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Residential Forum Workshop – 21/22 March 2011
DEVELOPING THE RESIDENTIAL CARE SERVICES WORKFORCE
Introduction
As part of its commitment to improving standards and raising the status of staff in residential services, the Residential Forum devoted its March 2011 workshop to considering how managers and staff could be enabled to meet the rising expectations of residents, relatives, commissioners and the public. The workshop was supported by Skills for Care and the Social Care Institute for Excellence.
In any discussion concerning the promotion of good practice in residential care it is inevitable that many of the issues will centre on the workforce.
As the population in residential care changes and complex needs increase, there are considerable implications for staff development and supervision. It is doubtful that residential staff are equipped sufficiently to meet the expectations and requirements of personalisation in care and support services.
The context
The current pressures on income and costs in residential care are likely to affect the resourcing of staff development and training and it is essential to show that investment in training benefits residents and relatives through improved outcomes, quality of life, staff retention etc.
For a long time, little was known about the workforce in residential care but in recent years the social care services have become better at gathering data about this most
important aspect of the service. The National Minimum Data Set for Social Care (NMDS), developed under the auspices of Skills for Care, is one such example.
The Social Care Workforce Research Unit at Kings College, London has produced some most interesting and helpful data, drawing on NMDS material.
Crucial to good practice is a satisfied workforce and continuity of care, yet the average turnover in England of social care workers is 15% and is highest amongst direct care workers (Hussein 2009).
Job satisfaction is surprisingly high. Social care is 8th out of 88 occupations in terms of highest job satisfaction (Rose 2002) yet the demanding nature of the work and its perceived low status are seen by care workers to produce great difficulties in enabling them to undertake their task.
At a time when the nature of residential homes is changing, and costs are being squeezed, we find that meeting the rising vulnerability of those who use care services requires an Increase in staffing levels.
Expectations of the social care workforce have changed and this has not always been recognised by those entering and those remaining in the service.
Obstacles to developing a professional workforce in residential services
The Residential Forum has identified some additional areas that make the professional development of the social care workforce, and residential care staff in particular, difficult:
- There are severe strains on the residential sector through increasing complexity, rising dependency, more challenging behaviour, demographic pressures, expectations of more personalised services and a search for better outcomes at a less cost
- As local authority budgets diminish there will be pressure to reduce fees for places and/or volume of places purchased, which may lead to competition by price and not quality. Training budgets in all sectors may suffer as a result of these pressures
- The image of residential care is outdated and distorted. The public, media and politicians do not understand the complex challenging nature of the residential task. The poor image is influenced by scandals in the press, reinforcing stigma and devaluing the status of residential care in ways that are detrimental to both staff and residents
- Social care leaders and Ministers are failing to champion the role of residential care
- The right values in residential care are not always bring promoted within the service and fostered in training of staff
- The value of professional supervision is not always promoted or even understood
- Professional autonomy of staff has diminished
- The age of the workforce is out of kilter with present and future demands of the service, and there is an unhelpful discouragement to recruiting and retaining younger staff
- There is a lack of clarity in the training provided to residential care staff
- England has no strategy about numbers to be trained
- Training needs in a particular subject in residential care are sometimes seen to be satisfied by very brief on-the-job instruction
- The provision of training is sometimes undertaken by people whose skills are insufficient to meet the requirements of the service
- There is no framework of quality assurance in place for those who offer training
- There is too little recognition that training and education is one strand of service and staff development, and it is insufficient on its own
- Positive professional relationships between residents, family and staff remain crucial. If we do not permit the building of relationships it will militate against appropriate training and care
- Empathy and understanding towards the issues faced by users of social care services and their families is a critical factor when considering the recruitment and retention of staff
- A great deal depends on the quality and capability of managers of care homes. They provide leadership, maintain values, create the right culture and ethos, motivate staff, empower residents, foster a focus on outcomes, ensure support, supervision and training of staff, and manage productive relationships with relatives, the local community, commissioners and regulators.
The Residential Forum intends to consider further the actions that are necessary to make progress to address these obstacles.
Preparing and supporting registered managers
The Residential Forum believes that the role of the registered Care Home Manager is so crucial that it warrants further attention.
There is, at present no recognised system in social care for preparing managers and we would wish to make the following points. The sector must ensure that:
- clear expectations of the role of the home manager are developed
- the multi tasking role of a care home manager is acknowledged
- people are allowed time to develop management skills
- the current qualifications are fit for purpose, and the complex issues around the training of managers for the different size of establishments is addressed
- differences between managing in child care sector and adult care are recognised, as well as similarities
- managers of care homes have an empathy with staff and residents
- gender issues are resolved, and residential work loses the perception of being only unskilled 'women's work'
- managers are allowed to manage, and empowered to take control over essential practice issues the
- isolation of the job is reduced by developing networks for managers to tap into, and encouraging mentoring
- we recognise that a care home manager is part of a team, and the team contribution as a whole is considered in the management process
- we reduce the administrative burdens on managers and develop the role of care home administrators (in larger care settings)
- there are greater links and better communications between managers and CQC
- in professional terms there is parity between a team leader in social work and a home manager in social care
- a model for the development of sabbaticals for home managers is developed
- we develop traineeships for home managers, and sponsorship of graduate entrants and people on qualifying courses
- initial recruitment aims to talent-spot potential managers
- there is a recognition that not everyone working in residential care can have, or wants to have, a management role and a presumption of an automatic progression to home management should be discouraged.
Further considerations
The Residential Forum makes the following general observations, in relation to the workforce in residential care. The sector should take steps to ensure that:
- care homes are not regarded, or allowed to operate, as closed facilities: opening them up to the community could be an aid to recruitment and community involvement
- we do not lose managers and other employees of good potential because of excessive bureaucracy
- as residents develop complex needs, so the need will grow for cross-recruitment from other professions to provide them with appropriate skilled care and support
- we break the stigma attached to working and living in residential care, and promote its status and contribution
- in recruitment, we promote the tasks that are exciting in residential care and the opportunities it offers
- we emphasise the diversity and positive aspects of the sector
- we present the individuality of people in the service
- there is mutual respect between social care workers and social workers
- consideration is given to restoring the 'residential placement' as a requirement in social work courses
- attention is given to the vital role of professional supervision and training
- staff are given encouragement to gain qualifications and to become registered
- imaginative and innovative leadership is encouraged.
The future of residential care
The Residential Forum is in no doubt that as well as managing the present, we must manage for the future of residential care homes. There needs to be a clear pathway into and through residential care employment, with varied and flexible career opportunities. Larger providers may find it easier to manage for the future: ways should be found , perhaps through the National Skills Academy, to give assistance to small providers to enable them in the management process in care homes.
We need to ensure that the vast potential of the workforce is used to the full and that we let people make things happen. Innovation and involvement should be encouraged rather than discouraged by the regulatory regime.
The media and the sector need to promote the positive and stop marginalising residential care services.
In social care in general, and in residential care in particular, the large and diverse workforce is the major resource. To provide quality residential care will be impossible unless the workforce is well managed, well trained, well supervised, and encouraged in the complex tasks that have to be undertaken with those who use the service.
For its part, the Residential Forum will continue to promote the best of residential care services, and seek to erase the negative aspects. Through its workshops and networks, it will continue to encourage those responsible for the provision, regulation, education and funding of the residential care services to ensure that the workforce is developed to deliver continuing best practice.