Chapter 9: Workforce issues
The pressures
The question we have to face is how are we to provide improving services, that are labour intensive, for a growing population of older people, when there will be fewer people coming into a labour market that is increasingly competitive, with the NHS, education, social care, supermarkets and call centres pursuing the same people. There are 4 responses:
- reduce the labour input where possible - by avoiding duplication and by better organisation
- designing new roles to reflect changing patterns of service delivery - if we are delivering integrated services, shouldn't we be integrating jobs/functions/roles?
- better, more skilled workforce - pay and train the workforce better
- use of alternative types of care: equipment, adaptations, technology and Telecare.
The Drivers for Change Paper considers workforce issues, and highlights a number of factors that lend weight to the need for service change in the NHS in Scotland:
- Demography - fewer people of working age in the workforce.
- Work-life balance - flexible working will be important in attracting and retaining staff
- New Deal Contract and Work Time Directive
- Consultant Contract
- Skills shortages
- Remote and rural issues.
Scotland's Social Care Labour Market Report published in August 2004 covered much the same ground for the social services workforce. It provides much information on the social care labour market including:
- employment trends and the sector composition of the workforce
- workforce age profile
- gender, qualifications and job characteristics
- the private and voluntary sectors
- local authority employment growth and labour market adjustment, and
- demographic trends; implications for labour supply and labour demand.
The delivery of care services is within a mixed economy, with the voluntary and private sectors increasingly delivering more services. Thus while employment in social work activities grew significantly, from 96,000 in 1994 to 118,000 in 2003, independent sector employment grew from 37,000 in 1994 to 65,000 in 2003 and overtook public sector staff late in 2000 (source: Scotland's Social Care Labour Market Report).
Local authorities have a key role in commissioning and purchasing care services. Consequently these issues are not unique to the NHS - local authorities and the voluntary and independent sectors face similar recruitment problems. Indeed in the draft report of the working group on the care of older people the point was made
'Substantial workforce issues - in education and training, in career flexibility and life-long learning - must be addressed, with a new focus on competencies rather than traditional labels, in education, training and career development. A health and social care workforce that reflects demography and need, increasingly community based and less focussed than at present on acute and unscheduled care: with changes delivered via training, education and career paths; knowledge skills and attitudes; with more people working in teams and away from hospitals; and making maximum use of technology.'
Although the Joint Future Model (Scenario 7) in our First Report starts to map a way forward, there are significant workforce issues which could essentially render the model unworkable if full recruitment is not achieved. The HM Government Report 'Opportunity Age' highlights
- helping unemployed and inactive people over 50 into jobs
- there should not be a cliff-edge between work and retirement
- opportunities to promote health and leisure to contribute to the community through caring and voluntary work
- flexible working, and
- helping people back to work.
Right people, right skills, right place, right time
It follows that developing the social services workforce is crucial if we want to realise our ambition to encourage new and better patterns of service delivery to users of social services, such as older people. For this, we will need a competent, confident, flexible and highly valued workforce. The National Strategy for the Development of the Social Services Workforce in Scotland 2005-2010, launched in November 2005, aims to ensure that employers have the right people with the right skills in the right place at the right time. As well as addressing demographic pressures in common with healthcare staff in Scotland - for which we need to develop complementary workforce strategies to avoid unnecessary competition - the skills of social services staff need further specific development on:
- working with other organisations;
- working in equal partnership with service users and their families;
- strong leadership and management; and
- critical decision-making.
These skills gaps have also been identified by the Report of the 21st Century Social Work Review (February 2006) about the future role of social workers and the development of the social work profession. It makes detailed recommendations on issues such as training and career development. The Strategy's action plan aims to make best use of projects, programmes and initiatives such as Leading to Deliver, the Scottish Credit and Qualifications Framework ( SCQF) and the Framework for Supporting Frontline Staff (to name but a few) to address these deficits.
Employee development is the foundation on which the confidence and competence of staff is built. Employee development is for all posts and people within an organisation, not just for those with a professional qualification, and individuals must take responsibility for their own development. Within social work particularly, employee development involves:
- experiential learning, which takes place through life, volunteering and work experiences, and is often but not always unintentional learning;
- informal and work-based learning, often provided by or supported by employers, such as induction and in-house courses, job shadowing, secondment, coaching, mentoring and peer group learning;
- formal learning, normally leading to a recognised award within the Scottish Credit and Qualifications Framework;
- qualifications required for registration with the Scottish Social Services Council ( SSSC) and other recognised regulators; and
- post-registration training and learning requirements necessary to maintain registration status.
The Strategy calls for employers and staff to use a mix of all these routes to validate the competencies and experience of their staff and to ensure that their organisations' standards of competence, experience and qualifications continue to rise as part of the overarching Scottish Social Services Council's agenda to upskill the social services workforce over the coming decade.
Inward migration
There has been interest in the number of foreign nationals working in the care sector in Scotland, notably in care homes. Generally we do not have reliable data, and much of the comment is anecdotal about residential care workers from Eastern Europe coming to fill jobs in care homes.
The Scottish Social Services Council will have a better understanding once it has developed its workforce planning capabilities, and when it starts to register adult residential workers.
Inward migration - information about numbers: Accession 8 countries
Meantime there is some information in the Accession Monitoring Report May 2004 - June 2005 (see Annex A for full information) about the employment of nationals from 8 countries that joined the European Union on 1 May 2004 - the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia, known as the 'Accession 8'.
The report tells us that of 181,085 registered workers from these countries in the UK in the period July 04 - June 05 5,485 were working as care assistants and home carers.
Between May 2004 - June 2005 14,845 from the Accession 8 countries were employed in Scotland, of whom 755 were working in the Health and Medical sector. Of these around 580 were working as care assistants and home carers in Scotland.
These figures are only from the Accession 8 countries listed above, and do not include nationals from other countries such as South Africa and the Philippines.
While we do not feel it is within our ability to guesstimate the numbers of foreign nationals who will come to Scotland in the next decade and take up employment in the care sector, we anticipate the numbers will grow. These incoming workers may need education and training in the standards of care we expect older people to receive.
Inward migration - contribution to the workforce
We believe the opportunities people from overseas have to work in the care sector in Scotland are positive, provided individuals are registered with the Scottish Social Services Council.
Where such workers are concerned, there are issues about:
- language comprehension - older people will often be hard of hearing, and may find communication difficult anyway. This may be compounded if the member of staff concerned does not have a full vocabulary of English, or if they have an accent that is difficult for an older person to pick up.
- cultural expectations and understandings - a foreign member of staff may not understand appropriate behaviour, and may behave inappropriately towards an older person in our cultural context; or may not understand normal behaviour in the UK and may accept inappropriate behaviour and practises taking place in a care home or in a care at home service.
Consequently there is a need for support for overseas care workers, with the aim of developing this available resource within Scotland to help fill identified shortfalls in service provision. As one example, UNISON gives people a comfortable forum to raise issues about their "new" environment. It should be added that there is no intention of depleting such developed resources from within Accession and Third World Countries.
Some of these overseas workers may not initially have all the necessary skills, but they may make a bigger contribution through their willingness to learn, their capacity for hard work, and their caring concern brought with them from their native culture. Training is vital in this context.
Workforce issues: conclusion
This section skims the surface of a wide area. It is covered much more extensively in both the Report of the 21 st Century Social Work Review and in the National Strategy for the Development of the Social Services Workforce in Scotland 2005-2010 referred to above.
In community care and healthcare, as elsewhere, people are an organisation's most valuable resource. Without staff, at all levels, the changes we and others are advocating across healthcare and community care will not happen.
There could helpfully be a workforce development strategy that focuses on how to provide services effectively for older people. It could include the personalised approach, rights-based principles and specialist skills, for example for working with people with dementia.
All statutory agencies and the independent sector across health and community care need to be encouraged to work more closely in relation to workforce planning and workforce development in particular in relation to identifying new roles, joint training and collaboration on recruitment.