Implications of labour markets for the social care workforce: report

1 Introduction

1.1 This report presents the findings of a research study to better understand the influences of labour markets on the social care workforce, for both adult social care and for early years and childcare, and to support planning at local and national levels.

A vital sector

1.2 The social service sector makes significant direct and indirect contributions to the Scottish economy, as a major employer, a driver for research and innovation and as a key purchaser of goods and services.^[24] It has an important part to play in enabling participation in the workforce by supporting the health and wellbeing of the population. It also enables parents and carers to take part in training, education and work. The adult social care sector contributes £3.4 billion to the Scottish economy.^[25] The sector covers a number of sub-sectors - including Early Learning and Childcare (ELC), adult day care, adult residential care, and care at home. There are a wide range of settings, roles and occupations within the sector overall. Social care sits within the broader social service sector, which also includes social work services (covering all local authority social work services)^[26].

1.3 According to the most recent Scottish Social Services Council (SSSC) workforce data report^[27] the social service workforce employs around 202,090 staff as of December 2017, an increase of 0.7% (headcount) overall since 2016. This is the highest level since the SSSC began publishing this data. The wider Scottish economy grew by 0.3% during this period.^[28] The past decade has seen significant changes in the numbers of workers within individual sub-sectors. For example, the number of care home for adult staff (headcount) decreased by 2.8% between 2008 and 2017. The numbers of care at home and housing support staff increased by 12.3% during the same period^[29], an increase which is least partly due to the drive to shift the balance of care out of hospitals and into homes or homely settings. The social service sector is a critical part of Scotland’s economy.

1.4 There are significant challenges for Scotland’s social service sector. The number of people living in Scotland of pension age and over and is projected to rise by 25.1% by 2041, while Scotland’s dependency ratio^[30] is expected to reach 43.07 by 2041^[31] (compared to 41.96 for the UK as a whole) and will place additional pressure on Scotland’s social care services and workforce. Demographic pressures – coupled with a driver to provide new models of care and to re-design services – will have a range of implications for the Health and Social Care workforce.

1.5 Within the last decade, there has been a considerable policy focus on health improvement, tackling inequalities in health and moving towards increased preventative and anticipatory care in Scotland. Significant changes have been made in the context and delivery of Health and Social Care. Integration of Health and Social Care is a principal strand of the Scottish Government’s public sector reform agenda and has a key focus on the role of the workforce.^[32],

A National Workforce Plan for Health and Social Care

1.6 The key challenges for the social care workforce are well documented. For example, in 2017 Audit Scotland made a number of recommendations for the Scottish Government and COSLA, which included addressing the challenges of recruitment and retention in the social care workforce^[33]. Working Collaboratively for a Better Scotland^[34] identifies Health and Social Care as having critical skills shortages. It also sets out a commitment to ensuring that Scotland has a demand-led skills system underpinned by evidence of employer need and using predictive analytics of future skills needs. In 2017 and 2018 the Scottish Government began publishing a series of national health and social workforce plans (NWP) for Health and Social Care. The plans are the beginning of a new process to improve planning across these sectors. Parts 1 and 3 focus on health and primary care respectively^{[35] [36]} .

1.7 In December 2017, the Scottish Government and COSLA jointly published the ‘National Health and Social Care Workforce Plan Part 2: a framework for improving workforce planning for social care in Scotland’^[37] which relates to the social care workforce. The second part of the NWP sets out a number of recommendations and actions to address key priorities which include recruitment, retention and improved opportunities for career progression. The second recommendation in part 2 is on the need to develop an improved understanding around national and local labour markets for social care. This is the background to our report.

1.8 There are a number of drivers impacting on the skills required to provide social care. One of the factors driving change is Scotland’s ageing population and lengthening life expectancy (although this has stalled recently) but with healthy life expectancy not increasing at the same rate. Two factors to consider are the integration of Health and Social Care and Self-Directed Support, which together provide the opportunity and expectation for reforming how social care for adults is delivered. The uncertainty created by the impact of Brexit is also likely to increase competition for staff from other sectors. Not only does the sector employ staff from the wider European Economic Area, it competes with other sectors such as food and drink, and tourism and hospitality that also employ substantial numbers of staff from out with the UK.^[38] Meanwhile rural areas in Scotland face particular challenges, such as a restricted number of service providers and geographic remoteness.

1.9 These factors all have significant implications for the social care workforce both for now and in the future; implications not only for workforce numbers but also for the roles, skill sets and career pathways across the Health and Social Care workforce. The future workforce must be well planned and evidence-based to ensure the delivery of high-quality, person centred care. There is significant data on the numbers of people using social care services, the profile of the sector’s workforce and the training they receive in their role. However, there is an ongoing need for substantial data around the recruitment and retention of these workers, and their movement within the sector and the wider economy. There is a particular lack of data around the movement of workers between social care and related sectors such as health and education. Drivers such as the integration of Health and Social Care are impacting on the way services are delivered and the way people work. An improvement understanding of workforce movements in the sector and between sectors is likely to be of value to workforce planners in considering future workforce needs.

Study aims and objectives

1.10 The objectives of the study were to provide insights into the way local and national labour markets impact on the social care workforce (including ELC staff), how different parts of the social care sector interact, and what these interactions mean for workforce planning locally and nationally.

1.11 The social care sector in Scotland covers a range of service providers and types of services. These sub-sectors and service types, are detailed in Appendix A, and are drawn from SSSC definitions. Our report is based on the survey responses from social care workers and employers across the third, independent and public sectors^[39]. This study does not include social work.

1.12 The study’s remit was also extended to incorporate the ELC sector. The Scottish Government and local authorities have committed to making a significant level of investment in ELC through the near doubling of the funded entitlement to 1,140 hours per year from August 2020 for all three and four year olds, and eligible two year olds.^[40] This expanded entitlement creates challenges for ELC providers, not least in recruiting and retaining an adequate workforce. Recognising this, the Scottish Government has set out the Delivery Support Plan^[41] for ELC providers, which will support workforce recruitment and training. Extending the remit to include ELC has meant that this study can explore the movement of workers across social care and ELC. The surveys asked similar questions for staff in social care and ELC.

1.13 The Social Care (Self-Directed Support) Act 2013 places a duty on local authority social work departments to offer people who are eligible for social care a range of choices over how they receive their support. Self-Directed Support includes the following four options: a direct cash payment; funding allocated to a provider of the individual’s choice; the council arranging services for the individual; or a mix of these options^[42]. For those who consider the first option, direct payment, they may decide to employ a Personal Assistant (PA). This offers flexibility in how and when the support is given. The roles and responsibilities of PAs include supporting an employer at work, education or in social activities, providing personal care and sometimes working as part of a team of PAs^[43]. Our report also draws on survey responses from PAs and employers of PAs, and aims to improve our understanding of any differences between PAs and other social care workers.

1.14 This is not the first piece of research into the social care workforce, or the first survey of the sector. There have been a number of studies, for example:

• The SSSC recently published a report which analysed registration data over a 12 month period, in order to understand the flow of workers into the social care sector, between different parts of the social care sector and the career progression within the sector. The report examines a range of similar themes to this study and will be updated annually^[44]
• The Fair Work Convention has highlighted the role of fair work in tackling recruitment and retention issues in social care^[45]
• Scottish Care’s Voices from the Front Line report^[46] which explores many of the factors that motivate and engage people in their work
• Reports by the Coalition of Care and Support Providers (CCPS) and the Voluntary Sector Human Resources Forum examine the impact of commissioning, contracting, and handing back contracts, including the impact of TUPE transfers^[47]
• The Institute for Research and Innovation in Social Services (IRISS)^[48] carried out a survey in 2015 to understand what motivates and challenges the social care workforce in their day-today job. The survey^[49] elicited almost 2,000 responses although 32% were from social workers and care staff were underrepresented.
• Studies of the ELC workforce are undertaken by a range of bodies including the Scottish Childminding Association and the National Day Nurseries Association.

1.15 In addition, these surveys and studies typically – but do not exclusively – focus on the views of part of the sector such as the membership of that body, and provide a range of specific insights into the sector. This report does not attempt to include a comprehensive review of their findings as our focus is primarily on a new survey of employers and employees in this sector. However, there are a limited number of references to these studies throughout our report.

Study methodology

1.16 The methodology comprised five main stages as illustrated in Figure 1.1. The primary research stage was undertaken in order to supplement the data and literature review, and add depth and detail to the evidence. This included a programme of consultations with key stakeholders, and an online survey of social care employers and the social care workforce (with the exception of social workers). The social care workforce sits within the wider ‘social service sector’, which itself contains two sub-groups: ‘care services’ which is all registered care services and ‘social work services’- that is, all local authority social work services. This study did not include social workers working with any employer. The social care workforce includes both adult services (i.e. adult day care, adult placement services, care homes, housing support/care at home for adults, nurse agencies, offender accommodation services, and fieldwork services) and children’s services (i.e. adoption services, fostering services, residential childcare and fieldwork services).

1.17 Daycare of Children (DCC) is a social care service which includes nursery classes, crèches, after school clubs and play groups. ELC is a sub-sector of DCC, and refers to those DCC services which are funded by Government to provide the free pre-school offer of 600 hours currently and soon to become 1140. Our surveys focused on adult and children’s social care and ELC (with the ELC findings presented in a separate report), and the need to develop a better understanding of the impact of the expansion of funded ELC on recruitment and retention across both sectors^[50]. It is worth noting that that many of the questions asked in the surveys are complementary, and it is possible to compare findings across both social care and ELC sectors. A separate survey was developed for PAs and the people who employ them.

1.18 The work was supported by a wide range of stakeholder organisations who helped to promote and disseminate the surveys. The research was also informed and supported by a Research Advisory Group (RAG), whose members reflected a wide range of interests and remits relating to social care and ELC across the public, independent and third sectors. The main roles undertaken by the RAG included an initial meeting to discuss the research scope and process; a meeting during the project to review progress and challenges and responding to research queries during the study.

1.19 A breakdown of the primary research undertaken is provided in Table 1.1, and shows that almost 10,000 social care employees and employers participated in the research. This is believed to be the largest or one of the largest surveys of its type in the social care and ELC sectors in Scotland to date. The survey typically examines the findings under three groups, namely adult social care, children’s social care and Early Learning and Childcare. It must be noted however, that survey respondents could choose more than one sub-sector in their response, and where this crosses more than one group (for example, children’s and adult social care) their response was necessarily counted in both. However, there were very few instances of this occurring^[51].

1.20 As Table 1.1 illustrates, there was an over-representation of ELC services (i.e. childminding and daycare of children) in the survey responses. To reflect this, a separate report solely focussing on the ELC sector has been produced, which complements and aligns with this report.

1.21 The profile of the survey sample and its alignment with the Scottish Social Care workforce is provided in Appendix B.

Table 1.1: Primary research

Stakeholder Group	Approach	Number of Responses
Social care employers[52]	Online survey	1,553 responses[53] comprising: Children’s services: 106 Adult’s services: 626 ELC: 764
Social care employees	Online survey	8,055 responses[54][55] comprising: Children’s services: 509 Adult’s services: 2,917 ELC: 3,585
PA employers	Online survey	20 responses
PAs	Online survey	76 responses[56]
Key stakeholders	Telephone consultations	23 consultations

Report structure

1.22 The remainder of the report is structured as follows:

• Chapter 2 presents a brief discussion of the social care policy environment and key drivers;
• Chapter 3 provides an overview of Scotland’s social care workforce, drawing largely on published data from official sources;
• Chapter 4 discusses the perceptions related to working in the social care sector, particularly in relation to the factors that attract people to the sector, and the factors that make them stay or leave;
• Chapter 5 discusses recruitment and retention issues;
• Chapter 6 looks at the extent that the social care workforce moves between parts of the social care sector and between this sector and other sectors; and
• Chapter 7 presents our overall conclusions and recommendations.

1.23 The following information is appended:

• Appendix A – SSSC Definition of Social Service Sectors in Scotland
• Appendix B – Alignment of survey sample with the Social Care Workforce
• Appendix C – Comparison of Social Care Workforce and Scottish Workforce
• Appendix D – Clarification of Wage Rates

Accompanying Reports

1.24 Three additional products accompany this main report.

• ELC Workforce Report

Given the particular issues facing ELC as a result of expansion, our companion report draws out the key messages for the sub-sector. That report is designed to complement this report and there is some read-across in relation to data on the movement of workers between social care and ELC.

• Report on the Implications for Workforce Planning

Drawing on all research sources (brief literature review, workforce data, the survey and the qualitative consultations) our report contains an initial appraisal of existing datasets for the sector; considers data gaps and limitations; and makes recommendations for future workforce planning in particular how best to respond to recruitment and retention challenges.

• Case Study Report

Part 2 of the National Health and Social Care Workforce Plan acknowledges some of the distinct challenges for workforce planning in the social care sector. These include the complexity of service provision and commissioning, the ramifications of the dominant market dynamic, and the distinct challenges within rural and urban areas^[57]. For instance, a key challenge for the delivery of social care in urban areas in Scotland is the competition for labour by other industry sectors, particularly when the area is experiencing high employment levels.

This case study report explores key local labour market characteristics and issues around recruiting into the social care sector in four different areas as illustrated in Table 1.2.

Table 1.2: Case study areas

Local authority	Features
Aberdeen	Urban area with high employment
Dumfries & Galloway	Remote rural area: ageing population and challenges in retaining and attracting young people
Argyll & Bute	Rural mixed economy with a high level of seasonal employment e.g. in the tourism sector
South Lanarkshire	Mixed urban and rural with a wide travel to work area

1.25 Each of the areas were discussed and agreed at an early stage with the RAG, however it should be noted that these are not necessarily representative of the wider social care sector, but aim to illustrate or reinforce some of the challenges faced.

1.26 The study methods have generated a substantial data set. Our report draws out the main findings from the survey and the qualitative consultations.