National Care Service consultation: discussion events summaries

28 September 2021

• Theme of discussion: fair work and valuing the workforce
• Time: 10:00-12:00
• Discussions leader(s): Anna Kynaston

Introduction

This is a summary of the key points raised by attendees at this session.  None of the points have been attributed to individuals as the purpose was to encourage broad and open discussion.  The summaries for all the national events will be provided to the independent contractor undertaking the consultation analysis.

Points raised at event

• CHSCB is just rebranding of IJBs – worry that the responsibility for everything is going to go into a new body and won’t solve the issues
• We can’t separate the drive to improve the working lives of the social care workforce. The parameters of what isn’t and is possible by employers is set by statutory bodies. No determined by the independent sector and their ability to help the workforce
• Trying to look at fair work on its own won’t work – we have to look at it with commissioning reform
• Children’s services – should be incorporated. We need to think about the relationship with education and housing so that the relationship isn’t broken down. There is still a notion of an integrated health and childcare education – would new bodies have an interest in this?
• Integrated qualification has benefits and people moved through the system from child to adult support. If there was a qualification it would be easier for staff to move through the different elements of the sector. Qualification can challenge and address it appropriate and standardised way. Previously decisions were made for children but they were not included. Children need to be included in decisions.
• It is important that there is flexibility with personal assistants. In England systems work really well in supporting PAs. There has to be a balance and challenge of flexibility and leaving out the whole section of the workforce. Example is Isle of Wight, Local Authority created a PA hub to support and recruit PAs and link up people to match with potential PAs. Peer support and support from LA.
• One concern is equality as it’s only mentioned once or twice in the consultation. We need to see equality embedded into a NCS from the start. Need to see real practical examples of how that will happen and in primary legislation. Social care sector is mainly women, social care reform has to recognise the challenges.
• Vacancy rate in the social care sector is twice the rate of the national average. Highly competitive appointment times for care at home which has an impact on giving people high quality care. This affects staff mental wellbeing as they don’t have time to give the proper care they want to do. There is overwhelming evidence to show pay is the issue. Trying to resolve issues in the sector while there is low pay will be hard.
• There needs to be investment in sector and social care to be designated a key sector in order to get the investment it needs. Care sector contributes to the economy, investment in care in the UK would produce 2.7 times as many jobs. Investment in the care sector is 30% less polluting than the construction sector. Care is missing from the job sector as it is mainly male dominated sectors in the labour market.
• A lot of people are scared to join the sector due to all the qualifications they require – some people may be illiterate but a great carer, but cannot join as they have to get qualifications.
• CPD and training is welcome but it’s won’t work to improve pay rates and progression pathways is good but pay rates need to be worth it. There is a need to be cautious around MAs as they are the lowest paid frameworks and are dominated by women. MAs are being used to employ low paid workers and they are not kept on at the end of the apprenticeship.
• Some PAs have had no training.  A PA employer should be accountable for employing PAs and not put their health at risk.  PAs should be kind, willing to learn and told necessary training will be given and pay correct wages. The choice should be there. There needs to be co-operation between council and employer on training.
• Good partnership working and thinking out of the box works well for respite from caring for unpaid carers. Example given of carers given respite by partnership between local authorities and SENSE Scotland to provide short hotel stay for person with disability.
• In house caring doesn’t always work for everyone – can be harder for disabled person sometimes to say goodbye to carers in their own home for respite period.
• Flexibility also important (for quick dentist visit, for example). Or to respond to crisis. Local infrastructure needs to respond to that. Flexibility should respond to individuality to see whether it works for the individual.
• Lack of local based and flexible respite.
• Investment and pay are the two important issues. Everything else hinges on these.
• SC not promoted as good career with progression. Needs to be promoted through schools as good career. Many children do not know what SC is.
• SVQ’s across sector can vary across different areas, and need that flexibility.
• Very challenging to manage T&D for managers given turnover of staff.
• What T&D services might be best for in house service, and which are generic SC training? Not all e-learning – needs hands on training particularly for new starts. Organisation want their own T&D plans – need that flexibility to ensure people centred approach.
• PA employer should be accountable for their PA’s, including appropriate training, and have choice of employing their own carer. SDS people should have the option and not be regulated/ enforced as to who they employ.  Examples given of people personally employing people with prison record or a disability where agencies would not have done. Good carers can be trained if they have the right aptitude/ social skills. Otherwise great carers could be lost. There should be co-operation between local authorities and those who need the PA’s.
• Work is allocated on time slots, it is very difficult to provide person centred care in 30 minutes slots. Staff need to be trusted and given flexibility to provide care, and tweak care packages as required to meet the needs of the service users. Staff need to form good relationships with care recipients. The culture needs to change in order for workers to feel valued, social care was more valued in the past, terms and conditions are poor and reinforce that the work is not valued.
• There are lots of opportunities for career progression in the social care sector, but the sector is not good at promoting careers. It is misunderstood as a profession, and schools need to be targeted as a means of attracting staff.
• Qualifications offered through the SSSC are good, and some organisations have internal SVQ’s tailored to their own needs. It is vital that the sector is worked with closely in terms of training issues. Existing challenges include organising training for staff, and increased turnover and vacancies. There is a feeling that the sector has attempted to address issues of recruitment and retention, but are running out of ideas. Staff really care about the people they support and commissioning should provide far greater investment to produce better outcomes.
• We need to produce an overall strategy in conjunction with providers and establish a group to look at this. There is current difficulty in establishing common themes in training, and any future proposals should ensure that training is not all about e- learning. It is a big piece of work to understand why are people are leaving the sector. Challenges exist where organisations want to be flexible to people’s needs, but cannot get staff together because of working arrangements and it is costly. Training plans could be tailored to each organisation according to its requirements.
• The consultation document has little onus on employers to put employees through registration. The SSSC framework has done a good job but needs to be accelerated. Covid has shown that things can be done quickly where needed, Academic institutions have a role to play, Stirling University teaches Nursing, Forth Valley College could be used to support qualifications but there is little knowledge of the qualifications by the institutions who could support them. There needs to be provision for training to take place centrally and not from individual providers, Also,  PA’s should be covered by the SSSC not Care Inspectorate.
• A Care Induction has been investigated by Scottish Care with providers and there is an appetite for that. Accreditation needs to be wider, as staff move between organisations, and in house training is fine but not transferable. This creates duplication of cost and time. The challenge is to create a framework. The system of SVQ’s are good in itself but we need to recognise how this interacts with mandatory training such as medication and health and safety.
• An example was given of how the Salvation Army restructured services, and adopted  a commissioning services induction, which was standardised and shared across partner organisations/providers. The commissioning process has responsibility for continued professional development and should be structured as such. While there are more providers of social care now than there were 20 years ago, little co-production takes place in the sector. There needs to be a forum for best practice and  where staff can share good and bad experiences.
• A passport for induction training was introduced around 10 years ago which was funded by the government, and was part of the Scottish Social Service learning network. The passport was implemented along with a Moodle platform for training that was accessed by a number of organisations. Due to the economic crisis the funding was withdrawn for these initiatives.
• Services aren’t funded to have extra capacity, therefore it is difficult to remove staff from the frontline to send them on training. Services can’t cover the cost to backfill these shifts, this is a long standing problem.
• There needs to be work to define what is a service and what funding is required for it to deliver. Providers are subsidising budgets to train their staff and keep people safe. If providers were funded to have some additional capacity they would use it. Providers are forced to develop own in house training, which has become the norm due to reduced costs and the flexibility it provides. 
• In remote and rural, areas,  there is a concern around flexibility when providing service users with care. In terms of the consultation and mention of procurement and commissioning, how much local flexibility will there be. Local solutions are needed. The experience of the pandemic and response has shown that local solutions can be found. Equality is needed to ensure that there is not a postcode lottery in service delivery in relation to mainland and island services. There is also a danger and risk to the quality of services if the pace of implementation of the NCS is too quick.
• In remote and rural locations, how do we build flexibility of care, in the context of existing pressures. This needs to be explored further. How do we address the situation of workforce being under or over regulated. Issues remain in remote areas where it is difficult to attract staff as there can be long travel to work for example 2 hrs on ferry, and hospitality roles may be more attractive/less onerous.
• Integration has not been achieved in health sector. Health workers would never be expected to deal in 20 minute slots with clients or work for minimum wage. It’s a huge challenge to achieve parity of fair work, terms and conditions. While the current structure is not fit for purpose, the proposed reforms are the right way to go. Scotland has good record historically at delivering services effectively at a local level, and consideration needs to be given to what positive lessons can be learned from the old “parish level”  model of delivery.