Skill Development in the Social Care Sector:

An Assessment of Institutional and Organisational Capacity

Helen Rainbird, Elspeth Leeson and Anne Munro

University of Birmingham

and Edinburgh Napier University

A research project commissioned under the Department of

Health, Policy Research Programme Social Care Workforce

Initiative

Acknowledgements This report was commissioned under the Department of Health‟s Policy Research

Programme Social Care Workforce Initiative. The research started in May 2007 and

ran until April 2009.

The research project would not have been possible without the help of a large number

of people. We are grateful to the individuals who facilitated access to the

organisations which were contacted in the course of the fieldwork and to all the

interviewees who generously gave their time to talk to us. We would also like to

acknowledge the contribution of the members of the project‟s Practitioner Advisory

Group, especially those who have been involved since the inception of the project.

Their advice has been extremely valuable and allowed us to establish a productive

dialogue throughout the project with the world of practice. We are also grateful to

Hazel Qureshi, the Programme Director, for her support and guidance throughout the

project.

Headline Summary

How can the quality of care be improved through workforce development?

The most effective forms of workforce development involve whole organisation

approaches to managing all workers involved in care services. This requires

management systems which treat training as an investment; developing and

recognising the expertise of frontline staff; valuing and trusting staff. These systems

contribute to workers‟ self-confidence and the ability to act autonomously.

What can be learned from the organisations which have been most successful in

developing workforce skills?

Whole organisation approaches are supported by resources dedicated to the training

needs of the organisation and staff, rather than relying on solely compliance with

regulatory requirements and the availability of free training. This requires building

management competence and using trainers who have competence in care and in

learning. Work/life balance policies and team-working allow flexibility and tailoring

of service delivery. Belonging to wider networks contributes to sharing knowledge of

good practice with other organisations which benefits the sector.

What can be learned about wider structures to support skill development?

Multiple institutions in the sector can be confusing, as are frequent changes in

institutions and regulatory requirements. Multiple sources of funding make planning

difficult and incur coordination costs. At regional level, a challenge lies in developing

sustainable management systems and funding mechanisms which are not reliant on

enthusiastic individuals and one off projects. Making social care an attractive career

for young people presents many challenges (appropriate funding for services; funding

for education, training and CPD; rewards for qualifications) which can not be

resolved at local level. The pay and status of the occupation affects how young people

and their parents perceive it, and the attitudes of other professional groups.

What are the implications of the personalisation agenda for the capacity of

organisations and workers themselves to improve their skills now and in the

future?

There is an anomaly if registration requirements which apply to domiciliary care

workers do not apply to personal assistants employed under direct payments systems.

Having intermediary organisations and local support systems for providing

management of training, CPD and mentoring systems is necessary to overcome the

isolation of personal assistants, and to ensure collective learning that allows services

to be tailored to users‟ needs. Direct employment with service providers will continue

to represent the best mechanism for creating the conditions for establishing a

professionally qualified workforce with a career structure and to attract young people

to the sector.

Contents

Page

1. Executive Summary 1

2. Introduction 4

3. Institutions in the social care sector 15

4. Approaches to skill development 31

4.1 Issues identified by service users and their carers 31

4.2 Organisational approaches to skill development 33

4.3 Developing training capacity 47

4.4 Developing organisational capacity through consortia arrangements 50

4.5 Educational and career development routes 53

4.5.1 Incorporating social care into the secondary curriculum 53

4.5.2 Providing a work-based higher education qualification 56

4.5.3 New pathways into professional qualifications 59

5. Expansive and restrictive learning environments 64

6. Conclusion 75

7. Bibliography 78

Appendices

1. Methodology 80

2. Major policy documents and summary of contents 92

3. User consultation: Ann Davis and Rosemary Littlechild, ‘Hearing Older

People’s Voices’, 2008 94

4. The case studies Service provider: The Residential Home 118

Service provider: The Community Caring Trust 122

Service provider: The Agency 126

Service provider: The Home Support Dementia Team 129

Training organisation: The Not for Profit Provider and Training Division 133

Training organisation: The Training Company 138

Regional consortium: The Limited Company 140

Regional consortium: The Council-backed Alliance 144

Regional consortium: The Institutionalised Alliance 147

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1. Executive Summary

The social care sector is highly dependent on the quality and training of the workers

who provide services to users. With an ageing population demand for these services is

set to increase. Many employers claim that their workers are their most important

resource, but how far is this evident in a sector which has traditionally relied on a low

paid and low qualified workforce? This project set out to examine the institutional

infrastructure of the social care sector and how organisations providing services

manage and develop their workforces.

Our headline findings to four major questions are as follows:

How can the quality of care be improved through workforce development?

The following factors facilitate employee learning:

Whole organisation approaches to managing the workforce.

Whole workforce approaches to learning and supporting the care of service

users.

Regarding training and development as an investment rather than a cost, which

contributes to the quality of services, relationship- and reputation-building

with commissioners, staff and service users.

Developing and recognising the expertise of frontline staff, contributing their

understanding of service users‟ conditions and needs, rather than seeing them

and allowing them to see themselves as „just a part-time worker‟ or „just a

carer‟.

Valuing and trusting staff and giving them autonomy.

Developing staff expertise through worker-led learning.

Developing competence in IT skills as a means of accessing further learning.

Building staff confidence through learning and involvement in ambassadorial

roles for the organisation.

What can be learned from the organisations which have been most successful in

developing workforce skills?

The following factors were linked to effective management systems for employee

learning:

Allocating dedicated resources to the training needs of the organisation and

staff, rather than relying solely on compliance with mandatory requirements

and the availability of public funding.

Building management competence through education and work-based learning

routes, as well as through sharing expertise across the sector.

Having trainers who have professional competence in care and in

management.

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Management systems which allow staff to give their best to the organisation,

for example, work/life balance policies.

Developing team working practices, which allow flexibility and tailoring of

service delivery.

Belonging to wider networks and communities of practice for access to

resources for training and knowledge resources (funding, policy

developments, information about National Minimum Data Set, sharing

knowledge of good practice with other organisations).

What can be learned about wider structures to support skill development?

Multiple institutions in the sector can be confusing, especially for smaller

organisations.

Frequent changes in institutions and regulatory requirements can be confusing

and create disincentives for improving workforce qualifications, especially for

smaller organisations.

Multiple sources of funding and eligibility criteria mean that accessing

resources for training and assessment can be difficult, and this impacts on the

ability to plan for organisational needs, especially for smaller organisations.

Innovative approaches involving partnerships with local authorities, service

providers, training organisations, educational establishments, agencies and

trade unions contribute to institution-building at local and regional level. A

challenge lies in developing sustainable management systems and funding

mechanisms which are not reliant on enthusiastic individuals and one off

projects alone.

The professional nature of care work can be enhanced by creating an

educational foundation for careers in the care sector and creating career routes

into professionally qualified work through educational and work-based

pathways. This requires support from stakeholder organisations and

consistency in the approach of sectoral bodies.

Making social care an attractive career for young people presents many

challenges (appropriate funding for services; funding for training and CPD;

rewards for qualifications) which can not be resolved at local level. Whilst

many care workers are motivated by intrinsic rather than purely financial

rewards, the pay and status of the occupation affects how young people and

their parents perceive it, and the attitudes of other professional groups.

What are the implications of the personalisation agenda for the capacity of

organisations and workers themselves to improve their skills now and in the

future?

The „best practice‟ organisations aim to tailor services to users‟ needs through

good management practices, for example, through their ethos of care, team-

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working, managing employees‟ work-life balance and allowing employees to

become expert workers, capable of making decisions autonomously.

They aim to recruit workers who have a disposition for care work and to make

care an attractive occupation by creating the conditions for staff to grow in

their jobs and progress in their careers.

Whilst these conditions are most likely to be found in providers which directly

employ staff, much can be learned from the case study of an agency which

provides training, CPD and believes that staff have „the right to be managed‟.

There is an anomaly if the registration requirements which apply to

domiciliary care workers do not apply to personal assistants employed under

direct payments systems. Having local support systems for providing training,

CPD and mentoring systems would provide an alternative structure to that of

direct employment.

Direct employment with service providers will continue to represent the best

mechanism for creating the conditions for establishing a professionally

qualified workforce with a career structure.

A key message is that many aspects of the institutional framework are changing:

how do small service providers keep pace with developments? What are the

implications for service users employing personal assistants? Case studies of

regional consortia arrangements suggest that sharing knowledge of changes in

the sector are significant in planning for, identifying and sharing resources to

support change.

Nevertheless, there are concerns about who has a strategic overview for the

sector and the incentives and disincentives for skill development created by

different funding regimes for services, on the one hand, and for training and

assessment, on the other.

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2. Introduction 2.1 Statement of the problem in the social care sector

The workforces of social work and social care are the backbone of the country‟s care

system. To achieve a life enhancing quality of care and to meet the government

objectives for the modernisation of the social care system requires „a world class

workforce that is skilled, dedicated and valued and supported to do its best‟

(Department of Health, 2006). Yet two events in the week starting the 6th

April 2009

indicate the extent to which there is still room for improvement in the delivery of

adult social care services in the UK.

A BBC Panorama Programme on 6th

April 2009 investigated „Britain‟s

Homecare Scandal‟, using two undercover care workers. Although they had

both received 4 days training from Help the Aged which exceeded the

National Minimum Training requirements prior to the programme, they

applied for jobs stating that they had no previous training. At one agency the

only training received was to watch four 20 minute DVDs, a 90 minute tutorial

and to work alongside a more experienced worker, who herself had not

received training in lifting and the use of hoists. At the second agency,

workers reported that they were so busy that they never had time for training,

a situation described as „training is on the “never, never” here‟.

On 10th April, 2009, The Guardian reported that a Local Government

Association survey of social services departments in England demonstrated

that 15 per cent of local authorities had seen closures of residential homes put

pressure on the supply of places. It warned that there was a potential shortage

of places in privately run care homes, as independent owners close their

businesses under pressures from the recession (The Guardian, 10.4.2009). In

the same report, Cynthia Bower, Chief Executive of the Care Quality

Commission, said in response to the Panorama investigation: “We will not

hesitate to use our statutory powers to take action against any companies that

fail to provide acceptable levels of care”‟.

These events encapsulate one of the core problems in the social care sector: the

difficulty of improving services for users where effective management and training of

the workforce are absent; and the difficulty of enforcing statutory requirements for

worker competence in a context where exit from the sector is always an option for

employers, and indeed workers.

The project aims to identify effective practice in skills development and the

recognition of workers‟ skills. It focuses on adult care services and on care workers

and other categories of non-professional staff in the sector in England, where the

social care sector represents a substantial sector of employment. There are over

25,000 providers of adult social care, the majority of which are in the private sector.

Other providers are the voluntary sector and a small number of direct services by the

public sector. The majority of adult placement schemes are provided by the local

authorities but the care workers are not employed by the public sector (Department of

Health, 2007a). Despite the size of this sector and growing demand for services, the

formal qualifications held by this workforce are low.

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A well trained, skilled workforce is essential to meet the government‟s objectives for

modernising the social care sector, improving standards and users‟ quality of life.

(Department of Health, 1998). Although there are common principles relating to a

shift from institutionalised to more personalised provision of services throughout the

UK, with political devolution, social care policy is separate between the four countries

This project relates only to England, where social care represents a substantial sector

of employment, with 922,000 workers in paid employment the core areas of social

work, residential, day and domiciliary care in England in 2004 (Skills for Care,

2007:9). These figures do not include the wider employed social care workforce,

which includes workers in childcare, early years, NHS staff with caring functions,

foster carers and adopters, some school staff, nor the estimated 5 million unpaid

carers.

Despite the size of this sector and growing demand for services, the formal

qualifications held by this workforce are low. In 2000, Arthur Keefe, the Chair of the

Training Organisation for the Personal Social Services (Topss) England reported that

80 per cent of the social care workforce in England had no qualifications and that this

was leading to „unacceptable variations‟ in the quality of care services provided

(Topss England, 2000:2). In a sector where labour costs represent 80% of

expenditure, the skill development of the workforce is central to achieving

improvements in service delivery.

Although local authorities used to represent the larger employers in the sector and are

still significant, corporate providers such as BUPA and Four Seasons are now larger.

The proportion of the workforce located in the public sector is declining and numbers

employed by the private and voluntary sectors are rising. As the role of local

authorities shifts from that of direct providers to commissioners of social care, their

capacity to work with external providers and a range of other stakeholders in the

private and voluntary sectors in securing a competent workforce is of considerable

significance. The diversity of the sector, the large numbers of small businesses and

the extensive use of agency workers means that capacity to provide competence

assessment, underpinning knowledge and wider/continuing professional development

is limited (Rainbird et al, 2004). This raises significant questions concerning

management skills: the development of the skills of trainers, assessors, lecturers; other

learning advocate and mentoring roles within the sector; and the potential for using e-

learning and on-line resources.

In recent years there have been significant shifts in the policy context workforce

development in the sector. The Care Standards Act 2000 set environmental standards

for residential care homes. It established a series of structures to improve the quality

of care services, including the Commission for Social Care Inspection (CSCI) which

merged with the Health Care Commission in 2009 to form the Care Quality

Commission; the General Social Care Council (GSCC); the Training Organisation for

the Personal Social Services (Topss), which became Skills for Care (SfC) in 2005;

and the Social Care Institute for Excellence (SCIE) (Department for Education and

Skills/ Department of Health, 2006). The Care Standards Act (2000) introduced

statutory requirements for induction and foundation training in April 2002, and targets

were set for workers and registered managers to attain National Vocational

Qualifications so that employers could demonstrate that they had a competent

workforce.

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This regulatory framework sets the context in which policy towards care services is

delivered. The White Paper Our Health, Our Care, Our Say (HM Government/

Department of Health, 2006) develops the concept of community services and a

commitment to tailoring services to individual needs. It also identifies the need to

integrate services across Health and Social Care by establishing joint teams and career

pathways. This has implications not just for practice but also for skills development.

Different government departments, institutional and professional legacies have

resulted in uneven progress towards this objective. A key concern is there the extent

to which relationships within the sector facilitate or hinder the development of

workforce skills.

The Options for Excellence (Department for Education and Skills/Department of

Health, 2006) review of the social care workforce considered the options for

increasing the supply of all workers in the social care sector and developed a vision

for it for 2020. It identified a series of challenges for supervisors, managers and

leaders; the need for strategies for training and development and for continuing

professional development that would allow workers to adapt to change and progress

in their careers; the need to identify a whole systems model for leadership and

management and development; and a means of improving HRM practices in the

sector (2006:xi). Its vision for the future included a more positive perception of the

workforce in the sector; a workforce which promotes participation from users and

carers; partnership working across the workforce and with other professionals and

sectors; and a professional workforce which was trained, accountable and committed

to delivering an excellent standard of care (2006:xi). In addition to improving the

qualifications of care workers, it identified the need for organisations to become

learning organisations, capable of promoting CPD and integrating the views of service

users in workforce development and improving leadership and management

(2006:xii). An emphasis on service user involvement in social care policy and practice

has influenced roles, tasks and the employment relationships of sections of the

workforce (Beresford, 2007).

However, this is a sector which, for various reasons experiences difficulties in

recruiting, rewarding and retaining staff. Barnard et al.‟s , survey of 58 members of

the Social Care Employers‟ Forum identified five major areas of concern which

contribute to this:

Funding shortfalls: the fee income provided by local authorities is insufficient

to cover the cost of providing services.

Increased costs: the implementation of the Care Standards legislation has

increased costs, including those of providing staff training.

Difficulties in recruitment and retention of staff: high employment, low

salaries and competition from local authority employers, alongside reliance on

overtime work and agency staff.

Competition for staff: local authorities pay higher wages to care staff,

managers and supervisors and are able to offer better pensions and benefit

packages. As public sector workers, they have „key worker‟ status, entitling

them to affordable housing, which does not apply to voluntary sector workers.

The low status of care work. (Barnard et al., 2004:4-5).

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Although the report highlights competition with local authority employers in

particular, social care employers are in competition with other low pay sectors which

do not involve intimate care (managers often refer to supermarkets as competitors, see

Rainbird et al., 2001). They are also in competition with the National Health Service,

which has greater capacity for skills development, the provision of career progression

routes and growing demand for employment. Institutional issues, combined with

labour shortages mean that the relationship with the National Health Service involves

both cooperation and competition.

Nevertheless, there are long-standing concerns about the low status of care work,

which may affect potential workers‟ perception the potential for developing their

career in the sector and act as a barrier to recruitment. The Platt Report (2007)

reviewed the status of social care services for adults and drew attention to some

longstanding problems in the sector, in particular, its lack of confidence which makes

it „timid in its vision and ambition for how adult social care services can be delivered,

(2007:1). Negative perceptions of the service, held by service users, policy makers

and the general public, are not a motivating factor for the workforce. In the context of

policy pressures emphasising cooperation with other services, it argued that the

workforce „needs to be more confident in its contribution and knowledge for the

impact, which good quality social care can have, to be realised‟ (2007:6). It proposed

a five point plan for raising the status of the social care workforce and services

including a recommendation for a Skills Academy for the development of leadership,

commissioning and management in the sector and a vision for a fully registered

workforce.

Although these policy initiatives are concerned primarily with the delivery of care as

a service, there are other policy arenas which impinge on the sector. The Leitch

Report (2006) has recommendations for increasing adult skills at all levels, through a

demand-led system with public funding for adult skills to be channelled through Train

to Gain and Learner Accounts, increasing employer engagement and investment in

skills. The recommendations have a potential impact on the skills infrastructure of the

care sector insofar as funding is available for supporting adult learning and can be

accessed by organisations within the sector.

Since the interviews were conducted with the institutional stakeholders in 2007, the

government‟s proposals for the personalisation of care services, including personal

budgets, were set out in „Putting People First: A Shared Vision and Commitment to

the Transformation of Adult Social Care‟ (Department of Health, 2007b). The interim

statement „Putting People First: Working to Make it Happen‟ (Department of Health,

2008) set out strategic priorities for the social care workforce and invited stakeholder

responses to the challenges and opportunities arising from this agenda. The potential

implications of these proposals are explored in the case studies, which were

conducted in 2008 and the final sections of report reflect on the significance of the

research findings for these developments.

Under these circumstances, employers can adopt a range of strategies towards skill

development and retention: they can invest in training and development, recruit

externally, including migrant workers who may have significant qualifications, or

seek to manage the workforce in ways which increase labour retention. Nevertheless,

small employers do not have the benefits of scale and are unlikely to have a dedicated

8

Human Resource Management and training function: there are therefore significant

questions about the organisational and business planning capacity of these

organisations, as well as the sources of external expertise that are available to them.

Skills are a collective good, in the sense that although individual employers invest in

workforce skills, they can be used, potentially, by any employer in the sector (Streeck,

1989). As a result, social institutions are needed to establish standards and to ensure

that mechanisms are in place to ensure an effective supply of workforce skills. The

main focus of the project is on skills development and, in particular, sources of

workplace learning and development which can contribute to workers‟ formal

qualifications and capacity to progress within their job roles and into professional

qualifications. It will examine the extent to which this can be provided within the

employing organisation, by cooperative arrangements with other employers and other

interest organisations, or by external agencies and institutions. The different funding

mechanisms which provide incentives support skills development and competence

assessment are therefore within the remit of this project.

In this report, we locate the analysis of skill development in the context of social

institutions in the sector, which regulate and structure it; the organisations which

provide services and train workers; and in practices in the workplace which contribute

to employee learning.

The objectives of the project are:

a. To examine institutional capacity for developing the skills base of the social

care workforce and employer‟s ability to contribute to skills development.

b. To examine how a range of agencies and interest organisations contribute to

the development of this capacity.

c. To identify effective practice in skills development and the recognition of

workers‟ skills.

2.2 Institutional capacity: definition

Skills are a collective good. When employers invest in training they invest in the

individual employee. Because they can never be certain that they will receive the full

benefits from this investment, rational self-interest results in a level of investment in

training which is less than optimal (Streeck, 1989). Social institutions governing

training are designed to overcome market failure in the provision of training and to

encourage cooperation to produce sufficient skills to meet the needs of all employers

in a sector.

A number of institutional mechanisms have been used in different countries to support

the supply of training. These include:

Providing vocational learning through the educational system (but there may

be problems with its lack of integration with practice and inputs from

employers)

Providing sectoral bodies to distribute funds to individual employers e.g.

through training levies or the distribution of state funding. Such bodies may

also have a role in defining occupational standards, monitoring employers‟ use

of public resources, data collection on training activity, commissioning

research and identifying future skill needs, and developing new training

initiatives. These bodies may involve different interest organisations in their

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decision-making structures, which may be tripartite (the state, employer and

employee interests), bi-partite (employer and employee interests) or have other

structures for engaging stakeholder groups.

Collective interest organisations, such as employer organisations, may provide

a mechanism for articulating training needs, ensuring compliance with

standards, providing sources of expertise, advice and information, and

sometimes access to collectively managed resources on behalf of the sector.

The state may devolve some responsibilities to collective interest

organisations.

Consortia arrangements and group training schemes at local level provide a

mechanism for sharing resources, which are particularly important for smaller

organisations. Whereas large organisations often have the resources and

economies of scale to meet their own needs, this is not the case for smaller

organisations.

Streeck (1989) argues that in deregulated training systems „islands of excellence‟ can

still be found, nevertheless, the problem lies in the sharing and wider dissemination of

good practice.

There are three research questions which need to be considered in relation to

institutional capacity for skills development:

To what extent do social institutions create systems of incentives and

sanctions which encourage investment in training?

How do they encourage cooperation at different levels in the development of

skills as a collective, rather than individual, good?

To what extent do they involve different stakeholder groups?

2.3 Organisational capacity for skill development

Social institutions have an impact on practices in organisations and individual

workplaces. Research on the relationship between regulation and its impact on Human

Resource Management practices suggests that there are a range of possible responses

to regulation, which may change over time. In other words, there may be one response

to the initial „regulatory shock‟, but over time meeting regulatory requirements

becomes embedded in routine practices. Ram et al.‟s (2001) analysis of the

introduction of the National Minimum Wage identified its varying effects: some firms

moved up market, others were pushed to the limits of legitimate activity or were

pushed out of business all together. One consequence of moving up market was the

formalisation of employment relations, though other firms relied increasingly on

informality and, in some cases evasion as well. Rainbird et al.‟s (2002) analysis of the

NMW and training examined three sectors, which included social care. They

identified proactive and reactive approaches to the NMW, alongside regulatory

pressures derived from the Care Standards Act (2000). Proactive home managers

adopted a more professionalized approach to managing their business, including

planning ahead for future regulatory changes and using a range of HRM techniques

(recruitment and selection, training) to improve the quality of the workforce and

services provided. In other organisations reactive approach to compliance was

adopted, with home managers waiting for inspection visits to identify problems and

HRM techniques developing on a piecemeal basis, in response to different regulatory

requirements (e.g. working time directive). Responses to regulatory measures can

therefore be classified in the extent to which they produce reactive or proactive

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responses; whether this results in compliance in meeting minimum standards or

innovation in approaches to managing labour; and the extent to which measures are

adopted on a piecemeal or holistic basis. In this research, in order to understand the

link between national institutions and practices in local care providers, we have

developed the concept of local and cosmopolitan actors. Based on the social

anthropologist, Frederick Barth‟s (1963) concept of local and cosmopolitan

entrepreneurs, this identifies social actors‟ capacity for innovation based on the extent

of their connectedness to wider social networks. In this respect, we see cosmopolitan

actors as engaged in networks which connect them to people and resources at national

and regional level. This represents a source of learning through shared expertise and

access to shared resources (financial, shared courses and facilities) which contribute

to capacity for business planning and innovation. In contrast, local actors are less

likely to have access to these networks and resources and as a consequence have less

capacity to plan ahead and innovate. One of the challenges for building capacity in

skill development is in creating resources for smaller organisations which have

neither the internal resources of large organisations, nor the resources which can be

accessed through engagement in wider social networks.

The Care Standards Act (2000) laid out requirements for the workers and managers in

the care sector. These included requirements for care service providers to ensure that

all workers receive training, supervision and appraisal and opportunities to attain

further qualifications. National Minimum Standards require registered providers to

publish statements of purpose relating to the aims, objectives and care ethos of the

organisation; demonstrate evidence of management systems and record keeping; and

specify the skill mix of staff for different types of organisations and service users.

This has consequences both for the training and qualifications of managers, for

induction and foundation training to sector standards and for the attainment of NVQ

qualifications for care workers. All staff should have 3 days paid training a year and

have a training and development assessment. These requirements have consequences

for the resources which service providers allocate to training and development within

their organisations, as well as resources which are available externally to support the

attainment of minimum standards. As with any policy intervention, regulatory

measures have intended and unintended consequences.

Requirements to manage an organisation in a certain way and to provide minimum

levels of training and assessment, do not necessarily result in holistic approaches to

learning and development which include all workers. In order to understand this, it is

first important to recognise that workplace learning does not just involve formal

learning, for example, going on a course to a college or training centre, where a

formal body of knowledge is acquired. It also takes place through on-going practice

and learning from experienced workers. Lave and Wenger (1991) developed the

concept of a „community of practice‟ to explain how workers learn through

participation in the social relations of the workplace. The concept of a community of

practice highlights the social and collective nature of learning and this means that

understanding the work group, the way jobs are designed, as well as opportunities to

share knowledge of practice outside the immediate work group, can shed light on the

quality of learning at work (Fuller et al., 2004:4). This concept of learning through

participation, can be contrasted with Sfard‟s (1998) concept of learning as

acquisition, which characterises learning in educational institutions, where there is a

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formal curriculum that is associated with a formal body of academic knowledge,

which can be assessed by testing and is imparted by an expert in the form of a teacher.

To understand the quality of learning in the workplace, Fuller and Unwin (2004)

developed the concept of an expansive/restrictive continuum of learning

environments, based on their research on apprentice learning. In some organisations,

the aim of apprenticeship was a gradual transition to working as a productive

employee, opportunities to learn in communities of practice inside the organisation

and outside (for example, in a college of further education), opportunities to gain a

range of knowledge-based qualifications (e.g. BTEC), and as a means of aligning the

goals of developing the individual and organisational capability. They characterised

these as expansive learning environments. In contrast, other apprentices made a rapid

transition to being a productive employee, had restricted opportunities to participate in

wider communities of practice, had opportunities to qualify restricted to competence-

based qualifications (NVQs), and employee development was tailored to

organisational needs. They characterised these as restrictive learning environments. In

other words, regulatory requirements may contribute to introducing formal

mechanisms for managing training in organisations and may result in workers

attaining defined targets in terms of qualifications. Nevertheless, this focus on

outcomes, does not tell us much about the process of managing learning in the

workplace, nor the quality of learning which takes place. In other words, compliance

with regulations may result in a professionalisation of management systems, and the

introduction of a more systematic approach to managing the training and development

of workers, but it does not tell us about the extent and quality of the learning that

takes place.

In order to explore what the implications of this framework might be in care settings,

the expansive-restrictive continuum was applied to a comparison between two units

delivering care services within a single NHS trust. This illustrates how a common

framework of Human Resource and training strategy as laid down corporate decisions

and regulatory requirements was subject to local interpretation (see Evans et al.,

2006:62-64). The two units, Clover and Arrow, were both secure units of clients with

severe behavioural problems and had a relatively high staff/client ratio, as many

clients required one-to-one care. Both had a relatively high proportion of

professionally qualified staff due to the specialist nature of the care, but non-qualified

care assistants did most of the direct care work. Both units were required to meet

regulatory requirements for competence assessment for care staff (SVQs) and the

Trust was committed to providing learning opportunities for all staff and encouraged

job progression.

Despite the similarities in the two units, the approaches to the learning needs of staff

were very different, with Clover demonstrating the characteristics of a restrictive

learning environment and Arrow a more expansive one. In Clover Unit training was

limited to health and safety although specialist courses were sometimes organised.

Not one member of staff was taking SVQs, training outside the unit or Access to

Nursing courses. In contrast, in Arrow Unit, as well as mandatory training, the unit

ran its own team-building sessions and staff away days. Six members of staff had

progressed through to professional nurse training, either through an Access to Nursing

Programme, by taking Return to Learn (a second chance education programme,

provided through a partnership between the Trust and the trade union, UNISON) or

12

by completing SVQ level 2. Few training opportunities were available in working

time, but if a member of staff was studying, their hours of work were adjusted to

allow them to participate. Some staff, including some who had left to take the nurse

training programme, worked extra hours on the bank, so the manager could always

provide experienced staff for cover. The quality of the learning environment had also

been enhanced by increasing the educational content of the SVQ, by working in

multi-disciplinary teams and by increasing the work autonomy of the care assistants.

Staff shared their experiences of courses with other members of the team.

In these case study examples, the expansive-restrictive continuum helped to

distinguish between different kinds of practice in care settings. In one unit, high value

was placed on the contribution of care staff and considerable attention given to their

development. Staff work in multi-disciplinary teams in which qualified staff are not

seen as the only holders of expert knowledge, and autonomous working is

encouraged. Learning and job progression are actively encouraged and facilitated and,

in particular, the key role of the manager as an enabler is highlighted. The manager

provided encouragement, a flow of information about learning opportunities and,

most importantly, ensured that the organisation of work was used to expand rather

than restrict learning opportunities, even where the organisation was facing financial

constraints on training budgets. These characteristics were not found in the more

restrictive setting.

The workplace as a site for developing organisational capacity for skill development

As outlined in the example of Clover and Arrow wards, even where organisations

have a systematic approach to managing training and development, this is often not

sufficient to provide an environment in which learning is encouraged. This is

especially the case for workers in relatively low paid jobs, who are often seen by

managers, and sometimes by themselves, as not being interested in learning or in

having a career. This is especially the case for women workers who are often part-

time because of their family commitments. Research conducted by the authors on low

paid work in the public sector, which included many care settings (Rainbird et al,

1999), found that managers and supervisors were key in controlling and facilitating

learning at work. An unsympathetic manager can simply block information about

opportunities or, by failing to provide cover for release from work, make it difficult

for staff take time off for learning. Some managers may feel threatened by the

prospect of increased competence amongst the staff they manage. Equally, the

development review can be used to limit learning opportunities to what is strictly

required by the current job role, which may be particularly restrictive where there is

no formal career structure, rather than potential future roles which may involve

growing within the job.

In many cases managers‟ roles in training and development are formalised through the

requirement to conduct forms of staff appraisal and development reviewing, as well as

through supervisions. Managers play this role not just in relation to training and

assessment, but also in relation to more informal types of learning which take place

through the opportunities to learn through practice and participation in communities

of practice. The acquisition of a formal role in development reviewing does not

necessarily involve managers perceiving themselves as teachers and mentors to staff.

Nevertheless, some managers in Rainbird et al.‟s (1999) study did see their role in this

way, which involved facilitating informal learning opportunities in the workplace as

13

well as formal learning opportunities outside it. These managers felt secure in their

own positions and able to share their knowledge. They did not feel challenged by staff

acquiring new knowledge, rather:

„They had taken in these roles partly in response to their own experiences and

philosophies towards learning at work. It was also notable that they saw this as

a process of sharing knowledge with other staff. They did not see this as

undermining their own position in the workplace and in many instances

recognised that it would mean the staff would move on and get promotion

elsewhere‟ (Rainbird et al., 1999:61).

Three other features were associated with the practice of managers who explicitly saw

their roles as teaching and mentoring their colleagues. The first of these was their

interest in listening to staff and taking on board their ideas. The second was their

interest in preparing colleagues to take on roles which would prepare them for

promotion. The third was their consciousness of the potential to use the workplace as

a site of learning and to see it as a learning resource for others outside the

organisation.

Even where an organisation has a positive approach to workplace learning, Rainbird

et al (1999:62-65) found that there may still be barriers that individual members of

staff experience to learning and assessment. Where expectations are raised, but

training is not delivered, staff may feel disillusioned. Those who work at night or on

shifts may find it difficult to attend courses, to be assessed for NVQ qualifications, or

to gain experience of different roles which would allow NVQ certification to be

achieved. Moreover, it is harder to meet the needs of groups of workers who work in

geographically dispersed sites or on a peripatetic basis, compared to those who work

in fixed workplaces. Some workers genuinely lack confidence as learners and need

significant support and mentoring. Others may feel they are too old to learn and these

negative attitudes may be reinforced by managers, if they give the impression that

there is no point in investing in staff because they are close to retirement.

Why workers are so important to the quality of care

It is common for Human Resource Managers to claim that people are their most

important resource. Nowhere is this more important than in labour-intensive service

sectors, where personal relationships are central to the perceived quality of the service

encounter. Nevertheless social care does not fit into conventional characterisations of

service work, which are often seen as polarised into low skill, low discretion work in

typical encounters with clients, on the one hand, as opposed to high skill, autonomous

work forms, amongst professional service workers. Indeed central to care work is the

relationship to the individual service user, which is usually based on an on-going

social relationship. It is in this context that the quality of social relationships both

within the organisation providing the service and with the service user assumes

central importance. Herzenberg et al., 2000:56-7) refer to care work as a form of

„unrationalised and labour-intensive work‟, where there is relatively loose task

supervision, low to moderate skill (often unrecognised) in relation to formal

qualifications and informal, often unrecognised learning from other workers. The on-

going nature of the service encounter and the centrality of personal relations to the

quality of care suggest that both formal training and on-going learning through

practice are of particular significance in this type of working environment.

14

The policy objective of tailoring services to the needs of users has been identified in a

number of recent policy documents, such as Options for Excellence (2006), Putting

People First: A Shared Vision and Commitment to the Transformation of Adult Social

Care (2007) and Putting People First: Working to Make it Happen (2008). Although

these concerns are not new, the continuing problem of providing responsive services

which respect individuals‟ needs lies at the heart of government policy. Not only is

the ethos of the service provider as an organisation of significance to the quality of

care given to users, but also the way workers are managed will impinge on the

transmission of these values through organisational culture and practices. In other

words, the way in which workers are managed, will affect their ability to provide a

reliable service, and the respect and consideration they are shown by managers will be

transmitted in the respect and consideration they show to users.

As part of the personalisation agenda, a significant development is the promotion of

user engagement in decision-making through the shift to personal budgets, as a

mechanism for giving users greater control over the commissioning of services. The

implications of this for the delivery of services and the capacity of the sector to train

and develop workers are not yet clear.

The research questions concerning organisational capacity for skill development are:

How is learning and service quality enhancement promoted?

What are the characteristics of the organisations which take skill development

seriously?

What are the triggers for innovation in skill development?

What is the role of social institutions in promoting skill development in

organisations and workplaces?

How can skill development contribute to the establishment of satisfying jobs

and career pathways which will make this an attractive sector of employment

for the future?

What are the implications of the personalisation agenda and direct payments

systems for skill development?

15

3. Institutions in the social care sector

3.1 Institutional actors and interest organisations

Recent policies, discussed in the previous chapter, have influenced the nature and

needs of the care sector workforce and the social institutions governing workforce

development. This section of the report summarises the findings of the first phase of

the project which involved analysing the capacity of social institutions to support

skills development in the sector. A full list of the organisations interviewed in this

phase of the project is provided in Appendix 1 and a list of policy documents, along

with summaries of their contents is provided in Appendix 2.

Interviews were carried out with key informants from a range of institutional and

interest organizations. These included:

The Commission for Social Care Inspection – a regulatory body set up in

2004 which brought together the responsibilities of the National Care

Standards Commission, the Social Services Inspectorate and the joint review

area function of the Audit Commission. It regulated all social care in England,

for adults and children for the 18,000 providers of social care in care homes,

children‟s homes, nursing homes, domiciliary care and council services. In

April 2007 responsibility for the regulation of children‟s services was

transferred to OFSTED, so it became the adult social care regulator. In April

2009, it merged with the Health Care Commission and the Mental Health Act

Commission to form a single inspectorate, the Care Quality Commission, for

adult and child health, adult social care, and mental health. Part of the

organisation‟s responsibilities include a framework of national minimum

standards, which are set by the Department of Health, which affect a person

living in care settings, including standards for the workforce.

The General Social Care Council – Set up by the Care Standards Act (2000)

with responsibility for standards and improvement in social care. A regulatory

body concerned with maintaining a register of social workers, student social

workers and home care workers (registration of the latter was due to start in

2008); operating a code of conduct that workers on the register must adhere

to; and endorsing the providers of graduate and post-graduate social work

education qualifications.

The Social Care Institute for Excellence – a body which identifies good

practice and disseminates guidance and resources with the aim of improving

social care. Its responsibilities cover any setting in which social care practice

takes place, in other words, the whole of the social care workforce.

Skills for Care – the sector skills council which is responsible for

occupational standards for adult social care and ensures that standards and

qualifications of the care workforce adapt to meet service user needs.

A Local Learning and Skills Council - funds and plans education and

training to improve workforce skills at the local level.

The Care Services Improvement Partnership – a body which was created

by the Department of Health in 2004 to provide assistance in modernising

service delivery and to promote integrated and partnership working across

health and social care. It supports the development of services by

implementing national policy locally.

16

Improvement and Development Agency (IDeA) – a company owned by the

Local Government Association to promote the improvement of local

government services. The workforce is one of the strands of work undertaken,

including that of adult social care.

Interviews were conducted with a number of stakeholder organisations, including

organisations representing service providers. These include:

The National Care Association – a trade association representing care

providers, the majority of which are care homes for older people, but also

representing children‟s homes, domiciliary care and younger adults. Members

are predominantly small, owner-managed, care homes.

The National Care Forum – an organisation representing the larger

providers of not-for-profit health and social care, who employ a combination

of paid staff and volunteers.

The Registered Nursing Home Association - an organisation representing

nursing home owners. Nursing homes tend to be slightly larger than care

homes and larger corporates tend to make up a larger proportion of the market

than in care homes. It includes private and voluntary sector members.

The Social Care Association – an organisation of individuals and corporate

organisations involved in social care for all service user groups, including

adults and children. It has a charitable arm, Social Care Education, which is a

training charity with the purpose of improving the training and qualifications

of staff in social care.

The UK Homecare Association - the professional association representing

independent sector providers of domiciliary care.

Stakeholders within the public sector who were interviewed were:

Association of Directors of Adult Social Services –a leadership organisation

for adult social care with a series of policy networks working with

government on policy initiatives and advising on the impact of policies. It has

a regional structure and a series of policy networks, including one on

workforce development. The network has representatives of the ADASS

regions on it and senior people from key organisations such as Skills for Care,

the Social Care Institute for Excellence, General Social Care Council, the

Commission for Social Care Inspection, Learn for Care (formerly the

National Association of Training Officers in Personal Social Services), the

Department of Health, the Care Services Improvement Partnership etc. The

organisation‟s remit concerns the social care workforce in whatever setting,

because of their role in commissioning services.

The Local Government Association - a member organisation of local

authority employers, which represents their interests in terms of lobbying

government and campaigning. It negotiates with different government

departments and external bodies and, in the social care sector, represents their

interests on bodies such as the General Social Care Council and the Social

Care Institute of Excellence on issues such as leadership and management. It

represents local government on the Board of Skills for Care and on the sector

skills body, the Workforce Hub, in the voluntary sector.

Birmingham City Council workforce development officer.

17

Stoke-on-Trent City Council – learning and development manager for

Communities and Adult Social Care.

Training organisations were represented through an interview conducted with a

regional representative of the Association of Care Training and Assessment

Networks.

In addition, interviews were conducted with representatives of an organisation

representing employees in the social care sector, in the form of UNISON, the public

sector union. Officers included those responsible for UNISON‟s Open College,

workforce development, the National Officer for the Local Government Service

Group, the South-East Regional Learning and Development Organiser, and the

Learning and Workforce Development Officer (Skills for Life).

A separate consultation exercise was conducted with service users to gain their

perspectives on what they valued in social care workers and how this could be

supported through training and skill development. This consultation was conducted in

the spring of 2008 by Ann Davis and Rosemary Littlechild of the Centre for

Excellence in Interdisciplinary Mental Health (CEIMH) at the University of

Birmingham. This is discussed in Section 4.1 and the full report is provided in

Appendix 3.

The complexity of the sector and its social institutions

In the previous chapter, the plural and fragmented nature of the sector was discussed.

This is a sector which is characterised by internal differentiation: employers are to be

found in the public, private, and not-for-profit sectors and vary from large

organisations to the very small. They provide care in a range of settings: in residential

and nursing homes, in day care centres and in service users‟ own homes. In addition,

there are agencies supplying workers: these may be employed by the agency or

simply introduced to another employer. However, because of the „fracturing of

employers‟ it represents a „really difficult sector to plan systematically across‟

(IDeA). The characteristics of the workforce - low paid, low status and with high

levels of turn over - make the creation of incentives for employers to invest in staff

especially difficult, given „a minimalistic approach over a long period of time‟. This

was described in the following terms:

„We‟ve actually got a low paid, low skilled, low everything. We‟ve got a

sector which is dealing with the most vulnerable people in society who are

being allowed to be practised on by non-qualified people, absolute outsiders, if

you like. You wouldn‟t allow a hairdresser anywhere near your hair if she was

doing her NVQ training, you know, and yet when you get to be 80 plus and

you‟re in a nursing home you haven‟t any choice over the fact that the carer

you‟ve got has got no skills and no qualifications. Other countries in Europe –

and we often go running to Europe if we want somebody to support our views

– other countries in Europe don‟t allow that. France, for example, won‟t allow

anybody in a care home that doesn‟t have a qualification, neither will

Germany from my understanding.‟ (RNHA)

It was recognised that different areas of government policy can pull in different

directions. In relation to the development of Skills for Life in the sector: „They developed material, they quality controlled it, they brought employers together with training providers to develop the materials. It was very … you

18

know, clearly bespoke, addressing what the employers said were the issues in their workplaces and none of that could have happened without that co-ordination and that injection of funds from the Local Authority and the other funders for that ……but in a sense it‟s trying to sort of un-do this fragmentation that‟s happened in the sector that has absolutely hampered the DfES‟s progress towards getting Skills for Life and other training delivered in this sector. So you‟ve got one Department breaking down this network of care providers and another really relying on them to be pointing at good employers consistently to deliver on the targets.‟ (UNISON)

The low status of the workforce is reflected in the low status of the sector, identified

in the Platt Report (2007). One interviewee described the sector as „us minnows on

the side of the Department of Health‟ and another spoke of childcare as having more

political focus through its stronger links to education and the Department of Children

and Schools.

This complexity has a number of consequences for the remit of institutions, the

coverage of regulations, but also for the capacity of different employers to meet

regulatory requirements and access resources for training to meet targets. The Platt

Report summarised this in the following terms:

„The sector is fragmented and there are serious barriers to creating an identity

for “social care”. Some barriers are attitudinal with some respondents having

the view that there is a divide between the public and the private and voluntary

sectors.

The public (including some politicians) does not know what the social care

infrastructure bodies have been set up to do, nor are some significant policies

well understood. For example, there are calls for a “NICE for social care” –

SCIE‟s role; and the public does not know that the title of social worker is

protected nor that social workers can be “struck off” for misconduct.‟ (Platt,

2007:22)

There are a number of ways in which this complexity impinges on workforce

development issues. The first of these concerns the coverage of regulations relating to

requirements for induction training and NVQ assessment. Effectively similar work

may be regulated if it is defined as social care and unregulated if it is seen as falling

outside social care. An example of this is the emergence of care trusts and social

enterprises with aspects of both health and social care in them. The blurring of

boundaries is in evidence in services which are located between health and social

care, learning disabilities, mental health services and palliative care. There are also

questions about how activities fall under the remit of different sector skills councils,

resulting in the need for good protocols and working arrangements between them in

relation to what is effectively „foreign policy‟.

A second set of issues concerns the domination of the sector by models of workforce

development which are framed in terms of the public and voluntary sectors, whereas

many service providers are for profit where „the motivation for quality and for

training is to do with the business and the bottom line‟ (SCIE). A key test will be the

extent to which social institutions can meet the challenges presented by the changing

nature of provision and the shift in local authority roles from providers to

commissioners of services.

19

There are separate issues which emerge from the policy emphasis on giving more

control to users over their lives. Although the tailoring of services to users‟ needs has

long been a preoccupation in the sector, direct payments systems will allow some

service users to directly employ carers. Personal assistants employed on this basis are

not covered by the regulations concerning domiciliary care work. Where there are

regulated and unregulated segments of the workforce, there is a possibility that those

who do not meet requirements in the regulated sector will move outside it to avoid

them.

Complexity is evident in the roles of different organisations in relation to standard-

setting, inspection, registration, skill development and the dissemination of good

practice, and how they work together. One interviewee explained the way in which

these roles interacted in the following terms:

„So if you take Level 2 as the National Minimum Standard, that‟s

government‟s role to set National Minimum Standards. Government then

require the inspectorate to police the National Minimum Standard. It requires

Skills for Care and other players to deliver that National Minimum Standard

and on an individual basis GSCC to register to that National Minimum

Standard. So you can see all the different bits of the jigsaw and how they do

and don‟t sometimes fit together.‟ (LGA)

This situation was seen as creating difficulties for individuals to understand how

different institutions relate to each other:

„For people outside staff development it is inordinately complicated; that it

exists in an environment of its own, uses a language and a series of acronyms

that are impenetrable to the world outside and at times to those of us who are

involved in it as well. So it is very, very complicated, which I don‟t think

….assists commitment or participation in it…..workforce has always been

seen as a slightly complicated area because of the plethora of bodies that are

associated with it and some of the associated bureaucracy that accompanies

their role‟. (ADASS)

This is especially the case for managers of small businesses in the sector:

„Workforce development issues – many members of the board are involved at

national and regional level. But we also have a number of people that find it

very confusing, and so if they‟re finding the agenda very confusing then, you

know, it‟s fairly tricky out there for real people to deal with it … for us

representatives of small business as well it‟s difficult sometimes for our

people to get a head round so much of what is said within the workforce

development field.‟ (NCA)

The complexity of the sector has been further complicated by changes in the

institutions. For example, Topss was replaced by Skills for Care when it lost its

responsibility for children‟s services in 2005. There have also been changes in

inspectorates. The National Care Standards Commission was set up in 2002, was

replaced by the Commission for Social Care Inspection in 2004. After four years

CSCI merged with the Health Care Commission to form the Care Quality

Commission in 2009.

„The pace of change and the scale of change is just phenomenal and you have

to feel sympathy for the people who are actually out there on the front-line

delivering services having to cope with all this melee going on around them.

They‟ve just got to get on with their daily job and have all the processes and

systems and methodologies change around them.‟ (CSCI)

20

With three different inspectorates in seven years, this raises questions about the

impact of this process of constant change on practitioners‟ perceptions of the

inspection process within the sector. Despite this complexity and flux, the Platt Report

noted that those consulted for the report recognised the struggle the institutions had

had for their existence and wanted new initiatives built in to existing institutions,

rather than their abolition (Platt, 2007:23).

Regulation and Standards: their impact on workforce skills

Amongst the interviewees there was a perception that regulation is a significant lever

for quality improvement and had resulted in the allocation of internal and external

resources to assessment and training. Care standards were seen as providing CSCI

with levers both through the inspection process and in developing their policy work.

There is a culture of low expectations of training for all workers but for management

development as well (SCIE). In particular, a clear link has been identified between

performance in inspections on the leadership and management standards and the

overall performance of the service provider. This suggests that one of the impacts of

regulation is to require employers to develop management skills and competence. The

inspection process also allows inspectors to identify problems with organisational

culture, management systems and wider workforce training needs: „So our inspectors will routinely ask people in care services, you know, “What‟s your experience like? What‟s it like for you here? What‟s your quality of life like? Any issues? Any problems?” and “Are there, for example complaints processes? How do the staff treat you?” Dignity is very important and it‟s a government priority and we have to make sure that that‟s embedded in services that people are treated with the dignity and respect that they deserve. So we seek feedback on all these issues. We also speak to staff. So we have to get a rounded view of what‟s happening and what issues might need to be addressed. If we discover issues around workforce training we can either take action ourselves regarding pointing out deficiencies to the provider or the manager to say “Look, you know, you‟re falling below standards,” or “There have been some problems with manual handling,” – for example. “You might want to do some remedial training or training to make sure your staff are properly inducted so that this is part of their initial process so that they‟re starting off on the right foot.” Alternatively we can signpost them to either Skills for Care or route them to training courses that we‟re aware of, but principally Skills for Care is our route so that they can access both training provision and possibly funds to make sure that they can link into what‟s available in their area and what might best suit their needs. And I think that links overall to our work with the sector qualification strategy.‟ (CSCI)

Some concerns were expressed that achieving targets may distract from underlying

workforce issues, as employers‟ use of resources are influenced by performance

assessment associated with regulatory targets. Some of the interest organisations had

strong views on the topic.

„At the moment the national minimum standards require us to have 50% of our

staff trained to level 2 NVQ. Now that automatically, on a limited budget,

places a very clear priority on where you have to spend your money because

it‟s got to be spent on NVQ2 and it means that you don‟t have necessarily

have funding to spend on more appropriate training if there is more

appropriate training. I mean there isn‟t a choice. You know, it‟s NVQ or

nothing. (RNHA)

Moreover, that the Registered Managers‟ Award was seen as being more appropriate

to care home managers than to nursing home managers, where there was a need to

21

recognise nurses‟ existing care qualifications. It was reported that some managers

with nursing qualifications preferred to take early retirement or downgrade

themselves to nurses because they do not want to go through the NVQ assessment

process to demonstrate they are capable of providing care. In section 4.5 of this

report, „Educational and career development routes‟, we discuss an attempt to develop

a foundation degree to provide more tailored learning for nursing home managers.

In addition to the CSCI standards concerning providers of care and their management

systems, the General Social Care Council was set up to act as a regulator of workforce

standards. The emphasis here is on the registration of workers individually through

the setting up of a register, operating a code of conduct and endorsing providers of

graduate and post-graduate social work qualifications. Its current remit concerns

social workers, student social workers and home care workers. The rationale for the

initial focus on homecare workers amongst the non-professional work force in the

sector is because workers are delivering a service individually to people in their

homes and so the greatest risk to users is here. The approach has been to focus on

making „sure that people who use services are protected and are safe and that they get

a quality outcome‟ (CSCI).

There are two main tests for registration for home care workers. The first is that the

worker already has an NVQ and the second is that they have taken an employers‟

induction course that complies with National Minimum Standards. Once registered,

there is a six year period for re-registration, with the condition that they will have

achieved a relevant NVQ. Although the implication of these requirements is that

within six years the home care work force will be fully qualified, GSCC recognises

that with high levels of turnover „it will be an annual battle to make sure that people

have the opportunity to get their qualification. ….obviously the registration system

isn‟t going to work unless the system is capable of generating the NVQ qualifications

that are required‟. This view was echoed by officers in the trade union, UNISON, who

were concerned to get advice out to their branches to convince both employers and

members to register. However, there was a view that the standards lacked ambition,

„it‟s supposed to be about pushing skills up. In fact, with the turnover you‟ve got in

that sector you‟re chasing your tail really‟.

The theme of turnover and how it impacts on the registration process was raised by a

number of interviewees, who recognised the difficulties in ensuring workers were

registered even if they are not committed long-term to the sector, as in the case of

migrant workers, or older workers close to retirement who are reluctant to go through

the NVQ assessment process. The low levels of profit margins in this sector and its

characterisation as a „cottage‟ or „kitchen industry‟ means that the registration system

has to recognise the nature of employers in this sector.

At one level we want to make sure every homecare worker who‟s going into

the home of a vulnerable, frail, elderly person is both highly skilled and, you

know, as pure as the driven snow but, short of employing an army of

inspectors which we aren‟t going to do and it‟s never been our intention, we

have to rely on employers, effectively, to ensure that our conditions are being

met and so we have to create a registration and conduct system which does

what the government wants it to do and meets the requirement of legislation

but isn‟t so heavily bureaucratic that it drives 30% of the companies that

provide homecare out of business. You know, we‟d end up with lots of very

22

highly monitored and inspected workers and loads and loads of old people not

getting a service. So it‟s that balancing act really (GSCC).

Even some larger organisations in the homecare sector are seen as having a „lack of

structure‟ for delivering skills to their workforce, described as „a bit of an eye-opener‟

by a local authority trainer.

Although registration is a requirement, concerns were expressed whether the

incentives for employers to support the registration process were sufficient to ensure

that staff do achieve NVQ2 in the six year period to re-registration. The aim of the

NVQ2 qualification is to increase standards of care but its effectiveness may be

hampered because the time to re-register is so long. Moreover, there is no leverage

over workers who do not intend to stay in employment for as long as six years. It was

reported that pressure exists to change inspection criteria to be based more on output

than input factors, and that this may have consequences for employers‟ perceptions of

the requirements. If the successor body to CSCI does not specify inputs around

training then tension may arise between the registration process which emphasizes

qualification and an inspection system which appears to be downgrading

qualifications.

„We‟ll be moving to a registration system which ramps up qualification, but

the CSCI inspection system may look as though it‟s down-grading

qualification. So there‟s a real concern. So again we‟re working very closely

with CSCI ……ultimately the national minimum standards are governmental

and DH will decide them, but obviously we‟re in conversation with CSCI and

the civil servants about what the unintended consequences might be of

changing the inspection system in terms of qualification‟ (GSCC).

Changes in commissioning services: their impact on skill development

Historically resources for social care workforce development have come primarily

through government grant funding from the Department of Health and these resources

were ring-fenced, for example for training social workers and for post-qualifying

awards. Most local authorities had significant training delivery units which were

funded from these sources and were also funded by resources from the authorities

themselves. More recently there has been an expectation that this government funding

will be shared with the private, independent and voluntary sector workforces. Skills

for Care had grant funding of its own, available to all sectors though it tended to be

focussed on the private, independent and voluntary sectors. Because of the different

splits between the sectors of social care across the country, different arrangements are

emerging for managing this process. For example, in one local authority it was

reported that there was a funding partnership of employers from all sectors, which

came under the Care Development Agency within the Social Services Department.

The project manager is employed by the City Council through its main funding

streams, but other resources are drawn down from Skills for Care and the Learning

and Skills Council. It was reported that local authority grant funding had changed as a

result of the Comprehensive Spending Review and ring-fencing of funds for

workforce development was no longer possible, as resources had been put into a

single pot of money to which members of the Local Strategic Partnership (health

organisations, the local authority, local businesses and regeneration organisations)

could bid. The shift to an annual bidding round, along with competing demands on

resources, were seen as potentially working against a workforce planning and

development strategy which requires a long-term perspective.

23

„So it‟s still a very uncertain picture ….so the whole structure for the

development of the social care workforce that‟s been based on the creation of

quite large infrastructures within Local Authorities that have been increasingly

been looking at their responsibility across the board is at risk of being

dismantled because it‟s all funded by the sources of funding that are changing‟

(Workforce Development Officer, City Council).

However, partnership approaches at local level were seen as creating a number of

challenges. Whereas with partners in the health sector, even if the workforce is

located in different organisations, there are consistencies around pay, terms and

conditions and the job evaluation scheme (the Agenda for Change), this is not

mirrored in social care, where there is much greater variability. The shift to a bidding

process for workforce development funds, where organisations are located in different

geographical spaces, was seen as likely to increase coordination costs and result in the

loss of economies of scale, as time and energy will need to be devoted to bidding

processes, as well as the monitoring and reporting processes once a bid had been

successful.

One lever for increasing workforce qualifications lies in the process of commissioning

services. There was a view that this could be included in commissioned workforce

standards so that contracts for services are not just based on best value, but can take

approaches to workforce development into account. In other words, local authorities

as commissioners of services need to have a strategic overview of the sector, given

the multiplicity of providers and the fact that the larger private and voluntary

organisations do not follow local authority boundaries (IDeA). However, there are

often no sanctions for failing to achieve standards.

„The fact that so many slipped and failed to achieve the target and there‟s not

any real sanction associated with it. …From the independent sector‟s point of

view the question‟s always been “What rewards are there for us if we follow

this strategy? Are we going to get paid a premium for better quality services?

How can we just stop training staff for other people to nick? How do we stop

volatility in the workforce? Can there be more of a career structure built into

the independent sector and would Councils be willing to pay for that?”

Generally Councils have used a crude approach to commissioning. It‟s been

based on price and so there‟s been a percentage for inflation ….so there‟s not

been much reinforcement as I‟ve said. So one of the key issues for the future is

how you incentivise the market to improve the quality of care‟ (IDeA).

CSCI has developed standards for workforce strategy, with leadership and

commissioning as themes in inspections. In recognition of this, the Skills Academy,

proposed by the Platt report (2007), was aimed at providing training in leadership,

management and commissioning. The General Social Care Council, as its role

expands, could represent a source for the improvement of workforce skills more

generally, especially around requirements for continuing professional development.

Some local authorities have developed a more strategic approach. The requirement for

local authorities to manage the market also requires them to think about collaborative

approaches to recruitment and retention, irrespective of employer. For example, Kent

holds recruitment events for whole sector and uses its regeneration responsibilities,

and Tower Hamlets has a tradition of growing its own partnerships with training

providers and building incentives into contracts to promote retention, recognising that

they charge a premium where they have a more qualified workforce. Birmingham

24

City Council has a range of initiatives to encourage black and minority ethnic

communities into health and social care, has a trainee social work scheme for staff

who are employed by the council, and is experimenting with new roles as health

services move out of hospitals, creating a career pathway between social care and

health.

The potential impact of the shift to personalised budgets was not fully understood at

the time of interviewing in 2007 and early 2008 though it was anticipated that it

would have a practical impact for future strategy, planning, delivery and resourcing.

At one level, there are issues raised for service providers and how they adapt to this

change in the market for care. At an institutional level, it was seen as raising

significant issues around the structures that have been put in place over the last few

years involving the regulation and registration of the workforce, quality assurance and

National Minimum Standards. It was clear that some strands of the strategy would be

maintained, in particular the allocation of Skills for Care funding for NVQ

achievement and qualifications that are recognised as part of the National Minimum

Standards for services, so training health & safety, first aid, food hygiene and

managing medication are likely to continue to be funded. The future of more

developmental approaches which could have an impact on practice was seen as less

certain.

A significant focus of concern about the move to direct payments is where a service

user employs a personal assistant as an employee. It was recognised that there is a

continuum of care provision which ranges from unpaid, informal care through to

formal, paid employment. Where a service user effectively becomes an employer, this

was seen as raising a series of issues about what they need to know as employers and

the consequences of this for ensuring that care workers are well trained and able to

deliver an appropriate quality of care. Unlike homecare workers, personal assistants

employed under direct payments systems were not covered by the requirement to

register with the GSCC. This creates the possibility that poor workers could move

from the regulated to the non-regulated segment of the workforce. This is an anomaly

that the GSCC has drawn to the attention of government. A number of interviewees

identified the need for brokerage or „navigator‟ roles in social care, whereby an

intermediary could act on behalf of a direct payments recipient to help train the

workforce, or users could band together to share staff. By moving to more collective

arrangements, personal assistants might come directly under the regulatory

framework. Alternatively, an option was perceived for the new regulatory body, the

Care Quality Commission, to regulate evolving patterns of service provision (CSCI).

For the trade union, UNISON, the growth of personal assistants in isolated

relationships to their employer posed the need for a framework for wages and

conditions of employment for an unorganised sector of the workforce. The need to

train service users in their responsibilities as employers was identified, as a number of

Employment Tribunal cases involving personal assistants had been reported. The

union‟s role was seen in providing access to training and networking as a means of

providing contact with other workers in similar situations. The Swedish experience

with direct payments was cited as an example of a more cooperative model of

provision, whereby the service user joins a cooperative, which takes responsibility as

an employer. In this context the union is able to deal with a single employer rather

25

than thousands of individuals and this was seen as a good mechanism for setting

benchmarks and employment standards.

Access to qualifications, training and learning may be difficult for personal assistants,

although some schemes have support services. On the one hand, there are questions

about individual service users‟ ability and willingness to pay for training and

assessment, especially if there are no requirements for individual registration. On the

other hand, if workers are employed by a single individual as an employer, learning

and career development opportunities are likely to be located at more restrictive end

of the continuum, compared to settings where they have greater contact with other

workers and are subject to the organisation‟s management and procedures.

So you‟ve got people that use the services themselves now becoming the

employer. They have got to commission training, they have got to commission

people to provide a pathway for their carers to obtain a qualification. So under

the current regime of qualifications or range of qualifications, people in order

to determine knowledge and competence have to demonstrate that they follow

the organisation‟s policies and procedures, they have supervision, they have

evacuation, there‟s emergencies, they comply with procedures for all of their

work roles for disposing of rubbish, waste, eating and drinking – everything

they do – and that is part of their NVQ. Now with direct payments when

they‟re caring for one person who is a person that uses services, they‟re not

going to have all of those things in-house (ACTAN).

These developments suggest that cooperative arrangements are needed between these

very small individual employers or intermediaries which can carry out their employer

functions if the sector is to have the capacity to deliver a skilled, competent and

professional workforce to deliver person-centred care. The challenge lies in creating a

framework which can support skill development in this context.

Enhancing the capacity of trainers

The introduction of regulatory requirements in the care sector has created the need for

a body of people who can conduct NVQ assessments and provide training so that

workers meet the standards. Initially there were few assessors and verifiers and little

support for their own professional development. According to the City and Guilds of

London Institute, the drop out rates for training of assessors is high (IDeA). This

means that although workers need to be assessed, there are sometimes problems

within the sector relating to its capacity to provide NVQ assessment, with the

potential that workers will lose enthusiasm for improving their qualifications if they

can not be assessed (NCA). This is even more acute for homecare workers, personal

assistants and agency workers than for those in residential and day care settings,

because of the difficulties of assessing competence on-the-job. The initial problem of

establishing a body of trained assessors was explained in the following terms:

„Ten years ago if you wanted to be an assessor in the health and social care

workforce you were sent off to a college for two days training, expected to

construct a portfolio with this guidance from the first day and you looked at

units, elements and competence and off you went with your candidates and

produced evidence so that you were competent and that was and has been

significantly a huge variance of good practice from this “two days training,

you‟re off, you‟ve got your award and away you go to assess people‟s

competence” to where we are today with quite a long and very structured and

supportive process. However, unfortunately, the quality assurance process is

26

not as stringent as it should be and despite awarding bodies following

procedures to check the level of training, people are still getting through the

assessors‟ award and the verifiers‟ award with very little training and very

little competence. They‟ve got areas of competence in health and social care,

but not through the quality assurance process that should be attached to that;

hence people are now let loose in society assessing that really shouldn‟t be

assessing.‟ (ACTAN)

It was in this context that the Association of Care Training and Assessment Networks

(ACTAN) was set up, organising workshops, seminars and conferences to improve

the skills of the assessors, share good practice and to provide a support network. Over

the years it has grown in strength, and increasingly acts as a voice in consultation with

Department of Health and with Skills for Care, and at national and regional level.

Initially its remit was seen as supporting and guiding people through „this quagmire

….of new legislation, new practice and new systems‟. It is now increasingly involved

in sector skills agreements, consultations with regard to changes to the national

occupational standards, the common induction framework and the quality framework

for accredited qualifications. They have seats on Skills for Care and Skills for Health

and, at the time of interview in 2008, were seeking seats on major sector skills groups

such as Children‟s Workforce Development Council. Members cover the whole

spectrum of health and social care, private and public sector and the third sector, the

voluntary sector. Over time, ACTAN‟s role has shifted from a support role for

assessors to what is perceived to be a more corporate and more strategic input into

skills policy.

Whilst initially efforts were focussed on assessment, over time this has shifted

towards learning, education and training. Through scoping exercises, management

training is one area which has been identified as a priority for building capacity

amongst small owner/proprietors and managers. Increasingly feedback from

employers has identified the need to provide effective training which impacts on the

workplace and this has lead to a focus on learning and teaching styles. This is because

there is enormous variation in delivery methods and the type of learning that takes

place within organisations. This was explained in terms of the need to go beyond

NVQs as mechanisms for measuring competence to give greater emphasis on training

and development. In particular, this had indicated a need to provide a benchmark of

quality, so that employers could have a degree of confidence in the quality of training

provided when presented with a list of potential providers. This connects with our

conceptual framework of a continuum of expansive and restrictive learning

environments:

„So if you can get somebody through an NVQ quite quickly or without a lot of

resource into that process, unfortunately there are people that do that, whereas

if you‟re committed and you want quality, then it comes sometimes at quite a

high cost, at quite high premium, a lot of contact with people, a lot of support

and it‟s the quality monitoring‟ (ACTAN).

This also has consequences for the assessment process and the extent to which

workers are able to demonstrate knowledge.

„If you‟re doing the process properly not only are you observing their

competence, you‟re assessing their rationale and confirming it‟s their

knowledge. If you do it by distance learning and you‟ve got sort of sheets of

answers, there‟s no clarification that they have the rationale or it is their own

knowledge, or indeed that they put it into practice. …..the feedback is that

27

you have got employers saying “Well, I‟ve got this organisation. They turn

up, they ask us to sign a lot of papers, they leave them work and we might see

them once, we might see them twice, they leave them to get on with it. The

people get a qualification at the end, but they haven‟t learned, they don‟t put it

into practice.” Then on the other end of the scale we‟ve got employers that are

saying “We have training providers. They come in, they do a skill scan, they

look at their roles and responsibilities, they action plan, they‟re very careful,

they offer support and underpinning knowledge sessions. The people learn on

route and that‟s really good. They‟re learning, they‟re developing, we‟re able

to promote them to be seniors, they‟re responsible, they‟re accountable,

they‟ve got a qualification at the end of it”‟ (ACTAN).

Although there were plans to develop a quality benchmark in association with Skills

for Care, ACTAN representatives recognised that some of the problems in the sector

are due to lack of resources. This means that if free training is available from

providers, there may be incentives to use it, even if it is not appropriate to the

organisation‟s needs. In other words, there is a need for employers and employees to

be able to understand what they should be able to expect from trainers and assessors

and that there should be a standardised method of learning, linked to a career pathway

that will give staff some opportunity to develop in the future.

A distinction was also made between more expansive and restrictive roles for

assessors. In some workplaces a care manager, a senior care, or a deputy might have

an assessor qualification and can assess staff at work. This can be effective and some

will be supportive and able to devote time to the task. Others are less able to cope

with the demands of their job role and that of assessor, so development, training and

mentoring are not embedded into the process to the same extent. This may also be the

case with peripatetic assessors. Whilst some may go out to a workplace and provide

considerable support and time to staff, some training companies have assessors that

„will go and drop off a portfolio and say “I‟ll see you in three months. There‟s your

work, get on with it”‟ (ACTAN).

Standardisation of practices was seen as contributing to improving employer

awareness, candidate awareness, assessor and verifier awareness, and knowledge of

codes of practice.

„So the codes of practice that are supposed to be used by awarding bodies in

ensuring quality and quality assurance, all the training packs that I can access

or centres can access as offering training qualifications, we take to empower

people to facilitate their learning, to improve their development so they can go

forward with renewed knowledge really and confidence and ask questions if

their particular organisation isn‟t supplying them with that information. So

we‟re trying to hit it from every direction – candidate awareness, employer

awareness, funding body awareness, Skills for Care awareness, assessors and

verifiers, all the stakeholders – and now we‟re trying to use people that use the

service to actually be part of this process to feedback their experiences of how

they‟re cared for and what they would like out of future initiatives for training

the care team being at any level, be it their Level 2, Level 3 or Level 4‟

(ACTAN).

Standardisation is also an issue in induction standards, which are aimed at providing

foundation knowledge to equip staff for care roles. This can range from what is

28

strictly required to meet the standard to a more expansive approach to learning for

care roles.

„Now ACTAN, Skills for Care and individual training providers have

identified that this in essence, whilst an excellent foundation, is again treated

with the same inequality and lack of quality assurance. So you get

organisations that will put a set of standards for each of their care staff and

tick the boxes because it‟s not monitored by any awarding body. Quality

assurance is in-house really, it‟s internal. The manager or their training

department has to sign that the people have worked through health and safety,

have worked through abuse training, have worked through values of care and

they have completed that course.‟

ACTAN aims to improve practice amongst trainers, on the one hand, and to improve

employers‟ understanding of good quality training to inform decision-making, on the

other. By developing resources, the intention is to encourage trainers and employers

to up-grade their provision and training methods. It sees this as the best mechanism

for supporting training providers to improve their practice and to raise the level of

delivery within the sector.

Enhancing workers‟ learning and career development The social care sector is one that is characterised by a predominantly female

workforce, whose contribution has been undervalued. There is a consensus that low

pay and poor management practices contribute to high levels of turnover, which in

turn impact on employers‟ ability to provide consistent and reliable services to users.

Training and development can be seen as both as a means of developing capacity and

skills within the sector, but also as part of the terms and conditions of employment of

workers. Training and development therefore needs to be perceived as part of the

broader conditions of employment in the sector and how the workforce is treated and

valued (NCA), including whether time is made available in working hours for training

(UNISON). This is underpinned by broader issues about the funding of services to

older people and the pay and conditions of employment within the sector which are

integrally related to the way in which the workforce is managed and developed and

the attractiveness of careers within the sector. These issues were dealt in Options for

Excellence (Department for Education and Skills/Department of Health. 2006) and the

Platt Report (2007), though interviewees were concerned that recommendations were

not being implemented because of their cost implications.

In order to enhance the quality of learning in the sector, there has been recognition of

the need to move from more restrictive approaches to qualifying the work force,

which focus on meeting statutory requirements, to one based on more expansive

forms of learning. This was made explicit by ACTAN, which emphasised the need to

focus more on learning and teaching styles and the need for a quality benchmark for

training providers. The trade union, UNISON, has been instrumental in supporting

more developmental, „second chance‟ learning, often in partnership with public

service employers. This results in improved self-confidence which contributes to the

development of the team skills, and „softer‟ communication skills which new ways of

working and interdisciplinary teams in the sector are supposed to require. UNISON

aims to embed „second chance‟ education programmes in the workplace, drawing on

workers‟ shared experience of working in the social care sector and understanding of

the service they provide. In the case of non-traditional learners, who are often older,

have negative experiences of schooling and fear of exposing themselves in front of

29

managers and colleagues, it was argued that it is important to provide contextualised

learning, linked to job roles. Funding available through „Train to Gain‟ through

general purpose brokers was seen as having the potential to de-contextualise learning,

for example, general purpose spelling as opposed to learning the vocabulary linked to

report-writing in social care job roles. The union is also supportive of whole

organisation approaches to learning which involve unions in negotiation and

consultation with employers on training, IDeA‟s GO award being an example of this.

Many interviewees mentioned the need for learning opportunities to be integrated into

organisational practices, alongside wider education progression and career routes into

social work and nursing, district nursing roles and potential roles in the housing

sector. Whilst the former focuses on the ways in which managers in organisations can

facilitate learning and job progression within their own workplaces, the latter is

related to career pathways within the sector. The need for an integrated competence

framework, similar to the Knowledge and Skills Framework in the National Health

Service was identified, though employer fragmentation makes this more difficult in

social care. UNISON has an agreement with the Open University to provide the K101

Certificate in Health and Social Care to members. This is an entry level qualification

for social care and health degrees. Other interviewees stressed the need for

educational provision to underpin careers in the sector. The new 14-19 diplomas were

seen as a mechanism for encouraging young people into careers in social care, whilst

foundation degrees and educational qualifications in leadership and management were

seen as mechanisms for encouraging good practitioners to qualify as managers. A

number of these developments are analysed in more detail in Section 4 Approaches to

Skill Development.

Conclusion

This section of the report set out to answer three questions:

To what extent do social institutions create systems of incentives and

sanctions which encourage investment in training?

How do they encourage cooperation at different levels in the development of

skills as a collective, rather than individual, good?

To what extent do they involve different stakeholder groups?

In response to the first question, social institutions in the sector have created

incentives in the form of the availability of funding for training to support investment

in training. Whilst the effect of regulation in itself has required the development of

more effective management systems, there is still scope for further improvement

particularly, but not exclusively, in smaller organisations. Moreover, constant changes

in organisations and in regulatory requirements may create confusion which may give

unintended messages about agency‟s and government‟s seriousness of intention as far

as increasing workforce qualifications are concerned. The ability to impose sanctions

for failure to comply with regulatory requirements for NVQ attainment in service

providers and the registration of homecare workers may be constrained by employers‟

and employees‟ option to exit from the regulated sector.

In a context of limited funding for services, internal resources for training and

assessment may be directed towards meeting assessment targets rather than towards

more holistic approaches to developing organisational systems which meet the needs

of the entire workforce. In addition, the availability of external funding for training

30

may mean that resources will be directed towards particular categories of worker who

meet eligibility criteria which are set by the targets of funding agencies rather than the

needs of the organisation or the sector. Nevertheless, there is recognition of the need

to focus more on learning and development, rather than just achieving competence

targets, and to identify educational pathways which can contribute to the

attractiveness of careers within the sector.

In response to the question concerning cooperation between employers and other

agencies, there is evidence of a policy network at national level which is represented

in different institutions and contributes to policy development. There is a shared view

of the problems in the sector, which is underpinned by the lack of resources for care

services. A number of authoritative reports have been published on a vision for a

professionalized workforce in the sector, though the implementation of this vision is

less in evidence and some developments appear to undermine the capacity of the

sector to achieve them. At regional level, consortia arrangements have been set up

which contribute to the capacity of the sector to train and to access funding. They

have potential to intersect with local authority commissioning roles and strategic

oversight for the sector. Nevertheless, concerns have been raised about the

opportunity costs of bidding processes, the potential loss of economies of scale and

the potential exclusion of smaller players and those organisations whose boundaries

do not coincide with those of local authorities.

More holistic approaches across the sector and within the workplace support worker

learning. The integration of services across sectors may provide new career pathways

between sectors, but this requires cooperation between employers. The development

of direct payments systems for users requires strategic approach to workforce

development and for local authorities „to manage the market and to think about

collaborative approaches to recruitment and retention of people in the workforce

irrespective of their employer‟ (IDeA). As the use of personal assistants under direct

payments systems becomes more widespread, collective or intermediary organisations

will be required to fulfil some employer functions. These relate to managing

employment relations, and training and development, if more expansive forms of

learning, supporting the development of a competent workforce, are desired.

Finally, as far as stakeholder representation is concerned, there are two groups whose

interests are weakly represented in the system: service users and care workers.

Historically, the voices of users have been weak in policy development and service

delivery. The shift to direct payments systems has been seen as a mechanism for

empowering them. The representation of worker interests and worker voice in the

sector has been undermined by fragmentation in the structure of employers and

employment. This fragmentation may be reinforced by changes in the funding system

and requires the development of new forms of supporting work quality and worker

learning and development to improve of the quality of services for users.

31

4. Approaches to Skill Development

Introduction

In the previous section we examined national institutions and a range of interest

organisations and how they contribute to the capacity of the sector as a whole for skill

development. In this section we examine different approaches to developing capacity

for skill development at a more local level. We start by examining the issues

identified by service users and their carers, focussing on what characteristics and

skills they value in care workers and identifying how they can make an input to

developing workers with these characteristics. We then focus on care providers for a

perspective on how organisations develop internal capacity for skill development,

taking into account differences in residential, domiciliary and agency settings. This is

followed by an analysis of the development of capacity in training organisations. We

then turn to consortia arrangements, which bring together different agencies, service

providers and training organisations and how cooperation at regional level can

contribute to developing capacity for the sector. Finally we focus on case studies

which aim to provide learning and career pathways into careers in the social care

4.1 Issues identified by service users and their carers

As part of this research project, a consultation exercise with service users was

commissioned from Ann Davis and Rosemary Littlechild at the Centre for Excellence

in Interdisciplinary Mental Health, University of Birmingham. This was conducted in

March 2008 and the results are reproduced in full in Appendix 3. The objective was to

seek participants‟ experiences of social care, what they had valued most and least in

these encounters, and what skills and knowledge they thought social care workers

should possess. They were also asked to identify how older people and their carers

could contribute to training. Twenty-six people participated in the research: fourteen

participants attended the workshop and a further twelve people were interviewed by

„phone. They had experience of a range of care services including home care, day

care, residential and nursing home care in the public, voluntary and private sectors

(Davis and Littlechild, 2008: 2).

Service users and their carers were aware that social care workers operate in a context

in which organisation and societal issues interact. This means that circumstances may

mean that regardless of the positive attributes of individual workers, they are not able

to deliver a satisfactory service. The users and carers valued friendliness, politeness,

having a calm manner and confidence, as well as honesty and integrity. Punctuality

and reliability of service delivery were important. Good communication skills and the

ability to listen were identified and in particular the ability to „go that extra mile‟ that

made a different to the person‟s quality of life and peace of mind. They appreciated

workers who treated them with dignity and respect, who explained what they were

going to do and would work alongside them so that they could continue to make a

contribution (2008:3). Good communication was understandably seen as essential:

this included English language skills; listening skills; willingness to learn; and to

adapt to individuals‟ disabilities. Good communication between workers and the

accurate recording of information relating to users were considered to be essential to

good care, especially where the person lived alone. Negative experiences included

workers who were „rude, patronising or made assumptions about people which caused

offence‟ (2008:4) Unacceptable standards of care involved thoughtless behaviour,

32

which caused users and carers distress, and dishonesty, which they did not always feel

able to challenge. Poor experiences include workers who made assumptions about

users‟ disabilities, were over familiar, or those providing unacceptable standards of

care. Induction into the ethics of care is needed, including the development of self-

confidence, and workers‟ ability to communicate and empathise with the people they

care for through understanding of their needs.

Some problems which were identified concerned the way in which work is organised.

Continuity in workers visiting them and receiving services at times agreed were

factors that were important to service users. Sometimes organisational issues meant

that workers have insufficient time allotted to home visits or needed to cancel without

providing notice. In contrast, people who had a team of workers who worked with

them regularly appreciated the fact that the workers got to know them and what they

liked. „They could “tune in” to the older person more easily and be flexible by putting

in a little more support when it was needed and leaving the person to do things for

themselves when they could manage‟ (2008:3-4).

Some problems concern effective management systems, the prioritisation of

paperwork over the quality of care, the timing of service delivery and the amount of

time available being based on the convenience of the organisation rather than the

needs of the individual. There are broader organisational and societal questions which

affect the care work force, not all of which can be resolved by training interventions.

Some service users were concerned about the supervision and monitoring of care

workers and that sometimes unsuitable staff are taken on and poor practice not

challenged. Concerns were also expressed at the low wages received by workers for

what is a responsible job.

„The older people and carers who took part in this study expressed concerns

about how as a society we fail to value older people. It was suggested that if

older people are not valued and people who provide social care are poorly paid,

then social care workers are less likely to value themselves and the people they

care for. In the view of several participants, more training for social care

workers could improve the quality of care for some people, but it was only one

response to a complex set of factors which needed addressing at a variety of

levels.

Ideas were shared about how issues of understanding and attitudes to older

people in the UK could be addressed. One participant thought that it was

important to provide education for children and young people at school about

older people so that they had opportunities to develop more positive attitudes

and understandings. Another thought that developing community based projects

that involved young people and older people could also help to build more

positive attitudes and understandings about old age amongst the future

generations of social care workers‟ (Davis and Littlechild, 2008:6).

In the consultation, specific recommendations about training inputs that service users

and carers could make included:

Being a resource for workers so that they can learn directly about how to

develop their skills and knowledge by placing themselves in an older

person/carer‟s position. Some examples given were providing one to one

33

tutorials for staff at day centres, inviting staff to spend time with them in their

own homes to understand the daily challenges they face.

Playing a part in the development and design of social care training schemes –

based on the good practice that has been established on qualifying social work

programmes, where the involvement of service users and carers is a

requirement.

Contributing to the delivery of training through working alongside trainers –

as co-tutors; contributing their experience and expertise to training sessions as

well as sitting in on sessions and providing feedback to tutors.

Producing training resources e.g. video accounts of their lives or what it feels

like to be on the receiving end of social care or what it means to have a

particular impairment. Providing case material based on their lives for

discussion groups to promote understanding and creative problem solving.

Contributing to the evaluation and assessment of staff in training, based on

some of the good practice developed on qualifying social work programmes.

Ideas about contributing to staff development included:

Providing feedback on service quality to contract commissioners and agencies

through questionnaires, interviews, focus groups and „mystery shopper‟

schemes.

Taking part in selection panels for staff appointments to provide a view based

on their experience and to give a strong message to applicants about the

importance that is placed on the opinions and experiences of service users and

carers by the agency.

(Davis and Littlechild, 2008:8-9)

Efforts need to be made to develop positive attitudes towards older people and

towards working in the sector, so that workers are valued and have opportunities to

develop careers.

4.2 Organisational approaches to skill development

In this section we focus on four case study organisations which had whole

organisation approaches to managing their workforces (The Residential Home, The

Community Caring Trust; the Agency and the Not-for-Profit Service Provider and

Training Division1) and a small local authority specialist team (The Dementia Team)

which had a highly autonomous approach to service delivery (see Appendix 4 for

Case Studies 4.1, 4.2, 4.3, 4.4, 4.5 respectively). All the organisations had a

systematic approach to managing their businesses and had training systems embedded

in their management systems. These shared characteristics involved a systematic

approach to managing staff, although it takes different forms. Training was related to

business planning processes and was organised in a systematic way, with formal

processes and mechanisms for assessing needs. These practices were bench-marked in

1 The Not-for-Profit Provider and Training Division (see Appendix 4.5) is referred to in this section as

a service provider. It runs four homes providing services for day care, residential and nursing care and

dementia. Its in-house training division is also a training provider, providing an external training

service for other homes and domiciliary care agencies and is discussed in Section 4.3 Developing

Training Capacity.

34

different ways, for example, through the Investors in People Award (IIP) at the

Residential Home and „The Times Top 100 Employers to Work For‟ at the

Community Caring Trust. The Not-for-profit Service Provider is concerned with the

education of staff in all disciplines and at all levels. Because of its status as a charity

rather than a commercial company, it has a more developmental approach to training

within the company and for raising care standards throughout the sector through its

training arm. It has a core development team made up of seven training staff and an

administrator, who are qualified in education, nursing or care and its training

programmes include a tailor-made BTEC induction programme, based on person-

centred care, and leadership and management training. In the Agency, training and

development are encouraged for all staff from first employment. Social care recruits

complete induction training, covering the Skills for Care Standards and the CSCI

National Minimum Standards as well as an induction to working for the agency. They

have access to NVQs, in-house training and various courses as part of continuing

professional development through the company‟s own, separate training company or

external providers. In all cases, internal and external resources were allocated to

training, both financial and in terms of personnel. These whole organisation

approaches were evident in an ethos of care, which was imparted to all staff not just to

care workers, and meant that all staff in contact with service users were aware of the

ethos of the organisation.

The organisations were prepared to invest in training and development to provide staff

with the skills they needed, rather than to rely solely on the recruitment of ready

trained staff. The Residential Home and the Community Caring Trust emphasised

disposition for caring over formal qualifications in recruitment, with the organisations

investing considerable resources in training. In the Residential Home induction

training is provided to new recruits, which had been tailored to the needs of the

organisation, by making handbooks more accessible and making greater use of

activity sessions. Support was provided for new recruits through their first six months

of employment. There was an expectation that staff would become competent in their

job roles through training and could be trusted to perform their duties with a

considerable degree of autonomy. In the Community Caring Trust, staff were

recruited on the basis of personal qualities appropriate for a caring role, whilst the

organisation took responsibility for providing technical ability and experience.

Employees without experience of care are given a 30 hour period of work experience

on a voluntary basis to assess whether they are suitable for the post and whether the

work is appropriate for them. Although managers within the Not-for-profit Service

Provider appreciated the caring nature of their staff, with the introduction of a more

regulated and inspected sector following the Care Standards Act, they recognised that

there was „a very real need to equip all staff with appropriate professional skills,

whatever their job role.‟ They were unable to source any courses that were relevant

for all staff levels and roles and so used their own expertise and experience to develop

their own courses, which were then accredited by appropriate awarding bodies. This

led to the development of their programmes „to cover an increasingly broad remit of

staff development and have expanded to reach many other organisations.‟

In contrast, whilst the Dementia Team required new recruits to have NVQ 2,

nevertheless there was an expectation that they would achieve NVQ 3 in employment.

New recruits go through a rigorous induction scheme and are monitored through a

three week induction process, during which mandatory training in health and safety,

35

food hygiene, medication and manual handling is covered. After meeting with service

users and completing this initial period, they discuss with management whether they

feel they are well-suited to the work.

Given that these organisations have developed a systematic approach to managing

training and have been perceived as examples of „good practice‟ through the awards

they have received, it is interesting to analyse the triggers for the adoption of these

new approaches. All service providers are regulated by the provisions of the Care

Standards Act (2001), so it is a case of examining how the regulatory requirements

interacted with other factors to produce innovative approaches to managing staff.

The triggers for innovative approaches to training

Some of the triggers concerned an external intervention, which resulted in the

adoption of an innovative approach to managing staff. At the Residential Home, the

trigger for the introduction of new management approaches was the decision to apply

for the Investors in People (IIP) award in 1994. According to the Director, prior to

this the home had been good on the operational side of training, largely due to her

own experience of being trained in the NHS and recognition of the return she herself

had gained on that training. The significance of IIP lay in its significance for

developing a strategic approach to managing training. She argued that it had required

them to look at their processes and to formalise them, which they had now done on

several occasions through the re-accreditation process. As an IIP panel member

herself, she saw this not only as a benchmark for ensuring that the organisation was

effective, planned its operations and communicated with its staff, but as a source of

management learning. She saw an explicit link between good people management

practices and providing a good service to users:

„They know what I‟m aiming for, I hope, they know that we‟re aiming to

provide the best quality by having the best training and by recruiting the right

people and that we want people who are committed to actually offering really

good care‟.

Residents are involved in training and were just starting to be involved with

recruitment. They are involved in almost all decision making and are appreciated for

their good ideas and many talents. Although she recognised the significance of the

inspection system for demonstrating the standards of care in a home, she felt that

because inspectors spend relatively little time with residents, it was necessary to gain

other forms of recognition of the quality of care. She felt that awards which involved

continuing professional development and carers reflecting on practice were important

to staff understanding that they were providing a high standard of care and gaining

external recognition for their skills. The organisation was also accredited by the

Practice Development Unit of a local university.

In the case of the Dementia Team, the trigger for the new approach was involvement

in a Skills for Care „New Types of Worker‟ project. The Dementia Team‟s innovative

teamwork approach to home support services to people with advanced dementia in

their homes challenges a time-limited and task-oriented delivery of domiciliary care

services. The service receives financial support from the Department of Health and is

delivered in partnership with the local NHS Foundation Trust. The service developed

out of the local authority‟s in-house Home Support Department, which had been

down-sized and then split into two teams: one for long-term support and the other for

dementia support. This involved recognising that users have variable rather than

36

standardised needs and that where care is provided by teams who share knowledge of

the users‟ needs, there is scope for providing care flexibly. This requires self-

confident, well-trained workers who can act autonomously and can redistribute work

within the team if one service user requires additional help. Continued funding for the

service through Local Area Agreements enables the team to continue to deliver this

high level of care. There were two main aspects which marked the distinctiveness of

the Dementia Team‟s approach. The first of these was that, in addition to the full

range of mandatory training, workers had specialist training in dementia care

(although there were problems with staff being able to attend these courses, due to

high levels of demand). The second was the way in which the teams were organised

so that they could work flexibly around service users‟ needs. All the workers are

salaried and were able to rearrange their visits if one service user required more time

on a particular occasion. The fact that all members of the team knew the users and

their needs, meant that rescheduling of visits did not result in unfamiliar workers

visiting them in their homes.

In the case of the Agency, it was experience of a failure which created the trigger for

a new approach to training and development. When the Agency registered with the

Commission for Social Care Inspection, they were offered ten free places on an NVQ

programme with the local authority six years previously. Only one of the ten

participants completed the programme and this forced the company to consider

whether sufficient thought had been given to the selection and support provided to

them. This led staff at the branch to think about how to identify the right people to

take part and to provide work experience that would allow candidates to complete the

NVQ assessment. It resulted in the Agency developing internal capacity by training

the trainer as an assessor herself and external capacity through relationships with

verifiers and assessors at two local colleges. This also led more generally to the

reassessment of the organisation‟s approach to training and CPD.

Another trigger which was evident in the case of the Community Caring Trust

involved the recognition that existing management systems or practices were

inadequate. The Community Caring Trust was set up in 1997 as a private company

and a registered charity following significant cuts in the social care budget by the

local authority. Managing employees effectively was seen as essential to

underpinning the organisation‟s objective of providing a reliable and consistent

service that would enable individuals to live in the community and maintain

independence, where possible. High levels of absenteeism indicated the need for

managers to go back to the fundamentals of good human resource management

practices to address the problem. At the time of the transfer, the workforce was

described as being:

„(t)otally demoralised, angry, cynical, depressed. Whether they had done a

good job, a bad job or an indifferent job, they‟d done something for twenty

years and they just saw this as a way of, you know, getting them out of the

organisation and not having to pay redundancy payments for them‟.

It became clear that if the organisation wanted service users to be treated with dignity

and respect, the workers would have their skills enhanced and that they would need to

„be happy and feel good about themselves‟. Since the major part of the service was

staff time, managing staff effectively was seen as the key to providing a good service

to users. The organisation was committed to national pay and conditions, so this

meant that they needed to adopt a creative approach to managing staff. Absenteeism

37

was not primarily due to illness and required creating sanctions and incentives for

reducing absenteeism. On the one hand, this involved recognising the need for staff to

be able to manage work/life balance demands to ensure a dependable service for

users. On the other hand, an incentive was created: staff who take no sick leave

receive a £600 bonus each year. Absenteeism through sick leave has declined from an

annual average of 22 days per worker to 0.3 days.

Nevertheless, a more fundamental problem was identified: staff needed to want to

come to work and, in this way, could provide an improved and consistent service.

This required focussing on human relations as central to the quality of management

and the delivery of services, rather than seeing managing staff as the responsibility of

the HR department. The Director described this in the following terms:

And one of the best things we did in changing this culture ….. what we found was the most important relationship is the manager and the employee and HR had got in the middle of it. Because managers used to go “Well that‟s an HR issue.” “No, it‟s not. It‟s your issue, it‟s your unit. It‟s the service you‟re providing that‟s affected”.

In other words, managers had to take responsibility for managing, motivating and

developing staff and thus contributing to the quality of employee relations. This

approach was reinforced by the company‟s participation in the Sunday Times „Best

100 Companies to Work For‟ award. This benchmarking system involves an annual

staff survey, which includes questions on the extent to which managers listen and

motivate staff, on work-life balance, training that makes a difference and working in a

supportive team. This process was seen by the Director as more effective than the

Investors in People award, because it provides staff feedback on management

practices, rather than an external view of management systems. The feedback from the

survey allowed management to identify weaknesses in leadership, which suggested

that more needed to be done to communicate with staff about the organisation‟s

strategy and priorities. As a consequence managers were required to prioritise

improved communications. The following year the survey findings showed that staff

felt they had managers who listened and motivated them. The Director described this

as „what we‟ve done now is we‟ve gone from having managers to leaders. The

workforce have become self-managing and self-motivating.‟

In the Not-for-profit Service Provider, the Care Standards Act and the need to meet

statutory requirements for induction and NVQ assessment prompted a new approach

to training. Training requirements of care workers are generally overseen by line

management but to some extent, training can be employee-led. Annual staff appraisals

and bi-monthly supervisions allow managers and staff to identify their personal

training needs which are accommodated on an individual basis. All staff are trained in

the ethos of care, regardless of level or discipline. In the care homes complete the

BTEC induction course designed by the training division. This programme is based

on person-centred care and trains all workers in the interaction with, and support of,

older people. The course was externally accredited and won a National Training

Award.

„We felt that it was just as important for the lady or gentleman that goes and

cleans the bedroom. They need to know as much about person centred-care

38

and how to interact with someone and what to look for and how to do it as the

carer, or even the person in the kitchen, you know.‟

Service users are actively involved in the work of the organisation and, more

generally, resident committees and annual confidential surveys are used to inform

planning at all levels. Most training programmes include sessions and/or activities

that involve service users.

Training for business and employee need: the link to innovation

In the case study organisations, not only were training and development integrated

into organisational systems and practices, but considerable resources were allocated

not just to training for business need, but for employee need as well. The

organisations allocated internal resources to training, over and above external sources

of support that were available for statutory training. At the Residential Home statutory

training is booked a year ahead, so that all staff know what to expect. However, the

Director was keen to provide a wide range of learning opportunities as a means of

building staff confidence and varying their work. IT was one area where she had been

encouraging all staff to learn skills. As she explained:

So we organise it according to appraisals and supervisions and things. So IT

is a big one at the moment and actually people say to me “Oh, how can you let

them do IT?” “Well it saves me hours of work if they do it and not me!” So

every form‟s printed out and in fact they now know much more than I do, you

know. So if I want posters done I ask M, if I want … and B, who only

touched a computer probably 9 months ago or something, you know, has now

done all these personal portfolios and she‟s responsible for keeping them up to

date. But also I‟ve done it because care work can be very robotic and very

basic and very repetitive and very boring. At least if they‟ve got training it‟s

something else.

This devolution of responsibility was evident in a number of areas: staff were trusted

to call for a doctor if a resident required medical attention; and key workers were

given specialist areas of responsibility to enhance their job roles. One key worker was

responsible for the medication system, another for equipment. A scheme called

„Colour Works‟ had been used to reflect on the way different personality types

interact with each other, which also helped understand what different members of

staff wanted out of life. This was seen by the Director as making staff feel valued, but

also helped them to understand what they were trying to do for the residents as well.

Other staff had been engaged in improvement projects. One had worked on a diabetes

handbook as a source of reference for the workforce, and another on a

„communications with the elders‟ project, which had been incorporated into induction

training. The Director had been involved in a project linked to expanding the role of

care workers. Funded by Skills for Care, this pilot project aimed to train care staff in

tasks normally performed by district nurses, taking blood, taking observations (blood

pressure, temperature, pulses), dressing and injections, because residents had

indicated that they would prefer this to waiting for district nurses to come in to the

home to do it. Although this had been supported in the pilot phase and evaluation,

funding had not allowed the project to continue. Whilst these represent examples of

job expansion, aimed at increasing job satisfaction and the improvement of the

service, there were also examples within the Residential Home of employee-driven

training, where staff had identified learning which would improve the service. One

39

carer had requested training in massage which had been agreed because it would

benefit the residents, and the entertainment coordinator who had identified a course to

improving her skills as an exercise trainer. The Director commented, „I just see

potential in everybody and I see potential in residents as well‟.

Considerable learning took place not just within the home, but through the Director‟s

and Manager‟s engagement in wider, cosmopolitan networks. The Registered

Manager attends six weekly „learning hubs‟ meetings with other local home managers

to discuss new legislation and training opportunities. She also participates in a

„management exchange‟ whereby managers from different homes swap roles for a

week as a means of sharing good practice. The Director had contributed to a Skills for

Care publication on „The Learning Organisation‟ as a means of publicising the

benefits of training and learning to small homes. She had previously run a county

association for the social care sector, which had been wound up two year‟s previously

since the kind of information it disseminated to members through its newsletter was

increasingly provided through internet sources, such as the Social Care Information

and Learning Services (SCILS) website which was set up in 2001 to provide learning

materials to health and social care organisations, and other resources are available

through organisations such as the National Care Forum and the English Care

Association.

This capacity to identify and develop potential in employees was seen as one of the

main benefits of investing in staff and was evident in the organisation’s ability to

grow its own managers. A previous manager, who had been recruited as a rebellious

teenager, but had taken a degree as a mature student, had gone on to work for Skills

for Care in London. The Residential Home had been involved in pioneering the Care

Ambassadors Scheme and had a number of young staff who had been involved in

encouraging school children into careers in the care sector. This included one of the

Registered Managers, who had started working at the home at weekends, making beds

and assisting with drinks, as a school leaver nine years previously. She had since

taken a vocational „A‟ level in Health and Social Care, then took NVQ2 and NVQ3

whilst working in the home. Following promotion to being a key worker, she took the

Registered Managers Award and at the age of twenty-three had been promoted to

Registered Manager. The Director of the Home explained the significance of a „like

recruits like‟ approach to the care sector:

„You know, you get a classroom. We did Year 9s and 10s who are the sort of 12

to 13s thinking about careers and things. I mean you‟ve got M. going in with her

short skirt and her pretty make-up and they were all kind of boggle-eyed. It would

have been no good me going in! So the secret was to send in the youngsters.

Now a lot of the kids in the school knew M. and knew T. because they‟d been in

the fourth form or whatever when there and they were all kind of like this. Now

they were saying exactly as M. probably said to you, “The friends that go to

university end up with debt,” – as I know only too well from my two daughters –

“And people like me, I‟ve done an apprenticeship and I‟ve been paid for it!” So

the kids sat up and took interest. The other thing they did which I think was a huge

… it‟s a big barrier – it‟s that parents didn‟t think going into care was

worthwhile.‟

As well as working to establish career pathways within care work, managers

developed ways of countering the problem that workers often can not progress in their

40

qualifications because they are not able to demonstrate competence in tasks which are

not currently part of their job role. In supporting learning beyond workers‟ immediate

job roles, both formal and informally, managers were creating opportunities for

progression within and beyond current roles. At the Residential Home care assistants

were preparing for senior care roles. This was also evident in a number of staff who

had been trained to NVQ level 3 and for the Registered Manager‟s Award at the

Community Caring Trust, even though jobs were not available. However, another

example of learning beyond the job role was to be found within the Dementia Team,

where a potential progression route was envisaged into a community practice nurse

role. In this instance, progression was outside the organisation, but within the sector.

In the Not-for-profit Service Provider it was recognised that the expectation of

training to NVQ level 3 was sometimes limited in practice because of the availability

of suitable posts and training budget restrictions. The innovative approach adopted

here involved a holistic approach to the training of all staff, but in developing

educational qualifications for career development. Leadership and management

training is considered to be of great importance throughout the organisation. Training

is given to staff at all levels with supervisory responsibilities, recognising the

importance of effective leadership and the need to acquire additional skills following

some routes of career progression.

In the Agency, the organisation had facilitated study for workers beyond their current

job role by arranging agency placements which allowed them to demonstrate

competence at higher levels. One benefit of the agency setting was that it was possible

to ensure that staff had appropriate „packages‟ of work, enabling them to demonstrate

competencies relating to more advanced NVQ levels. Because the agency offers the

full range of work and levels of care, progression may be more achievable for some

staff through this route than it may be in permanent posts in care homes or in the local

authority. It was reported that staff employed by the local authority in the area

covered by the branch of the agency had had problems in accessing NVQs within the

authority and took work with the agency for a few hours a week on addition to their

main job to access training. One member of staff spoke of having started her NVQ ten

years previously with another employer, but not completing it through lack of support.

She was in the process of completing it with the agency at the time of interviewing.

The agency felt that they could be flexible and creative in working around

individuals‟ learning needs.

Because agency staff can be quite isolated in the work that they do, bringing them

together for CPD represents a way in which individuals can feel part of a shared

community of practice and to overcome this isolation. In addition to the training

outlined above, the Agency keeps a central fund equivalent to 1 per cent of salary for

each member of staff for continuing professional development, which supports in-

house courses which run at evenings and weekends. Staff do not get paid to attend

these but they are free of charge and have proved to be popular. Some were deterred

by the lack of payment for attendance, but still spoke positively about the training. As

well as an opportunity to learning new knowledge and update skills, these workshop-

based courses allow staff to meet with colleagues in similar job roles, and to share

experience and best practice, which is not usually possible in an agency setting.

„It does help with feelings of ….I didn‟t know, I was isolated until I actually

came to do this….I actually didn‟t know I was isolated, but I was and it felt so

41

nice to be with other people. I like how you have to think things through

yourself in small groups, ….it‟s very simple, but I find it really useful.‟

These examples demonstrate how the organisations provided an expansive learning

environment by providing opportunities to learn through courses, through practice or

through shared participation in wider communities of practice.

Seeing training as an investment, not a cost

A further characteristic which these organisations shared was not only their

commitment to training, but their perception of it as an investment rather than a cost.

The Director of the Residential Home reported allocating 8 per cent of turnover to

training, although she recognised that some of this was refunded through Train to

Gain, Partners in Care and Skills for Care and through prizes. What was distinctive

was that she saw this as part of her marketing. Although the home had a website, they

did not spend on marketing. Rather, the good publicity gained from winning awards

was seen as more than repaying the investment in training. She commented:

„If you ask most homes they‟ll have an advertising and marketing type budget.

I haven‟t got one really. I use that towards training and that brings its own

rewards because, you know, having been around for 25 years now a lot of

people obviously know us and your best advertising is word of mouth and I

need all my local practitioners, you know, all the GPs and nurses etc. to say

“That is a good home. We have confidence in it” because that‟s what it‟s all

about. …..because I‟m in a village situation, you‟ve got a lot of people round

here and we‟ve got a lot of staff. I mean M‟s own granddad‟s here. You know

we have a lot of people looking in on us, so my advertising is all of them

really and that budget has gone on training.‟

The contribution of training to reputation-building was also apparent in the Agency,

where managers saw training as contributing both to staff recruitment and to repeat

business in the local area. As reported earlier, some staff employed by other local

employers work at the Agency for a few hours a week in addition to their main job

specifically to gain access to training and experience of a wider range of care roles.

Well-trained Agency staff were seen as playing a role as ambassadors for the

organisation and in attracting repeat business. This was explained in the following

terms:

„When H trains five workers who go out and do a wonderful job, that‟s better

than G spending a week on the phone trying to get business. You know, those

five people are our sales arm.‟

Even when staff leave to work for other employers, the investment in training is still

regarded as positive. This is especially the case if they progress into management

roles and gain responsibility for commissioning agency workers themselves.

„It‟s always great to see where you started off a worker a few years ago in a

general sort of support worker setting and then that worker‟s now become one

of G‟s clients at management level because they‟ve progressed with us and,

you know, G now has a different relationship with them....it‟s a win for both

sides really.‟

The relationship between training, organisational culture, staff recruitment and

retention was also evident in the Community Caring Trust. Training is viewed as a

42

means to achieve a competent workforce through learning and the acquisition of

skills, as a means of bringing staff together to enforce the organisational culture and

as a means of empowerment of staff. Over 90% of staff are qualified to NVQ level 3

and many proceed to level 4 and the Registered Manager‟s Award. Staff training

needs are assessed by management but may also be identified by employees through

supervisions and appraisals. Examples were cited of employees who had been

supported to take up specialist training e.g. at degree level, funded by the Trust. This

was seen as means of gaining specialist knowledge and experience for the

organisation. Investment in training is underpinned by the payment of premium rates

of pay for the local care labour market and a willingness to recruit male carers in an

area of high unemployment. Retention of staff has resulted in a turnover rate of only

4% compared with a 20% norm for the sector. Combined with the reduction in

absenteeism, savings have been made on recruitment and eliminated the need to

employ expensive agency workers and service users have benefited through more

reliability and continuity in their care.

These observations suggest that the case study organisations have moved beyond

seeing training as a cost which is difficult to recoup, to seeing it as an investment.

This is not just a reflection of the particularistic characteristics of local labour

markets, for example, the location of the Residential Home in a rural area and the

Community Caring Trust, in a relatively depressed local labour market which make it

easier for the organisations to reap the benefits of their investments. Rather, there is

evidence from the case studies that training contributed in a number of ways to

innovations in managing the workforce. Firstly, training contributed to workers‟

understanding of organisational culture and the ethos of care, as well as the

expectations of their own job roles. Secondly, it was used to devolve responsibility to

workers, allowing them to make decisions autonomously and reducing the need for

layers of management and supervision. Thirdly, employee-led learning and

involvement in improvement projects extended work roles and expertise, combining

the possibility of increasing job interest and satisfaction for workers, with the capacity

to improve services for users. Fourthly, training was part of a package of human

resource management practices which contributed to recruitment and retention and the

reputation of the organisation as an employer and a service provider within the local

area. Fifthly, the development of potential in staff was seen as a benefit in its own

right, whether or not it resulted in career mobility within or external to the

organisation. Sixthly, where individuals did leave the organisation, this was not

necessarily seen as a loss of investment, but as a means of extending reputational

resources.

Trust in competent employees who understand users‟ needs

The case study organisations all claimed to have a moral and ideological commitment

towards their staff and service users. In the Community Caring Trust a clear link was

made between the way the workforce and service users are treated.

„The last bit is the vision. You‟ve probably seen all of this before. “Service

user, individual employee and the organisation.” [draws links] If you can do

that, fantastic, everybody‟s happy, but you can‟t do that most of the time. So

what we‟re all absolutely committed to is what they want and need comes

first.

43

The Director continued:

„If we want our workforce to treat the people we care for with dignity and

respect and develop their skills, we have to treat them in the same

way…..They are mirror images. How you treat your workforce is the

experience the service users get.‟

In a similar vein, the Agency saw itself as a family firm with a commitment to „good

work‟. It engages in charitable activity and has a commitment to looking after its staff.

Many interviewees were able to articulate what they felt was significant to the quality

of the service they provided to service users. The Coordinator of the Dementia Team

pointed to the quality of care as meeting users‟ needs based on an understanding of

their medical conditions, and how they respond to colour and loss of taste at different

stages of their disease, rather than being swayed the characteristics of the physical

environment, which may affect relatives‟ choices for them. In the same way, when

asked what she liked about her job, one part-time night-care assistant at the

Residential Home highlighted the contribution of caring to personal relationships. She

compared her current job to her previous occupation in the following terms:

„…it was all targets, hard sell and people were customers and not people and it was just what can you get off them, as in it‟s a target, and after 10 years of doing that I thought “Right, I want to do a job now where there‟s no money involved and no hard sell and you‟re actually doing a job that you get satisfaction from.” And I know even caring can be quite challenging, but it‟s nice because you feel like you‟re doing something for somebody and it‟s not for any monetary gain or any target. I don‟t know if you understand what I‟m saying. ….it‟s a totally different career choice because you‟re doing something for the benefit of somebody rather than, you know, the shareholders‟ back pocket and that‟s what I quite like.‟

In relation to this discussion, her co-worker commented:

„Yeah, pretty much the same in that, you know, you go home feeling “I‟ve actually done something good today.” I mean I haven‟t worked in a shop before, but it‟s completely different and, you know, you‟re helping people which at the end of the day is appreciated, so you develop a reputation with other people in the community and you respect other people of all ages really.‟

The theme of reputation in the community and amongst relatives was also highlighted

as a factor in the quality of care by the Director of the Residential Home. Involving

relatives on a regular basis was seen as a good way of contributing to the quality of

care. She argued:

„Whether you‟re old, disabled, learning disability, you deserve good care,

don‟t you, because you‟re very vulnerable, very vulnerable, and I hope that the

people that I come into contact with do feel … And also, you see, people don‟t

use the resources of their relatives. You know, you can have some really

clever relatives who are only too pleased to help, but nobody ever asks them

because they don‟t want them in the house or they … Well, if you‟ve got

something to hide you shouldn‟t be doing the job, should you? You know, to

me my strength is in my relatives being so involved because if I am inspected

and somebody says, you know, “This never normally happened and we‟re in

the house all the time and we know this is something…” You know, that‟s

44

part of protection for me, but if you don‟t … I mean there‟s still homes, aren‟t

there, where you‟ve got visiting hours. Why? Why?‟

This commitment to improving care standards and meeting users‟ needs was not

tokenistic and recognised users‟ entitlement to a normal life. In the Dementia Team,

the emphasis was on providing person-centred care, recognising that the particular

needs of the clients they look after demand a more flexible approach to service

delivery. The team engages with family and neighbours to look at how care can be

managed in a day-to-day way that suits the clients‟ lives rather than normal care

provision practice. They look at the whole spectrum of caring from personal care and

attending to meals to shopping for clothes and taking clients to appointments such as

dentists, opticians or to a day centre. They aimed to encourage service users to keep

using their own skills for as long as possible rather than to do things for them.

Where services are delivered in service users‟ homes, the effective management of

working time was seen as central to providing a service which meets their needs. This

may require delivering services at times which are not always convenient for workers,

particularly those with family commitments. As a result, strategies related to

managing work/life balance are central to providing consistent services at times when

they are needed. The ability to provide cover for absence, work flexibly within teams

or to be able to reorganise shifts, involves training commitments and also contributes

to organisation‟s ability to provide a consistent service to users. At the Dementia

Team cover is provided from 7.30am until 8.00 pm, organised around two shifts from

7.30am until 4.00 pm and from 11.30am until 8.00 pm. The Council has a policy of

only recruiting staff who are prepared to work shifts so that they can provide flexible

cover to service users. This was seen as creating a particular problem for the

recruitment of women with young families. Here, workers were organised in

autonomous teams who had shared knowledge of users and their needs. This meant

that if one user required additional support, members of the team had the ability to

adjust their workload to individual needs by calling for cover from other members of

the team. In other words, shared collective knowledge of users‟ and their needs meant

the members of the team could substitute for each other without disruption to the user.

At the Community Caring Trust, meeting users‟ needs meant requiring high level of

flexibility in service delivery. This was achieved through a number of mechanisms:

managing work/life balance and reducing absenteeism, on the one hand, and

maintaining a pool of qualified relief workers, on the other. In the same way, at the

Residential Home, shifts were arranged for two sisters in a way that allowed them to

share a car and on occasions had included bringing their mother into the home on a

day care basis.

Nevertheless, team work was also significant to managing services around users

needs, including good relationships within the team, workers‟ ability to self-manage

rotas and to be able to rely on their immediate colleagues to resolve problems. At the

Community Caring Trust, an example was cited of a worker whose mother was

terminally ill, whose five colleagues had recognised her need to be with her mother

during her illness. They had organised cover informally for her. The Director

considered this to be an example of how training had contributed to a culture of

supportive teamwork, which had reduced the need to refer problems to managers for

solution. These links were also evident in one of the interviews with the Dementia

45

Team, where the staff were asked to sum up, from their own perspective, why they

thought the team was successful in delivering high quality care.

R2: Okay. Like you say, dedication, hard work, real communication. We all love our jobs and we‟re a good working team.

R1: Hmmm, and I think we‟ve got a good understanding of our clients and compassion as well.

R2: And we‟ve got good managers because like, you know, if we need something we just phone up and they say “Right, okay, we‟ll move that client down or we‟ll take that client off you” and, you know, it just works out well, doesn‟t it?

I: And appropriate training as well.

R2: Yeah, good training. Yeah, it‟s been brilliant.

In other words, the organisations demonstrated a level of trust in competent

employees who were able to make decisions without reference to supervisors and

managers. As the Director of the Residential Home commented, „you have to let staff

run the organisation‟.

Developing specialist expertise and shared knowledge of users‟ needs

All the organisations recognised the professional and vocational element of workers‟

role. This included their understanding of users‟ needs through their day-to-day

contact with them, as well as the ways in which they developed knowledge of

particular medical conditions, through specialist training (for example, in dementia at

the Dementia Team) and employee-driven training. This meant that at times care

workers were better able to identify medical problems than GPs because of their

specialist knowledge of conditions and situated knowledge of service users. One

example, cited by the coordinator of the Dementia Team, illustrates this problem.

„Hmmm, it is quite sad and there‟s so much problem with mis-treatment of

people as well – being given anti-psychotic drugs when really they‟re not

psychotic at all, they‟ve got dementia. They‟re seeing that they can see

something because they actually can see it; that their perspective has

completely altered. We had a lady who the doctor was saying was, you know,

completely delusional because she was walking along the edge of the walls;

and the reason she was walking along the edge of the walls is because there

were big brown circles in the carpet and she thought they were holes. To her

that was what she could see – she could see holes and she didn‟t want to fall

down a hole. She wasn‟t delusional, that‟s what she could see, but they

drugged her up to the eyeballs, the poor thing, and it‟s very sad to see that

happen when you know that there are people that could have within ten

minutes worked that problem out; and when it was worked out she was happy,

happy as Harry. They put yellow carpets down and she was fine. It‟s just lack

of understanding.‟

46

Despite the team‟s specialist training in dementia and their shared, situated knowledge

of users‟ needs, this was not always recognised by other professionals, whose

attitudes sometimes appeared to be that they were „just Mums doing this is their spare

time‟. This was despite the fact that they had been recruited on the understanding that

they would work shifts, as required.

One of the problems for this specialist team is that essentially their role is to stabilise

dementia sufferers, when they are under threat of deterioration, in order to allow them

to remain in their own homes rather than go in to residential care. This was seen as

good for the service user as well as for their family, since it allowed them to stay in

familiar surroundings. Once they are stabilised, the team is expected to hand their care

over to agency workers, most of whom do not have specialist dementia training and

this created a dilemma for the team. The coordinator explained:

„I‟m not saying you have to have specific dementia training to work with

people with dementia. You don‟t. If you‟ve got a good insight and you have a

natural affinity to doing it, you can do it. But, unfortunately, most of the

people that work for agencies don‟t and it‟s … You know, we sit at case

meetings trying to decide who we‟re going to let go and the staff don‟t want to

let anyone go because they know what‟s going to happen, but then I‟m sat

there with three people in hospital waiting to come out that can‟t because they

don‟t have the care. So I‟ve got to let someone else go and it‟s a very difficult

position to be in and I think they need to have agencies trained as well as

us…‟

As a result, the team is often in the position of taking back service users, after a period

without specialist support. The coordinator was aware of practice towards dementia

sufferers in Holland, where care is delivered in a more holistic way, so that as service

users‟ conditions deteriorate they can remain within the same unit, but receive higher

levels of care appropriate to their needs, without being taken out of a familiar

environment.

Conclusion: organisational approaches to learning

The Directors and Managers interviewed in the case study organisations saw a well-

trained, well-managed workforce as being central to offering personalised services to

users. Effective training and development of staff were seen as a means of achieving a

competent and happy workforce, who would deliver good quality care. Staff in the

organisations appreciated the learning opportunities that were available and working

for an employer who would „go the extra mile‟ for them. In the Residential Home, the

Community Caring Trust and the Dementia Team, directly employed workforce and

managing employees‟ work/life balance, were seen as good mechanisms for meeting

users‟ needs for consistent, good quality services. The basis for delivering this was

based on employees‟ shared understanding of the organisation‟s ethos of care, shared

knowledge of users‟ needs, and the capacity to identify the need for, and develop

expertise, in specific conditions.

The Agency was the only example in which workers were more isolated in their work,

but workers‟ right to be managed and receive feedback on their work were

emphasised by managers. Not only did the Agency actively use its coverage of a

range of different care settings to provide learning opportunities for staff, which might

not otherwise have been available, but through the CPD that was offered to staff in

their own time, an attempt was made to overcome the agency workers‟ problem of

47

isolation. This structure and the resources associated with it allowed isolated workers

to brought together in a community of practice at local level, providing an alternative

support structure for staff organisations.

4.3 Developing training capacity: the training organisations

This section draws primarily on case studies of two different types of training

organisation. The first of these is the Not-for-Profit Provider and Training Division,

an internal training function of large charitable organisation which provides

residential, nursing and dementia care for the elderly. The function is responsible for

training all staff within the parent organisation and also runs external training

services. The second is the Training Company, a small private company which

provides training and consultancy services to the care sector. Case studies 4.5 and 4.6

in Appendix 4 provide more details of the two organisations.

A common feature in training providers as well as care providers was an

organisational ethos which values the training staff and encompasses a real

commitment to improving the quality of care. The Not-for-Profit Provider had a clear

organisational mission that was „dedicated to improvement of care of the elderly.‟

There was an underlying ethos that the quality of training and the quality of care are

related to the way staff are treated as individuals and the commitment shown towards

them as employees. „We‟ve always believed intuitively that staff development leads

to better care.‟ They see themselves as a learning centre looking at the education, not

just training, of their staff at all levels and in all disciplines. Their external services

are run „because, you know, what we want to do is raise the standards of care as far as

possible…our strategy is very much how we are going to advance the standards of

care, not how many programmes we‟re going to do.‟ Similarly, in the Training

Company there was a strong commitment to good employment relations with a focus

on the „socially useful‟ nature of their work. Training is work-based and outcome-

focused with a view „on the individual achieving a qualification and that‟s coming

together to help an employer.‟ Learning is seen as a means of making a difference.

There was a notion of the „virtuous circle‟: that they are committed trainers, providing

a quality service to care staff who are valued by their employer and in turn provide

sensitive, good quality care services.

Both training organisations saw their role as providing training and development, as

well as assessment. The Training Company provides training and consultancy

services to the care sector. Ninety per cent of its work involves the provision of NVQ

training at levels 2 to 4. Much attention is paid in the service offered to employers on

the importance of creating an appropriate environment for an individual‟s learning to

take place. Their service is seen as a partnership between training provider, employer

and learner.

„One of the things is about “Who‟s the outcome for?” you know, you‟ve got

the learner and you‟ve got the employer and you‟ve got us and I think that

that‟s what it‟s about. It‟s about those three partnerships and, you know, if

we‟ve got a learner who‟s not motivated and doesn‟t want to do it, I don‟t

want an assessor to think “Okay, I‟ll give them more time.” No, because that

employer needs that learner. So it‟s about seeing the whole thing about that

learner might not want to do it, but we‟ve got to get them to change that

around because there‟s an employer in there who needs them to have that

qualification … So outcomes is about seeing everybody we start with as a

48

finisher and that‟s really important because it means if they disappear, you

follow them.‟

The skills and commitment of the trainers are valued by the company. They are well

paid in return for hard work and are involved in business planning processes. The

company has a strong commitment to the development of its own staff through

mentoring and training programmes.

The internal training function of the Not-for-Profit Provider provides training

programmes for care staffing the homes run by the organisation and extends its

services to the provision and delivery of external training courses. The function has a

developmental approach to the design of its courses which is aided by the charitable

status of the organisation removing the need to make a profit. As in the Training

Company, trainers and assessors are required to hold appropriate qualifications and

have work experience that equip them with understanding and knowledge of the

learner‟s workplace role. The core training team are highly qualified in nursing, care

and education and other members of the training team have specialist skills and

experience in areas such as domiciliary care and health and safety. The mix of

expertise provides a means of examining situations from different angles „all our

trainers come from a nursing or care background, so they know the problems. So they

can go in and they can teach, they can train, and they know, you know, what learners

are coming up against in what they are doing.‟ As part of a care-providing

organisation, knowledge of worker‟s training needs can also be gained from the wider

organisation. Workplace issues confronted by the charity‟s care homes provide

practical knowledge to be used in programme development.

In both organisations, stress was placed on the need for trainers to have dual

qualifications: in training and development, but also as care providers and managers.

In other words, they were knowledgeable care workers as well as trainers. This

impacted on recruitment strategies and on the training provided for staff. The Not-for-

Profit Provider seeks dual qualifications when it recruits training staff, in nursing or

care and education. In the Training Company, assessors have dual qualifications in

care management and training. However, it has not always been able to find potential

recruits with both. In this case a key part of personal development is gaining expertise

in the missing element and their learning and development is constantly reviewed.

Supervisions are used as a means of reflecting on the individual‟s practice and

learning. Learning, development and training needs are assessed for any new roles or

responsibilities that staff will take on in the future. Individuals are observed every six

months by another team member to verify their practice and learning. „So actually it‟s

about making sure people have the confidence in what they‟re doing and are skilled

up and they build on that over time.‟ Trainers and assessors are qualified in both care

and management as both types of skills and experience are seen as necessary for their

roles. In both organisations it was considered essential that trainers have experience of

issues faced by workers.

A key aspect of the training provided in these two organisations was its tailor-made

nature, for the individual organisation and for the individual carer. Most of the clients

of the Training Company are small employers with differing staff training needs.

Flexibility in their approach to training includes accommodating many or just one

learner or working within a limited time frame for gaining qualifications. Learners on

night or weekend shift work are visited for training and assessment during their

working hours. There are many examples of how the company accommodates to the

49

needs of the individual learner by adapting training programmes. For learners with

basic literacy problems, assessment by observation and oral questioning is increased.

Workbooks are adapted to help those not used to writing formal accounts or who

suffer from dyslexia. The effect of the intrusion of an assessor on the service user is

also considered and this is avoided by the involvement of an expert witness in

sensitive situations. Sign language interpreters were used in an award winning

initiative for deaf carers and communication improved by the assessor learning how to

sign.

„Like the deaf candidates I‟ve got, that was a real learning curve as an

assessor. I mean I hadn‟t met any deaf people before I started working with

them and you just think, you know, “They‟re deaf but they can see,” but not

realising that English isn‟t their first language British Sign‟s their first

language.‟

In the same way, flexibility was evident in the way the Not-for-Profit Provider had

developed its internal training resources, which were subsequently made available to

other employers through its training division. An in-house BTEC induction

qualification was developed to train all members of staff in person-centred care,

interaction with, and support of, older people. The programme was externally

accredited and won a National Training Award and can be tailored to the specific

needs of other organisations. It also underpins a „whole workforce‟ approach,

whereby the needs of all staff, not just carers are addressed.

„We felt that it was just as important for the lady or gentleman that goes and

cleans the bedroom. They need to know as much about person centred-care

and how to interact with someone and what to look for and how to do it as the

carer, or even the person in the kitchen, you know.‟

There was some indication that the training function of the Not-for-Profit Provider

had „more freedom to be developmental‟ because of its charitable status and the fact

that it did not have to achieve a profit. However, both organisations had a number of

creative and flexible approaches to the design of work-based training.

In this discussion of the training organisations and in the previous section 4.2 on

organisational strategies to skill development, we have identified the relationship

between employers‟ internal capacity to manage employee resources and their ability

to bring in expertise to train and accredit the workforce. In larger organisations, an in-

house training function may facilitate the tailoring of training to an organisation‟s

specific needs, but specialist trainers can also offer flexibility and service awareness

as illustrated by the Training Company and the Not-for-Profit Provider‟s training

division. Smaller organisations relying on external provision can develop internal

capacity, which can help identify training needs and to evaluate the quality of external

provision. This can contribute to customising external training so that it complements

forms of learning which are available within the organisation. In the Residential

Home, training was generally delivered in-house by external providers or externally at

local colleges. However staff within the organisation are trained as NVQ assessors

and work alongside learners to evaluate training and learning and give support to staff

during their learning and assessment. All staff keep personal development folders,

providing a record and reminder of their individual learning achievements. The

Community Caring Trust employed external trainers but monitored activity so that

managers were familiar with exactly what the care staff had learned. In this

organisation, training for most levels of management includes a monthly shift of care

50

work to retain their practice orientation and experience any work issues that carers

may face.

Some areas of care require training in the development of expertise which can only be

provided by particular specialist training sources. Members of the Home Support

Dementia Team received statutory and NVQ training from their in-house local

authority provider but relied on external expert dementia training to develop the skills

and knowledge necessary for their role. Despite current and growing demand for this

kind training for care workers as the population ages, there appears to be limited

capacity to provide this specialist provision.

4.4 Developing organisational capacity through consortium arrangements

We examined three consortia, which were at different stages of development and have

different structures. In each case their formation was a response to the increasing

fragmentation of the sector. Particularly significant to the growth of consortia

arrangements was the shift from public to private provision and the need to ensure

compliance with the Care Standards Act and the requirement for care establishments

to have 50% of their employees qualified to the standard of NVQ Level 2. Combined

with this, the complexity of funding arrangements made it difficult for the large

number of often small, private sector providers to access funding for training. Because

these arrangements are local or regional responses to overcoming this complexity,

these bottom-up initiatives take many different forms.

Of the consortium arrangements included in this research, the Limited Company is a

private not-for-profit organisation with a Development Manager who acts as a

coordinator. The Council-backed Alliance covers one local authority area and it

employs a single Workforce Development Officer. The Institutionalised Alliance is

based in a local authority, although supports training developments in five local

authority areas, and has a total staff of 23. The consortia have different legal statuses

and this has implications for the types of funding that they can access (e.g. ESF,

LSC). Case studies 4.7, 4.8 and 4.9 of the consortia can be found in Appendix 4.

In each consortium employer involvement is central. In the Limited Company, the

partnership forum is made up of eighteen organisations including representatives of

the statutory sector (unitary authorities), care providers in the voluntary and

independent sectors and government bodies such as Skills for Care South West and

CSCI. In the Council-backed Alliance there is an Education and Provider Network,

made up of employers, representative of the local authority and the local college. All

care providers in the county may join the Alliance and access support, advice, access

to funding, access to training programmes and chance to become involved with any

Alliance initiative. Members include larger organisations with their own in-house

training functions through to the very small care home or domiciliary agency. The

Institutionalised Alliance is hosted by the council and staff are council employees. It

has the legal responsibility for the Alliance, although its work is overseen by a

Strategic Partnership Board. These include five members from local authorities, one

employer representative from each of the five geographical employer networks it

supports, and a specialist on disabilities, plus the Alliance Manager.

A key feature of the alliances is their ability to respond to local need. In the Council-

backed Alliance the Workforce Development Officer conducted research around

recruitment and retention and found that one of the key factors was quality of

51

management. As a result of the Alliance set up a successful performance management

programme. It was felt that such programmes, by adding to people‟s confidence, were

contributing to career progression.

In the Limited Company several projects were developed by the manager following

visits to local employers concerning training options. Here he discovered the

challenges local employers faced, such as which trainers to use and where to go if

something went wrong. A website was set up to provide information and all training

providers hosted on it joined the forum to facilitate a route for discussion of any

issues that might arise. It is also used as site for other information relating to the

sector.

Although each of the Alliances began with a prime focus on accessing funding for

training, they have all expanded their activities beyond this original purpose.

„So whilst it started off about money, I think the work the organisation has

done is to build, you know, a knowledge base and partnerships where people

can share best practice and qualifications that they‟re offering and, like I said,

I think there is more than enough business…‟ (Limited Company)

Having established itself, the Institutionalised Alliance now bids for training contacts

and sub-contracts to a range of preferred providers, keeping a top slice to fund the

running cost of the Alliance. It places an emphasis on the quality of provision,

inviting tenders from providers and working mostly with fifteen main ones. One

employer described the difference the Alliance made. They had always been

enthusiastic about training, but did not always have the resources to pursue it. Another

employer explained how she would previously attempt to recruit staff who were

professionally qualified nurses or social workers. With access to the full range of

training through the Alliance, there was opportunity to access training and

development for progression within the organisation. Other local authorities in the

region joined the Alliance, each making small financial contributions. It now has 23

staff (2 Managers, 2 in the Quality Team, 6 network development officers, an NVQ

co-ordinator and 7 in the Business Support Team) and they have become extremely

effective at making successful bids through Train to Gain, Skills for Care, the

Training Strategy Implementation fund and the Learning and Skills Council. It has

also developed training as a route into work in the NHS and care sector for the

unemployed, and organises regional conferences. It has 729 members (employers

mostly in the residential and domiciliary care, but also charities and community

groups) and has employer networks in five parts of the region with a member of the

Alliance staff supporting each of these, through which employers share information.

Network meetings host presentations on specialist topics and are an important site for

sharing knowledge about new developments in the sector. Again there was some

resistance initially, but employers found that there were more benefits from sharing.

As one manager said „...I think what the Alliance has done is build up confidence in

each other so actually we do share good practice.‟

This aspect of overcoming suspicion and the notion of being competitors and a move

to sharing of information and good practice was evident in all three case studies. The

Institutionalised Alliance holds regular provider forums, which enable providers to

share good practice. Some initially had reservations about the forum, but have moved

from being slightly suspicious to working together and sharing ideas. The Council-

based Alliance has brought together large and small employers, who willingly share

good practice and sometimes teaching materials. There are a number of sub-groups

52

looking at specific issues and the willingness to share was demonstrated in the

policies and procedures sub-group:

„I think in the old days there was a lack of trust. So these people in the very

first meetings didn‟t really know each other and there was a bit of a sort of

hesitancy in terms of getting stuck in really, but then over a period of time sort

of trust has developed and now people actually share good practice. They‟ll

pass on policies and procedures....‟ (Domiciliary Care Provider)

A similar view came from the Limited Company, „Most of us I don‟t think see each

other as competitors. It is about sort of sharing practice.‟

Coordination between organisations means that skills can be treated as a collective

good, sharing knowledge, financial resources, creating new training resources which

would not otherwise be available. One consequence of this cooperation is that when

workers move between organisations to develop their careers, this movement may not

be seen in such a negative light as when organisations compete for workers and see

training as an expenditure on which the returns are uncertain. In this respect, consortia

can overcome competition and individual self-interest and smaller organisations can

benefit from the expertise of larger ones.

A key aspect of the consortia was their role as providers of social and professional

networks. We have already identified the significance of connections to the wider

sector as a source of learning for practitioners in the care sector. We make the

distinction between local and cosmopolitan care professionals within the sector,

where the latter are more closely integrated into wider networks at regional and

national level. Some members of the consortia are cosmopolitan and they take

advantage of the consortium because they are already oriented in this direction.

Involvement in these networks offers more external connections and sources of

learning than individuals can access on their own.

Initially, these networks may be highly dependent on a small number of enthusiastic

local actors (Munro et al., 1996). Their connections contribute to understanding

changes in the regulatory framework, sharing good practice and developing resources

that smaller organisations, in particular, do not have the capacity to provide

themselves. In the Council-based Alliance, the local enthusiasts make it more than

just a funding mechanism but bring a real sense of pleasure of having a shared project

and social events. This raises questions about the extent of reliance on particular

individuals and how such arrangements might be reproduced or replicated in different

situations. The resources may be financial (for example funding to pay for a course)

or to do with the types of learning that are available in different types of organisation

(for example, an understanding of particular work roles or medical conditions). So

long as these cooperative arrangements are reliant on the efforts of these enthusiastic

local actors they are fragile and can be undermined by the departure of individuals.

They become sustainable once cooperation becomes embedded in formal structures

which are underpinned by resources and no longer dependent on the voluntary efforts

of individuals. In other words, they become institutionalised. In the Institutionalised

Alliance each of the five regional employer forums is supported by a member of the

Alliance staff and one of their activities is to recruit and involve local employers who

might become more active in the alliance. In this way there is a strategy for

sustainability of enthusiasts, as well as sustainability of funding.

53

In each Alliance, some consideration had been given to the implications of a move to

more personalised care and especially to the growth of direct payment arrangements.

The Institutionalised Alliance prides itself on being in the forefront of all new

initiatives. They are currently planning for individual budget holders and considering

whether there is a need for a separate employer network. The budget holders can join

the Alliance and can access training in the same way as any employer. Through the

Council, the Alliance has contacts with the Personalisation Officer and Direct

Payments Officer, who keep a list of all employers. In this way it is in a position to be

able to contact all employers and provide the routes to access training for employees.

They are thinking about providing specific training for personal assistants and will be

seeking funding from the Council to pursue this. The Limited Company is working on

guide for potential service users. Some of the employer members of the Council-

based Alliance expressed more concern about the implications of these developments.

It was suggested that in isolated areas the potential loss of economies of scale could

represent a threat to the service. There was uncertainty about the impact of direct

payments on business planning.

4.5 Educational and career development routes

Educational development routes are based on learning in educational settings, usually

leading to qualifications. They provide theoretical knowledge and are not dependent

on the learners‟ current job role. In this section we discuss attempts to provide

educational and career development pathways in the social care sector. The first of

these is the 14-19 diploma, which aims to introduce a vocational learning route within

the school curriculum, serving as a foundation for young people wishing to go into

careers in social care. The second is a foundation degree which was developed to

provide learning that was tailored to the needs nursing home managers with nursing

skills. The third and fourth examples are schemes supported by local authorities to

create learning and career pathways into Social Work for members of local

communities and for staff in frontline occupations in care.

4.5.1 Incorporating social care into the secondary curriculum: the 14-19 Diploma

One mechanism for increasing the supply of qualifications entering the social care

workforce is to adopt an educational route, whereby young people in full-time

education are encouraged to learn about social care as a vocational route within

general education. The 14-19 diploma is an example of bringing vocational learning

into the school curriculum. Given the raising of the school leaving age to 18, this

represents a mechanism for getting young people to think about and understand the

nature of careers in the social care sector.

This educational route was explored through an analysis of a Partnership in the South-

West, which brings together a further education college and five schools in urban area

around the development of 14-19 diplomas. This brought together further education

college staff who had professional qualifications in health and social work, and who

also had teaching qualifications, or were working towards them, with professionally

qualified school teachers who were academically qualified in subjects like Psychology

and Sociology. However, it also required employer engagement for vocational

expertise and understanding. This partnership has gone through the „first gateway‟

with five lines of diplomas, one of which is Society, Health and Development.

54

One of the factors that is quite striking in this and in other examples of educational

and vocational innovation examined in this project is the engagement of key

enthusiastic local actors in wider social networks which have constituted a significant

source of learning about changes in the wider policy environment and its implications

for workplace learning. As in the consortia, these innovators can be characterised as

cosmopolitans. The sector lead for the partnership brought her own vocational and

educational experience of the sector to the initiative, but understood that her role

would be strengthened through being involved nationally. She therefore contacted the

two Sector Skills Councils, Skills for Health and Skills for Care, and worked with

them in writing the diploma, as well as participating in national implementation

meetings. She also worked with the Qualifications and Curriculum Authority (QCA)

on the expert panel that approved the qualifications. She found this national

engagement helpful in providing information and in understanding what were often

confusing and contradictory communications about what was expected. Although she

saw the problem of information, not as a criticism of the way in which the process

was managed, but as a function of any innovation which was „fairly common to new

things starting in lots of areas‟. Nevertheless, she also recognised that where

representatives of different organisations come together, it is important to have a

methodology for working together through a programme of planned meetings which

can address problems such as common time-tabling, which had to be resolved if the

initiative was to work.

The development of the 14-19 diploma requires institution-building at local level.

This is because the content of the curriculum is contextualised to the needs of the

sector, so a high level of employer engagement is needed. A strategy was developed

to inform local employers about the diplomas and to involve them. The initial event

planned was a conference held in December 2007, which provided information about

the development of the diplomas for the sectors of health, social care, children and

justice. The conference also aimed to set up a consultative forum, with employer

representation from these sectors. This representation needed to be with „key people

in organisations with deep pockets‟, by which the coordinator meant not just

representatives who could provide advice, but who would also be able to provide

financial resources and staff to support curriculum development. The project therefore

brought together people with expertise in teaching young people, with others who had

knowledge of the sector and its ethos, all of which needed to be valued. The project

needed to be underpinned by effective teamwork: the coordinator described this as

being in a position „with lots of pieces of a jigsaw puzzle really and it‟s about getting

the best fit, as I see it, so that everyone can come out with a positive result. That‟s

totally the way I think we‟ve got to work‟.

The process of identifying common standards across the partnership was part and

parcel of developing a common scheme of work. The decision was made to use the

same awarding body and, at the time, only one had been approved by the QCA. A

common scheme of work followed from this decision and advice was sought from the

employer consultative forum, as well as additional resources which would support

some of the more specialist areas of work. In this way, engagement began to take a

more formal, institutionalised form. As a result, by July 2008, a „shared scheme of

work‟ had been agreed, which was used as a model for other diplomas in the field.

Communication within the project team was maintained through the writing of shared

assignments, which valued the academic input from colleagues in education and the

55

understanding of the ethos of care, which colleagues from a practitioner background

brought with them. This sometimes involved working to develop a shared

understanding of terminology and images of the sector, on the one hand, and the

requirements that were being made of learners, on the other. The development of the

diploma also required support for teacher learning. The local university established a

post-graduate qualification for staff working on the new diplomas. In other words, the

partners involved in developing the diploma have had to learn from each other as

members of the team in anticipation of the qualification being put in place (cf

Hodkinson and Hodkinson, 2004).

The first students in the partnership began their diplomas in 2008, with Level 2

learner groups starting in three schools and a Level 1 diploma starting in the college.

As in any situation of curriculum innovation, there are both advantages and

disadvantages to learners in being „guinea pigs‟. The advantages lie in participation in

cross-partnership workshops on communication, careers and this is seen as creating

economies of scale in terms of contacts with employers in the course of the diploma.

These include a member of the staff development team in the local Health Authority

and Social Services Department, a representative from Skills for Health, the Care

Ambassadors Scheme, the Children and Young People‟s team and the Community

Justice team. The private and voluntary sectors are represented through Care

Learning.

The curriculum content of the Society, Health and Development diploma starts with

the structures and roles of the different care services. It includes a communications

module which is seen as being central to understanding roles within the wider sector,

focussing on attitudes, practice and „how people can make a difference‟. The problem

here does not concern something that can be learned academically, but attitudes and

communication skills, which require contact work and reflection. In other words, part

of the diploma is not about obtaining a qualification, but awareness-raising through

reflective practice. This is particularly difficult for young people to understand and

requires the development of pedagogy which is linked to practice, drawing on case

studies which help them to understand this aspect of the work. There are also

requirements for periods of work experience: 10 days at Levels 1 and 2, and 20 days

at Level 3. Although the coordinator of the Diploma felt that this was insufficient

compared to what would normally be expected in a BTEC national diploma (400

hours in the workplace over the programme), she recognised for younger students

under 16 placement experience is more difficult to organise because of the nature of

personal care.

In reflecting on key issues for the future, the coordinator of the programme identified

the need to understand why people were coming to the sector without the right

attitudes and communication skills. There are issues around basic skills needs and

wider problems which concern young people‟s understanding and interpretation of

what old age is and the extent to which they value working with older people. The

Care Ambassador Scheme allows young people to talk to their peers about the value

of working with older people: the value of the job, what good practice entails and the

difference one can make to people‟s lives. Having good experience on a placement,

supported by a mentor who can answer questions, can contribute to understanding and

build confidence. Nevertheless, there are problems concerning the lack of career

routes into professionally qualified care roles and this may influence young peoples‟

56

(and their parents‟) perceptions of the potential for careers within the sector, or indeed

the capacity of the sector to develop them in the future.

„I feel very positive about the whole diploma development and I have always felt

very positive about a more vocationally, practically focussed education for young

people. And especially if the agenda is for young people to stay in education or

employment and that‟s going to increase their kind of prospects and qualifications

until they‟re 18, then I think the Diplomas are a very good way forward in that

respect.‟

Nevertheless, there may be problems in recognising the academic validity, strength

and robustness of the diplomas, particularly in higher education. The development

was lengthy, involving a process of employer, sector skills council and educational

consultation over a two year period.

„When I was first looking at the development of the Diploma, there was the

possibility that it would become a sector endorsed qualification, leading to a

licence to practice at Level 3. This is not their purpose, it is the purpose of the

young apprenticeships, which use more work-based evidence. So the diploma is a

vocational awareness raising qualification for young people which is also aimed at

strengthening their academic opportunities.‟

4.5.2 Providing a work-based, higher education qualification: the foundation degree

This initiative to provide one foundation degree for managers of nursing homes by e-

learning came about when the University was approached by representatives of a

residential care organisation. The particular problem identified was that a survey

funded by Skills for Care had found that nurses in management roles in nursing

homes were being required to do the NVQ Registered Manager‟s Award, and felt that

they were not being credited with sufficient prior learning for their nursing

qualifications. In other words, they were being required to cover basic care

management issues for which they already had a formal qualification.

The first steps of the initiative involved mapping general nursing qualifications

against the occupational standards which were the basis for the Registered Manager‟s

Award with a view to setting up a one year foundation degree, which would exempt

nurses from the care management aspects of the award and would focus on the

personnel and financial management aspects of the award. The qualification combines

educational and work-based learning, involving the production of a portfolio and a

work-based learning project. Since potential students for the award were in post as

care managers or assistant managers, or being prepared and supported by their

managers for the award, the degree was to be offered on a part-time, distance learning

basis. The curriculum was designed in consultation with employer representatives and

academics, and the degree was successfully validated. The degree was publicised in

an article in The Nursing Times, whilst the involvement of the residential care

association and initial responses from conferences where it was discussed suggested

that there would be substantial interest in the programme.

Although there were enquiries from approximately 40 applicants, only 12 students

enrolled in the first cohort. When those who had enquired but had not enrolled were

questioned, they reported that they had not had support from their managers because

the foundation degree was almost twice as expensive as the NVQ award. Despite

initial financial support for the project from Skills for Care and their support for the

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idea of an e-learning foundation degree, they subsequently withdrew this. Without the

Skills for Care endorsement, recruitment, particularly from larger charitable

organisations, was unlikely. Indeed, the position of the charities has been that it has to

be recognised as equivalent to the Registered Manager‟s Award, even though

academically it is at a higher level. Of the twelve students who enrolled on the

programme, three graduated. In the autumn of 2008 the Foundation Degree was

reported as „officially sort of extinct and (it) is no more because we couldn‟t recruit

on to it…..We spent years on it, did an awful lot of work putting all the on-line

materials. A colleague and I wrote a book that sort of underpinned the theoretical

components and it‟s gone!‟

It is worth reflecting on a number of factors which lie behind the failure of this

initiative. The first of these concerns the suitability of e-learning as a mechanism for

supporting learning, and continuing professional development in the sector, in

particular. Although the Options for Excellence specifically recommended e-learning

and interactive programmes for continuing professional development in social care

(Department for Education and Skills/Department of Health 2006:53), the experience

of those involved in setting up the foundation degree was that many students were

resistant to it and found it „quite scary‟. This was particularly the case for more

mature women, who have limited use of computers as part of their normal work roles.

In other words, there is a need to address the basic computer literacy of the workforce

before e-learning can become a significant medium for CPD. In contrast to the social

care sector, the National Health Service is seen as having made progress by

encouraging staff to take the European Computer Driving Licence, to support the

move to electronic record keeping.

A second factor is endorsement from sectoral bodies. Although inspectors from the

Commission for Social Care Inspection saw the foundation degree as an appropriate

alternative to the Registered Manager‟s Award, Skills for Care has not given

endorsement to foundation degrees. Skills for Health, a closely related SSC, does

have a framework for foundation degrees, but the wider framework for job

progression, careers and expectations for continuing professional development are

very different in the healthcare sector.

A third factor concerns the small size of many nursing homes and the difficulties they

have in meeting CSCI regulatory requirements relating to staff with nursing

qualifications. One student on the course had an agreement with her managers that she

would have one afternoon a week in the workplace, so that she could do the course

on-line. However, it was impossible for her to protect this time because if a qualified

nurse was ill, she had to be available as a replacement. So the people who wanted to

do the Foundation Degree – staff with nursing qualifications who needed a

management qualification – were not able to study, because they were not replaceable

within their own workplaces. Ironically, regulatory requirements were seen as having

a negative impact on the availability of time for learning for managerial staff. Our

respondent commented: „Oddly enough it‟s at the higher levels, the managers and the

assistant managers, because they have to be there. They‟re the person with the

qualification that keeps the home recognised by CSCI.‟

This case study experience of the development of a foundation degree throws some

interesting light on the problem of establishing professional qualifications and career

58

pathways in the sector. The qualification was initially developed because the NVQ

Registered Manager‟s Award was not seen as appropriate to staff with nursing

qualifications, because it failed to recognise their prior experience in care. Although it

was tailored to the needs of this group of workers, differential pricing meant that the

managers of homes were not prepared to pay the additional cost of the course over the

cost of the NVQ which is a regulatory requirement. Moreover, release from work

which is a problem in many organisations, especially smaller ones where extra staff

may not be available to provide cover, was intensified by the regulatory requirement

to have qualified nursing staff on the premises. The net effect of this is to restrict the

funds available for training to that which is strictly required by the regulations, even if

it does not meet the needs of staff, and to restrict access to learning which is more

tailored to their needs and can lead to progression into professional qualifications.

Whilst the Foundation Degree had initially been developed because of the

requirement for nursing home managers to have recognised management

qualifications, as well as a nursing one, changes in the requirements and timescales

undermined this initial impulse. So whilst some of the students on the course had been

enthusiastic, others „regarded it as an imposition and while there was a feeling that if

they didn‟t complete it they wouldn‟t be able to continue with their jobs, then they

stuck to it, but when that all seemed to disappear, they just shrugged their shoulders

and gave up‟. The regulatory framework therefore creates sanctions and incentives for

home managers and potential students to invest in learning and qualifications of

certain kinds, which may be supported or undermined by changes in the regulatory

requirements.

There is also a degree to which an initiative like this disrupts existing relationships

between nursing home managers and NVQ providers. The organiser of the

Foundation degree initiative explained that she first realised that there might be

problems with the initiative, despite early support, when she went to a conference and

the practitioners were:

„sort of shaking their heads and saying “Oh, we don‟t know about a

Foundation Degree. We have a lot of trouble with people who come in with

fancy management MBA qualifications and we still send them off to do the

NVQ”. ...There‟s definitely resistance against the academic world generally

and there‟s the thought that, you know, we‟re trying to impose an agenda on

them‟.

In other words, there is a tension between the recognition of the need for an

educational progression route, but certain blockages to taking this route up in practice.

Finally, there appear to be very different educational and career progression routes in

the care sector and in the health service for staff with nursing qualifications. In the

health service there are clear career pathways and expectations for the acquisition of

key skills and continuing professional development which are not found in the social

care sector to the same degree. These limited expectations are held by staff about their

own career prospects and are reinforced by the expectations of their managers. In this

way, managers in the sector may be complicit in restricting the aspirations and

opportunities of their own staff and the learning potential of residential homes as a

site of learning and access to learning is not fully developed.

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4.5.3 New pathways into professional qualifications: Local Authority A and Local

Authority B.

Both local authorities have developed innovative approaches into professional social

work qualifications. Although there are a range of different programmes, the key

focus in this section is on routes that were established, with differing levels of

success, into professional work. In both organisations, this was not just a case of a

commitment to equal opportunities and providing learning opportunities for low paid

workers, using a „grow your own‟ approach to developing staff. It was also part of a

wider political commitment to serving the needs of local communities and, in

particular, having a workforce which reflected the local community and was better

able to meet their needs. In other words, these initiatives combined an approach to

creating opportunities for the workforce, with one which aimed to make services more

responsive to local communities, by recruiting and training members of those

communities. In Local Authority A, 36 per cent of the local community is Asian and

Asian British and there was a particular concern to increase the numbers of

Bangladeshi and Somali workers in social services. Nevertheless, there was also a

strong perception that recruiting and developing local people either from within the

existing workforce or from the local community, would produce workers who were

committed to the local area and where more likely to stay in employment. This was

particularly important in relation to alternative strategies based on recruiting overseas

workers and newly qualified workers from outside the area.

It is worth underlining from the start that in both cases these initiatives required

significant commitment of resources and an ability to take the long-term view. As in

any situation in which an innovative approach to managing human resources is being

developed, it required commitment at senior level and initially, the involvement of

enthusiastic local actors. Although we have not been able to establish the full details

of the origins of the two programmes, it is clear that at Authority A, there was a

significant political change in the mid-1990s after the election of a Labour council,

following years of Liberal Democrat control. This produced a „political push‟ for a

council-wide equalities commitment which translated into the „Workforce to Reflect

the Community‟ policy, which led to the initiation of a number of positive action

programmes across the council. These were particularly aimed at the Bangladeshi and

Somali communities and the aim was to encourage members of these communities to

train in a number of areas where professional shortages were experienced. In other

words, at the political level, there was a radical vision. At senior management level,

the then Director of Social Services acted as a champion of the initiative, and this

resulted in a positive action programme in 1998.

In the Social Services Department, there was a scheme leading to professional

qualifications in Social Work and in Occupational Therapy. As far as the progression

routes into social work were concerned, there was a system of secondments. This

aimed to provide professional qualifications for unqualified social workers, some

whom had been recruited under previous initiatives supported by Section 11 funding.

There were also secondments for staff who wanted to become social workers. A

second scheme aimed to recruit local graduates onto a Masters qualification. A third

recruited local people onto an undergraduate social work course with opportunities for

work placements in the local authority during vacations. The programmes were part

of the mainstream training provision within the Department which, at the time,

included an NVQ assessment centre, children‟s training, adults‟ training and mental

60

health training. Subsequently, all training has been reorganised into a single cross-

departmental Organisational Development function, in which training teams are

structured around particular services (such as children‟s services, adult services, etc.).

As a consequence, the positive action scheme for social workers has merged with the

wider council positive action schemes, known as the Positive Action Progression and

Accreditation Programmes. In total 166 people have been trained under these

programmes and the council has been successful in increasing the representation of

the local community in the workforce. Nevertheless, managers and graduates of the

scheme alike identified the problem of further progression, once professional training

was completed and a first job obtained.

The experience at Local Authority B was somewhat different. Here, the public sector

trade union, UNISON, which at national level was promoting workplace learning as a

means of redressing inequality and lack of opportunity for its low paid members,

established a partnership on workplace learning with the Council. As at Local

Authority A, there was direct recruitment into social work trainee jobs from the local

community as part of a „grow your own‟ approach to creating a workforce to reflect

the local community. One of the innovative programmes created was sponsored Open

University course which leads to a professional social work qualification. Care

workers, residential care workers, home carers, Social Services administrative staff

and social care assistants were recruited onto the course.

This is a classic case of an innovative initiative established by enthusiastic local

actors which had encountered temporary difficulties following a change in personnel

on both the management and the union side. When the partnership agreement had

been set up, the students were seconded into social work trainee jobs and were

effectively on a placement, on the understanding that they would be offered a

qualified social worker job on completion of the four year course. This was to involve

a commitment to remain in employment in the authority for a „tie-in‟ period of two

years. The students took the K100 course in Health and Social Care, which is an entry

level course to degree level study. Following this, they had taken a three year course,

the Foundation for Social Work Practice. Seven students had qualified in 2008 and

were awaiting registration (at the time of interviewing in December 2008) and a

further 15 were due to complete in 2010.

However, innovative approaches to learning can be risky and a culture of blame is not

conducive to innovation. By the autumn of 2008 there was a moral panic about social

workers, following the „Baby P‟ case in Haringay. Following a reorganisation of the

HR Department and the departure of the manager who had initiated the programme,

the local authority was questioning whether students coming through this route were

„up to the job‟, despite the fact that they had passed their exams and had been

mentored and assessed on their practice.

UNISON did finally reach agreement with Management that the trainees on the Grow

Your Own Social Worker scheme who passed the course would then be placed in a

Social Work post in the authority following their registration in January 2009.

Management agreed that rather than make them go through an interview, there would

be a management assessment that would look at where their aspirations and where

their skills best fitted, and a discussion would take place to determine whether there

were any ongoing support needs. UNISON had argued that since they entered into a

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firm contract that would result in them being given a Social Work post upon

successful completion of the course, making them go through a full selection process

breached that contract. As it turned out, all the students who completed the course

were „snapped up‟, and Management commented that they were all had very good

assessments. The final year of trainees will qualify at the end of 2009, will get

registration in January 2010 and will follow the same course into permanent

jobs. Unfortunately, this will be the last group going through this „grow your own‟

scheme in the authority. Part of the reason given by Management for this is that there

is less of a need for newly qualified Social Workers, and a greater need for those with

at least two years experience.

The other programme concerns part-time qualification trainees. This is where

existing staff apply for funding to cover Social Work training. They are given release

from their substantive posts for the periods of time on placements, but it was always

the case that they would have to make an application for a Social Work post when

qualified, and would have to sit a full interview. UNISON has managed to secure a

range of support measures for these students, such as mentoring, interview skills and

regular checking on their progress into a Social Work post whereas they previously

were left to their own devices. This group of trainees were from a wide range of

backgrounds, often frontline jobs such as residential support workers, home carers,

and there are different expectations and skills needed when applying for social work

posts. Support of this nature is intended to contribute to more home grown success.

This group of trainees also had a clause in their learning agreement whereby they had

to remain in employment in the local authority for two years as social workers

following the training because of the investment in them. Where it has proved

difficult to get a permanent social work post in the authority, management has agreed

to forego this clause after a period of time of between 12 – 18 months, so that they

can apply to other employers. While this does not give any guarantee of a job, it is a

step towards achieving UNISON‟s objective of providing ongoing support for those

who successfully completed the social work training.

These case studies also make it clear that making services more responsive to users

has more than an individual dimension. In both case studies, the initiatives aimed to

tailor services to the needs of local communities by recruiting and developing staff

from these communities. In other words, tailoring services to the needs of the local

community involved making the workforce more representative of the community,

and providing opportunities for career progression for those entering at lower levels.

This required facilitation by the organisation, along with other stakeholders, including

the trade union. Another positive outcome of this initiative, reported by one of the

trainees who successfully completed social work training at Local Authority A, is that

it allows members of minority ethnic communities to challenge some aspects of the

Eurocentric curriculum of the educational pathway.

4.6 Conclusion

The questions we sought to address through the analysis of the case study

organisations were as follows:

How is learning and service quality enhancement promoted?

What are the characteristics of the organisations which take skill development

seriously?

62

What are the triggers for innovation in skill development?

What is the role of social institutions in promoting skill development in

organisations and workplaces?

How can skill development contribute to the establishment of satisfying jobs

and career pathways which will make this an attractive sector of employment

for the future?

What are the implications of the personalisation agenda and direct payments

systems for skill development?

We started this section of the report by focussing on the needs of service users and the

features they identified as desirable in care workers. The case study organisations

were selected on the basis that they have been recognised through the awards they

have won as exemplifying good practice in the training and development of workers

for this sector. The triggers for their innovative approaches varied, but the impetus

often came from managers‟ recognition of the need to do things differently if

particular problems or mistakes were to be overcome. The introduction of the Care

Standards Act was one factor in this, but many of the organisations recognised the

need to go beyond compliance and the opportunistic use of free resources for training.

Much can be learned from the factors associated with good practice in these

organisations which involve holistic approaches to managing the workforce and could

be more widely disseminated to organisations in the sector. The development of

cooperation between employers, trainers, commissioners of services, trade unions and

other agencies is contributing to the capacity of the sector to treat skills as a collective

rather than purely individual good, and to share good practice. Shared resources and

wider forms of cooperation are necessary to establish career pathways and innovative

forms of job expansion within the sector, since it is difficult for smaller organisations,

in particular, to do this on their own.

Mechanisms such as employee-led learning, devolution of responsibility and the

improvement project can result in skill development, job expansion and the creation

of more satisfying work. Engaging in external relationships, through initiatives such

as the Care Ambassadors scheme represents a source of learning, and enhances job

roles and self confidence. Managers and trainers engagement in networks at regional

and national level can provide a source of learning through sharing practice and

knowledge, as well as providing access to training and CPD resources.

It is also clear that the tailoring of services to users‟ needs does not necessarily

involve individualisation, but has collective dimensions, for example in the ability of

workers to reflect the communities they serve, as seen in the „grow your own‟ social

worker initiatives, and to meet the needs of a group of service users, which may vary

from day to day, by reallocating work amongst the team, in the case of the Home Care

Dementia Team.

Although the focus of this report is on skill development in social care, it is important

to point out that some of the factors identified by users and carers as contributing to

good quality care services, do not necessarily derive solely from the quality of

training, but from the quality of management of care workers and their wages and

conditions of employment which contribute to workers‟ motivation to work in the

sector in the first place. Since wage costs form a significant proportion of the total

63

costs of the provision of care as a service, the resources that are allocated to care

services lies at the heart of the quality of service provision. The possibility of creating

learning and career structures is crucial to the ability of employers to recruit young

people into the sector and to grow, develop and retain other workers.

Finally, given the predominance of women workers in this sector, the management of

care workers‟ work/life balance is central to the ability of organisations to provide

services that users require at the times they need them and in a way which is

consistent and reliable. Although this is important in all care settings, it is especially

true in domiciliary care, where workers go into the homes of service users. The

experience of the Dementia Team is especially instructive as far as workers‟ ability to

adapt to users‟ needs on particular occasions is concerned and, in particular, their

ability to substitute for each other, whilst assuring continuity for the service user.

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5 Expansive and restrictive learning environments in the

social care sector

5.1 Approaches to skill development in social care

We now turn to the different approaches to skill development which we encountered

in the fieldwork. In our discussions with managers, trainers and representatives of a

range of organisations, it became apparent that there were a range of different

approaches to skill development within the sector. Whilst wider regulatory

frameworks for regulating services and skill influence this, the employing

organisation and the immediate workplace also impact on training and development,

the assessment of competence, as well as more informal forms of learning which take

place through on-going activity. In interviews, examples of good practice were often

contrasted with other ways of meeting statutory requirements for workforce

competence, which were seen as being less conducive to employee learning. As a

consequence, the team was able to identify six approaches to skill development,

which are not necessarily mutually exclusive.

1. The compliance approach

These are approaches to training and assessment which focus only on meeting the

formal requirements of NVQ assessment, required by the regulatory framework.

Compliance with statutory requirements can be a significant driver for changing

training practices and may result in innovations in an organisation‟s approach to

training and development. Although compliance with regulations has been a

contributory factor in our case study organisations‟ approaches to training, it was

not always the primary trigger for innovative approaches, discussed in Section 4.1.

2. The funding driven approach

One of the consequences of statutory requirements for workforce competence in

the social care sector has been that funding has been available for training and for

projects. Some of the training organisations reported that the availability of

funding, for example, at the end of the financial year, could result in training

organisations needing provide a particular type at a specific time. Whilst free

training may be attractive to organisations which have limited internal resources

for this purpose, such training may not contribute to the organisation‟s ability to

plan for its needs, or to ensure that training is appropriate. Amongst our case

studies we found that the availability of external funding for particular training

courses had driven the Agency‟s decision to send ten workers on a free course,

which only one had successfully completed. This had not been based on a planned

and systematic approach to identifying the organisation‟s and the individuals‟

needs. In this instance, the failure of the funding driven approach had forced the

Agency to reassess its approach to training and to learn from this mistake. In

contrast, the Residential Home planned its statutory training on an annual basis, as

part of its wider approach to planning training needs.

A second type of funding which may be available for training is what could be

called „seed corn‟ funding for innovations. We have identified cases where

funding of this nature has contributed to innovations, for example, in supporting

the development of specialist dementia training for the Dementia Team, which

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works across health and social care, and the project that the Residential Home was

involved in for developing district nursing skills for care workers.

3. The educational route

This route is based on learning in educational settings, usually leading to

qualifications. Such approaches provide theoretical knowledge and are not

dependent on the learners‟ current job role. Examples of this include the 14-19

diploma; the foundation degree; the Not for Profit Provider‟s BTEC induction

programme in person-centred care and its leadership and management courses;

and the routes into professional social worker qualifications, sponsored by the two

councils. Even so, educational routes into care qualifications also need to be based

on a strong relationship with the world of practice. For the 14-19 diploma,

practice-based knowledge was essential for students‟ understanding of the ethos of

care, and this anchoring of knowledge in the world of practice was brought by the

different partners with experience in the sector in further education and service

delivery who developed the diploma. The foundation degree was tailored to the

needs of managers in nursing homes who had nursing qualifications. The

educational qualifications developed by the Not for Profit provider were linked to

the perception that a more developmental approach was needed to the design of

programmes to equip staff with professional skills for their job roles. These

needed to be tailored to the needs of particular categories of staff bringing

together teaching, training and practical knowledge. Although the two Councils

used different routes for developing their own staff and linking them in to career

structures, degree level educational qualifications were central to this.

4. The whole organisation approach

These approaches involve a systematic approach to business and human resource

planning within organisations. This involves the development of organisational

competence, for example in management and in the ability to manage and develop

human resources. It involves having mechanisms for identifying the learning

needs of all the workforce and making provisions for them to acquire the skills

and qualifications identified.

5. The training and development approach

As part of a whole organisation approach to skill development, there are different

routes for allowing learning, job progression and career development to take

place.

workplace learning route – workers enhance their knowledge of their job role

and users‟ needs, becoming expert workers who are self-confident in team

work and in their dealings with other professionals. The focus of this kind of

learning is on becoming more proficient within an existing job role, which

may include expansion into new areas of competence and tasks.

career progression route – learning on and off the job underpins a career

development route into more highly qualified work. In this context, skill

development is linked to job progression usually within an internal labour

market.

learning progression route – learning opportunities are available on and off the

job which are independent of, and not restricted by, current job role and

location within a career progression pathway. The existence of learning

66

progression routes may allow career progression routes to be established

where they did not previously exist.

6. The coordinated regional approach

Employers, commissioners of services, sector bodies and training organisations

work together to provide a coordinated approach to training within a regional or a

locality, with a view to creating economies of scale, creating local career

structures and sustaining training investment. These regional bodies contribute to

building capacity and sharing resources within the sector at local level.

Cooperation rather than competition between employers on training contributes to

capacity building within the sector, creates economies of scale through shared

facilities. It benefits smaller organisations, in particular, which do not have in-

house resources. Engagement in these networks is a significant source of learning

for managers and trainers, and allows them to understand, anticipate and plan for

changes in regulatory requirements.

5.2. The expansive restrictive continuum of learning environments

Building on their research on different forms of apprenticeship in the UK, Fuller and

Unwin developed the concept of an expansive/restrictive continuum of learning

environments to help understand the barriers and opportunities that workers

experience to learning in their workplaces (2004:129). Drawing on Lave and

Wenger‟s (2000) concept of learning as participation (as opposed to the more normal

concept of learning in educational settings as involving a formal curriculum and a

transfer of codified knowledge) and the ways in which participation in communities of

practice contributes to learning, they attempted to bring together the pedagogical,

organisational and cultural factors that contribute to approaches to workforce

development and the creation of learning environments. They argued that the quality

of learning at work relates to organisational features such as culture, history, work

organisation, business goals and external pressures which determine the extent to

which organisations can create „expansive‟ or „restrictive‟ approaches to learning.

EXPANSIVE LEARNING ENVIRONMENTS are most likely to engage staff fully

in a range of learning opportunities which meet the needs of the individual and the

organisation.

RESTRICTIVE LEARNING ENVIRONMENTS are least likely to take staff

beyond immediate task related training and competence assessment to meet minimum

regulatory requirements.

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Figure 1: the expansive/restrictive continuum

EXPANSIVE RESTRICTIVE

Participation in multiple communities of

practice inside and outside the workplace

Restricted participation in multiple

communities of practice

Primary community of practice has

shared „participative memory‟: cultural

inheritance of apprenticeship

Primary community of practice has little

or no „participative memory‟: no or little

tradition of apprenticeship

Breadth: access to learning fostered by

cross-company experiences built in to

programme

Narrow: access to learning restricted in

terms of tasks/knowledge/location

Access to range of qualifications

including knowledge-based VQ

Access to competence-based qualification

only

Planned time off-the-job including for

college attendance and for reflection

Virtually all-on-job: limited opportunities

for reflection

Gradual transition to full participation Fast – transition as quick as possible

Apprenticeship aim: rounded expert/full

participant

Apprenticeship aim: partial expert/full

participant

Post-apprenticeship vision: progression

for career

Post-apprenticeship vision: static for job

Explicit institutional recognition of, and

support for, apprentices‟ status as learner

Ambivalent institutional recognition of,

and support for, apprentice‟s status as

learner

Apprenticeship is used as a vehicle for

aligning the goals of developing the

individual and organisational capability

Apprenticeship is used to tailor individual

capability to organisational need

Apprenticeship design fosters

opportunities to extend identity through

boundary crossing

Apprenticeship design limits opportunity

to extend identity: little boundary

crossing experienced

Reification of apprenticeship highly

developed (eg through documents,

symbols, language, tools) and accessible

to apprentices

Limited reification of apprenticeship,

patchy access to reificatory aspects of

practice

Source: Fuller and Unwin, 2004:130.

This model is useful for thinking about the characteristics of skill development in the

social care sector. It provides policy makers, managers and trainers with a tool for

thinking about the quality of learning environments and how they can be enhanced.

These characteristics can be linked, in turn, to the quality of care provided, with the

assumption that more expansive learning environments create workers who are more

likely to tailor care to the needs of service users than those in more restrictive learning

environments.

Approaches to Apprenticeship

68

Figure 2: Expansive and restrictive learning environments in the social care

sector

The continuum

Expansive

↔ Restrictive

Relationship to external environment Learning and development ↔ Tick box approach to compliance

Learning and development

↔ Funding driven opportunism

Nature of training and assessment task Assessor as trainer and developer ↔ Assessor as administrator

Assessor as knowledgeable care

worker

↔ Assessor as administrator

Assessor has dual qualification

assessor/trainer & developer

↔ Assessor has single qualification

Tailored assessment and

development

↔ Standardised assessment

Integration with business strategy organisational processes Organisation – whole organisation

approach

↔ Organisation – reactive and compliance

driven

Organisation integrates training,

development and assessment into

organisational practice

↔ Assessment, training and development

are bolted on

Organisation has internal capacity

for assessment and training

↔ Organisation relies on external sources of

expertise

Moral & ideological commitment to

improvement and maximising staff

potential to achieving best quality

care

↔ Lack of commitment to staff

development as an element in delivering

quality care

Commitment to employee driven

learning & employees encouraged

to identify learning needs,

developing expert roles

↔ No opportunities for employee driven

learning, employees see themselves and

are seen by others as „just a care worker‟

Structuring, enhancement and management of care workers‟ roles Trust in competent employees who

understand client need

↔ Care staff treated as unskilled workers

with little autonomy

Recognition of professional and

vocational element of workers‟ role

↔ Not appreciating professional and

vocational element of workers‟ role

Career routes into more qualified

work and learning routes extend

knowledge beyond job role

↔ Absence of career routes and learning

restricted to job role

Ambassadorial role for the

workplace/sector

↔ Role restricted to job role

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Staff development contributes to

reputation building (awards,

recruitment, gaining contracts,

creating innovative service

provision, tapping in to new sources

of expertise, as an alternative to

marketing expenditure)

↔ Limited concept of role of training

Employees understand and have

confidence to question practices

↔ Employees are not able to question

practices

Employees are listened to and feel

respected

↔ Employees are not listened to and do not

feel respected

Organisational links to wider institutions and networks Organisation is connected to the

wider sector, which is valued as a

source of learning and development

↔ Organisation is insular

Inspirational champions for care

sector workforce development

contribute to building social

institutions

↔ Absence of inspirational role models

The first group of characteristics relate to the impact of the external environment on

training decisions in organisations, as determined by the regulatory framework and

the availability of funding. In the introduction, we argued that regulation can produce

responses from organisations ranging from innovation, compliance or exit. In terms of

the management of human resources, this can result in increasing formality in

employment relations and enhanced organisational capacity for managing employees.

However, the extent to which this results in whole organisation approaches as

opposed to a focus on meeting targets, will affect the extent to which this promotes an

expansive learning environment. In the same way, the availability of external funding

from a range of sources will not necessarily result in the development of whole

organisation approaches to managing training. Indeed, in the case of The Agency, a

more systematic approach to training and CPD was developed because of the failure

of the company‟s response to external funding. Similarly, in the example of the

Foundation Degree, organisations‟ interest in meeting targets for NVQ assessment

undermined an initiative which was aimed at providing more appropriate learning for

managers with nursing qualifications in nursing homes.

The second group of characteristics is associated with the nature of the training and

assessment task, the extent to which it is seen as an expert worker/teaching role or as

an administrative role and is tailored to the needs of the organisation. Here we can see

the relevance of having trainers and assessors who have qualifications and experience

in caring and in managing, as well as in training, not just assessing.

The third group are related to the extent to which training and development are

integrated with business strategy and organisational processes. Although integration

may promote a more expansive learning environment, this also requires internal

capacity for managing, and managing human resources in particular. Sources of

external expertise, where appropriate, will contribute to the quality of the learning

70

environment, though not if this is combined with a reactive, rather than proactive and

committed approach to staff development.

The fourth group of characteristics concerns the way in which care workers‟ roles are

structured, enhanced and managed. These are reflected in the extent to which staff are

seen as „just a care worker‟, rather than skilled workers capable of exercising

autonomy in decision-making and/or who are on a career development route into

professional work. At the most expansive end of the continuum, workers are trusted

as ambassadors for the organisation, contributing to building its reputation within the

local community. They provide new sources of expertise for the organisation,

contribute to enhancing the range of services it offers and have the self-confidence to

question practices.

The final group of characteristics concerns the extent to which the organisation is

connected into wider networks and institutions. These relationships contribute to

capacity building for the sector creating shared resources from which many

organisations benefit. Through the opportunities they afford for management learning

through the sharing expertise and understanding of good practice, they enhance

capacity building in the organisation as well.

5.3 The implications of the personalisation agenda for learning in the social care

sector

Having discussed the factors that contribute to expansive learning environments in the

social care sector, we would like to turn now to the potential implications of the

personalisation agenda for learning needs, in particular for managers and service

users. The starting point for this analysis is a recognition that social care is provided

in the formal sector of employment and in more informal ways by family, neighbours

and friends on an unpaid basis. Within paid employment, there is a sector of care

work which regulated and the direct payments sector which is unregulated.

Figure 1: Employment in the social care sector

Regulated sector ---------------- Non-regulated sector

Compliance with regulations Personal assistants (direct payments)

Non-compliance with regulations Informal care (unpaid)

The research evidence suggests that regulation has contributed to organisations

developing more systematic approaches to managing the workforce and to ensuring

that workers meet competence requirements. Nevertheless, there are organisations

which have yet to fully meet regulatory requirements and amongst those that do, there

are those which do so on the basis of a restrictive learning environment and those that

do so on the basis of a more expansive learning environment. As pointed out in the

discussion of the regulatory framework earlier in the report, the fact that personal

assistants directly employed by service users are not covered by the regulations

creates an anomaly. In other words, domiciliary workers who are employed by

organisations are expected to meet the requirements for registration and this continues

to apply if a service user employs them from another organisation. If they are

employed directly by the service user, the regulations do not apply. There are, in

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addition, concerns that even in the regulated sector, the ambitions for

professionalizing domiciliary workers through the registration requirements are low.

If we look at the different situations in which care may be provided, there are a range

of learning needs, stretching from the informal carer who needs to understand another

family member‟s needs through to the paid worker in employment. The fact that

individuals move between these settings can be both a strength (the possibility of

recruiting staff who realise they have an affinity with care work through their personal

experience) and a weakness (moving from regulated to unregulated settings as an

avoidance strategy).

Finally, service users themselves need to develop knowledge in order to use direct

payments systems. In order to use direct payments to pay for care needs or to use an

individual budget to pay for care and the broader services that these payments may

include, an individual must either take the option of using an agency service (if an

appropriate one is available for the required service in the given area) or have

knowledge of aspects of being an employer. Guidance from Care Learning on the

latter identifies the need for:

familiarity with the requirement for registration with the Inland Revenue, be

aware of National Insurance and tax requirements, employees‟ entitlements

such as maternity and sick pay and of the National Minimum Wage

a knowledge of payroll schemes and possibly payroll providers

awareness of Health and Safety responsibilities, carrying out risk assessments

and have a knowledge of the responsibilities regarding safety belonging to the

proposed personal assistant

awareness of the need for insurance against accidents, injury to staff as well

as potential damage to property and its contents

the ability to deal with conflicts, disputes and disciplinary procedures

appropriate levels of control for the working relationship

To employ an assistant, the individual must be familiar with aspects of recruitment

such as

discrimination laws, CRB checks,

writing a job description (which requires an astute recognition of the service

user‟s needs), devising application forms, advertising and interviewing

employment contracts, pay rates

On employment of the assistant the service user must then

be able to carry out an appropriate employee induction

ascertain any training needs of the employee and find out what training is

available from which providers and at what cost

keep accounts and audits of direct payments as they are monitored by local

social services (Care Learning, 2007).

In order to help the service user cope with the multiple tasks required of them a range

of organisations have produced documents and guides to provide information about

and assistance in the processes involved. Organisations such as the consortium Care

Learning, Age Concern, and the National Centre for Independent Living provide fact

sheets, websites and publications with detailed advice on job descriptions, advertising,

interviewing and recruiting staff as well as information on local schemes, from the

72

local authority or run in partnership with the local authority, which offer support to

the service user both in the employment of an assistant and in gaining knowledge

about or access to training provision. Training in areas such as health and safety and

manual handling may be provided free by local authorities. There may also be

provision for funding some training in „start up‟ packs for direct payments from local

authorities.

5.4 Conclusion: expansive and restrictive learning environments

In this section of the report, we have examined the characteristics of learning

environments in care settings, emphasising the collective, situated knowledge that

care workers have of users, which contributes to reflective practice. Where workers

have access to expansive learning environments, they are more likely to acquire

theoretical, standards-based and experiential knowledge that allows them to become

expert workers. The way in which this knowledge and skill is perceived, relates to

way in which it is socially constructed in relation to other occupations. As a low paid,

predominantly female occupation, care work is not seen as a high status occupation.

Its status is affected not just by the formal qualifications held by the workforce, but

also their pay and conditions in relation to other occupations. Regardless of the

situated knowledge care workers have of service users and their needs, this

knowledge is not always valued by other professionals, who have professional

qualifications and have greater status in the hierarchy of occupations, or by the

general public and other agencies.

A number of influences were identified which contribute to the development of

knowledgeable workers, who are able to meet user‟s needs. The first set of factors

relate to the culture of an organisation and the quality of management. This

presupposes the recognition of the need to manage human resources effectively and to

have management systems in place to plan ahead for business needs. Key factors

include the ethos of care embodied in organisational strategy and values, and the

extent to which business planning processes and link to wider processes for managing

the workforce. The recognition of the significance of management skills is a key step.

There are many sources of learning for developing management capacity. These

include education (theoretical knowledge), training (practical knowledge) and through

learning from good practice from within the organisation (shared collective

knowledge of the organisation and service users‟ needs) and from outside the

immediate organisation (shared collective knowledge of social care as a sector of

activity). In other words, management capacity can be enhanced through engaging in,

and learning from, a wider community of practice and regional consortia and

networks for social care professionals constitute a significant source of learning.

The second set of factors relate to the quality of the working conditions and the work

environment. Pay and conditions of work are significant and will affect the

organisation‟s ability to recruit and retain staff. Although care work is not well-paid,

it can be satisfying work. A number of organisations specifically seek new recruits

whose disposition was appropriate to care work. A good quality of work environment

requires good communications systems and for staff to feel respected and valued.

Given the timing of service users‟ needs, the management of work/life balance for

workers is essential both for allowing staff to manage conflicting demands on their

time and to allow the organisation to provide a consistent and predictable service to

73

users. Shared knowledge of users and team-working practices allow care to be

tailored to users‟ needs and for workers to substitute for each other when work needs

to be rescheduled or covered for absence. Since care workers are in regular contact

with service users and this relationship determines the quality of care, this contact

makes them a source of understanding of particular service users‟ conditions and

needs.

The third set of factors concern the quality of the learning environment and how this

can be enhanced through education (theoretical knowledge) and training (practical

knowledge). Nevertheless, the workplace itself is an important source of learning,

through opportunities afforded by enhancing job design (through incorporating new

roles) and opportunities for acquiring new skills and knowledge. Significant learning

takes place from other workers and service users through shared collective

knowledge, good communication and reflective practice. Employee-identified

learning represents a way of developing specialist expertise, which contributes to

innovation, benefiting both the organisation and service users. Work autonomy can be

a significant source of job satisfaction, both for individuals and for teams. When it is

based on a well-trained workforce which management trusts, this can be a mechanism

for reducing layers of supervision.

These three sets of factors contribute to workers‟ ability to meet users‟ needs and thus

to meeting the personalisation agenda, understood as the objective of tailoring service

delivery to these needs. The factors identified above derive from institutional and

organisational environments which promote good working conditions, management

systems which allow working time to be managed effectively, respect for workers and

users, and enhance service quality through expansive learning environments, for both

managers and workers. Although regulatory requirements for organisations and for

workers may contribute to the more effective management and the availability of

resources for training and assessment, as we have indicated in the analysis of the case

studies, this is not sufficient to promote expansive learning environments.

We would argue that for organisations in the social care sector, there is much that can

be learned from case studies of organisations, trainers and consortia which have

successfully implemented strategies to train and develop the social care workforce.

These organisations were selected for study because they have been recognised

nationally through awards, such as the Skills for Care accolades. We have identified

the factors that contribute to the quality of the learning environment within

organisations and for the sector through the application of the concept of the

expansive/restrictive continuum of learning environments. We have identified, in

particular, the significance of the inter-connections between training, learning and

other HRM practices for workers, as well as the significance of sources of learning

outside the immediate workplace. The expansive/restrictive continuum is also useful

in understanding sources of learning for managers and owners of social care

organisations and, in particular, the role of wider networks and engagement in

regional coordinating structures as a mechanism for connecting with leading practice.

These findings also have implications for the quality of care in the context of

personalised budgets. Some interviewees, as for example, the Director at the

Community Caring Trust saw personal budgets as an opportunity. He felt the

organisation was already delivering personalised services and would keep business

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under a direct payments system. Other organisations, including one of the homecare

organisations in the Council-backed Alliance, felt that changes in income streams

might affect the viability of services, particularly in rural areas. If organisations are

able to maintain the conditions which support expansive learning, the conditions are

present for maintaining and enhancing service quality. If these conditions are not

present, or workers are separated from the conditions relating to the quality of

management, the work environment and the learning environment, then the

implications for the quality of care may be negative. In other words, the move to

personalised budgets may present significant challenges to shared collective learning.

It is in this context, that the experience of the Agency is particularly instructive,

whereby mechanisms were found to support collective shared learning for their staff.

They did this through providing workers‟ entitlement to learning, through courses

provided on Saturdays. In this way, not only did the workers have access to formal

learning, but they participated in a community of practice which shared similar

occupational roles and employment with the same agency.

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6. Conclusion

In this research project we set out to answer a number of questions relating to the

institutional and organisational capacity of the social care sector for skill

development. We were concerned with how social institutions create systems of

incentives and sanctions which encourage investment in training; how they encourage

cooperation at different levels; and the extent to which they involve different

stakeholder groups. We were interested in the ways learning and service quality

enhancement can be promoted in service providers; the characteristics of the

organisations which have exemplary approaches to learning; and the triggers for

innovative approaches. The analysis explored links between these different levels,

highlighting the role of enthusiastic actors in building institutional capacity and

innovating at the local level. The project examined initiatives to establish educational

and career pathways to make this an attractive sector of employment for the future

and the implications of the personalisation agenda and direct payments systems for

skill development.

The analysis of the institutional environment suggests that there is a consensus on the

problems the sector faces amongst key players in the agencies and representative

organisations. Much of this revolves around the under-funding of care services, the

need to enhance the quality of care through the tailoring of services to users, and the

empowerment of users‟ in decisions about their care. Nevertheless, there are a series

of over-lapping institutions with inter-related responsibilities regarding the regulation

of the sector, which can be confusing, and this complexity has been complicated by

changes in names and remits, along with changing deadlines for meeting regulatory

requirements. These changes are sometimes difficult for managers in smaller

organisations to follow, and the effect of constant change in requirements can act as a

disincentive for meeting targets.

This situation is further complicated by the range of different funding sources for

training which means that considerable resources must be invested in commissioning

and bidding processes. These funds come from a range of sources, some of which are

specific to the sector. Others are linked to the regional development and the wider

skills policy agenda. The institutional players responsible for the latter are not so well

embedded in the social care policy community at national level.

Small organisations often do not have the capacity to access resources for training

themselves and must use intermediaries such as colleges and training organisations.

They have less capacity to develop dedicated resources for skill development and

learning opportunities internally than larger organisations, and less ability to

commission and customise training provision from external providers. The

combination of regulatory requirements for NVQ attainment and the availability of

resources for training have led to the emergence of intermediaries in the form of

regional consortia. This represents a mechanism for sharing resources amongst

employers, building capacity and exchanging good practice, although some national

interest organisations are concerned about their inclusiveness. This helps to overcome

employers‟ investment problem in relation to training and contributes to their

cooperation in securing a collective good. These regional consortia are highly

dependent on the presence of enthusiastic local actors who are enthusiasts for

76

learning and for the sector and whose cosmopolitan links provide a significant source

of learning. This dependence on individuals means that the consortia are

institutionally fragile, although one consortium studied had succeeded in securing

funding streams and this had allowed a degree of institutionalisation. This fragility is

also evident in initiatives such as the Foundation Degree and the career and learning

pathways established in the two local authority case studies.

In the case study organisations we identified factors which were associated with more

holistic approaches to managing skill development, located within the concept of an

expansive-restrictive continuum of learning environments. Whilst the regulatory

framework may contribute towards organisations adopting more systematic

approaches for managing their workforce, it can also result in a focus on meeting

targets rather than a more developmental approach. These disincentives are reinforced

where external sources of funding are themselves subject to meeting different sets of

targets which have little to do with the needs of the sector, and are available on an ad

hoc basis and for particular categories of staff.

As far as providing a personalised service for users is concerned, our research

indicates that most employers seek a certain „sort of person‟ when they recruit care

staff. This is a person with the sensitivity and communication skills to relate and

respond to the users‟ needs and wishes, and who is able to understand their care needs

in more than a purely technical manner. In other words they are seeking a person with

a vocation, or commitment to the value of the work they are doing. These features are

often more important to the employer than initial training and qualifications that a

person may bring to the job. There are, of course, wider issues concerning the

recognition and valuing of such skills or abilities which go beyond the remit of this

project, but raise important issues about the frequent undervaluing of attributes often

regarded as „natural‟ abilities of women. This may relate to the way in which

professionals, such as GPs and social workers recognise and value the contribution of

care staff.

Even if an employee is found with these abilities, the research has revealed three

„layers‟ of requirements to enable this vocationally committed person to effectively

utilise their skills:

Training and development – they need access to gaining the qualifications

necessary to practice, access to training and development opportunities to

enable them to grow more specific expertise in their area of care.

Organisational systems – the organisation within which they work needs to

facilitate a type of working that enables them to participate in communities of

practice, sharing of information, knowledge and expertise. This may mean

team working, where the team collectively develops shared knowledge and

has the autonomy to apply knowledge and experience to situations and to

change work arrangements to the collective benefit of the service users.

Employment relationships – certain sorts of employment relationship are

more likely to facilitate the above: being a salaried worker rather than tied to

strict time allocations per service user is key to the flexibility and autonomy

described above. The isolated worker will have no access to the essentially

collective requirements for learning and development. The agency

demonstrated how it is possible to overcome to some extent the isolation of

individualised services and this represents a key challenge in the move

77

towards more individualised services through direct payments. To recruit and

retain the committed care workers, it is likely to require the employer to

recognise and cater for the work-life balance needs of the individual

employee. All of this requires well informed and trained managers, with the

confidence to managed devolved decision making.

The policy commitment to a personalised agenda, although not necessarily tied to

direct payments and personal budgets, may result in the individualisation of social

care work. The evidence from the case studies suggests that a key aspect of care

delivery is the quality of the collective knowledge of workers and the collective

learning that underpins it. This is well illustrated by the Dementia Team, who share

information and expertise and have the autonomy and flexibility to organise work and

vary time allocations to each service user based on the collective needs of the service

users. This may mean that sometimes a service user may have slightly less or more

time, responding to the collective best interest of the service users as a group. This is

likely to result in a different pattern of care from a service based solely on individual

services users‟ isolated perceptions of need. This example suggests that a key aspect

to the delivery of care may be the nature of work organisation: the expansion of jobs

in a collective context, applying collectively developed expertise. This facilitates the

tailoring of services to both individual service users and to groups of services users.

Another key feature of the dementia team is that they are salaried staff: so the nature

of the employment relationship may also be key to delivering personalised care in the

expanded sense of the term. There are broader issues about the collective needs of

service users, which were highlighted in the two local authority case studies designed

to make the social care workforce more representative of the community it serves.

Workers initially bring to care work a number of „soft‟ skills or attributes, but they

need also need sector specific training to ensure basic and specialist skills and

expertise. Furthermore, they need to work in a context which enables the development

of collective knowledge and skills and they need an employment relationship which

gives them the scope and flexibility to exercise their skills. Agency work already

operates in an individualised context, yet we found in the case study an attempt to

overcome aspects of isolation through in-house training and development activities.

One of the alliances is also preparing for a more individualised context and

considering how to bring personal assistants working through direct payments

together for training opportunities. So it is possible to create some aspects of a

collective learning environment even in an individualised context.

Finally, a number of authoritative reports and policy documents have been published

in recent years. They identify the problems in the sector and recommend solutions: the

problem lies in implementation. We would like to suggest that as far as promoting

skill development is concerned, solutions which support the treatment of skills as a

collective good and learning as a collective process are those which will best meet the

aspirations of service users and a range of stakeholders, including policy makers,

service providers, care workers, and their representative organisations, for

personalised services.

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Report on Recruitment and Retention Issues in the Voluntary Sector by the Social

Care Employers’ Forum. London, Social Care Employers‟ Forum.

Barth, F. 1963. The Role of the Entrepreneur in Social Change in Northern Norway.

Bergen, Norwegian University Press.

Beresford, P. 2007. „The changing roles and tasks of social work from service users‟

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Personal Assistant. Report developed by Care Learning for the Skills for Care South-

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Excellence: Building the Social Care Workforce for the Future. London, DfES/DOH.

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Appendix 1: Project Methodology

The overall aim of the project is to investigate the skill development in the social care

sector through an assessment of institutional and organisation capacity.

The more specific objectives are:

a. To examine institutional capacity for developing the skills base of the social

care workforce and employers‟ ability to contribute to skills development.

b. To examine how a range of agencies and interest organisations contribute to

the development of this capacity.

c. To identify effective practice in skills development and the recognition of

workers‟ skills.

To address these objectives the following activities were completed:

1. The formation of an Advisory Group made up of representatives of key

stakeholder organisations:

Commission for Social Care Inspection

Department of Health (observer)

General Social Care Council

National Care Association

National Care Forum

Skills for Care

UNISON

University of Birmingham

Edinburgh Napier University

The Advisory Group met 4 times and advised the research team on all aspects

of the project process and progress.

2. A consultation with service users and carers was carried out for the project by

Professor Ann Davies of the Centre for Excellence in Interdisciplinary Mental

Health, University of Birmingham and Rosemary Littlechild of the Institute of

Applied Social Sciences, University of Birmingham. The exercise gathered

the views of 26 older people or carers on their experiences of social care

81

services and on the training of the social care workforce and the role they

might play in that process (see Appendix 3 for the full report).

3. A review of relevant policy documents and literature.

4. Empirical research fieldwork (described below).

5. Analysis of data from the empirical research.

Focus of project

The main focus of the research is on adult social care and on care workers and other

categories of non-professionally qualified staff within the care sector, rather than

social workers.

Empirical research approach

The research approach was qualitative with empirical data collection divided into two

phases:

Phase 1. (May 2007- December 2007)

The first phase of research involved face-to-face interviews with 22 representatives of

a range of agencies and interest organisations with interests in the skill development

of the social care workforce. The organisations were selected on the basis of

discussion with members of the Advisory Group:

ACTAN

Association of Directors of Social Services

Birmingham City Council Social Care Workforce

Development Officer

Commission for Social Care Inspection

General Social Care Council

Care Services Improvement Partnership

Improvement and Development Agency

Local Learning and Skills Council

Local Government Association

National Care Association

National Care Forum

82

Registered Nursing Homes Association

Skills for Care

Social Care Association

Social Care Institute for Excellence

Stoke on Trent City Council

UK Homecare Association

UNISON

The purpose of the interviews was to explore the interviewees‟ perceptions of the

issues and challenges facing the sector, the policies of their organisations towards

sectoral arrangements for support for training, as well as initiatives that they or their

members had taken. Where appropriate ideas or suggestions for case studies were

sought from the informants. All interviews were recorded, transcribed and retained in

an NVIVO file for analysis.

Almost all of the interviews were conducted on schedule with one or two of the

research team present, the main challenges in this phase were around interviewees‟

availability for the interviews.

Phase 2. (December 2007 – December 2008)

The second phase of the research involved 13 case studies of organisations involved

in innovative practices in the training and development of social care workers.

Initially it was planned to conduct 20 case studies. On the basis of advice from the

Advisory Group the number of case studies was reduced to enable a more in-depth

analysis of each of the case studies. These included organisational case studies of

provider organisations, training organisations and consortia, which were chosen

because they had been identified as representing good practice in social care training

and development. They had either won awards, represented examples of innovative

practice or had been recommended either by interviewees in Phase 1 or by members

of the Advisory Group as providing exemplary practices. Summaries of these nine

case studies are all included in Appendix 4. In the main body of the report, they are

analysed in synthesis form, which identify common themes which emerge from the

service provider organisations; the training organisations; and the consortia. In

addition, there were four further case studies which are analysed in the main body of

the report in the section on educational and career development routes. These case

83

studies concerned an initiative relating to the 14-19 curriculum, the development of a

foundation degree, and two examples of routes into professional social work

qualifications. Because it was harder to identify common analytical themes these are

presented as case studies in the text.

In addition two planned case studies could not proceed. One was an initiative by

UNISON to provide induction training for domiciliary care workers in membership of

the union as part of Union Learning Fund project. Because the deadline for individual

workers registration with the General Social Care Council with was put back, the

UNISON initiative was delayed and this made it impossible to include it as a case

study. The second case study which did not proceed was on training support services

for direct payment schemes. The main body of published work and activities of

organisations concerned with support for direct payments has been found to be in the

form of advice to potential recipients on claiming payments, arranging services and

points to be considered when choosing direct payments. Organisations involved in

this area have been found to be concerned mainly with services for adults with

learning and physical disabilities rather than those for the elderly, the main focus of

our project. Some discussion with Age Concern has provided information on

particular issues surrounding the needs of the elderly with regards to direct payments

but very little information has been found concerning training and skill development

of personal assistants.

A total of 85 people were interviewed as a part of the case study analysis. The

majority of interviews were one-to-one; in some cases two researchers took part in the

interviews; in some cases two or more interviewees were included in a single session.

The nature of interviewees varied depending on the nature of the case study. In the

case of organisations providing care services managers and the agency,

trainers/assessors, care staff and other ancillary staff (where the organisation felt they

should be included as a part of the whole care team) were included; in the case of

consortia, Workforce Development Officers and consortia partners (managers from

member organisations – care providers and educational providers) were interviewed;

in the case of training organisations, trainers/assessors, training managers and carers

were interviewed; and in the case of the educational routes, educationalists, union

representatives, managers and social workers were interviewed. The choice of

84

interviewees at each case study was agreed in conjunction with our main informant at

the organisation, in part depending on the availability of staff although informed by

our indication of the range of people we would hope to interview.

Analysis

All but two interviews were taped and transcribed. The remaining interviews had

written notes. All transcriptions were placed in Nvivo. Analysis was conducted

through a themed approach drawing on both the literature, knowledge from previous

related research projects and an immersion in the data (via repeated reading of

interviews and research team brainstorming meetings). Key words were identified to

retrieve relevant material from the interviews.

85

Case Study

Rationale for Case

Study

Interview record

Service provider:

The Residential

Home

Holistic approach – integration of training, monitoring, supervising through reflexive practice. Private sector

Director Tape

Two Care Assistants Tape

Registered Manager digital recording (+

tape)

A deputy registered manager and

keyworker

Tape

A Keyworker and Assessor and a

Trainee Keyworker

Tape

A Keyworker and a Care Assistant Tape

Service provider:

The Community

Caring Trust

Example of ‘best practice’ won ‘best employer award (LLSC)

IT Manager digital recording

Senior Careworker digital recording

Senior Careworker digital recording

Driver digital recording

86

Two Care Managers digital recording

Day Care Officer digital recording

Supported Living Manager digital recording

Senior Careworker digital recording

Chief Executive Officer digital recording

Care assistant-1 digital recording

Care assistant-2 digital recording

Care assistant-3 digital recording

Assistant manager digital recording

Day support worker digital recording

Care worker no recording

Home manager no recording

Service provider:

The Agency

Good practice in agencies National Quality and Compliance

Manager

Branch Manager

Training Officer

digital recording

7 agency care staff digital recording

Service provider:

The Home Support

Dementia Team

Winners / nominees for Skills for Care ‘Skills Accolades’ – (winner most innovative) and winner of winners

Team manager

digital recording

87

Assistant team manager, Home

Support Services

digital recording

Carer digital recording

Carer digital recording

Team Coordinator digital recording

Carer digital recording

Two Carers digital recording

Training

Organisation: The

Not-for- Profit

Training Provider

and Training

Division

Example of good practice in management development – won award for management training. Not-for-profit sector

Manager digital recording

Training and Development

Manager

digital recording

Dementia Care Training Specialist digital recording

Director of Homes, digital recording

Chief Executive Officer digital recording

Training Manager, residential

home

digital recording

Senior carer residential home digital recording

88

Carer-residential home digital recording

Carer –residential home digital recording

Training

Organisation: The

Private Company

Winners / nominees for Skills for Care ‘Skills Accolades’ 200 – best practice – (best training provider)

Managing Director digital recording

Quality Assurance Coordinator digital recording

NVQ Assessor/Verifier digital recording

NVQ Assessor/Verifier digital recording

Regional

Consortium: The

Limited Company

Consortia arrangements – examples of overcoming fragmentation / partnership working

Development Worker (Manager

Care Learning)

digital recording

Director (Care Learning digital recording

Director (Care Learning) digital recording

Director, (Care Learning) digital recording

89

Regional

Consortium: The

Council-backed

Alliance Consortia arrangements –

examples of overcoming

fragmentation /

partnership working

Workforce Development Officer digital recording

Contracts Manager, Social

Services

Implementation Group member

digital recording

General Manager private

domiciliary care provider

Implementation Group member

tape

Director of Nursing

Private residential care provider

Implementation Group member

tape

Owner, small domiciliary care

agency

Implementation Group member

digital recording

Chief Executive, Regional Age

Concern,

Implementation Group member

digital recording

Training Manager

Private residential care provider

Representative of Implementation

Group member

digital recording

Chief Executive, Regional digital recording

90

Colleges Ltd.

Implementation Group member

Training Manager and Care

Ambassador, private domiciliary

care provider

Regional

Consortium: The

Institutionalised

Alliance

Consortia arrangements –

example of overcoming

fragmentation /

partnership working

Quality and Procurement Manager written notes

Alliance member – Care Provider digital recording

Alliance member – Alzheimer‟s

Society

digital recording

Alliance Member – residential

home manager and training

manager

digital recording

Alliance member – Manager small

residential home

digital recording

The 14-19 diploma

Incorporating social care

into the secondary

curriculum

College representative of diploma

partnership

digital recording

91

Foundation degree

Creating a qualification

for nursing home

managers

Programme Director digital recording

Borough Council

New pathways into

professional

qualifications serving the

needs of local

communities

Unison Convenor, Adult Social

Care.

digital recording

Borough Council

New pathways into

professional

qualifications serving the

needs of local

communities

Unison Representative no recording

Learning and Development

Manager (Adults)

digital recording

Deputy Manager, Child Protection

Team

digital recording

Life Long Learning Team

chairman

digital recording

Social Worker/NVQ Assessor digital recording

Learning and Development

Manager, Social Services

digital recording

92

Appendix 2. Major Documents and Reports Document Document purpose Summary

Care Standards ,2000 (HM Government)

Act

The act aimed to regulate the provision of all forms of care. It provided for nationally applied minimum standards, instigating induction and induction and foundation training. It established a series of structures to regulate and improve the quality of care services, including the Commission for Social Care Inspection (CSCI); the General Social Care Council (GSCC); the sector skills council – the Training Organisation for the Personal Social Services (Topss) - which became Skills for Care in 2005; and the Social Care Institute for Excellence (SCIE) (Department for Education and Skills/ Department of Health, 2006). Also introduced were targets for the registration of individual workers and the attainment of NVQ qualifications to increase the competence of the workforce.

Our Health, Our Care, Our Say, 2006 (HM Government/ Department of Health)

White paper

The paper develops the concept of community services and a commitment to tailoring services to individual needs. It also identifies the need to integrate services across Health and Social Care by establishing joint teams and career pathways.

Options for Excellence, 2006 (Department for Education and Skills/Department of Health)

Policy development

This review of the social care workforce considered the options for increasing the supply of all workers in the social care sector and developed a vision for 2020. This included a more positive perception of the workforce in the sector; a workforce which promotes participation from users and carers; partnership working across the workforce and with other professionals and sectors; and a professional workforce which was trained, accountable and committed to delivering an excellent standard of care (2006:xi). In addition to improving the qualifications of care workers, it identified the need for organisations to become learning organisations, capable of promoting CPD and integrating the views of service users in workforce development and improving leadership and management (2006:xii).

Prosperity for all in the global economy, 2006 (Leitch)

Report The report has recommendations for increasing adult skills at all levels across the economy. The recommendations have a potential impact on the skills infrastructure of the care sector.

93

The status of social care-2007, 2007 (Platt)

Report This report reviewed the status of social care services for adults proposing a five point plan for raising the status of the social care workforce and services including a recommendation for a Skills Academy for the development of leadership commissioning and management in the sector

Putting people first: a shared vision and commitment to the transformation of adult care, 2007 (Department of Health)

Policy and guidance publication

This publication describes the government’s proposals and vision for the transformation of care services to deliver a more personalised approach to care enabling people to live their lives more independently.

Involving service users and carers in social work education, 2004 (SCIE)

Resource guide

This guide looks at involving service users and carers in all types of training

Future of regulation of health and social care, 2006 (Department of Health)

Consultation/discussion

This document sets out the roles and functions of the new health and social care regulator formed by the merging of he Commission for Social Care Inspection, the Healthcare Commission and the Mental health Act Commission.

Independence wellbeing and choice: our vision for the future of social care for adults in England, 2005 (Department of Health)

Green paper

This paper sets out how the vision for adult social care for the next 15 years might be realized and how the organisation of community, voluntary and government agency services may be improved.

‘Putting People First: Working to Make it Happen’ , 2008 (Department of Health)

Interim statement

The statement set out strategic priorities for the social care workforce and invited stakeholder responses to the challenges and opportunities for workforce development arising from the personalisation agenda.

94

Appendix 3

Hearing the Voices of

Older People

Final Report for Department of Health

Skill Development in the Social Care

Sector: an assessment of institutional

and organisational capacity

Ann Davis and Rosemary Littlechild

Institute of Applied Social Studies

The University of Birmingham

March 2008

95

The authors

Rosemary Littlechild is a Senior Lecturer in Social Work, IASS, University of

Birmingham. She has overall strategic responsibility for service user and carer

involvement in the social work programmes. She is a qualified social worker and

has extensive experience in working with older people and in training health and

social care staff. Her recent research project for Birmingham City Council was an

evaluation of a specialist occupational therapy service from service users’ and

providers’ perspectives.

Professor Ann Davis is Professor of Social Work and Director of the Centre of

Excellence in Interdisciplinary Mental Health, University of Birmingham. She is a

qualified social worker and has researched and written about service user and

carer experiences of social welfare services. Her most recent book ‘Social Work:

Voices from the Inside’, co-authored with Professor Viviene Cree, was based on a

collection of the views of service users, carers and social workers across the four

countries of the UK.

The facilitators

Alex Davis is a registered social worker and a member of Suresearch, a West

Midlands education and research network of mental health service users and their

allies.

Angela Tebboth is a registered social worker who has worked for over 30 years

as a practitioner and manager. Over the past 10 years, as a carer for older

relatives, she has had first hand experience of social care services.

Authors’ acknowledgements

Many thanks to:

Helen Harris, Administrator, IASS for her hard work throughout the project and

report production

The Centre of Excellence in Interdisciplinary Mental Health for providing a

welcoming and accessible venue for the workshop

Everyone who participated, gave their time and shared their expertise and

experiences with us.

96

CONTENTS

The consultation process 1

Findings 4

The training of social care workers 9

What older people and carers can contribute to

social care training 11

Conclusions 12

References 13

Appendices

Appendix 1 – Letter to participants 14

Appendix 2 – Letter to BACOP 17

Appendix 3 – Consent form 20

Appendix 4 – Table 1 - Profile of the participants 21

1

THE CONSULTATION PROCESS

Introduction

“There is still a mismatch between what older people want and what policy

and practice are delivering.” This was a key finding generated in the report of

the Joseph Rowntree Foundation’s Older People’s Steering Group, which

examined 18 projects focusing on older people’s lives (Older People’s Steering

Group, 2004, p.3). Giving older people the opportunity to engage in meaningful

research is a critical way of helping people influence the development and delivery

of future services (Ray, 2007). This consultation makes a contribution to the

University of Birmingham Business School’s research project about the skills

development of the social care workforce by ensuring that older peoples’, and their

carers’, views are heard and valued. This report describes how which we gathered

the views of 26 older people or carers on their experiences of social care services

and their views on the training of the social care workforce and the role they might

play in that process. The quotes in bold throughout this report are the words of

those who participated in this consultation.

Objectives

To give older people and their carers the opportunity to tell first hand of their

experiences of social care workers.

To identify with older people and their carers what it is that they have valued

most and least about these encounters.

To identify the knowledge and skills which older people and their carers

think that social care workers should possess in order to provide an

effective service.

To identify how older people and their carers could be involved in the

training of social care workers.

Selecting the participants

We aimed to gather the views of 25 people who either identify themselves as older

people who receive social care services in their own homes, or in residential or

nursing homes, or people who are the carers for older people who receive such

services. We sent letters to:

service users and carers who currently work with us on the social work

programmes at the Institute of Applied Social Studies (IASS);

Carers in Partnership organisation, a West Midlands based registered

Community Interest Company, based at CEIMH, and comprising people

who are the carers of people with mental health problems;

members of BACOP (Birmingham Advisory Council of Older People), the

main advisory group of older people for Birmingham City Council.

By social care services, we mean home care services in a person’s own home, day care

services, respite care, short term or long term care in residential or nursing homes.

2

We also asked these three groups to assist us in recruiting to the sample by

inviting people within their own networks who fulfilled the criteria above and were

interested in contributing their views (Appendices 1 and 2).

Process

We asked participants to attend a half-day workshop in March 2008 where there

were 4 working groups facilitated by ourselves and two experienced older

facilitators. We sought participants’ views of their experiences of social care, what

they valued most and least about those encounters, what skills and knowledge

they thought social care workers should possess and how they thought older

people and their carers could contribute to that training. The proceedings of the

working groups were tape recorded and the four facilitators produced written

reports immediately after the events.

At the end of the workshop, all participants were offered lunch and were paid in

cash for travel expenses and for any expenses they had incurred in arranging

alternative care for people they would otherwise be caring for. They also received

a £20 Boots voucher as a token of appreciation for their involvement.

We recognised that not everyone would be fit enough to travel or available to join

us at these workshops but may wish to participate. We therefore arranged for

those people to have a face to face conversation or a telephone conversation with

one of the two researchers.

Ethics

The research complied with the University of Birmingham Research Ethics

process. All participants signed a consent form (see Appendix 3).

Profile of the participants

A total of 26 people participated in this research. Fourteen people attended the half

day workshop and 12 people were interviewed in person or by phone. Table 1

(Appendix 4) gives a summary of their characteristics. Participants had

experienced a range of services including home care, day care, residential and

nursing home care in the public, voluntary and private sectors. Fifteen people

identified themselves as carers, five people as service users and six people said

they had both received services and given care. Nine participants also described

themselves as having been professional carers now, or at some point during their

careers. Approximately three fifths of the participants were women and two fifths

were men. Seven carers were aged under 60 and the oldest service user was 101.

All the participants described their ethnicity as ‘White British’ which does not reflect

the ethnic diversity of the total group of people whom we invited to take part in the

study. This is likely to be the result of a number of factors but could be indicative of

the difficulty of accessing the views of older people from minority ethnic groups in

3

consultation exercises. Other research, (for example, Chau, 2007; Raynes et al,

2001) has found that running small focus groups of older people who share a

common language is the most effective way to overcome this.

4

FINDINGS

Regardless of the setting in which people had experienced social care services,

there was clarity and considerable agreement from participants about what it is that

they valued about their experiences. There were also some strong and consistent

messages about what happened if services were not delivered in an appropriate

way. However, as one participant succinctly concluded, “You can’t always blame

the workers!” There was universal recognition that the job social care workers do

is shaped by a complex interaction of organisational and societal issues. This

means that, whatever the positive attributes of individual workers, they can find

themselves unable to deliver a satisfactory service to older people.

What people valued

The particular characteristics which older people valued in social care workers

included quiet friendliness, politeness, having a calm manner and confidence

about what they were doing. Honesty was highly valued, not just with money and

personal belongings but behaving in a trustworthy way around people’s bodies and

with the personal details that users and carers might share with them. Punctuality

and reliability were important and the knowledge that if services had been

promised, they would be delivered as agreed.

Older people valued workers who interacted with them socially and who were

prepared to “do the little things that make all the difference” such as

unscrewing jars or light bulbs that the individual couldn’t manage any more.

Workers who were prepared to “go that extra mile” and do things that were

important for the older person’s quality of life or peace of mind were highly

regarded.

Participants described the ways that some workers delivered care so that it was a

positive experience for the older person or their carer. These workers treated the

older person with dignity and respect – this meant things like saying they were

going to wash your face or clean your teeth before they did it, telling you about

what your meal was when you could not see it and working alongside the older

person so that they could still make a contribution to what is being delivered to

them. As one person concluded, “The best ones never forget you are a human

being, they are sensitive to you as an individual, the worst ones just go

through the motions as if you aren’t there.”

Good communication was considered vital to good social care practice. Workers

who were good communicators were described as listening to what the older

person and their carers wanted, being prepared to learn from them and taking

notice of the ways the older person liked things done. Good communication also

involved workers adapting themselves to the way in which individuals

communicated as a result of their physical or mental impairments. In addition it

5

was considered important that workers communicated well between themselves,

recorded important details or changes and informed their managers if the situation

had changed, particularly where the older person lived alone.

Continuity of workers was an important aspect of the service – people who had a

team of workers who worked with them regularly appreciated the fact that the

workers got to know them and what they liked. They could “tune in” to the older

person more easily and be flexible by putting in a little more support when it was

needed and leaving the older person to do things for themselves when they could

manage it.

Negative experiences

Where the positive qualities identified above had been absent, people recounted

poor experiences of social care workers.

Workers who were rude, patronising or made assumptions about people caused

offence. One carer said, “Just because my husband can’t use his arms, they

assume he’s stupid – the fact he has a double first from Cambridge is

irrelevant!” Similarly people were upset when workers were over familiar and

immediately called people by their first names, “My father was a formal person,

he’d been a headmaster for 20 years and like to be called Mr. S.” Older people

did not like to be called generic names by care workers such as ‘grandad’, ‘darling’

or ‘chuck’. Other presumptuous behaviour by workers was highlighted such as

walking in without ringing bell, making themselves drinks or food without asking

and making personal phone calls whilst working. The appearance of workers was

also important to older people. Workers who chewed gum or dressed

inappropriately, e.g. in skimpy or tight clothes made some older people feel

embarrassed.

Unacceptable standards of care caused older people and their carers distress.

Examples of this that were shared included leaving a person wet or soiled in a

residential home for long periods of time; a man, living at home, when his wife

went away for five days break, having dirty clothes and bedclothes and not having

been fed properly. In some cases thoughtless behaviour had been rectified when

the carer or older person had the confidence to challenge it – for example, asking

the care worker to leave dirty shoes at the door; explaining that the older person

was not deaf so the worker did not have to shout at her all the time. In other

situations older people or their carers had felt unable to raise their concerns in

case they lost the service they received or antagonised the worker.

Dishonesty by social care workers had been experienced by several older people.

Often this related to people recording that they had worked longer than they had

and asking the older person to sign falsified records. For some people this had

serious consequences. One carer’s account of the cumulative impact of this kind of

6

experience on her father resulted in him “refusing to have any help because he

couldn’t see the point in paying for something he wasn’t getting.”

A lack of continuity and a stream of different workers caused frustration, confusion

and exhaustion for many people living at home, using day care or living in

supported accommodation or residential care. Older people and their carers

described how they became tired of constantly relating the same information to

different workers about their conditions, circumstances and needs and, in some

cases, showing them how to use equipment. There were numerous complaints

about the high turnover of staff in residential care resulting in no one really knowing

or understanding the needs of residents. One woman explained that staff caring for

her father in a residential home ignored her concerns that her father was losing

weight because he could not hold a knife and fork at meal times. They insisted that

he chose not to, which meant he simply did not eat.

Poor communication was at the source of many negative experiences. This

included workers talking to the older people as if they were children, or not

speaking to them at all whilst doing tasks, including personal care. Some workers

turned on the radio, without asking first and played it loudly whilst working in

people’s homes. Some older people described workers, who were washing or

dressing them, talking over their heads to other workers about their own concerns.

Some care workers did not speak English fluently or did so with unfamiliar accents

which caused difficulties for some older people and carers. Other workers had

difficulty communicating in written form which meant that records could not be

understood and a lot of time was taken completing paperwork. As one older person

who found that her residential social care workers were struggling to get their

paperwork right said, “I sometimes wondered whether the staff were clerical

workers more than care workers - they prioritised the paperwork over the

people.”

Organisational issues

Older people recognised that whatever the characteristics of individual workers,

there were times when their employing organisations constrained the way in which

they were able to do their jobs. These constraints were seen to contribute to the

delivery of low standards of care, despite the workers’ best efforts.

The most common complaint was that people felt they had clearly explained what

was needed and it had been agreed in principle but then when service began, it

was at the times that were convenient to the agency rather than the older person.

Inconsistent and unpredictable times of arrival were commonplace – daily meals

on wheels lunches could arrive any time between 11am and 2.30pm; a 7am call to

get someone up resulted in a social care worker arriving at 5.30am and one person

recounted, “I was with an elderly person and the home carer came in and

didn’t say anything to us and proceeded to undress the elderly woman. I

could not believe my eyes. It was 4.30pm in the afternoon.”

7

Some people felt the amount of time that a worker was allocated to meet their

assessed needs was inadequate and, however good the worker, the work could

never be done satisfactorily. For example, fifteen minute slots allocated to home

support workers had been experienced by a number of people who failed to see

what could be accomplished in such a short space of time. Some workers spent

time telling the older person or their carer about the pressures of the work they had

to do and their frustrations about this. This often left users and carers worried and

made them reluctant to ask for what they wanted because they felt they were a

nuisance.

Older people and their carers recognised that emergencies might arise for

agencies that meant that priorities had to be made at short notice resulting in their

home care workers being delayed or not able to come at all. However, there was

dissatisfaction that this information was not relayed to them by phone as a matter

of course, leaving them worried and uncertain about when they might next receive

care. For example, an older woman who was blind and lived alone said that her

home carer had simply not arrived the previous Saturday night “No one came and

I had to get into bed on my own, I had no hot drink.”

Service users and carers reported that written care plans, which had been

completed at the initial assessment were not widely read by the workers and, as

far as the older people were concerned, were rarely updated. The system of

exchanging messages in a notebook left in the home only worked if workers read it

and contributed to its updating. As a result, a possible source of information which

new workers might consult to orientate themselves to the needs and

circumstances of the individual was not available.

Overall, there was concern about how workers were supervised and monitored.

Older people and carers thought that sometimes the agencies were so desperate

for staff that unsuitable people were taken on, and their supervisors accepted

mediocrity and did not challenge poor practice. For their own part, older people felt

that having to complain about getting things done, or done better, took effort, which

they did not always have the energy to exert. There was also concern about the

effect of giving negative feedback to someone providing a crucial and personal

service directly to you, or as someone said, “Things get better for a while, then

deteriorate again”.

Societal issues

Older people and carers also recognised that a number of societal factors

impacted on the overall quality of care they received. Many people commented on

the low wages the social care workers received, “£5.80 an hour for doing a

responsible job in the community is a disgrace, it’s appalling.” Another

person commented, “When they can earn more in Asda stacking shelves,

8

there is something very wrong about how we value social care staff in this

country.”

The older people and carers who took part in this study expressed concerns about

how as a society we fail to value older people. It was suggested that if older people

are not valued and people who provide social care are poorly paid, then social

care workers are less likely to value themselves and the people they care for. In

the view of several participants, more training for social care workers could

improve the quality of care for some people, but it was only one response to a

complex set of factors which needed addressing at a variety of levels.

Ideas were shared about how issues of understanding and attitudes to older

people in the UK could be addressed. One participant thought that it was important

to provide education for children and young people at school about older people so

that they had opportunities to develop more positive attitudes and understandings.

Another thought that developing community based projects that involved young

people and older people could also help to build more positive attitudes and

understandings about old age amongst the future generations of social care

workers.

9

THE TRAINING OF SOCIAL CARE WORKERS

Participants provided a range of views about what kind of training should be

available for social care workers. These included:

the identification of the kind of knowledge and skills that were essential for

those employed in the social care sector;

discussions about the attitudes and approaches which were essential to

those delivering good social care.

In addition there were some participants who thought that sustaining good social

care services involved more than the provision of training for staff – “It’s the

continuous assessment and monitoring of staff that is as important as the

training.” However, for others – “It’s the person really, the way they are – you

can’t train them, you just have to find them.” Recognition was also given to

some of the positives and negatives of the current approach to training via National

Vocational Qualifications (NVQs).

Knowledge and skills: the older people and carers recognised that there were

some basic knowledge and skills that were essential for social care workers. Key

here was the importance of verbal communication with older people which took

account of the impairments that they might have and was focussed on learning as

well as listening to what older people wanted. In addition it was considered

important that workers learnt how to lift, move and touch people; work safely with

the preparation of food and beverages; administer first aid and understand about

some of the main physical and mental health conditions associated with old age.

Workers also needed to learn how to complete the necessary paperwork with

confidence and have an understanding of how to signpost older people and their

carers to the kind of resources and services they might need to sustain a good

quality of life.

Attitudes and approaches: many participants emphasised the importance of

workers learning how to conduct themselves in a person centred way that

demonstrated respect for older people and an understanding of difference and

diversity in relation to ethnicity, faith and gender. Key to this was an understanding

of the psychological impact of being dependent on others, and the loss of dignity

that may be experienced, as well as learning how to work calmly and positively,

whatever the difficulties of the person or situation you are involved with.

“It isn’t just about training”: some participants thought that sustaining good

social care must involve systematic monitoring and the support of workers by their

supervisors to ensure that they are delivering to standard. Some users and carers

suggested that they could play an active part in these processes. Others felt that

the selection of staff with the right approach to the work was more important than

training and that older people and carers could also play a part in the selection

10

procedures used by agencies to provide a perspective on the attitudes and values

demonstrated by applicants.

NVQs were seen by some older people and carers as successfully providing

training in basic social care skills as well as making workers feel that their work

was recognised and valued. However, others participants pointed out that it

provided a route out of direct social care work and also depended on low paid

workers giving up their own time to study for the qualification. Until issues of salary

and status were addressed in the sector service older people did not think that

NVQs alone could attract, train and retain good staff.

11

WHAT OLDER PEOPLE AND CARERS CAN CONTRIBUTE TO

SOCIAL CARE TRAINING

“It’s crucial that carers and service users are involved through the whole

process of selection of people who go on courses, the actual training for

people on the courses and the selection of people for their jobs in social

care.”

Considerable interest and creativity was expressed in discussing the ways in

which older people and carers might contribute to social care training as well as

ongoing staff development.

Ideas about training inputs that service users and carers could make

included:

Being a resource for workers so that they can learn directly about how to

develop their skills and knowledge by placing themselves in an older

person/carer’s position. Some examples given were providing one to one

tutorials for staff at day centres, inviting staff to spend time with them in their

own homes to understand the daily challenges they face.

Playing a part in the development and design of social care training schemes

– based on the good practice that has been established on qualifying social

work programmes, where the involvement of service users and carers is a

requirement.

Contributing to the delivery of training through working alongside trainers – as

co- tutors; contributing their experience and expertise to training sessions as

well as sitting in on sessions and providing feedback to tutors.

Producing training resources e.g. video accounts of their lives or what it feels

like to be on the receiving end of social care or what it means to have a

particular impairment. Providing case material based on their lives for

discussion groups to promote understanding and creative problem solving.

Contributing to the evaluation and assessment of staff in training, based on

some of the good practice developed on qualifying social work programmes.

Ideas about contributing to staff development included:

Providing feedback on service quality to contract commissioners and

agencies through questionnaires, interviews, focus groups and ’mystery

shopper’ schemes.

Taking part in selection panels for staff appointments to provide a view based

on their experience and to give a strong message to applicants about the

importance that is placed on the opinions and experiences of service users

and carers by the agency.

12

CONCLUSIONS

The participants in this research study brought a wealth of knowledge and

experience to their discussion of the topic areas. They exchanged a range of

ideas, issues and concerns about the way in which social care for older people is

being delivered and what needed to change. A consensus emerged from the group

about what good social care was and what it can deliver to older people as well as

their carers. An equivalent measure of consensus emerged from discussions about

some of the negative consequences of being at the receiving end of social care

services.

The kind of services which people said they valued - personal and adapted to their

individual needs - resonates with the Government’s current agenda of developing a

system of adult social care services which offers personalised care, more

preventive services and promotes independence well-being and dignity

(Department of Health, 2006; Department of Health, 2007). It is now mandatory

that people eligible for local authority social care services are offered Direct

Payments and in the next three years they will be eligible for Individual Budgets.

However, it is worth noting that only one of our participants was receiving Direct

Payments, one person was in the process of arranging them and only two other

people claimed they knew much about them.

As they exchanged accounts of what social care is delivering to them, older people

and their carers reflected on the randomness of service provision. People who had

seemingly similar needs and lived in the same City noted that they received quite

different services both in type, quantity and quality. The answers to the questions

that some of them had raised with providers about the quantity as well as the

quality of social care they receive had made little sense to them. This suggests that

the forthcoming review of eligibility criteria by the Commission for Social Care

Inspection is of key importance to future considerations about how to achieve a

more equitable distribution of social care services.

What was striking about the responses of participants to the issue of the training of

social care staff was the understanding shown about the potential as well as the

limits of what training can contribute to service improvement. The creativity shown

by participants in thinking through what they might offer to staff training, staff

development and service improvement suggests that older people who use

services as well as carers should not just be viewed as service recipients. They

have the potential to be resources in building institutional and organisational

capacity for skill development in the social care sector. The outcomes from the

growing user and carer involvement in qualifying social work training provides

evidence and models for how this resource might be harnessed in the training of

social care workers (Kemshall and Littlechild, 2000; Levin, 2004; Moriaty, 2007).

13

The service users and carers who participated in this study were clear that their

interest in suggesting that people like them could play an active part in current and

future changes to this sector was not solely driven by their own immediate needs

for a better service. They were taking a longer view which was shaped by their

concern that “the future looks bleak” for social care because demographic

trends indicate that there will be increasing numbers of older people and

diminishing numbers of younger people in the UK. This suggests that far fewer

people than are needed will be joining the social care workforce. Addressing this

situation as a matter of urgency was, for a number of participants, a matter of

placing a consideration of workforce training in the wider context of attitudes to

older people in society and the consequent undervaluing and low rewards

associated with social care work.

References

Chau, R.C.M. (2007) The involvement of Chinese older people in policy and

practice: aspirations and expectations, York: Joseph Rowntree Foundation

Department of Health (2006) Our health, our care, our say: a new direction for

community services, London: TSO

Department of Health (2007) Putting people first: a shared vision and commitment

to the transformation of adult social care, London: HM Government

Kemshall, H. and Littlechild, R. (eds) (2000) User Involvement and participation in

social care :research informing practice, London: Jessica Kingsley Publications

Levin, E. (2004) Involving service users and carers in social work education,

London: SCIE

Moriaty, J. and others (2007) The participation of adult service users, including

older people, in developing social care, London: SCIE

Older People’s Steering Group (2004) Older people shaping policy and practice,

(Foundations publication), York: Joseph Rowntree Foundation

Ray, M. (2007) ‘Redressing the balance? The participation of older people in

research’ in M. Bernard and T. Scharf (eds) Critical Perspectives on Ageing

Societies, Bristol: Policy Press

Raynes, N., Temple, B., Glenister, C. and Coulthard, L. (2001) Quality at home for

older people, Bristol: Policy Press

14

Appendix 1

January 15th 2008 Dear Colleague HEARING THE VOICES OF OLDER PEOPLE PROJECT We are writing to you because of the contact you have with the Institute of Applied Social Studies or the Centre of Excellence in Interdisciplinary Mental Health. We hope you can assist us with a small research project that we are undertaking We are looking for 25 people who can help us. These people should be:

a) Over the age of 60 years and have recently used social care services in their own homes or in residential or nursing homes;

b) Carers for older people who have recently used social care services in their own homes or in residential or nursing homes;

c) People who have experience of both a) and b). By social care services we mean home care services in your own home, day care services, respite care, short term or long term care in residential or nursing homes. We are not including other services provided by the NHS such as district nursing services, hospital care or community psychiatric nursing care. This project is funded by the Department of Health and is part of a study which is being undertaken by the Business School at the University of Birmingham. It is looking at the range of workers in social care and their qualifications and we want to ensure that the voices of older people and their carers are heard. We would like to meet this group of 25 people for a morning to share their experiences and views of social care services. Our focus is on what people think makes a good social care worker and what kind of training they should have. continued…..

THE UNIVERSITY

OF BIRMINGHAM

Institute of Applied

Social Studies

Edgbaston

Birmingham B15 2TT

United Kingdom

Telephone: 0121 414 5733

Fax: 0121 414 5726

Head of Institute

David Stephenson

15

The meeting will be held on Monday March 10th 2008 from 10am-1pm at the University of Birmingham and will be followed by lunch. People will be asked to work in small groups with a facilitator and the discussions will be recorded. Travel and caring related expenses will be paid on the day together with a £20 Boots voucher. If you are interested in taking part in this project and meet one of the criteria a-c above, please fill in the attached form and return it to us by Monday February 1st using the enclosed FREEPOST envelope. If you know someone else who would be interested in taking part and meets the criteria, could you please let us know by using the enclosed envelope or ringing Helen Harris on 0121 414 5733 or emailing Helen Harris at h.m.a.harris@bham.ac.uk and we will contact them directly. If you know someone who would like to make a contribution to this project but is unable to travel to the meeting, and would be prepared to talk to us over the phone, could you let us know through Helen Harris (details above) and we will contact them directly. Yours sincerely Ann Davis – Professor of Social Work Rosemary Littlechild – Senior Lecturer in Social Work enclosures

16

HEARING THE VOICES OF OLDER PEOPLE PROJECT

Meeting – Monday March 10th

2008

Please fill in this form and return it to Helen Harris in the enclosed FREEPOST envelope by February 1st 2008 (you do not need a stamp!) I would like to take part in this project

NAME……………………………………………………………………………………………… ADDRESS………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… PHONE NUMBER……………………………………………………… EMAIL……………………………………………………………………. I HAVE EXPERIENCE OF (please circle the appropriate statement below and explain briefly your involvement): a. USING SOCIAL CARE SERVICES b. BEING A CARER OF SOMEONE WHO USES SOCIAL CARE SERVICES c. BOTH I would like you to note that I have the following requirements: (Please list any arrangements you would like us to make for you regarding diet, access etc. on the day) ……………………………………………………………………………………………………… ………………………………………………………………………………………………………

17

Appendix 2 February 12th 2008 Dear Colleague HEARING THE VOICES OF OLDER PEOPLE PROJECT

I am writing to you as a fellow member of BACOP to ask for your assistance. Some of you will have received this letter before because of the contact you have with the Institute of Applied Social Studies or the Centre of Excellence in Interdisciplinary Mental Health at the University of Birmingham and I apologise for the repetition. I am hoping you can assist me and a colleague, Professor Ann Davis, with a small research project that we are undertaking

We are looking for 25 people who can help us. These people should be:

a) Over the age of 60 years and have recently used social care services in their own homes or in residential or nursing homes; b) Carers for older people who have recently used social care services in their own homes or in residential or nursing homes; c) People who have experience of both a) and b).

By social care services we mean home care services in your own home, day care services, respite care, short term or long term care in residential or nursing homes. We are not including other services provided by the NHS such as district nursing services, hospital care or community psychiatric nursing care.

This project is funded by the Department of Health and is part of a study which is being undertaken by the Business School at the University of Birmingham. It is looking at the range of workers in social care and their qualifications and we want to ensure that the voices of older people and their carers are heard.

We would like to meet this group of 25 people for a morning to share their experiences and views of social care services. Our focus is on what people think makes a good social care worker and what kind of training they should have.

The meeting will be held on Monday March 10th 2008 from 10am-1pm at the University of Birmingham and will be followed by lunch. People will be asked to work in small groups with a facilitator and the discussions will be recorded. Travel and caring related expenses will be paid on the day together with a £20 Boots voucher. continued…..

THE UNIVERSITY

OF BIRMINGHAM

Institute of Applied

Social Studies

Edgbaston

Birmingham B15 2TT

United Kingdom

Telephone: 0121 414 5733

Fax: 0121 414 5726

Head of Institute

David Stephenson

18

If you are interested in taking part in this project and meet one of the criteria a-c above, please fill in the attached form and return it to us as soon as possible but by Friday February 22nd at the latest. If you put your reply in an envelope addressed to Helen Harris, Institute of Applied Social Studies, FREEPOST, University of Birmingham, Edgbaston, Birmingham B15 2TT, there is no need to put a stamp on it. If you know someone else who would be interested in taking part and meets the criteria, could you please let us know by passing this letter to them, or ringing Helen Harris on 0121 414 5733 or emailing Helen Harris at h.m.a.harris@bham.ac.uk and we will contact them directly. If you know someone who would like to make a contribution to this project but is unable to travel to the meeting, and would be prepared to talk to us over the phone, could you let us know through Helen Harris (details above) and we will contact them directly. Yours sincerely Ann Davis – Professor of Social Work Rosemary Littlechild – Senior Lecturer in Social Work enclosures

19

HEARING THE VOICES OF OLDER PEOPLE PROJECT

Meeting – Monday March 10th

2008 Please fill in this form and return it to Helen Harris, IASS, FREEPOST, University of Birmingham B15 2TT by February 22nd 2008 (you do not need a stamp!) I would like to take part in this project NAME……………………………………………………………………………………………… ADDRESS………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… PHONE NUMBER……………………………………………………… EMAIL……………………………………………………………………. I HAVE EXPERIENCE OF (please circle the appropriate statement below and explain briefly your involvement): a. USING SOCIAL CARE SERVICES b. BEING A CARER OF SOMEONE WHO USES SOCIAL CARE SERVICES c. BOTH I would like you to note that I have the following requirements: (Please list any arrangements you would like us to make for you regarding diet, access etc. on the day) ……………………………………………………………………………………………………… ………………………………………………………………………………………………………

20

Appendix 3

HEARING THE VOICES OF OLDER PEOPLE PROJECT

Information and Consent Form

Could you please complete the following 5 questions and bring this form with you on March 10th. There is no need to put your name on the form.

1. I have experience of (please tick the appropriate statement below – there is no need to explain your involvement):

a. using social care services

b. being a carer of someone who uses social care services

c. both

2. I am MALE/FEMALE (please circle as appropriate)

3. My AGE is in the following range (please tick as appropriate):

Under 40 70 – 79

40 – 49 80 – 89

50 – 59 90 and over

60 – 69

4. Ethnicity – please describe …………………………………………………………………………… …………………………………………………………………………… ……………………………………………………………………………

5. I give permission for my responses to be recorded and to be used in the research on ‘Hearing the Voices of Older People’ by the University of Birmingham, and for my comments to be quoted in a way that will not identify me individually. (please tick)

21

Appendix 4 Table 1 Profile of the Participants

Age

Experience Totals Service User Carer Both

Male Female Male Female Male Female

40 – 49

2

2

50 – 59

2

3

5

60 – 69

2

3

1

1

7

70 – 79

2

2

2

1

7

80 – 89

2

1

1

4

90+

1

1

Sub-Totals

2

3

5

10

3

3

26

Totals

5

15

6

26

118

Appendix 4: The Case Studies

4.1 Service Provider: The Residential Home

Rationale for case study

The Residential Home has won a series of high profile awards for its training. It has

been involved in innovating the „Care Ambassadors‟ scheme, whereby young care

workers go into schools to encourage young people to think of careers in care

The context

The Residential Home has been run in the village for approximately 24 years. It is

family owned and registered as a limited company. The organisation employs in the

region of 50 staff and provides residential and some day care services to the elderly.

It is registered for 35 residents. Places are both commissioned by the local authority

and privately funded.

The management team is comprised of the directors, involved in the home on a day to

day basis, a registered manager and a care and deputy senior care manager. The care

team has nine key workers (senior carers) each responsible for four or five residents

and approximately 30 care assistants.

All staff receive induction training on joining the organisation. The standard

induction has been adapted to meet the needs of staff and the home and offer support

to the carers‟ in their first six months of employment.

„We‟re just looking at tailoring it slightly more to the home and having some

more accessible handbooks for people. From the staff‟s point of view they felt

that some of our induction was quite a lot of paperwork and we do a lot of

discussions, but they felt that a lot of the paperwork could bog people down

quite easily. So we‟re having more activity sessions, more handbooks with

pictures on what we expect the staff to look like in appearance and care needs

and things so it‟s something that they can have to hand as well afterwards.‟

Training staff to a high standard is seen as a key factor in the success of the home.

This emphasis was triggered by the director‟s own training as a „good nurse‟

remembering always to see people as individuals and not just patients or residents and

accompanied with the view that the passing on of knowledge and helping others to

learn enriches, improves and encourages achievement of goals and aims.

Potential is seen in everyone. High standards of training are seen as means of adding

interest to „the robotic side of care work‟ and as a link to the provision of quality care.

Well trained staff become competent in their roles and can be trusted to perform their

duties with a considerable degree of autonomy. Any mistakes are dealt with using

119

reflective practice. Job satisfaction and personal fulfilment are additional benefits for

the employee and in turn, these result in a very low level of staff turnover, benefiting

the home.

„I‟ve always trained because I always felt the health service trained me for

nothing and that, you know, these girls deserve training and I know that I get a

return on that training.‟

Mandatory and NVQ training is provided by external trainers, mainly within the home

but also at local colleges. Experienced staff work alongside others to evaluate training

and learning. Two of the staff are qualified as NVQ assessors and give support to

others during learning and assessment. Many staff expressed a preference for

workplace training as „learning on the job‟ „puts theory into practice‟. Importance is

placed on both types of learning and also on how the staff relate to the trainer in order

to achieve the best learning.

Staff training needs are discussed at appraisals and supervisions. Staff are encouraged

to gain qualifications beyond the level of their current position and several individuals

have progressed though NVQ levels 2, 3 and 4 to the Registered Managers Award.

Gaining qualifications is often accompanied by promotion from carer to key worker

or even to manager, within the home.

Employees are also encouraged to identify their own training needs and interests for

both standard vocational training and in other areas, for example IT, massage and

exercise. Such additional skills are seen as giving carers their own responsibilities in

the special areas they are trained for and as valuable contributions to services offered

and the running of the home. All staff keep personal development folders providing a

record and reminder of their individual achievements. Residents are involved in

training and are just starting to be involved with recruitment („you need the right

resident‟). They are involved in almost all decision making and are appreciated for

their good ideas and many talents.

The home has gained several high profile awards (Skills for Care Accolade, Edge

Award). Winning the awards has provided recognition for the achievements of

employees and good publicity for the home, particularly in the local community.

„You know, it‟s big for them if their peers and colleagues say “Actually you‟re

doing really well,” and for me especially … For a lot of these ladies like L and

like S this morning, they would have never had any recognition in life, you

know, least of all from husbands and children, so when those kids see their

mum in the paper with an award for best carer or best new carer or whatever,

it raises their status.

Entering for the awards is also seen as a means of reviewing practice which is

continuously evaluated in search of improvement. The Investors in People Award

acted as a trigger for a more systematic approach linked to planning.

120

„What the Investors in People did for me was it formalised the structure which

is what we should have been doing. We were pretty good at operational stuff,

but not very good at strategic stuff.‟

„I mean it‟s done a good job for us because how I see it is that if I‟m

constantly trying to benchmark myself I‟m learning.‟

Membership of a local learning „hub‟ provides further opportunities for review

through a management exchange scheme to share and examine practice in other

homes in the region. Going outside the immediate care home environment has helped

break down competitive barriers to sharing good practice.

The home was involved in establishing the Care Ambassador scheme in the county.

Several of the carers have been active in the scheme, visiting local schools and

organisations to give presentations to young people promoting the image of care work

as an interesting and worthwhile career with prospects for development and

progression in care and related healthcare professions.

Key themes

Many of the staff interviewed explained how they had been promoted

following training and saw themselves as having a career in care.

There were opportunities to progress within the organisation or to take on

specialist roles.

The owner has a policy of devolving as much responsibility to individual

members of staff as she can and believes that this high level of trust

contributes to a competent and self-confident workforce, whose stability has

more than repaid the high level of investment in training.

Employee-led training, whereby staff identify their own training needs,

contributes to high levels of involvement in learning and the development of

expertise.

8 per cent of turnover is allocated to training and this contributes the

organisation‟s high profile through the awards it wins, its reputation within the

community and with other care professionals.

Innovative practice

Investing highly in training to let reputation replace the need for marketing.

Linking staff personal development and autonomy with high standards of care.

121

Main challenges

Dealing with the constant changes in legislation.

As a small home, attracting residents at the current levels of funding following

the introduction of the personalisation agenda.

Limited levels of funding.

Recruiting and retaining staff able to work unsociable hours.

Recruiting and training staff to comply with future requirements for dementia

training.

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4.2 Service Provider: The Community Caring Trust

Rationale for case study

This organisation was a winner of the Times Top 100 Companies to Work for Award

and has been rated very highly in the tables for this award for several years. The

award is based on employee responses to a survey on their satisfaction with their jobs,

working conditions, a range of management practices and training.

The context

The Community Caring Trust provides a wide range of care services in the Midlands.

These services include residential and day care for the elderly and for adults and

children with physical and learning disabilities, respite care and supported living for

disabled adults. It has five residential and day care centres and over 35 properties

providing accommodation for supported living. The Trust is a private company

limited by guarantee and registered as a charity. It was spun out from the local

authority in 1997 following cuts in public sector services and has grown from

employing 85 to 500 staff who care for in the region of 700 service users. The

Community Caring Trust has a budget of £13.5 million of contracted income from

local and health authorities.

The need to address high levels of staff absenteeism triggered a new approach to the

provision of care services. The subsequent success of the Trust is built on the high

quality of service that it provides at rates competitive with those of other local

organisations in the sector. This has been achieved by adopting strategies that result

not only in cost cutting but in recognising and attending to the needs of the workforce.

Staff that feel valued provide a better service.

„If we want our workforce to treat the people we care for with dignity and

respect and develop their skills, we have to treat them in the same way.‟

„They are mirror images. How you treat your workforce is the experience the

service users get.‟

„It's just making that link between making people feel good about themselves

delivers you value for money and delivers you quality.‟

„Because when you‟re just a number you can become demotivated and you

can lose what path you really want to go down and you just come in for the

sake of coming to work really, but if you‟re motivated and you‟ve got drive

and somebody gives you that motivation, you‟re more enthusiastic, which can

only benefit the clients.‟

These policies have resulted in a shift to a relatively flat management hierarchy which

means that 85% of the organisation‟s income is available for the provision of care.

The senior management team is intentionally small. This allows not only for

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administration costs to be kept very low (6% of turnover as opposed to a norm of 35-

40% in the sector) but also aids in good communication between the senior team and

staff. They have a „hands on‟ approach to their roles –reading stories to clients,

driving the minibus and open door policy for managers and carers to talk about

anything they want to. Listening to staff is treated with great importance.

„But this organisation as well, you feel as part of the bigger picture. For

example, I worked in a private organisation for several years, 5 to 8 years, but

I never seen one chief executive once, you know. Now as a carer I‟d see [the

CEO] weekly…. So I think that that feeling of being part of something … you

know, you‟re not just a number, you‟re actually a part of something.‟

„Then suddenly you come here and you‟re allowed to have an opinion and

you‟re allowed to make suggestions… Staff are allowed to make suggestions

about policies and procedures and how it could be improved if we took them

on board and changed them. Paperwork - staff can make suggestions, “This

would maybe work better,” and it‟s took on board and things are changed. I

think that‟s really positive for the staff because if they think “I know this could

be done better,” we can all learn, we can never stop learning. And I feel that

you could go to either of the senior management team and suggest anything,

which is a rarity, you know, in my experience.‟

There are 14 managers at a middle management level. The structure of the

organisation differs according to the types of care. Homes have separate managers

and deputy managers leading a team. In supported living, six managers are each

responsible for approximately 20 staff delivering care to 20 or 30 service users.

These managers run their own units with considerable autonomy being responsible for

recruitment and staff induction and accountable for their budget and the work of their

team in providing a flexible service prioritising clients‟ varied needs. 30% of their

time is allotted to talking to service users, their families and care staff to motivate and

lead but they also carry out a monthly care shift to keep in touch with staff and service

users‟ needs.

„We scrapped a load of admin because we need to be out there leading people‟

„Because what we‟ve done now is we‟ve gone from having managers to

leaders. The workforce has become self-managing and self-motivating.‟

Training is an important element of the management of staff at the Trust. It is viewed

as a means to achieve a competent workforce through learning and the acquisition of

skills, as a means of bringing staff together to enforce the organisational culture and

as a means of empowerment of staff. Over 90% of staff are qualified to NVQ level 3

and many proceed to level 4 and the Registered Manager‟s Award. Staff training

needs are assessed by management but may also be employee led through

supervisions and appraisals. Employees are supported to take up specialist training

e.g. at degree level, which is funded by the Trust and seen as means of gaining

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specialist knowledge and experience for the organisation. Limited opportunity to

progress to a managerial position has led to the loss of some highly qualified staff but

this is not seen as a reason to limit training provision. Training is provided in-house

by external trainers and monitored by senior management.

Investment in training is underpinned by the payment of premium rates of pay for the

local sector. Retention of staff has resulted in a turnover rate of only 4% compared

with a 20% norm for the sector. Satisfaction at work and a bonus incentive has also

led to a reduction in absenteeism through sick leave from an annual average per

worker of 22 to 0.3 days. Subsequent savings have been made on recruitment and

eliminated the need to employ expensive agency workers and service users have

benefited through more reliability and continuity in their care.

Recruitment of staff is not based on qualifications but on personal qualities that are

seen to be appropriate for a caring role. Technical ability and experience can be

provided by training. Potential employees without experience are given a 30 hour

session of work on a voluntary basis to assess whether they are suitable for the post

and whether the work is appropriate for them.

Key themes from the Case Study

The concept that „making staff feel good about themselves‟ results in a quality

and value for money service for the service user.

The recruitment of staff for their caring qualities rather than experience or

qualifications. Staff can be trained in the job but not in their nature.

Viewing the staff as the major asset and attending to their needs - in the

workplace and in their work-life balance.

Paying premium wages within the local social care sector.

Trusting the staff and allowing them autonomy and flexibility in meeting the

needs of the service users.

Regarding training as a means to create opportunity and providing training

beyond the statutory requirements.

Using training to reinforce both skills and the organisation‟s ethos reducing

the levels of senior management to improve communication between staff and

cut management costs.

Employee-led learning.

Encouraging men into care roles.

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Innovative practice

Using „virtuous circle‟ management practice to create job satisfaction and

good work-life balance for staff and the provision of high quality care for

service users.

Main challenges

Adapting to constantly changing legislation and requirements.

Extending the provision of service to another region in the country.

Maintaining the ethos of high standards of care.

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4.3 Service Provider: The Agency

Rationale for choice: Staff Development in the private agency sector, where a

framework has been created for learning and career progression for workers who

would otherwise experience individualisation and isolation.

Context

The Agency is part of a group of companies providing temporary staff across the

labour market. This is a family company, dedicated to charitable activity and a

commitment to looking after staff. In the context of agency staff, one senior manager

said „the staff have a right to be managed‟, meaning they have the right to positive

feedback, as well as feedback and training where there are problems with

performance.

Training and development are encouraged for all staff from first employment. Social

care staff working for the agency complete induction training (covering the Skills for

Care Standards and the CSCI National Minimum Standards as well as an induction to

working for the agency, have access to NVQs, in-house training and various courses

as part of continuing professional development through the company‟s own, separate

training company or external providers. Managers described the training and

development functions in the branch as still evolving, but having improved

enormously over the previous few years.

The initial trigger to develop the training activities began six years previously when

they registered with CSCI (Commission for Social Care Inspection). Around this time

the company was offered ten free places on an NVQ programme via the local

authority. Reflecting back, it was considered that insufficient thought had been put

into the choice of the participants and what sort of support they would need, because

only one out of ten completed the programme. This led staff at the local branch to

think seriously about how to identify the right people to take part, to ensure they had

the opportunity to work in an appropriate area to complete the NVQ, and how to

provide appropriate support. The company now has good relationships with two local

colleges providing NVQs, have regular meetings with the verifiers and assessors, and

the company trainer has qualified as an assessor herself. In-house courses are offered

in the evening and on Saturdays. Staff do not get paid to attend the courses, but they

are free of charge and have proved to be popular. Some staff were deterred by the lack

of payment for training sessions, but still spoke positively about the training. As well

as opportunity to learn new things, these courses provide an important opportunity for

staff to meet one another, which is not usually possible in an agency setting. The

courses are workshop based and provide opportunity for sharing of experience and

best practice.

„It does help with feelings of.....I didn‟t know, I was isolated until I actually

came to do this.....I actually didn‟t know I was isolated, but I was and it felt so

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nice to be with other people. I like how you have to think things through

yourself, in small groups....it‟s very simple, but I find it really useful.‟

Much recruitment is through word of mouth and many staff remain with the Agency

for many years, some work on an agency basis while also maintaining a permanent

job, or work with the company while studying for a professional qualification.

Training has become an important element in the recruitment of staff, with staff

choosing to go to or return the agency in order to access training. Staff are encouraged

to go beyond NVQ Level 2 and to pursue training whatever the stage of their career,

“...she‟s actually 68 and she did her NVQ 2 two years ago and she did her

NVQ 3 about six months after that and that‟s just a real success story that

one....and then she rang up and she went „I don‟t think I‟ll do my NVQ 4 just

yet because I don‟t want to be a manager.‟”

Managers at the Agency regard training as a positive investment, linked to reputation-

building. This was explained in the following terms:

„When H trains five workers who go out and do a wonderful job, that‟s better

than G spending a week on the phone trying to get business. You know, those

five people are our sales arm.‟

Even when staff move on to other employers, the investment in training is still

regarded as a positive,

„It‟s always great to see where you started off a worker a few years ago in a

general sort of support worker setting and then that worker‟s now become one

of G‟s clients at management level because they‟ve progressed with us and,

you know, G now has a different relationship with them....it‟s a win for both

sides really.‟

It was reported that staff employed by the local authority have problems accessing

NVQs within the authority and go to the Agency for a few hours a week in addition to

their main job specifically for the training. One member of staff spoke of having

started her NVQ3 ten years previously with another employer, but not completing it

because of lack of support. She was now completing her NVQ3.

„So they‟re coming here and doing 2 here and then wanting to do 3.....and

we‟re very flexible and we work creatively around each individual‟s learning.‟

One benefit of the agency setting is that it is possible to ensure that staff have

appropriate „packages‟ that enable them to demonstrate the competencies relating to

NVQ 3 or 4. In this way progression may be more accessible than in permanent posts.

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Issues from the case study

Company ethos – „All we need to do really is care for our workers. If we can

care for our workers and they feel cared for, they can go out and do the job.

That‟s simple. It‟s basic.‟

Funding arrangements – The Agency keeps a central fund equivalent to 1% of

salary for each member of staff. The member of staff can then draw on this

money to fund external courses as part of continuing professional

development.

Having an in-house training function with a dedicated trainer with professional

experience as well as a training company with discounted courses for staff.

“I think having your own trainers is a massive part of it.....It‟s consistency

from the same trainer and people share things...”

Seeing the advantages of training: the benefits to reputation are a central

aspect of the company‟s approach and reputation is considered a key feature of

business success: a reputation for providing quality training opportunities and

for quality services. This in turn attracts potential staff to the organisation and

produces staff who act as good ambassadors for the company.

Commitment to career progression. Because the Agency provides staff in a

range of occupations and at all levels, there is scope for them to develop

careers and progress while staying with the company.

Training is not regarded as a cost. When staff do leave the Agency it is

frequently for promoted posts, they often become potential clients and

purchasers of services.

Challenges

Involving staff who have not yet seen the importance of continuing

professional development.

The difficulty of developing company-wide (national) strategy in a sector with

enormous regional variations.

The lack of consistency in relation to certain policies e.g. the use of restraint in

different local authority areas.

Understanding the various funding streams.

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4.4 Service Provider: The Home Support Dementia Team

Rationale for case study

The Council‟s Home Support Dementia Team represents an example of a team of

specialist care workers whose expertise and innovation have proved to be highly

successful in improving the care of local dementia sufferers. Their work was

recognised when they were awarded the Skills for Care Accolade for the most

innovative New Type of Worker or Way of Working and the National Winner of

Winners of the Accolade award.

The context

The Home Support Dementia Team is part of the In-House Home Support Services of

the Council. The team is dedicated to maintaining dementia sufferers in their own

homes, for as long as possible, by the provision of specialist care. The approach of the

Home Support Dementia team was triggered by the fact that dementia patients in the

area were ending up in hospitals and residential homes sooner than they should have

been. The view was that:

„As long as service users could accept that they needed the specialist care

provided by the team and that they could be kept safe then their own home

was a more appropriate place for them to be.‟

The project was originally developed with funding from the Department of Health

through the Skills for Care New Types of Worker scheme and is delivered in

partnership with the Berkshire Healthcare NHS Foundation Trust. Funding for the

service has been continued through the Local Area Agreements.

Their approach to care „challenges the way domiciliary care is traditionally delivered

which is time-limited and task-oriented.‟ The emphasis of their service is on

providing person-centred care, recognising that the particular needs of the clients they

look after demand a more flexible approach to service delivery. The team engages

with family and neighbours to look at how care can be managed in a day-to-day way

that suits the clients‟ lives rather than normal care provision practice. They look at the

whole spectrum of caring from personal care and attending to meals to shopping for

clothes and taking clients to appointments such as dentists, opticians or to a day

centre.

„The biggest aim is to keep as many skills as they‟ve got and so encourage

them to do rather than do for them.‟

The team of approximately fourteen individuals has a manager, coordinator and group

of home support workers. The coordinator is responsible for preliminary visits to

assess clients‟ needs and is the first point of contact for any staff problems or issues.

Care is delivered in shifts running from 7.30 in the morning until 11.00 at night. Shifts

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are arranged on a three weekly roster. Dedicated days off allow staff to plan their

personal lives.

Staff are grouped into teams of three and each team allocated a number of service

users. Carers are provided with mobile phones to contact each other and have

sufficient autonomy in the organisation of their work to arrange cover, within the

team, should service users require extra time from their carer on particular occasions.

Although the service is commissioned on a time orientated basis, with this flexibility,

the carers‟ hours can be used in the way that best fits the service user.

Staff interact with each other on a regular basis. Monthly meetings of the whole

group are used to discuss aspects of clients‟ care. All carers are familiar with the

needs of all service users should cover outside their team of three ever be required.

`Staff also meet informally without managers to sort out problems and the whole

group often meets on a social basis.

Carers must be qualified to NVQ level 2 before joining the team and the expectation

is that they should then achieve NVQ level 3. On recruitment they go through a

rigorous induction scheme and are monitored during a three week period of mentoring

by experienced staff. Mandatory training in areas such as health and safety, food

hygiene, medication and manual handling is also carried out at this time. After

meeting with service users and completing this initial phase they discuss with

management whether they are comfortable with the work. Service users are involved

in an indirect way in training in the induction of new staff when mentoring of the staff

is carried out.

Funding for, and access to, training is provided by the council‟s in-house training

services. Team members can identify any additional training from which they might

benefit at their six-weekly supervisions or annual appraisal. Specialist external

training in dementia is provided for the team but the limited availability of this

training means that some carers must work for up to 18 months before attending a

course. All training is evaluated by the group and they share their learning.

Rates of pay have recently been increased. Increments in pay are related to training.

The team are salaried, allowing them to spend more time when necessary with

individual service users. This helps to provide consistency for the service users.

„It‟s archaic to be paying people by the amount of work that they‟re doing.

That is what makes people rush. If you‟re going to get paid twice as much for

doing twice as many clients, you‟re going to try and do twice as many clients.

Our girls get paid the same if they do one or if they do ten.‟

Opportunities for career progression are limited but carers have progressed to

coordinators of other teams or continued training as Community Practice Nurses.

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Most of the team are dedicated to their work and prefer to stay in their caring role

than move on to other employment.

Key themes from the case study

A holistic approach to client care. The team works closely with district nurses, day

centres and the client‟s family to achieve this within the constraints of a time

commissioned service.

Access to quality in-house training provided by the council. All team workers are

initially qualified to NVQ2 level with the expectation of reaching NVQ3.

Specialist external training in dementia. This is provided where possible and is

considered to be of great importance in helping the team worker to learn about

dementia and form a better understanding of the needs of the clients.

Good communication: regular discussions take place between team members.

Dedication: members of the team gain great satisfaction from their work and many

would prefer to forgo any career progression in order to remain in their jobs.

Employee-led learning: regular discussions with management about any additional

requirements for training that the team feel would be useful. These needs are

accommodated wherever possible.

Team work based on a strong network of communication. Regular meetings of

team members are held with both managers and other team workers enabling

discussion of the needs of both clients and workers. The whole team is familiar

with the needs of all service users.

A flexible approach to client care. The team‟s main focus is adaptability around

the individual service user whose needs may not always fit to a regular schedule.

Autonomy in their work and the ability to reschedule work as a team allows the

home support workers to adapt routines to cater for the individual client‟s needs.

Managing working time to meet service users‟ needs and allowing staff to plan

their personal lives.

Innovative Practice

Adaptation of a time-commissioned service to the needs of service users.

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Main challenges

Gaining recognition for the care work as a profession and as work requiring

qualifications.

„It has got to become more of a profession and recognised as such. At the

moment, if you talk to a lot of lay people about “Oh, I‟m a carer,” or “What do

you perceive a carer being?” it‟s a mum that wants a bit of part-time work to fit in

with the children. And yes, it is. At the moment it is mostly that. A lot of people

it is it fits round with their children and the school, but if we‟ve got to provide the

care the way we need to look at it, that‟s got to change.‟

The need for greater availability of specialist dementia training and recognition of

its significance as a qualification for caring for users with dementia.

Gaining recognition from other professionals of the specialist knowledge of

dementia and skills that the team members possess.

Gaining recognition from other professionals of the team‟s shared expertise and

understanding of individual users‟ needs.

Recruitment – recruiting carers who can work the required shifts in competition

with external markets where more sociable hours are available.

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4.5 Training Organisation: The Not-for-profit Service Provider and Training

Division.

Rationale for case study

This is an example of an organisation in the not-for-profit-sector which has an in

house training division. The division has won national awards for its programmes

which include a tailor-made BTEC induction programme and leadership and

management training.

The context

The care provider is a charity with a strong commitment to improving standards of

care for the elderly. It began in the mid-19th

century as a charity supplying surgical

services and distributing surgical aids to the poor throughout Britain and the

commonwealth countries. With the advent of the National Health Service,

approximately sixty years ago, the Society refocused its aims to the care of older

people and now runs four homes providing services for day care, residential and

nursing care and dementia. It employs in the region of 300 care staff and provides

homes for approximately 200 residents

The training division develops and provides training and learning programmes for the

staff of the organisation‟s nursing and residential homes. It also provides an external

training service for other homes and domiciliary care agencies. It is concerned with

the education of all staff in all disciplines and at all levels and aims to help raise care

standards throughout the sector through its external training activities. The

organisation‟s status as a charity, rather than commercial company, enables them to

take a more developmental approach to the design and execution of their programmes

and to be responsive to the specific needs of staff and clients. Their approach is „not

looking at just getting out there and doing programmes of learning‟ but to ascertain

the best way to design a programme that will have an effect.

The core development team is comprised of seven training staff and an administrator.

Members are qualified in education, in nursing or care and have experience of

working in the care or related sectors. Specialist skills of the training team, in areas

such as domiciliary care, dementia and health and safety provide a good mix of

backgrounds which enables the training to be viewed from different perspectives.

„…all our trainers come from a nursing or care background, so they know the

problems. So they can go in and they can teach, they can train, and they

know, you know, what learners are coming up against in what they are doing

and I think that‟s an enormous benefit to managers as well.‟

Although managers within the organisation appreciated the caring nature of their staff,

with the introduction of a more regulated and inspected sector following the Care

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Standards Act, they recognised that there was „a very real need to equip all staff with

appropriate professional skills, whatever their job role.‟ They were unable to source

any courses that were relevant for all staff levels and roles and so used their own

expertise and experience to develop their own courses, which were then had

accredited by appropriate awarding bodies. This led to the development of their

programmes „to cover an increasingly broad remit of staff development and have

expanded to reach many other organisations.‟

Training provided includes a specially devised BTEC induction qualification; the

statutory NVQ2 and NVQ3 for carers; mandatory training such as moving and

handling fire safety and infection control; the Registered Manager Award;

programmes in leadership and management training and development.

Training requirements of care workers are generally overseen by line management but

to some extent, training can be employee-led. Annual staff appraisals and bi-monthly

supervisions allow managers and staff to identify their personal training needs which

are accommodated on an individual basis. Training and assessment to NVQ Level 3

can be limited by the availability of suitable posts. The expectation of the opportunity

to train to NVQ Level 3 is sometimes limited in practice, by the availability of

suitable posts that will accommodate this career progression. This may also be

compounded by restrictions of training budgets.

All staff in the care homes complete the BTEC induction course designed by the

training division. This programme is based on person-centred care and trains all

workers in the interaction with, and support of, older people. The course was

externally accredited and won a National Training Award.

„We felt that it was just as important for the lady or gentleman that goes and

cleans the bedroom. They need to know as much about person centred-care

and how to interact with someone and what to look for and how to do it as the

carer, or even the person in the kitchen, you know.‟

Leadership and management training is considered to be of great importance

throughout the organisation. Training is given to staff at all levels with supervisory

responsibilities, recognising the importance of effective leadership and the need to

acquire additional skills following some routes of career progression.

„Everybody, every head of department, every team lead, everybody in any sort

of management position, not just the ones that one would normally see as the

manager.‟

„And once again it‟s not just care, it‟s everybody because we feel they all

make up the whole workforce, as it were. So, you know, the housekeeper

perhaps who is the head housekeeper or head of department may never have

seen a budget or anything and, you know, part of that will be budget skills,

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communication skills … Really it‟s the whole sort of remit of management

and we‟re finding that extremely useful.‟

Most of the training programmes involve input from service users. This may be

through resident committees, confidential surveys or through activities and sessions

within the training programmes.

Key themes of the study.

The Training Division sees itself as a learning centre and supports the ethos of

the organisation in which learning and development are seen as a means of

advancing standards of care. This is evident in the perception that „we‟ve always

intuitively believed that staff development leads to better care.‟

Trainers have work experience of the care profession. As an in-house training

provider, knowledge of care training needs can also be gained from the training

divisions‟ relationship to the wider organisation.

The training team is highly qualified and experienced, with a developmental

approach to the design of programmes based on training outcome.

There is a concern to train all employees in the ethos of care, regardless of level

or discipline, in order to achieve a complete person-centred care. „So I think

basically for us it‟s looking at the whole workforce as a group; that they‟re all

working with the resident and looking at it from that point of view.‟

There is recognition that all forms of supervision require both caring and

management skills and that these need to be underpinned by educational and

vocational qualifications, as a means of increasing professionalisation and

improving career paths.

„Many people who are caring and many people who are reaching managerial areas

don‟t have that professional qualification ….. but I think there needs to be further

in-depth assessment of not just vocational stuff but also look at… There needs to be

more emphasis on academic skills so that people are able to perhaps develop

strategies to be able to move organisations on and look at … Sometimes I feel that

the managers in some organisations are more at a carer level.‟

Innovative practice

Providing leadership and management training to all staff with any form of

supervision in their role.

Creating educational qualifications to support career development.

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Adopting the view that the whole organisation is involved in care.

Adapting training programmes to the specific needs of individual

organisations.

Main challenges

Improving the image of care work.

Encouraging young people to see care work as a potentially progressive career.

Fulfilling the increasing need for dementia care.

Providing means for career progression.

Promoting an emphasis on person-centred care.

‘ but I can see that [in other homes] where you can see things that have been done

for the benefit of the staff and not for the benefit of the residents. “Oh, our staff

are wonderful,” and yeah, they are. I think my staff are fantastic, but we need to

get people to see the people we care for as being in charge and that does require a

shift in mind-set.‟

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4.6 Training Organisation: The Private Company

Rationale for Study

This organisation was recognised as „best training provider‟ by the Skills for Care

Accolade Awards.

The Context

This small but expanding company of twelve employees provides training,

qualifications and consultancy primarily to the social care sector in the North-West

region. It is registered as a limited company. The organisation started approximately

fifteen years ago as a provider of training. Following the introduction of regulatory

requirements for accredited qualifications linked to outcomes under the Care

Standards Act, it became as an assessment centre, extending its activities to NVQ

assessment. The organisation now offers training packages in induction and NVQs in

health and social care, learning and development and management. Approximately

90% of their work is in NVQ training and 10% in consultancy.

Trainers and assessors are qualified in both care and management as both types of

skills and experience are seen as necessary for their roles. Their learning and

development is constantly reviewed. A personalised induction scheme is drawn up for

new staff and related to their role and previous experience. This would include a

varied programme of learning about the company and shadowing each member of the

team, followed by mentoring and a „protective caseload‟ for a three month period.

„So actually it‟s about making sure people have the confidence in what they‟re

doing and are skilled up and they build on that over time. So that‟s really

important.‟

Supervisions of all staff are carried out on a regular basis, depending on the level of

need of individual team members. This might be two weekly for a new member of

staff and every eight weeks for well established workers. Supervisions are used as a

means of reflecting on the individual‟s practice and learning. Learning, development

and training needs are assessed for any new roles or responsibilities that staff will take

on in the future. Individuals are observed every six months by another team member

to verify their practice and learning. Management operates an „open door‟ policy

enabling good communication amongst the team.

The company aims to deliver qualifications to the care sector in a way which both

makes a profit and meets the needs of the employers and learners. It has been working

for the past two years on establishing a new way of working to achieve this aim and

achieve credibility in its service delivery. Most of its clients are small employers with

differing staff training needs. Flexibility in their approach to training includes

accommodating many or just one learner, a limited time frame for gaining

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qualifications and learners on night or weekend shift work. Training is work-based

and outcome-focused with a view „on the individual achieving a qualification and

that‟s coming together to help an employer.‟ Learning is seen as a means of making a

difference.

„One of the things is about “Who‟s the outcome for?” you know, you‟ve got

the learner and you‟ve got the employer and you‟ve got us and I think that

that‟s what it‟s about. It‟s about those three partnerships and, you know, if

we‟ve got a learner who‟s not motivated and doesn‟t want to do it, I don‟t

want an assessor to think “Okay, [xxxx]. I‟ll give them more time.” No,

because that employer needs that learner. So it‟s about seeing the whole thing

about that learner might not want to do it, but we‟ve got to get them to change

that around because there‟s an employer in there who needs them to have that

qualification … So outcomes is about seeing everybody we start with as a

finisher and that‟s really important because it means if they disappear, you

follow them.‟

„One of the things is that you make a difference and all learning should be

about making a difference, shouldn‟t it? I think one of the things with our

approach is you can make a difference. We do get people who just want to get

an NVQ and have been in the job forever and don‟t feel they‟ve anything to

learn and fine, we have to work with it … But the majority of people we‟re

working with they want to learn. It might be their first opportunity, it might

be that even if people have been in the job a long time they‟ve never really

reflected on their practice and no-one‟s ever said “Actually there is a standard

you can work to.” So I think there is the potential to make a difference with

individuals…‟

There are many examples of how the company attends to the needs of the individual

learner by adapting training programmes. For learners with basic literacy problems,

assessment by observation and oral questioning is increased. Workbooks are adapted

to help those not used to writing formal accounts or who suffer from dyslexia. The

effect of the intrusion of an assessor on the service user is also considered and this is

avoided by the involvement of an expert witness in sensitive situations. Sign

language interpreters were used in an award winning initiative for deaf carers and

communication improved by the assessor learning how to sign.

„Like the deaf candidates I‟ve got, that was a real learning curve as an

assessor. I mean I hadn‟t met any deaf people before I started working with

them and you just think, you know, “They‟re deaf but they can see,” but not

realising that English isn‟t their first language British Sign‟s their first

language.‟

Management see networking and participating in partnerships as a positive means of

promoting their services and keeping up to date with changing regulations and

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approaches. Regular network meetings include City and Guild workshops, regional

meetings, the county‟s Workforce Learning Resource Network and regional Skills for

Care conferences. The organisation has also been commissioned, by Skills for Care,

to work on the NMDS for their region.

The company has recently won three direct contracts from the Learning and Skills

Council to provide funding for training.

Key themes of the study

The view that learning should make a difference.

A creative and flexible approach to the design of work based training. All

training is customized to meet the needs of clients and individual learners,

matching learning styles with different types of learners.

Involvement in partnerships with other organisations.

Innovative practice

The individualisation of training programmes.

The significance of gaining their own direct funding contracts with the

Learning and Skills Council.

Main Challenges

Coping with expansion of the organisation.

Recruiting suitably qualified assessors due to a lack of career structure in

learning and development.

Issues surrounding training for the direct payments system.

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4.7 Regional Consortium: The Limited Company.

Rationale for Case Study

This private company was identified as an example of an effective consortium of

social care employers.

The Context

This organisation is a partnership of social care employers committed to supporting

the social care workforce of the independent and voluntary sectors in the West of

England.

It was originally set up, in 2002, as a consortium shortly after the instigation of the

Care Standards Act and the requirement for care establishments to have 50% of their

employees qualified to the standard of NVQ Level 2.

At that time it was a „loose collective of employers‟ including four local authorities

and the larger employers in the sector in the area. Its function was the administration

and dissemination of funding for training from TOPSS, provided to support

employers in meeting the training target.

The partnership „proved a bit of a place to coalesce views about what employers were

thinking locally‟. Additional funding from the Learning and Skills Council was

obtained to further this function and the partnership expanded its role to help TOPSS

disseminate information „to a very disparate independent sector‟ in the area.

A development worker was employed to manage the partnership and it was decided to

„formalise the structures around that organisation by turning it into a (not for profit)

company limited by guarantee‟ in 2006. This is now run by an elected Board of five

Directors and has a core operational team led by the Development Manager. Its main

sources of funding are the Learning and Skills for Care and Development, The

Department of Health and the local authority members of the consortium.

The partnership forum is made up of eighteen organisations altogether including

representatives of the statutory sector (Unitary Authorities), care providers in the

voluntary and independent sectors and government bodies such as Skills for Care

South West and CSCI. Members of the forum are from providers in different parts of

the sector and represent not only their organisation but a perspective of „their angle of

social care‟ such as learning disabilities, dementia, drugs and domiciliary care.

It aims „to improve the quality of care provision across the West of England‟ through

its activities in promoting workforce development initiatives, supporting voluntary

and independent organisations in meeting training standards, finding training options

and providers and in securing training funding. It manages the Training Strategy

Implementation Fund contract from Skills for Care.

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„So local employers can phone them and, you know, say “Do you know

anybody that does this training?” and they won‟t just say one person but

they‟ll say, you know, “There‟s three or four people that offer that, so, you

know, try phoning them.” So that‟s quite good because a lot of employers just

get inundated with things from people whose training isn‟t particularly great

but they just want to make money. So it‟s quite good from that point of view.‟

Its status as a limited company allows it to be „neutral‟ and not perceived as giving

biased information. It sees its role as ensuring that access to funding is „fair and

equal‟ for employers in an environment where competition and lack of knowledge

processes are barriers to obtaining funds.

„So if I‟m running a small residential home in E G, I‟m probably getting my

services commissioned by the Local Authority in some cases and I‟ve got a

whole issue about how I train my workforce which is quite difficult to get my

head round because the funding streams are complicated. “What can I get

from colleges? What is this Train to Gain funding? What do Local Authorities

have and how can I get my hands on that? What is the European Social Fund

and might I benefit from that?” So (the consortium) is there to help me as a

small employer really get my head round some of those issues.‟

The organisation promotes cooperation within the sector through networking and

training facilitation. Larger employers with their own training and assessing facilities

may provide training at workshops for smaller employers or provide places on courses

for employees from other organizations.

„I‟m often asked to provide some of the training at the workshops and things

like that. So I‟d say that the larger providers probably do give more, but again

that‟s because, you know, we want to do this to improve service delivery. So it

isn‟t just about our own organisation‟s… But, you know, because we are

involved, we have much more effective networking and links with people and

that benefits us organisationally. So it‟s, you know, sort of partnership

working is much easier really.‟

Building these relationships within the partnership has led to the sharing of good

practice and knowledge.

„So whilst it started off about money, I think the work the organisation has

done is to build, you know, a knowledge base and partnerships where people

can share best practice and qualifications that they‟re offering and, like I said,

I think there is more than enough business…‟

„Most of us I don‟t think see each other as competitors. It is about sort of

sharing practice.‟

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Several projects were developed by the manager following visits to local employers

concerning training options. Here he discovered the challenges local employers faced

such as which trainers to use and where to go if something went wrong. A website

was set up to provide information and all training providers hosted on it joined the

forum to facilitate a route for discussion of any issues that might arise. It is also used

as site for other information relating to the sector.

Other projects include the Essential Skills Pilot in collaboration with Unison using

Train for Gain funding for the improvement of care workers basic literacy skills, the

Care Ambassador scheme, in which care workers promote the notion of care as a

progressive career to young people and the Learning and Exchange Network through

which homes with poor ratings from CSCI can be helped to improve and develop

good practice.

Key themes from the case study

Improving the standards of care in the region by providing access to funding

for training.

Aiding smaller establishments by providing information on appropriate

training and training providers.

Aiding employers in keeping up to date with changing requirements and

regulations.

Providing support and help to care providers through the Learning Exchange

Network and NMDS.

Building cooperation by encouraging the exchange of good practice between

employers who don‟t see themselves as competitors.

Providing a network for discussion of issues and problems.

Building relationships for employers with bodies such as Skills for Care and

CSCI.

Innovative practices

Ascertaining the needs of local employers and designing projects to address

the issues and challenges they face.

Ensuring, by virtue of its membership base, that the organization takes account

of the perspectives of all types of care providers.

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Main Challenges

Securing continued funding for projects such as the Care Ambassador Scheme

and the Learning and Exchange Networks.

changes in training requirements and the qualification framework that will be

in place in 2010

The personalisation agenda.

„I think the biggest challenge in the future is going to be how do we manage

people who do decide to be responsible and manage their own care and what

are the safeguards in place for that. I think those are the challenges.‟

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4.8 Regional Consortium: The Council-backed Alliance

Rationale for choice:

This is an example of an attempt to overcome fragmentation in the sector. The

Alliance has received a Skills for Care Accolade.

Context

The trigger for the formation of the Alliance came from the Care Standards Act, with

increased demands on care providers, key stakeholders or strategic partners

recognised that they could take a role in supporting the providers, who historically

have tended to be isolated. In this region, the Learning and Skills Council and the

County Council share geographical boundaries which simplified the development of a

consortium grouping for the area. At the same time the County Council had been

allocated a government grant (the Human Resource Development Grant) part of

which was to be utilised in the private and voluntary sectors. As a result a number of

key strategic partners (the County Council, the Learning and Skills Council, Skills for

Care, the Regional Development Agency and Job Centre Plus) came up with a

proposal in 2004 to form the Alliance and formulated a plan to employ a Workforce

Development Officer. A member of staff was appointed by the County Council with a

remit to establish an Alliance involving employers and tasked with setting up two

groups – an Implementation Group and an Education and Provider Network.

Although the involvement of the strategic partners has changed, the Alliance has since

grown with local employers as the key activists in the group and was described as

„employer-led‟. All care providers may join the Alliance and access support, advice,

access to funding, access to training programmes and chance to become involved with

any Alliance initiative. Members include larger organisations with their own in-house

training functions through to the very small care home or domiciliary agency. The

Alliance is promoted through the Local Authority and by the contract managers who

have contact with the care providers.

Although the Alliance is made up of employers, it remains part of the Local Authority

in financial and legal terms. This situation contrasts with areas where this work has

been moved into the private sector (see Consortium Case Study 1: the „not for profit‟

company). One member described the benefits of the system,

„....though we sit very closely aligned to the county council, we‟re actually

seen by them as fairly sort of independent. So we have access to their systems

and all the good things, but in lots of ways we‟re not sort of hampered by

some of the bureaucracy.‟

The targeted development grant has now been replaced by general funding with no

development aspect ring fenced. However, because of the positive achievements of

the Alliance, the Workforce Development Officer has had no problem accessing funds

from the Local Authority. The Alliance also accesses funding from Skills for Care,

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which supports NVQ programmes; funding from Skills for Care for the Care

Ambassador scheme; and funding from the Local Authority to fund a recruitment and

retention project. Funding from the latter two projects currently supports two further

posts.

The Alliance has retained the one member of staff who co-ordinates its work with a

key activity being accessing and allocating resources for workforce development.

Funding continues to come from the Local Authority and from Skills for Care.

Activities funded included NVQs and management development, as well as running a

bidding system for special projects – for up to £1,000 for bespoke training such as

dementia training.

The Alliance is able to respond to local needs. One of the particular successes has

been the „Move On‟ programme, which it was felt had „an impact on

retention.......confidence and professionalism of organisations‟. The Workforce

Development Officer also conducted research around recruitment and retention and

found that one of the key factors was quality of management. As a result of the

Alliance set up a successful performance management programme. It was felt that

such programmes, by adding to people‟s confidence, were contributing to career

progression.

The Alliance has brought together large and small employers, who willingly share

good practice and sometimes teaching materials. There are a number of sub-groups

looking at specific issues and the willingness to share was demonstrated in the

policies and procedures sub-group,

„I think in the old days there was a lack of trust. So these people in the very

first meetings didn‟t really know each other and there was a bit of a sort of

hesitancy in terms of getting stuck in really, but then over a period of time sort

of trust has developed and now people actually share good practice. They‟ll

pass on policies and procedures....‟

As one provider from a small organisation said, „we‟re introducing an electronic

rostering system and so we‟ve asked on that. They‟ve [other large organisations in the

Alliance] been really useful.‟

The Alliance is now considering a mentoring scheme across organisations in

geographical areas. The employers who sit on the management group have

particularly gained in terms of a support network and link into the sector more

generally, which has established a route to essential up-to-date information about

developments in the sector. Another benefit to members is the social side to the

professional grouping, getting together with likeminded enthusiasts, „I think they

really quite like the buzz of our meetings as well...‟

There is some concern about the personalisation agenda as it is not yet clear what

impact it will have, which makes planning more difficult. While some Alliance

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members see the developments as positive or likely to have limited impact, one

manager of a small rural concern providing domiciliary care pointed out that it would

only take one care user to withdraw from their services in a particular locality for their

provision in that village to become unprofitable.

„..there might be.15 people in x. If we lose 2 of those people because

someone‟s providing care to them directly, you know, from direct payments

and employed by themselves, it makes the rest less sustainable....and the

people that are going to want private carers are the ones that have a heavy

caseload....at the moment those are sustaining all the other care visits that we

make in that area because we go back to this person, we provide a lunch, then

we go off and do some more calls and then go back and do their tea.....‟

This is regarded as threatening by the smaller providers.

Issues from the case study

Providing access to funding that individual employers do not have, or would

find difficult to access.

Sharing good practice between employers – overcoming potential suspicion

between employers.

A key source of important sector-specific knowledge.

An important social and professional support network for those involved – the

enthusiastic local actors.

Scope for innovation in training and development – forum for developing new

ideas.

Extending development activities to employers who might not otherwise offer

little.

Challenges

Accessing funding is complex and requires some specific expertise.

Members may have different priorities for development - need to find

appropriate ways to allocate resources.

The need for professional staff to support the work of an Alliance.

Sustainability of the Alliance – how to build an on-going funding stream?

Does it have too great a reliance on key enthusiastic actors?

The move to personalised social care creates some uncertainty for the future

and makes planning difficult.

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4.9 Regional Consortium: The Institutionalised Alliance

Rationale for choice: Skills for Care Accolade winner for „Most effective partnership

for workforce development‟, identified as making a significant contribution to

regional economic development.

Context

The Alliance started small with funding from a local council, but the key trigger to its

expansion was a successful large European Social Fund project. The Alliance is

hosted by the council: its staff are council employees and it has the legal

responsibility for the Alliance, although its work is overseen by a Strategic

Partnership Board (5 members from local authorities, 1 employers‟ representative

from each of the 5 geographical networks and 1 specialist on disabilities, plus the

Alliance Manager).

Having established itself, the Alliance now bids for training contacts and sub-

contracts to a range of preferred providers, keeping a top slice to fund the running cost

of the Alliance. Initially, training was offered free through the funding, but in some

cases employers booked places and then staff did not turn up. Therefore, a minimum

charge was introduced and attendance improved significantly. It places an emphasis

on the quality of provision, inviting tenders from providers and working mostly with

fifteen main ones. One employer described the difference the Alliance made. The

organisation had always been enthusiastic about training, but did not always have the

resources to pursue it. Previously Service Managers were required to be

professionally qualified nurses or social workers, but with access to the full range of

training through the Alliance, there was the opportunity for progression within the

organisation.

„We‟ve got a Service Manager at the moment who came in as quite a novice,

as a support worker, worked her way up to Senior Support, then Home

Manager and now she actually manages...about 10 different services and that‟s

because we want to develop and train staff and she came up through the NVQ

system.‟

A manager of a small residential home explained that when she took over the home,

none of the staff had any qualifications and training was very expensive. With the free

course via the Alliance all the staff have gained NVQ2 and three were then doing

Level 3 in Medication. She described how staff had grown in confidence and were

now willing to make suggestions, talk with visitors and discuss care with the manager.

She felt this contributed to the good reputation which the home had established.

Occasionally employers have the opportunity to access cheaper training from

providers outside of the Alliance, but frequently find the quality of provision does not

match that provided through the Alliance. Regular provider forums are held, which

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enables the providers to share good practice. Some of the providers initially had

reservations about the forum, but have moved from being slightly suspicious to

working together and sharing ideas.

Other local authorities in the region joined the Alliance, each making small financial

contributions. It now has 23 staff (2 Managers, 2 in the Quality Team, 6 network

development officers, an NVQ co-ordinator and 7 in the Business Support Team) and

they have become extremely effective at making successful bids through Train to

Gain, Skills for Care, the Training Strategy Implementation (TSI) fund and the

Learning and Skills Council. Previously there had been few training opportunities

available to employers, but the Alliance has enabled 15,000 people to attend short

courses and 3,000 NVQs completed and a success rate of 86%. It has 729 members

(employers mostly in the residential and domiciliary care, but also charities and

community groups) and has employer networks in five areas of the north east with a

member of the Alliance staff supporting each of these, where employers share

information. Network meetings host presentations on specialist topics and are an

important site for sharing knowledge about new developments in the sector. Again

there was some resistance initially, but employers found that there were more benefits

from sharing. As one manager said „...I think what the Alliance has done is build up

confidence in each other so actually we do share good practice.‟ Another manager

said,

„..it‟s quite an isolated job...running a care home, so from a management point

of view we can talk to other managers and find out what difficulties they‟ve

got and how they‟ve, maybe, sorted things....we know quite a lot of

managers...and we often like pick the phone up and there‟s communication.‟

One manager explained that if she was buying in specialist training and had six staff

to attend it, she might be able to get it cheaper with ten – so would offer other

employers the chance to share it. The Alliance is able to respond directly to the

training needs identified by employers and create economies of scale. A manager

described needing training on risk assessments for fire service inspections – she phone

the Alliance asked for some training and it was organised, „ ...they put it on the list

and find the funding.‟ By generating this level of activity, it has also been able to

make a significant contribution to the local economy.

There have been some attempts to include service users in the activities of the

Alliance, although this has tended to be in seminars rather than directly into training

events. There is a service users‟ group in Newcastle and views and experiences from

the group feed into training and are fed back to employers. Because of the wide

ranging nature of the network, the Alliance is well placed to build direct links with

service users.

The Alliance runs a wide range of projects as well as providing training opportunities,

including assisting recruitment of staff into the care sector. A project with one of the

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member Councils, „Pathways to Care‟, identified people who were not „job ready‟,

gave training on interview techniques, communications and basic skills. This project

enabled 70 people to gain jobs in the care sector. The Alliance has built up a

momentum of activity, when an opportunity arises like this, the other councils see the

positive outcomes and want to do something similar. In another project, the Alliance

worked with a Primary Care Trust to provide induction and training for people not in

employment. Thirty people took part and were guaranteed an interview for a position.

All participants got jobs with the hospital.

The Alliance staff pride themselves on being in the forefront of all new initiatives.

They are currently planning for individual budget holders and considering whether

there is a need for a separate employer network. The budget holders can join the

Alliance and access the training that any employer could. The Alliance, through the

council has contacts with the Personalisation Officer and Direct Payments Officer,

who keeps the list of all employers. In this way it is in a position to be able to contact

all employers and provide the routes to access training for employees. They are

thinking about providing specific training for personal assistants and will be seeking

funding from the council to pursue this. Individual employer members involve service

users in a range of ways and have recently raised the possibility of accessing training

for service users as well as for staff.

Issues from the case study

Providing access to funding that individual employers do not have, or find

difficult to access.

Sharing good practice between employers – overcoming potential suspicion

between employers.

An important social and professional support network for individual managers.

Scope for innovation in training and development – forum for developing new

ideas.

Ensuring the quality of training provision and the sharing of good practice

between providers.

Providing links between social care and the health service.

Facilitating the development of career progression routes for staff in smaller

establishments.

Stimulating a wide scale of activity that contributes towards the local

economy.

Taking a brokering role for the provision of training.

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Establishing a sustainable funding stream through a combination of local

authority support, top slice from fees and funding bids.

Providing access into employment through training and development for those

not in employment.

Challenges

Accessing funding is complex and requires some specific expertise. This was

described as a constant challenge.

Although initially the Alliance may have been reliant on key employees, it

now has sufficient experienced staff to be able to cope with the loss of some

key staff.