Adult social care: independent review
The Independent Review of Adult Social Care in Scotland was led by Derek Feeley, a former Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland. Mr Feeley was supported by an Advisory Panel comprising Scottish and International experts.
Chapter 10 Fair Work
"The carers that came in were worth their weight in gold and should be rewarded or acknowledged for this.”
While carrying out this review we heard from many people about their experiences of working in social care. We also met representatives of the workforce, including trade unions, and employers.
We heard much that is impressive, heart-warming and uplifting about the commitment of the workforce to supporting people who use social care support. But we also heard much about a workforce that is undervalued, badly paid for vital, skilled work, held in low esteem in comparison particularly to the health workforce, poorly supported in terms of learning and development, and generally under-represented.
The social care workforce in Scotland is so notably disadvantaged because it is highly gendered. The sector is about 83% female. Were it 83% male, it simply would not be marginalised and undervalued as it is. The consequences of this are obvious, and highlighted by the pandemic. Turnover is high at roughly 30% p.a., recruitment is challenging and it is difficult to maintain and improve standards when investment in training and development is low.
We recognise that efforts are underway to improve the situation. We are not the first to listen to the challenges facing the social care workforce and as we have carried out our review we have been careful to understand progress made by the Scottish Government to realise its ambitions on fair work and gender equality at work, and as part of its programme to reform adult social care support, which was launched in June 2019 and includes a commitment to ensuring the workforce is valued and skilled.
In February 2019, the Fair Work Convention published its report Fair Work in Scotland's Social Care Sector. The report called for urgent reform to improve the quality of work and employment for the 200,000 people who work in social care support in Scotland. It made five recommendations, as follows:
- A sector-level body should be established by the Scottish Government with responsibility for ensuring that social care workers have effective voice in the design, development and delivery of social care services.
- Key stakeholders should develop and agree appropriate minimum contract standards for the provision of publicly-funded social care services, consistent with the Fair Work Framework and the Scottish Government's Fair Work First initiative.
- Commissioning practices should be overhauled to ensure that fair work drives high quality service delivery through the adoption of both minimum contract standards and through engagement at a sector level between purchasers, providers and deliverers of social care services.
- Key stakeholders in the social care sector should apply the Fair Work Framework and commit to improving pay, conditions and opportunities for progression for directly employed care workers and for Personal Assistants.
- The Scottish Government should support delivery of these recommendations, and incorporate them into their Fair Work Action Plan and Gender Pay Action plan. A central location within Scottish Government's Health and Social Care Directorate should coordinate policy for the social care workforce, integrated with workforce strategies for the health workforce, and support delivery of these recommendations through its own Fair Work action plan.
In August 2019 it was agreed that the Social Care Living Wage Implementation Group, whose membership comprises representatives from Scottish Government, COSLA, Integration Authorities, third and independent sector providers and the Scottish Trade Union Congress, would be renamed the Fair Work in Social Care Implementation Group and would focus on implementation of the report's recommendations. The Implementation Group is chaired by Andy Kerr of the Piper Group and is due to report to Scottish Ministers in February 2021.
We agree with all of the recommendations of the Fair Work Convention and support their rapid implementation when the work of the Implementation Group is complete. We recommend that the Scottish Government set an ambitious implementation timetable to ensure progress and momentum.
In setting that timetable, we recommend that priority is given to the establishing of the sector level body as a means to take forward the Fair Work recommendations in partnership. That body should also take the lead in creating national sector level collective bargaining of terms and conditions.
Valuing the workforce
Throughout our review we have heard that the social care workforce feels undervalued and under-recognised. The inclusion of social care staff, alongside their health colleagues, in the recent announcement of bonuses in recognition of their work during the pandemic will help here but there is a deeper underlying sense that social care workers have not had parity of esteem with their NHS counterparts. The recommendations made below for training and development opportunities are designed to tackle this issue. However, it will also be necessary to consider some basic terms and conditions on issues like sick pay, time-off, and travel time. But at the root of the sense of value is pay. Social care staff do not feel valued in relation to the work they do. They pointed us to numerous comparisons in the retail sector where an entry level position paid more than an experienced care worker could secure. In order to establish the true value of the skills, competences and responsibilities of social care, we propose that a national job evaluation programme is undertaken.
"Without tackling the chronic low pay and gendered undervaluation of social care work itself it will not be possible to attract and retain a quality workforce or to deliver substantive improvements in the quality and provision of care.”
There is currently no national oversight of workforce planning for social care in Scotland. With many different employers in Local Authorities and the third and independent sectors, and only very limited, recent, arrangements for mutual support, current arrangements make it too hard to ensure appropriately skilled staff are trained, supported, employed and available in the right place at the right time. Experience during Covid-19 has shown us how difficult it is to deploy appropriate staff quickly when there is an urgent priority to meet. Longer-term, problems result from failure to plan ahead for training, recruitment and retention, and failure to work with partners in health and housing in particular to model innovative new approaches that depend on the availability of a suitably trained workforce who understand each other's contributions.
Given both the size of the workforce and its importance to people's wellbeing, this lack of planning, and resulting lack of resilience and flexibility, needs to be addressed. Some workforce planning is undertaken centrally for the NHS in Scotland, but there is plenty of scope to take a holistic approach across health and social care support and improve for both.
As noted in Chapter 6, workforce planning should be a priority for a National Care Service. An adaptive and nuanced approach will be important as it will not simply be seeking to meet the staffing requirements of local delivery agencies. It will need, for instance, to be supportive of, without taking over, employment arrangements between Personal Assistants and people who use a direct payment under self-directed support Option 1. As well as enabling training for Personal Assistants one suggestion is that a national workforce planning function could establish bank arrangements for Personal Assistants who are available to support people either on an ad-hoc or more permanent basis. Social care needs workforce planning support that is equal to, but not the same as, that provided to the NHS in Scotland, so that it addresses individual requirements like this as well as helping plan for the resilience of small, medium and large providers.
Commissioning and Procurement
We cover commissioning for the public good in Chapter 9. A key priority for a National Care System should be to establish mandatory parameters within which adult social care is commissioned and procured by Integration Joint Boards, including minimum fair work standards for social care.
As part of this, the Scottish Government should review national commissioning and procurement policy and guidance to support the delivery of these mandatory parameters in commissioning and procurement decisions delivered locally by Integration Joint Boards.
Training, development and regulation
Significant improvements are needed in training, development and regulation of the workforce, and commitment by employers to workforce development should be a key feature of revised commissioning and procurement arrangements.
As part of the National Care Service, described in Chapter 5, the Scottish Government should establish a national organisation for training and development, recruitment and retention for adult social care support, including a specific Social Work Agency for oversight of professional development, with appropriate read-across to shared and reciprocal learning with the NHS workforce.
The Scottish Social Services Council (SSSC) has an important role to play in this, along with NHS National Education Services (NES). Neither is currently equipped to meet the needs of the social care workforce in full. A priority for the National Care Service should be to review the role, functions and powers of the SSSC, taking account of activities that could be more effectively carried out in close partnership with NHS NES. This is an important example of a priority task for joint working between the National Care Service and the National Health Service. At the same time, care must be taken not to "medicalise" social care and social work training: what is needed here is better joint working, and joint support, for professionals without losing the core integrity of professions that have developed over many years in different ways in response to different priorities.
Specific attention should be paid to developing professional support and supervision for people who often work in isolation from their peers, providing care and support in people's own homes and communities. Scotland needs to acknowledge and respond to the power of the workforce in these circumstances to transform people's lives for the better, to celebrate that contribution and embed a professional culture to support it. The unique importance of relationships and trust between people providing care and people using support as part of their lives should be central to our understanding of "what good looks like" in this respect.
I'm a woman migrant worker. I have been a support worker for adults with multiple/complex needs since 2011. I currently juggle four part time jobs, two of them still in the field of adults with complex/multiple needs.
In one of my social care roles as a Support Worker for a private provider I get paid £10 an hour, the same hourly rate since 2015. In my other social care role as a Personal Assistant, Option 1 Self Directed Support (SDS), I get paid £9.30 an hour. I rely on benefits to make ends meet at the end of the month.
I've been helping someone with complex/multiple needs to access support through SDS since 2015. After six assessments and two complaints against the local authority, this person who has met substantial and critical criteria to access support, is still waiting on a care package. I am aware of another two adults with complex needs that have died waiting on a SDS care package. The current provision of adult social care has been in crisis long before the pandemic, as described by the Fair Work Convention Report On Social Care 2019. I think that a National Care Service is the way forward. Publicly owned and free at the point of need. The implementation of such a system will require time and investment. In the meantime, as a matter of urgency, I think that we should improve terms and conditions for care workers through sectoral collective bargaining and the involvement of all stakeholders: the Scottish Government, Local Authorities , employers and unions.
"The current provision of adult social care has been in crisis long before the pandemic, … a National Care Service is the way forward."
Our recommendations for creating a National Care Service provide a mechanism for delivery of Fair Work in social care and support. To improve terms and conditions for the social care workforce, and to properly reflect the value social care brings to Scotland's economy and wellbeing of its people, we recommend:
42. Rapid delivery of all of the recommendations of the Fair Work Convention, with an ambitious timetable for implementation to be set by the Scottish Government.
43. Conduct a national job evaluation exercise for work in social care, to establish a fair and equitable assessment of terms and conditions for different roles. This should take account of skills, qualifications, responsibilities and contribution.
44. Putting in place national minimum terms and conditions as a key component of new requirements for commissioning and procurement by Integration Joint Boards. Specific priority should be given to pay, travel time, sick pay arrangements, training and development, maternity leave, progression pathways, flexible pathways and pension provision. The national evaluation of terms and conditions should be undertaken to inform these minimum standards and these should be reviewed as required.
45. Establishing a national organisation for training, development, recruitment and retention for adult social care support, including a specific Social Work Agency for oversight of professional development. The current role, functions and powers of the SSSC should be reviewed and appropriate read-across embedded for shared and reciprocal learning with the NHS workforce.
46. Establishing a national forum comprised of workforce representation, employers, Integration Joint Boards and the Scottish Government to advise the National Care Service on workforce priorities and to take the lead in creating national sector level collective bargaining of terms and conditions.
47. National oversight of workforce planning for social work and social care, which respects the diversity and scale of employment arrangements while improving resilience and arrangements for mutual support should be a priority for a National Care Service.
48. The recommendations listed above should apply to Personal Assistants employed by people using Option 1 of SDS, who should be explicitly recognised as members of the workforce, as well as employees of providers in the public, third and independent sectors. This recommendation should be delivered in full partnership with the independent living movement.
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