Department of Health Evidence for Change Seminar

17th November 2009

Michelle Cornes, Jo Moriarty, Saidah Blendi-Mahota, Tim Chittleburgh, Shereen Hussein and Jill Manthorpe

Temporary Agency Workers in the Adult Social Care Workforce

Issues in procurement and management

‘By 2020 it is expected that employers will no longer need to rely on temporary staff to cover tasks that would normally be carried out by a permanent social worker and that as a result those receiving care will be able to count on continuity in the person providing their care’

Options for Excellence (DH, 2006)

Policy Background

Study Aims

To explore how local councils with adult social services responsibilities are implementing ‘Options for Excellence.’

To assess the impact of ‘Options for Excellence’ on the employment businesses sector and what if any role the sector is likely to play in the social care workforce of the future.

To gain a better understanding of the motivations, work histories, and future employment plans of agency workers.

Methods

Case studies of progress in three local council areas (rural, metropolitan, urban).

Interviews with: social services managers (n=18); recruitment consultants (n=15); and agency workers [both qualified (n=45) and unqualified (n=15)].

A survey of local councils (n=151) in England (36% response rate).

‘An under fire social services department spent nearly £1.5 million on agency staff in just six months… This is equal to £5,500 per agency social worker per month – it should cost about £2,000 for each social worker… [A local councillor] who wanted to see how successful the council’s recruitment campaign had been, branded the findings shocking…’

Local Newspaper Report 2009

Hitting the Headlines

Literature Review

‘Agency working poses a very real threat to the fabric of public service delivery, creating a downward spiral in which permanent employees leave to become agency workers to reap the benefits of agency employment… The institutionalisation of agency working into local managers’ employment practices is an extremely bleak scenario.’

Hoque and Kirkpatrick (2008)

The Agency Workforce

According to the NMDS-SC bank, pool and agency staff account for 5.6% of the social care workforce (Eborall and Griffiths, 2008)

Children’s services and the London boroughs are making most use of agency staff (Barstow, 2009)

In our survey, the average spend per authority in the 2008/9 financial year as a proportion of the adult social care budget was 8% (the figure was 17% for London boroughs).

Implementing ‘Options for Excellence’

80% of respondents in our survey of local authorities reported that their department had implemented strategies to reduce the use of agency workers:

¼ had introduced staff banks or pools ¾ of respondents had introduced managed vendor schemes

Managed Vendor Schemes

There is good evidence that managed vendor schemes are delivering cost savings to councils of between 3 and 10% (IDeA, 2006)

In our survey, 60% of respondents reported that their expenditure on agency working in 2008-2009 was less or the same as their expenditure in 2007-2008

Only one respondent thought expenditure would increase in 2110/2011

Impact on quality of service

‘We have to do more safeguarding and as a result our costs are increasing, however [our income] is being reduced and those two don’t really match up…

Recruitment Consultant‘…it is the [quality] parts of a recruitment service which are quietly removed…’

Recruitment Consultant

Recruitment consultancies as ethical businesses

‘I know local authorities that are struggling to fill their permanent roles and I have got the perfect candidates. However, the local authority policy is that they can’t use agencies for permanent recruitment. When they can’t fill a post they just keep spending another £20,000 on putting an ad out. It doesn’t make any sense... I wish they were keener for partnership working with us rather than being so against us.’

Recruitment Consultant

Impact of ‘Options for Excellence’ on Business Confidence

‘Recruitment into the [nursing and social care sector] will continue to be challenging and will demand more innovative strategies as well as models for sourcing and skill development e.g. increased reliance on bank and agency workers’.

Recruitment and Employment Confederation,

First Sector Profile for the Nursing and Social Care Group (2009)

Business as usual

‘[Local councils] tend to go round in cycles They will put a recruitment freeze on locums… It’s really strict and then six months later they realise that people have left or that they haven’t been able to recruit and then go back to using agency staff again. So it is just kind of cyclical. They all take turns in doing it so I won’t take [Options for Excellence] too seriously’.

Recruitment Consultant

Perspectives of front line managers

In our survey 92% of responding authorities had used agency workers in the 2008-2009 financial year.

‘Agency workers will always be with us… They are the only way to keep the show on the road and to keep those gaps filled’

General Manager Adult Social Care

Reasons for recruiting agency social workers

Difficulties in recruiting permanent staff (80%)* To fill a post quickly (78%) Sickness cover (65%) For a specific task or activity (69%) Other reason 22%

*Percentages of responses - figures are based on multiple responses so percentages will exceed 100%)

Advantages – a balanced approach

‘I don’t think that you necessarily have to have a completely permanent workforce, I think there is some value in having people who are short term and potentially more flexible, I don’t know in terms of how I would cut that… maybe 80/20 [permanent/agency]… I like to see a bit of a mix.’

Manager of an Integrated

Learning Disability Service

What is over reliance on agency staff?

‘If you have too many agency workers then the [permanent staff] in the team think [the agency workers] are getting more - I had better become an agency worker. It can be very negative… They [agency workers] become the more dominant influence on the team’.

Social Services Manager

‘Many teams which rely on agency staff are dysfunctional. They are characterised by poor management practices. In these teams, many permanent staff are ‘burnt out’ and the overall culture or working environment is poor.’

Agency Social Worker

‘I had one assignment where I only did a few days [and left]. Unfortunately it was in Children and Families and that reinforced my view of Children and Families these days. I don’t like it, it doesn’t suit me and I am too old for it. It was very much here is your case load - an extensive case load - get on with it. I didn’t like the practice. I felt very unsafe...’

Agency Social Worker

Poor management of agency workers

Giving agency workers the most complex case load (cases that no one else wants to deal with)

Expecting them to ‘hit the ground running’ (lack of induction especially for newly qualified social workers)

Unequal access to training and supervision

What is under-reliance?

‘If you need to get [a service user] out of bed then you need someone there immediately. Whereas the services I provide don’t necessarily need that immediate response so we are able to manage [staff] absences more easily than perhaps the other services [who will need to use agency workers].’

General Manager Adult Social Work Team

Gold collar workers or just trying to find the right team?

‘I am going now to work in a permanent position in a relatively poorly paid London borough but I like the job and the people and the managers; they are a great bunch of people; they are a bit of an old fashioned social work team but they do understand twenty first century social work, the post will be right for me, I know it.’

Agency Approved Social Worker

Implementing ‘Options for Excellence’ Progress Update

There is evidence that most local councils have introduced measures to tackle over reliance on agency workers.

There is evidence of efficiency savings and a trend toward further reducing expenditure on agency working

Indications that agency use may increase as challenges in recruitment and retention continue

Need to wait for next set of NMDS-SC figures to know if the size of the bank, pool and agency staff workforce has reduced (last reported figure was 5.6%)

Policy Recommendations

Assess the scope for partnership working with the employment business sector – bring them to the table when it comes to workforce planning (e.g. around the personalisation agenda)

Produce guidance on managing agency workers - clarify what constitutes ‘best practice’ with respects to standards for induction, training and supervision.

In terms of recruitment and retention, encourage strategies which look at team building, leadership and management development.