Social care providers will survive if they invest in the right people
by Robin Bush

Care Quality Commission (CQC) said recently that it expects more providers to fail. When considering the financial landscape, is it any wonder?

For years, local authorities haven’t increased their fees in line with inflation; in many cases they have reduced them. At the same time there have been increases to the national minimum wage and the living wage. Now, there’s ‘sleep-in’ legislation, meaning each duty is paid as working time. Soon there will be the apprenticeship levy on top of the already introduced auto-enrolment (new mandatory pensions’ legislation).

Even for providers that paid above the living wage for their entry level support staff, an increase in wages was necessary in order to encourage staff into the workforce and maintain existing talent. For my organisation alone, the living wage and sleep-in issues has cost an additional £500,000 for 2016/17.  Against this backdrop of enforced increased expenditure, there was little (read no) commitment from the commissioning authorities that they would proportionately increase their revenue to cover the increased financial demands on service providers.

How can social care providers afford to recruit quality staff?  To train staff takes a huge amount of resources – plus, managers are expensive and other costs such as utilities, fuel and office rent continue to increase.

One of the great anomalies of being a social care provider is that the market place is biased towards the commissioner of the services. In essence, we get told how much a local authority will pay for our services, whether we like it or not. Commissioners will argue that they use a fair tool to work out the price of services, such as the Care Funding Calculator, which, whilst having some merit, does not provide sufficient flexibility to work out the cost of specialist support packages.

Local authorities will blame central government for the funding shortfall and rightly so in my opinion. In turn central government state that they have increased the investment in adult social care.  Well, they would say that, wouldn’t they?  Even with government attempts to improve the funding situation, it falls woefully short of what is required and therefore we are working in an industry that is on the verge of collapse.

But hang on a minute: aren’t some providers still rated ‘good’ or even ‘outstanding’ by the CQC?  How are they achieving this in the face of the toughest financial operating environment our industry has ever seen?  I’m proud to say Autism Together is one such provider.

In our experience the key to a successful care and support service is investing in the workforce. However, this investment is not solely of the financial kind and features high amounts of energy and emotional commitment from senior managers.

Of course quality starts with staff; the people who have face to face contact with people requiring support on a daily basis have to have the right skills and talents to undertake what is often a demanding role. But what we have found is that skills and talents do not mean experience and qualifications. It’s a person’s values that are as important- and I would argue more important – than their previous experience or qualifications. To understand this point I suppose you need to consider what is required from a support worker, they need a range of qualities; empathy, understanding, compassion, consideration, respect, patience, flexibility not to mention a sense of humour. As far as I am aware these qualities/values are not taught and I’d suggest they are unable to be taught to people, either a human being has these or they don’t.

Assuming that we have recruited the right candidate to become a support worker, then, of course, equipping them with the necessary knowledge and skills to undertake what is a specialist role is the logical next step. However, traditional training approaches only go part way to ensuring that people have the necessary detailed understanding of the role. It is vital that organisations have a core set of values that are understandable to the workforce and underpin day to day operations.

NHS England in their paper, Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition (October 2015), describe ‘golden threads’ which should run through service delivery. Taking this a step further, values should not be used in isolation, but should form part of a wider organisational culture that embeds good practice. Culture is therefore a synergy between the values or principles of working and how, in practical terms, support is provided. It would stand to reason that if the staff recruited have a positive set of values and the culture in which they work reflects positive organisational values, then the service provided will be reflective of this and therefore have a positive impact on the outcomes experienced by those using the service.

In order to embed values, there needs to be an innovative approach to training staff.  But how do you teach organisational culture?  Staff are provided with some classroom-based learning whereby they are informed what our values are, but from then on it is down to the managers in each service to act as mentors and role models to demonstrate the culture in practice.

From an organisational point of view, value-based recruitment, education, training and management support is all very resource-intensive.  In an industry where financial resources are becoming increasingly hard to find it is essential that, having invested in their workforce, providers are able to retain their employees.  Retention is crucial, not only from a financial standpoint reducing the overall recruitment costs (estimated to be around £5,000 per employee), but it is also vital for ensuring service quality.

Employee engagement is a term that has been around for a while and has different definitions depending on what book you read. For us, employee engagement is about demonstrating to the people who work with our organisation that they are valued, that their contribution means something and that as an organisation we respect and appreciate them. It is not about paying lip service and offering patronising pats on the back, but it is about giving people a voice in how the organisation is run and communicating openly and honestly with the entire workforce.

We strongly believe that our values need to be reflected not only in how we provide services but also how we treat our employees. It would be unfair to expect one of our support workers to be respectful to the people we support, if the organisation wasn’t respectful to them. We do provide staff benefits that stand outside of the main terms and conditions, such as holiday buy back, nursery vouchers, health care schemes and a discount shopping card, but these are more of a thank you. The real demonstration of valuing an employee comes through our culture of engagement.  Senior leaders promote engagement at every juncture and try to be as visible as possible.

We have been developing our engagement strategy for the last two years across our 1000-strong workforce and whilst we recognise we still have a way to go, our retention is improving and, more importantly, our service delivery is consistently rated as ‘good’. Plus, we now have an ‘outstanding’ service.

Providing quality services in time of austerity isn’t an impossible dream, but it does require some reflection and investment in what’s really important: people.  Social care organisations have two great resources, the people we support and the staff who support them.  If we lose sight of this, then I would suggest we’ve lost sight of the purpose of adult social care.

Robin Bush is CEO of Autism Together