National Care Service: consultation analysis

9. Valuing people who work in social care

Chapter overview

This section of the report considers the responses to proposals for a 'Fair Work Accreditation Scheme', the development of an integrated workforce planning system and the establishment of a national organisation for training and development within social care. The role of personal assistants and the support available to them are also addressed.

There was strong support for the concept of the Fair Work Accreditation Scheme amongst individuals and organisations alike (279 of 334 (83%) individuals and 144 of 177 organisations (81%) were in favour). There was a view that such a scheme would help underscore the value and importance of people who work in social care.

Improved pay and conditions for people working in the care sector were also supported, with, of the 507 respondents to this question, 83% ranking improved pay and 79% ranking improved terms and conditions (improvements to sick pay, annual leave, maternity/paternity pay, pensions, and development/ learning time) as factors that would make social care workers feel more valued in their role. Respondents highlighted however issues such as the need for parity of pay and terms and conditions across all sectors, including the private and third sectors, and between the NCS and NHS, and the need for more investment in the workforce as a whole.

The majority of respondents (411 out of 473 respondents (87%)) were in agreement that a national forum should be established to advise the NCS on workforce priorities, terms and conditions and collective bargaining which would include workforce representation, employers and Community Health and Social Care Boards. It was suggested that a national forum is an opportunity to give employees 'a voice' and would make the sector more attractive to recruits and increase engagement of staff.

The majority of respondents agreed that the NCS should set training and development requirements for the social care workforce.

There was also support for a national approach to workforce planning (341 out of the 453 (75%) who responded to this question).

The majority of respondents agreed that all Personal Assistants should be required to register centrally in the future (399 out of the 461 (87%) who responded to this question).

Introduction

This section of the report considers the responses to proposals for a 'Fair Work Accreditation Scheme', the development of an integrated workforce planning system and the establishment of a national organisation for training and development within social care. In addition to this, views were also gathered on whether personal assistants should be given the same provisions. The section covers: fair work; workforce planning; training and development; and personal assistants.

Fair Work

Q87a. Do you think a 'Fair Work Accreditation Scheme" would encourage providers to improve social care workforce terms and conditions?

	Individuals	Organisations
Yes	279 (83%)	144 (81%)
No	55 (17%)	33 (19%)
Total	334 (100%)	177 (100%)

There were 512 responses to the question about a 'Fair Work Accreditation Scheme'. The majority of both individuals (279 out of 334 respondents (84%)) and organisations (144 out of 177 respondents (81%)) agreed that the scheme would encourage providers to improve social care workforce terms and conditions.

There were no real differences by subgroup, with the exception of frontline care workers, with 92% in agreement. There were 300 free text responses to this question. Common themes here referenced:

• The need for equal provision across all settings
• The need to put the Scheme on a statutory footing
• The potential use of the Scheme as a key procurement criteria
• It would support staff in feeling valued
• Remuneration and Terms and Conditions could be inspected as part of the scheme

The minority who disagreed with the proposed Fair Work Accreditation Scheme, raised concerns about: the need to make the Scheme mandatory; levels of compliance in the private sector; existing challenges in recruiting and retaining staff at present and the ability or inability of employers to improve terms and conditions financially.

Some comments addressed the inequalities across sectors and the need for greater investment, while others emphasised the importance of local autonomy:

"The proposals potentially have significant implications for our workforce… Dumfries and Galloway Council has operated a successful programme of "growing our own'' social workers for the past several years. We are concerned that the NCS proposals would disincentivise this programme, as the local authority would no longer be in control of workforce issues''. (Dumfries and Galloway Council)

"I don't think you should have to implement another costly scheme for care providers to treat their staff fairly and pay them fairly." (Individual respondent)

There was widespread agreement that the third sector should be given equal status in these proposals and that their circumstances needed to be taken into account in relation to the Scheme:

"The consultation paper proposes an opt-in scheme for providers. It is unclear how an opt-in scheme would work in practice and it could create difficulties for independent and third sector providers." (Organisation respondent)

The Scottish Trade Union Congress stated that embedding the Fair Work principles of Security and Effective Voice in a National Care Service would require, in addition to improved pay:

• Collective bargaining, starting with trade union recognition, to ensure workers are represented effectively
• Improved employment contracts and terms and conditions to provide enhanced sick pay, paid rest breaks and address gender pay inequality
• An end to zero hours and precarious contracts to provide wage and job security
• Development of a national workforce plan to provide enhanced training and career progression opportunities

Q88. What do you think would make social care workers feel more valued in their role? (Please rank as many as you want of the following in order of importance)

Respondent Type	Individuals		Organisations		Total
	Rank 1	Rank 1-3	Rank 1	Rank 1-3	Rank 1	Rank 1-3
Improved pay	221 (63%)	296 (84%)	92 (63%)	121 (82%)	313 (63%)	417 (83%)
Improved terms and conditions (improvements to sick pay, annual leave, maternity/paternity pay, pensions, and development/learning time)	64 (18%)	285 (81%)	20 (14%)	113 (76%)	84 (17%)	398 (79%)
Removal of zero hour contracts where these are not desired	31 (9%)	171 (48%)	8 (6%)	51 (35%)	40 (8%)	223 (44%)
More publicity/visibility about the value social care workers add to society	14 (4%)	69 (20%)	6 (4%)	37 (25%)	20 (4%)	106 (21%)
Effective voice/ collective bargaining	4 (1%)	26 (7%)	1 (1%)	9 (6%)	5 (1%)	35 (7%)
Better access to training and development opportunities	1 (0%)	54 (15%)	2 (1%)	27 (18%)	3 (1%)	81 (16%)
Increased awareness of, and opportunity to, complete formal accreditation and qualifications	0 (0%)	18 (5%)	0 (0%)	8 (5%)	0 (0%)	26 (5%)
Clearer information on options for career progression	0 (0%)	11 (3%)	0 (0%)	3 (2%)	0 (0%)	14 (3%)
Consistent job roles and expectations	4 (1%)	28 (8%)	1 (1%)	10 (7%)	5 (1%)	39 (8%)
Progression linked to training and development	0 (0%)	16 (5%)	0 (0%)	9 (6%)	0 (0%)	26 (5%)
Better access to information about matters that affect the workforce or people who access support	0 (0%)	7 (2%)	0 (0%)	3 (2%)	0 (0%)	10 (2%)
Minimum entry level qualifications	4 (1%)	20 (6%)	2 (1%)	3 (2%)	6 (1%)	23 (5%)
Registration of the personal assistant workforce	1 (0%)	14 (4%)	0 (0%)	3 (2%)	1 (0%)	17 (3%)
Other	6 (2%)	11 (3%)	14 (10%)	18 (12%)	20 (4%)	29 (6%)

When asked what would make social care workers feel more valued in their role, improved pay was ranked first, out of a total of thirteen statements, for 313 out of 497 respondents (63%) and ranked in the top three by 417 out of 503 respondents (83%). Improved terms and conditions followed with 84 out of 497 respondents (17%) ranking first and 398 out of 503 respondents (79%) ranking in the top three.

There were 187 responses to the "other" option at Q88. Common suggestions and comments here included:

• Less paperwork and scrutiny
• Uniforms supplied to care staff
• Being valued by senior staff
• Training, including protected time for training and health and safety training
• Identifiable career pathways
• The balance between professionalising the workforce and retaining those who may have strong empathetic and interpersonal skills but may find it difficult to undertake formal qualifications
• The need for a media or public relations campaign to promote the sector

Several respondents highlighted the differences in pay and conditions across different sectors:

"The TSI Network proposes that priority should be given to leveling up pay, terms and conditions between health and social care and between the third and statutory sectors. This should include the importance of ensuring funding for third sector services allows for incremental wage increases that are the norm across the statutory sector." (TSI Scotland Network)

"Pay and conditions differences between NHS and local authority staff remain unresolved. This consultation does not appear to be proposing any plans to address this. There is a risk that the significant investment proposed will, ultimately, not result in the increased workforce capacity needed to meet increasing demand… The terms and conditions for the NCS workforce should mirror the NHS workforce brand and status. There should be no risks to staff pensions, terms or conditions for any staff transferring from one organisation to another." (Health and Social Care Scotland Chief Officers Group)

Q89. How could additional responsibility at senior/managerial levels be better recognised? (Please rank the following in order of importance)

Respondent Type	Individuals		Organisations		Total
	Rank 1	Rank 1-3	Rank 1	Rank 1-3	Rank 1	Rank 1-3
Improved pay	147 (48%)	235 (74%)	68 (50%)	93 (68%)	215 (49%)	328 (72%)
Improving access to training and development opportunities to support people in this role (for example, time to complete these)	50 (16%)	235 (74%)	18 (13%)	88 (65%)	68 (15%)	323 (71%)
Improved terms and conditions	58 (19%)	239 (75%)	22 (16%)	92 (68%)	81 (18%)	332 (73%)
Increasing awareness of, and opportunity to complete formal accreditation and qualifications to support people in this role	35 (11%)	155 (49%)	6 (4%)	53 (39%)	41 (9%)	208 (46%)
Other	16 (5%)	20 (6%)	21 (16%)	27 (20%)	37 (8%)	47 (10%)

Considering how greater responsibility at senior/managerial levels can be better recognised, improved pay was ranked first by nearly half (215 out of 442 respondents (49%)) and ranked in their top three by 328 out of 456 respondents (72%). Improving access to training and development opportunities to support people in this role followed, with one in five (81 out of 442 respondents (18%)) ranking it first and 332 out of 456 respondents (73%) ranking it within their top three choices.

Other responses at Q89 included: clear career structures; involvement in decision-making; pay linked to levels of accountability and responsibility; and better public recognition and value. There were some comments that all four options are of equal importance. There were 138 free text responses in relation to this question.

Q90a. Should the National Care Service establish a national forum with workforce representation, employers, Community Health and Social Care Boards to advise it on workforce priorities, terms and conditions and collective bargaining?

	Individuals	Organisations
Yes	277 (87%)	133 (87%)
No	42 (13%)	20 (13%)
Total	319 (100%)	153 (100%)

The majority of respondents (411 out of 473 respondents (87%)) were in agreement that a national forum should be established to advise the NCS on workforce priorities, terms and conditions and collective bargaining which would include workforce representation, employers and Community Health and Social Care Boards.

As can be seen from the table above, there is no real difference in the responses from individuals and from organisations to this question. Overall, there were 223 free text comments provided for this question. Common themes from those in agreement included:

• It is an opportunity to give employees 'a voice' and increase communication
• It would make the sector more attractive to recruits and increase engagement of staff
• It would create consistency and equality across Scotland
• It would improve work conditions, including pay, and sharing of experiences
• It needs to be truly representative of all staff, locations and experiences including trade unions and key stakeholders
• It should become more in line with the NHS

"Anything to engage, motivate and encourage the workforce should be tried - particularly as recruitment and retention is going to be an ongoing challenge." (Individual respondent)

"Establishing a national forum with workforce representation and collective bargaining sounds like a prerequisite for improving terms and conditions and placing social care on a more stable and sustainable footing." (Individual respondent)

Some comments in relation to a national forum related to the need for greater clarity on how the proposed forum would fit within existing collective bargaining arrangements in Scotland.

"It is important to understand how any planned structures might sit within current governance arrangements for the NHS… it would also be useful for clarity in relation to where this might sit with existing structures involved in current collective bargaining arrangements, such as COSLA, and other NHS bodies such as STAC and SWAG. We would respectfully suggest that further clarity is required in terms of what the potential suggestion for the NCS and CHSCB workforce may be" (NHS Scotland HR Directors)

"The proposal to establish a national forum with workforce representation, employers, and Community Health and Social Care Boards to advise it on workforce priorities, terms and conditions and collective bargaining is worthy of exploration but replete with challenges, principally because there is no existing ability to represent the hundreds of employers in the sector." (Quarriers)

Nearly all of the respondents to the Easy Read questionnaire (40 out of 41 respondents (98%)), agreed that the NCS should take action to make pay, working conditions and training and development for social care workers better (Q22 of the Easy Read questionnaire). Comments related to this question suggested that care workers should be paid much more and be given better, and more standardised, training. There was also a recognition that staff needed to be valued more and that this would help recruitment.

Workforce planning

Q91. What would make it easier to plan for workforce across the social care sector? (Please tick all that apply)

	Individuals	Organisations
A national approach to workforce planning	210 (74%)	130 (77%)
Workforce planning skills development for relevant staff in social care	185 (65%)	130 (77%)
A national workforce planning framework	168 (59%)	124 (73%)
Consistent use of an agreed workforce planning methodology	173 (61%)	116 (69%)
National workforce planning tool(s)	153 (54%)	111 (66%)
An agreed national data set	140 (50%)	116 (69%)
Development and introduction of specific workforce planning capacity	141 (50%)	91 (54%)
Something else	37 (13%)	53 (31%)
Total	283 (100%)	169 (100%)

Individuals and organisations alike were in agreement that having 'a national approach to workforce planning' (74% of individuals and 77% of organisations) as well as 'providing skills development' opportunities for relevant staff in social care (65% of individuals, and 77% of organisations) would be the easiest way in which to plan for workforce across the social care sector.

There were 184 free text comments on this question. Other areas of suggested focus were:

• Better pay and conditions, limiting local variations in pay
• Registration of all staff and an awareness of standards would lead to more consistent services
• There are a diverse range of needs across Scotland: local variations need to be considered

In the open-ended responses to this question, there were mixed views on the relative advantages and disadvantages of a national versus a local approach. The need to take into account the requirements of rural and remote areas, including the Islands was also noted.

"Workforce planning within the front line social care workforce is very much influenced by local requirements and demands. It is difficult to see how this could be undertaken on a national basis" (West Lothian Council)

"It should be [the] same right across the country and the planning of delivery of this service will have adjustments for distance i.e. [in the] Highlands and Islands but the basic principles should apply" (Unpaid carer)

For some respondents, it was thought important to explore in greater detail the actual needs of the people accessing care and support and the actual care that is required before establishing a national structure. Other respondents noted the importance of a gender analysis, highlighting, for example, the circumstances of female social care workers in rural areas who may be reliant on public transport.

"The social care workforce and the settings they work in are not homogenous. Planning for and providing person-centred support requires flexibility, close knowledge of the supports being offered, the ability to match the skill sets needed for different support arrangements with the available staff who have those skills, and insight to any preferences that a supported person may have for who is part of their team. Doing this on a national scale across multiple locations and providers would be challenging." (Key and Community Lifestyles)

Training and development

Currently, access to workforce development and the support offered to achieve qualifications and learning are variable. The responsibility for obtaining relevant qualifications for registration and continued employment lies with individual workers. With a projected shortfall of training provider capacity to meet the demand for qualifications required for social services registration over the next five years, NCS proposes setting training and development requirements that support both entry level staff and continuous professional development.

Q92a. Do you agree that the National Care Service should set training and development requirements for the social care workforce?

	Individuals	Organisations
Yes	283 (87%)	162 (90%)
No	41 (13%)	18 (10%)
Total	324 (100%)	180 (100%)

The majority of respondents, at Q92a agreed that the NCS should set training and development requirements for the social care workforce (283 out of the 324 (87%) individuals and 162 out of the 180 (90%) organisations who responded to this question).

Frontline care workers are more in favour of the proposal (106 out of the 113 respondents (94%)) than social workers (59 out of the 73 respondents (81%)).

When asked whether the NCS should set training and development requirements, the 317 respondents who responded to this question suggested:

• Training should be mandatory due to the many different areas that an individual worker can be responsible for
• It would develop appropriate skills and consistent quality of service/care, with greater consistency in training helping to improve standards
• It would help to build trust between partnerships and carers and their clients
• It would encourage recruitment and lead to confident, competent employees
• It would increase safety and the quality of care
• Training delivered bespoke to local issues is important as it can be variable depending on location

Social Work Scotland however stressed the importance of retaining some external responsibility for training and development:

"Regulators like the SSSC must retain responsibilities around training and development which precludes the NCS from having outright control." (Social Work Scotland)

The main reasons for this view given by Social Work Scotland are that: large parts of the 'social care' workforce are already under the regulatory umbrella of the SSSC; and there is a he need for regulators to remain independent of the delivery part of the system,

Public Health Scotland highlighted the importance of training for unpaid carers as well:

"We believe that carers, paid or unpaid, should have access to proper training which allows them to support those they care for to ensure that they have the best quality of life. This must include the ability for them to engage with their local community and to take part in activities, including employment." (Public Health Scotland)

While the Equality and Human Rights Commission highlighted the need for leadership, culture change and investment in training and in the wider context of equality:

"We agree that training and development requirements should be revised and improved, especially in relation to equality. Better performance on equality and the Public Sector Equality Duty will require a combination of leadership, culture change, and investment in people and resources. The Scottish Government should therefore consider how training and development can be offered as part of a broader package of measures to support improved performance in relation to equality." (Equality and Human Rights Commission)

Q93. Do you agree that the National Care Service should be able to provide and or secure the provision of training and development for the social care workforce?

	Individuals	Organisations
Yes	301 (90%)	163 (88%)
No	32 (10%)	22 (12%)
Total	333 (100%)	185 (100%)

There was also strong support at Q93 for the NCS providing and/or securing the provision of training and development for the social care workforce (301 out of the 333 (90%) individuals and 163 out of the 185 (88%)) organisations that responded to this question) agreed with this proposal.

Reasons given by those who disagreed with this approach tended to reference: the need for local or flexible solutions; the role of the SSSC, and the need to balance this with other statutory roles and responsibilities.

"No, because we do not want a monolithic social care sector. There needs to be a view as to what is mandatory and then services can add what they want to this. We also need to mindful that there is no verification system for training across the sector at present" (Individual respondent)

"I would suggest that there needs to be clarity regarding the role and responsibility of the National Care Service versus a National Social Work Agency, and how this will fit with the current governing bodies (SSSC and Care Inspectorate)." (Individual respondent)

Personal assistants

Respondents were asked to consider whether they agreed that all personal assistants (PAs) should be required to register centrally in the future (Q94a).

Q94a. Do you agree that all personal assistants should be required to register centrally moving forward?

	Individuals	Organisations
Yes	272 (86%)	126 (88%)
No	44 (14%)	18 (13%)
Total	316 (100%)	144 (100%)

The majority agreed that this should become a requirement with 87% (399 of the 461 respondents) to this question, in agreement. Overall, there were 279 responses to this question. Reasons provided by those in agreement included:

• It offers security and safeguarding of both the PA and the employer/vulnerable adult
• It ensures standards and pay are equal within the social care system
• It allows access to support and training for the PA
• It provides increased regulation and knowledge of the number of PAs and training record
• Protecting Vulnerable Group (PVG) checks should be a minimum requirement for PAs

For individuals, a higher proportion of frontline care workers (97 out of the 106 (92%) that responded to this question) as well as people in management of care services (94 out of the 101 (93%) respondents) agree that personal assistants should be centrally registered compared to people that receive, or have received, social care (42 out of the 55 (76%) respondents).

"This could work in a similar way to registered childminders in safeguarding vulnerable people. It would feel more professional and give the personal assistants value and self worth." (Person accessing care and support)

"The levels of risk currently experienced by thousands of service users with a workforce that is unknown, unsupported and unscrutinised is unsustainable." (Dunfermline Advocacy)

There were a few concerns around registration relating to the nature of the workforce with some respondents highlighting the risk of undue bureaucracy and potential financial costs on low paid and perhaps unpaid workers.

Respondents to the Easy Read Q23 tended to agree that personal assistants should be required to register in one place (25 out of the 38 (66%) that responded to this question) with a proportion (12 out of the 38 respondents (32%)) having no preference.

Q95. What types of additional support might be helpful to personal assistants and people considering employing personal assistants? (Please tick all that apply)

	Individuals	Organisations
Recognition of the personal assistant profession as part of the social care workforce and for their voice to be part of any eventual national forum to advise the National Care Service on workforce priorities	248 (81%)	109 (74%)
National minimum employment standards for the personal assistant employer	242 (79%)	124 (84%)
Promotion of the profession of social care personal assistants	219 (72%)	106 (72%)
The provision of resilient payroll services to support the personal assistant's employer as part of their Self-directed Support Option 1 package	217 (71%)	97 (66%)
Regional Networks of banks matching personal assistants and available work	210 (69%)	96 (65%)
A free national self-directed support advice helpline	187 (61%)	95 (64%)
Career progression pathway for personal assistants	176 (58%)	89 (60%)
Other	25 (8%)	42 (28%)
Total	306 (100%)	148 (100%)

There was a high level of agreement in relation to the type of additional support which may be helpful to a personal assistant or someone considering employing one. The most helpful support overall was considered to be 'national minimum employment standards for the personal assistant employer' (individuals, 79%, organisations 84%) as well as 'recognition of the personal assistant profession as part of the social care workforce and for their voice to be part of any eventual national forum to advise the National Care Service on workforce priorities'.

Organisations believed that a more structured framework would be beneficial in terms of availability of regional networks of 'bank' staff (65%), payroll services (66%) and career progression pathways (60%).

When Easy Read respondents were asked about other support that might be helpful for personal assistants and people wanting to employ personal assistants (Q24), the top rated answer was "a free national phone line about self-directed support advice" (27 out of 37 respondents (73%)) followed by ways to match employers with personal assistants who want work; and a recognition of personal assistants as part of the social care workforce (all selected by 25 out of 37 respondents (68%)).

Q96. Should personal assistants be able to access a range of training and development opportunities of which a minimum level would be mandatory?

	Individuals	Organisations
Yes	280 (90%)	131 (89%)
No	30 (10%)	17 (12%)
Total	310 (100%)	148 (100%)

There was also very strong support from both individuals (280 out of the 310 (90%) that responded to this question) and organisations (131 out of the 148 (89%) respondents) in personal assistants being able to access a range of training and development opportunities, of which a minimum level would be mandatory (Q96).