes, and their staff, strive to provide person-centred care, meaning that care is designed around a person’s needs, which requires getting to know the service user and their desires and values. But due to resources and organisational realities, care can often become more task-focused, despite intentions and aspirations to deliver person-centred care,” said co-author Dr Penny Rapaport (UCL Psychiatry).

“Carers can’t just be told that care should be person-centred – they need to be given the support and training that will enable them to deliver it,” she said.

The study is part of the UCL MARQUE cohort study, which is also looking into cost-effective interventions to improve the quality of care for people with dementia, and will be using this anonymous reporting as a measure of how well training interventions are working.

More than two thirds of care homes service user’s suffer from dementia. Agitated behaviours such as pacing, shouting or lashing out are more common in dementia, and can make provision of person-centred care very challenging for care staff to deliver, often with minimal training and limited resources.

“With the right training, care home staff may be able to deliver more effective care that doesn’t need to be more expensive or time-consuming. If they understand and know how to respond to behaviour, they may be able to do more without greater resources,” said the study’s senior author, Professor Gill Livingston (UCL Psychiatry).

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, commented: “70% of people living in care homes have dementia, and it’s clear from these findings that they’re bearing the brunt of a chronically underfunded social care system.

“It’s upsetting but unsurprising that abusive behaviours were more common in homes with higher staff burnout. We’ve heard through our helpline of people with dementia not being fed, or not getting the drugs, they need, because a carer isn’t properly trained, or a care home is too short-staffed.

“By 2021, a million people in the UK will have dementia. The government must act now, with meaningful investment and reform, or we risk the system collapsing completely and people with dementia continuing to suffer needlessly.”

Summary

The study carried out by UCL provides evidence of the pressures that care staff who provide a service for people with dementia are under. Some of the negative responses from care home staff relate to time consuming tasks, which may suggest they have insufficient time to carry them out. However, whatever the reason this is still tantamount to neglect.

The notion of person centered care comes under threat in these situations through lack of funding and availability of resources. and it is disturbing to learn that some service users never leave the care home.

If we are to avoid staff burnout, and ensure service users quality of life, managers must provide staff training in person centered care planning and supervision, that ensures staff know what is expected of them and receive the necessary support to carry out their role.

The study was conducted by researchers at UCL and the Camden and Islington NHS Foundation Trust, and funded by the Economic and Social Research Council and the National Institute for Health Research.

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