A National Care Service for Scotland: consultation

Valuing people who work in social care

BSL version of Chapter 7: Valuing people who work in social care

The case for change

Scotland's dedicated primary/community health and social care workforce provide critical support to people across Scotland every day. We need to do more to ensure that there is a greater understanding of the role that they play in the economy, the skills strength of their response to the needs of individuals, and the compassion and care they bring every day to the job they do. There is a need to grow the workforce in line with the increasing demand for support and care needs. The workforce need to be valued by all of us and they need to consider their job a career with opportunities to grow and develop. Our current workforce are our best advocates to encourage new entrants and promote working within the sector.

We know that to enable advocacy of this nature by the workforce we need to continue to embed our Fair Work expectations. Scotland's ambition to become a Fair Work nation by 2025 is underway, with many industries and sectors making positive steps towards this, and there is a commitment to ensure that social care is central to this work. Training and development, pay, terms and conditions and a better understanding of the plan for the future skills the sector will need should be the focus of national work moving forward.

This chapter explores the longer term system changes needed to support the workforce, within the wider context that there is already considerable work underway in this space to secure early progress.

Fair Work

How it works now

There are thousands of social care providers across adult, children's and justice services. Many of these provider services are commissioned by Integration Joint Boards (IJBs), and each social care provider is responsible for setting their workforce terms and conditions.

The desire to do a job that makes a difference is the main reason why people are motivated to take up a career in social care. However the general levels of pay within the social care workforce are low, with the majority of workers at the lower end of the pay scale, regardless of position, tenure, or experience. Staff have indicated this leaves them feeling "undervalued" and "underpaid". Having a workforce who feel valued will have positive impacts on people's experience of care. Stability of staff and continuity of care is important for people who access support, and progression and professional development for social care workers will result in better quality services.

There is currently no ability to set minimum standards for workforce conditions within individual providers; this leads to variety of workforce conditions across the sector.

While employment rights are reserved to the UK government, the Scottish Government is committed to promoting and supporting fair working practices wherever possible.

The social care sector is generally not well unionised. Whilst legally, every staff member is free to become a union member, many providers do not recognise a trade union, nor provide ongoing opportunities to engage. This can lead to poor membership in the workplace, and lack of representation in the sector as a whole. This is especially so regarding personal assistants.

Trade union recognition is more prevalent in larger, established workplaces (such as local authorities). These working relationships can support positive change for the workforce, however improvements in larger trade union recognised workplaces further cause disparity with the experiences of the workforce in smaller, non-unionised settings.

Issues and problems

The vast number of different social care providers has led to inconsistency and variation in pay and terms and conditions across the workforce. There is also a lack of parity for third and independent sector social care staff compared with those employed by local authorities, and more broadly between the health and social care sectors. This includes pay, terms and conditions, and role definition.

There has always been a lack of data regarding why staff leave their roles, and we need to fully understand this to address retention, however poor rates of pay can lead to a perception that social care is not an attractive career. A Scottish social care labour market report published in March 2020 found that one in ten social care employees indicated they would like to leave the sector in the future. This was reported to be mainly due to the stress and workload of their current job. The perception was that the main reason why people leave the workforce is for better terms and conditions, particularly pay levels, and another driver was in order to do a less demanding job for similar or better rates of pay. These drivers are likely to contribute to the longstanding difficulties with recruitment and retention in the sector.

Since 2016, the Real Living Wage policy provides annual funding to providers to ensure that staff in direct care roles earn at least the Real Living Wage, however this has meant that for some, there has been a stagnation of wages for more senior or experienced care workers, due to funding being focused on the lower pay-bands, which tend to be less experienced or tenured staff members.

Some members (or parts) of the workforce suggest they are not always valued or well treated by employers and there is no collective voice of the sector. This again can be especially so for personal assistants.

Many providers, when surveyed, have indicated they would want to do more to enable their workforce to have an effective, collective voice at a local level, enabling them to comment on and address matters of importance, such as their terms and conditions, with their employer. Many providers however suggest that much of the changes the workforce request rely on increased funding or changes which cannot be made at a local level.

Many staff, when surveyed, note frustration with changes not being implemented, which can lead to a loss of staff engagement and innovation.

Relevant Independent Review of Adult Social Care Recommendations

Recommendation 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.

Recommendation 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.

Recommendation 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.

What we propose

To address the issues outlined above, we propose and seek your views on the following:

To ensure the workforce is recognised as a central pillar to the high quality outcomes expected, the National Care Service (NCS) could take the lead in the development, administration, and assessment of national workforce quality standards that support the practical delivery of Fair Work principles. This could include rates of pay, security of employment contracts, and training and development within the sector. This could take the form of a "Fair Work Accreditation Scheme", which would enable providers, staff, clients, and funders to easily identify where Fair Work practice is embedded within an organisation.

The NCS could oversee the creation of a National Job Evaluation framework/scheme which providers can opt into, to ensure they are able to confidently assess and reward staff on the basis of recognised job families (which align to long term workforce planning needs). The NCS could provide the opportunity to implement a national pay-band structure similar to that within the NHS.

We propose that the NCS will develop and manage a National Commissioning and Procurement Framework of standards and processes for social care, which will include templates and core criteria to base decisions and award of contracts on. Core criteria will include an emphasis on workforce terms and conditions that support, develop, empower, and value their staff, and requirements for a level of financial transparency of publicly funded service providers. Commissioning and procurement will therefore be a driving force to ensure the workforce, including personal assistants, is appropriately valued.

Questions

Q87. Do you think a 'Fair Work Accreditation Scheme" would encourage providers to improve social care workforce terms and conditions?

BSL Version of Question 87

• Yes
• No

Please say why.

Q88. What do you think would make social care workers feel more valued in their role? (Please rank as many as you want of the following in order of importance, e.g. 1, 2, 3…)

BSL Version of Question 88

• Improved pay
• Improved terms and conditions, including issues such as improvements to sick pay, annual leave, maternity/paternity pay, pensions, and development/learning time
• Removal of zero hour contracts where these are not desired
• More publicity/visibility about the value social care workers add to society
• Effective voice/collective bargaining
• Better access to training and development opportunities
• Increased awareness of, and opportunity to, complete formal accreditation and qualifications
• Clearer information on options for career progression
• Consistent job roles and expectations
• Progression linked to training and development
• Better access to information about matters that affect the workforce or people who access support
• Minimum entry level qualifications
• Registration of the personal assistant workforce
• Other (please say below what these could be)

Please explain suggestions for the "Other" option in the below box

Q89. How could additional responsibility at senior/managerial levels be better recognised? (Please rank the following in order of importance, e.g. 1, 2, 3…):

BSL Version of Question 89

• Improved pay
• Improved terms and conditions
• Improving access to training and development opportunities to support people in this role (for example time, to complete these)
• Increasing awareness of, and opportunity to complete formal accreditation and qualifications to support people in this role
• Other (please explain)

Please explain suggestions for the "Other" option in the below box

Q90. Should the National Care Service establish a national forum with workforce representation, employers, Community Health and Social Care Boards to advise it on workforce priorities, terms and conditions and collective bargaining?

BSL Version of Question 90

• Yes
• No

Please say why or offer alternative suggestions

Workforce planning

How it works now

Workforce planning across social care employers is varied and complex, which makes accurately planning workforce requirements difficult.

Issues and problems

The complexity of health and social care, given the number of employers, makes workforce planning difficult and lessons learned from the pandemic should be an initial priority.

A lack of consistent, robust, and easy to access data across the social care sector is a continuing issue that needs resolved, making it difficult to workforce plan nationally, regionally, and locally.

Relevant Independent Review of Adult Social Care Recommendations

Recommendation 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.

What we propose

To address the issues outlined above, we propose and seek your views on the following:

The development of a consistent approach to integrated workforce planning with health, supported by a national tools/framework and an agreed data set.

A National Care Service could ensure a longer term strategic approach to meeting social care workforce requirements across the public, private and third sector social care providers in Scotland.

Questions

Q91. What would make it easier to plan for workforce across the social care sector? (Please tick all that apply.)

BSL Version of Question 91

• A national approach to workforce planning
• Consistent use of an agreed workforce planning methodology
• An agreed national data set
• National workforce planning tool(s)
• A national workforce planning framework
• Development and introduction of specific workforce planning capacity
• Workforce planning skills development for relevant staff in social care
• Something else (please explain below)

Training and development

How it works now

There is variation in access to workforce development and the support offered to achieve qualifications and learning.

The current regulation framework covering over 200,000 employees cannot compel providers to ensure workers gain the required qualifications or undertake ongoing development. It is the responsibility of the individual worker to obtain the qualification necessary for their registration and continued employment.

There are specialist courses and qualifications available for people considering a career in social care, however there may not be great awareness of these. For example, how to access information on what qualification may be required for specific roles or specialisms.

There is a projected shortfall of training provider capacity to meet the demand for qualifications required for social services registration over the next five years, particularly in relation to a key qualification required for adult social care workers. Work is underway to explore solutions to this.

Issues and problems

The end of freedom of movement following the UK's exit from the EU could exacerbate existing staff capacity issues and impact continuity of care. Social care workers (other than senior care workers) are not currently in scope for the new UK Health and Care Visa nor included in the Shortage Occupation List. To backfill a loss of staff, the sector is heavily reliant on agency workers which incurs inflated costs for providers, possibly reducing available funding which could be invested in other areas.

Whilst apprenticeships are used in the sector, particularly by private providers, there is concern that social care is not seen as a priority for allocation of funding for apprenticeships or qualifications at higher and further education levels.

The five year period to achieve the required social care qualification is seen as too long and a disincentive for some employers to invest in the learning and development of the workforce. This has led to variation in standards and may have contributed to the high turnover.

Skills and training do not always follow a clear pathway and there are inconsistent approaches to training, as it is not a requirement within contracts.

Whilst there are specialist qualifications available in the sector, the titles they are given may make it difficult to understand which ones are required for particular roles or specialties.

Relevant Independent Review of Adult Social Care Recommendations

Recommendation 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 Scottish Social Services Council should be reviewed and appropriate read-across embedded for shared and reciprocal learning with the NHS workforce.

What we propose

Workforce training and development is inextricably linked to quality delivery and continuous improvement. To ensure that there is appropriate and relevant training and development the National Care Service (NCS) will set training and development requirements that support both entry to the workforce and continuous professional development.

To ensure access to training is sufficient the NCS will provide and/or secure the provision of training and development for the social care workforce. This will complement the leadership and development role proposed for social work.

Questions

Q92. Do you agree that the National Care Service should set training and development requirements for the social care workforce?

BSL Version of Question 92

• Yes
• No

Please say why

Q93. Do you agree that the National Care Service should be able to provide and/or secure the provision of training and development for the social care workforce?

BSL Version of Question 93

• Yes
• No

Personal Assistants

How it works now

Personal assistants are individuals directly recruited by people in receipt of direct payments of Self-directed Support (SDS) and/or Independent Living Fund (ILF) funds from among the general population. Personal assistants may, or may not, have qualifications or prior experience as these are not always required by their prospective employer. Some personal assistant employers may prefer workers who have not been pre-moulded by prior regulated employment or formal training.

Personal assistant workers provide a key role in the care and support for individuals who require support. This work is unique, centred upon the individual's needs and enabling them to exercise choice and control in the decisions about their life. The role of the personal assistant is very much in-keeping with the ethos of SDS, allowing an individual to participate in life with dignity. However, as a workforce offering paid support to a personal employer they share some of the employment profiles of "domestic service", despite often carrying out complex care needs for individuals with significant support requirements. Examples of this can include catheter care or managing challenging behaviours sometimes reserved for qualified staff. Personal assistants have no supervision, or complaint/personnel mechanism, other than directly with their personal employer. They have no collective bargaining.

Personal assistants are paid for by the person who is in receipt of funding from SDS option 1 and/or ILF. Personal assistant support is not a service regulated by the Care Inspectorate. Nor are Personal assistants registered through the Scottish Social Services Council (SSSC). Personal assistants may be employed by means of other funding sources, such as state benefits or private funds/savings.

It is the responsibility of the direct payment/ILF recipient or their guardian/responsible adult to comply with employment legislation.

In the future there will be a requirement for non-family Personal assistants to complete a Disclosure Scotland Protecting Vulnerable Groups (PVG) check.

Personal assistants are dispersed throughout Scotland, in personal employment and are non-unionised.

Issues and problems

There is currently no accurate data on publicly funded personal assistants, estimates are upwards of 6,000 in Scotland based on available data on personal assistant employers collected by NHS National Services Scotland, and an estimate of the average number of personal assistants per employer.

As personal assistants are not registered, it makes it difficult to identify, engage, and support them. Whilst there has been previous work done to consider registration of personal assistants, some independent living movement organisations and disability led organisations representing the personal assistant employer have views to be taken into account.

There is no requirement for personal assistants to receive clear and consistent information, training, and capacity building in supporting and delivering self-directed approaches, other than from their employer. There is currently no consistent standard or checks or support on relevant and appropriate values, skills, knowledge, confidence, and training for personal assistants, other than from their employer.

A lack of knowledge and understanding of SDS across the social care workforce in Scotland leads to situations where SDS option 1 is not fully understood, and the need for the personal assistant and the personal assistant's employer to receive sufficient training in the requirements of employment law.

If the decision is made for any form of registration of personal assistants then this will need to be legislated for.

Due to the lack of profile of this workforce, there is significant difficulty in reaching personal assistants in order to provide further support.

Some people accessing SDS option 1 – direct payment have spoken of the administration burden of securing personal assistant support and also of struggling to secure the right care at the right time. There is some evidence that providing further administrative, recruitment, or employment support (such as a bank of personal assistants) may encourage greater adoption of direct payments of self-directed support or ILF.

Relevant Independent Review of Adult Social Care Recommendations

Recommendation 48: The recommendations listed above [relating to Fair Work] should apply to personal assistants employed by people using Option 1 of self-directed support [or Independent Living Fund], 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.

What we propose

In order to understand the extent of personal assistants operating across Scotland and improve and ensure appropriate support across the workforce, we propose that processes will be put in place to require personal assistants in Scotland to register centrally.

In addition, there has been consideration of national minimum employment standards for personal assistants to ensure parity and fairness across Scotland. The National Care Service (NCS) could have a role in supporting these as part of future care standards.

Consideration of provision of further administrative, recruitment or employment support may encourage further adoption of the full range of SDS options. Any changes should ensure that personal choice about how care is delivered is protected and should smooth the process rather than making it more bureaucratic.

There is also a desire to ensure that personal assistants are able to access training and development opportunities to ensure they are have the necessary skills to provide support.

Questions

Q94. Do you agree that all personal assistants should be required to register centrally moving forward?

BSL Version of Question 94

• Yes
• No

Please say why.

Q95. What types of additional support might be helpful to personal assistants and people considering employing personal assistants? (Please tick all that apply)

BSL Version of Question 95

• National minimum employment standards for the personal assistant employer
• Promotion of the profession of social care personal assistants
• Regional Networks of banks matching personal assistants and available work.
• Career progression pathway for personal assistants
• Recognition of the personal assistant profession as part of the social care workforce and for their voice to be part of any eventual national forum to advise the National Care Service on workforce priorities
• A free national self-directed support advice helpline
• The provision of resilient payroll services to support the personal assistant's employer as part of their Self-directed Support Option 1 package
• Other (please explain)

Q96. Should personal assistants be able to access a range of training and development opportunities of which a minimum level would be mandatory ?

BSL Version of Question 96

• Yes
• No