Social care employs more people than the NHS. Our ageing population and headwinds impacting staffing, mean we are at the start of a workforce crisis that is only getting worse. One day we will all need social care, it’s almost a guaranteed certainty, if we don’t think differently then it may not be there for us when we need it.
A challenge of this scale needs both national level engagement and a willingness to change outdated processes and thinking at the coal face. However, at a political level, social care will always be the poor cousin of the NHS. The simple fact is the NHS wins votes and social care doesn’t. The electorate turns a blind eye to elderly care, dementia and people with learning disabilities for example. Possibly, because we try not to think about it too much as we don’t want to imagine it impacting us. The NHS on the other hand is different, it’s there when we give birth to our children, when we see a GP and where we go when our child falls off their bike and breaks an arm. The NHS is special and long may it remain so.
With this in mind, the reality is, pound for pound social care can never compete with the NHS head on so it needs to rethink and do things differently. Over the past few Parliaments the narrative has been about a lack of funding but more recently it has turned to workforce. Workforce is and will be for the foreseeable future, the biggest challenge.
In the UK, social care is largely State funded but delivered privately. There are pros and cons to this but let’s assume social care is not going to be nationalised anytime soon. The private model is by nature fragmented and this brings challenges for the workforce. There is very little consistency across social care operators which adds complexity and challenges.
Take training for example, a key component of delivering high quality care. The NHS spends £1000s per minute on training and even so doesn’t always get it right. This approach is not taken in social care given the fragmented nature and a lack of willingness to standardise across providers. To date, social care providers are so terrified about losing staff they are reluctant to do anything that they perceive would increase the chances of staff moving between providers. This way of thinking is understandable but is now outdated, if social care is to be sustainable then providers need to change.
There are a few key steps that can be taken:
1. Provide flexibility — Social care can’t compete with the NHS on many fronts so it has to lead with flexibility. If it did one thing only this would make a huge difference.
Social care needs its facilities and services covered with the right staff, it has a regulatory obligation to do so. However, social care to date still largely operates traditional fixed rotas and in many cases on paper sheets. It’s employees are contracted for 36 hours a week and they do 3 x 12 hour shifts a week. Often the rota is done by the manager in isolation and then workers see on the wall that one week they are on days then nights and some weekends. This has not changed for 50 years. This rigidity is not suitable for many modern day healthcare professionals, especially those with two working family members. They are likely to have kids or have to care for parents. They need the flexibility to pick and choose and perhaps break the 12 hour fixed shift pattern.
The providers that embrace this will win. Those that remained fixed in their ways will not. Technology has to be used to achieve this.
2. Stop demonising agency staff — there is a stigma associated with agency staff in some cases this is justified but in many it’s not. The reality is given the dynamic staffing needs across social care there is always going to be a need for flexible staffing. Providers first of all need to start comparing like for like costs. There is a tendency to say “I pay my staff £18 per hour, how come an agency charges me £30 per hour.” If you look at this objectively, what a provider chooses to ignore is that on top of the £18 you need to cover them when they are on holiday and sick, you need to recruit, onboard, train and re-validate them, you need to provide them uniform, pension, insurance, pay employers NI, fund a central L&D function, HR function, Recruitment function etc….. The true cost of an employee you will see is not £18ph.
If you can reconcile the cost point then you should try to build a relationship with a core group of flexible staff. These can be from or an agency or if you use the right software tools you can build a bank of workers in such a way that they get the benefits of being an agency worker but also of being a staff member of yours. The changes to IR35 actually make this more of an attractive proposition to workers who want to work flexibly but can no longer use their Ltd Company. Make sure they understand your policies, procedures, processes and the residents. For an average nursing home of 40 or so beds, you only need a small bank of flexible workers to provide a great service if used in conjunction with your core staff.
3. Standardisation of roles — there are a lot fewer specialisms in social care vs the NHS. While a nurse is fungible, in theory, other worker types are not so. The industry needs to mobilize around the role of a senior carer / nurse associate and create a consistent framework and central register. This sounds complex and bureaucratic but can be solved by technology in an efficient way. Not only will this create a more engaged type of worker, it will save providers costs as they will not need to use nurses for lower level tasks. Nurses, who will continue to be in short supply can focus more on the clinical skills they are trained for. The added benefit will be nurse retention.
4. Professionalise Care staff — Healthcare assistants make up the backbone of the social system yet today in England they are entirely unregulated with little consistency around training or expectations. Professionalising this worker type has been ignored as being too hard and too expensive by central Government. So the care sector should do it themselves. Create a register and agree a basic framework. It may not be perfect but it will improve matters dramatically.
5. Review central functions and processes — the market is supply short, healthcare workers are and will remain in high demand for the foreseeable future. The nature of being in demand means there will be an inevitable degree of turnover that the industry just needs to accept. Given these factors the current expensive and highly manual approaches to recruitment, onboarding and training need to be reviewed. There is an opportunity to centralise, form partnerships and use technology to drive efficiencies to all providers. Take training, how many training sessions have a spare place or two in them? Imagine if they never had vacancies and the impact on the bottom line.
In summary, social care is a fundamental part of our society and for many is a highly rewarding profession. Its workforce is facing unprecedented challenges and has to think differently and embrace new methods and approaches. Counter to what providers believe, those that offer the most flexible and dynamic approach to their workforce and form meaningful partnerships are the ones that will win and have the most engaged and effective workforce. You will find that although they are qualified to leave they will actually decide to stay.
I am personally optimistic about our ability to solve these challenges and would welcome any conversation with anyone who also is.
dan@florence.co.uk
