The Recruitment and Retention of a Care Workforce for Older … · 2019-02-25 · The Recruitment and Retention of a Care Workforce for Older People Jill Rubery, Gail Hebson, Damian

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The Recruitment and Retention of a Care

Workforce for Older People

Jill Rubery, Gail Hebson, Damian Grimshaw, Marilyn Carroll,

Liz Smith, Lorrie Marchington and Sebastian Ugarte

February 2011

European Work and Employment Research Centre (EWERC)

University of Manchester

Project funded by the Department of Health as part of

the Social Care Workforce Initiative

Disclaimer

This is an independent report commissioned and funded by the Policy Research Programme

in the Department of Health. The views expressed are not necessarily those of the

Department.

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Acknowledgments

This report is based on the final two years of a University of Manchester research project on

the recruitment and retention of the social care workforce for older people under the

Department of Health‟s Social Care Workforce Initiative undertaken by a team based in the

European Work and Employment Research Centre in Manchester Business School. The

results of the first year of the project were reported on separately by the Manchester PSSRU

unit in 2009.

We are grateful to the Department of Heath for funding this project, while the usual

disclaimer applies (see above). We would also like to thank the academic coordinator of the

initiative, Hazel Qureshi, for her support and guidance over the course of the project. We are

extremely grateful for the time taken by the participants in this research project to provide us

with the data without which the report could not have been written. The participants ranged

from local authority commissioners and contract managers, to independent sector providers

(owners and managers), human resource managers of national chains and nearly 100 care

workers. The project has also benefitted from the active participation of members of our

advisory board, whose names are listed below. We are particularly grateful to Mary Murphy

for facilitating the setting up of a focus group of users and to Dan O‟Donoghue for

facilitating the piloting of our telephone questionnaire. Over the course of this project a

number of researchers have been involved in this project in addition to those named on the

report; these include Colette Fagan, Carrie Hunt and Claire Shepherd, and we would like to

record our thanks to them.

Members of the Project Advisory Board

Name Position/Organisation

Ged Taylor Consultant

Mary Murphy Lay Person

Judy Scott Lay person

Sharon Brearley Age Concern

Peter Urwin/ Ray Short Unison

Michael Wyatt St Helens Council

Dan O‟Donoghue Home Care Support

Sue George Skills for Care

Gillian McCormack Skills for Care

Chris Hopwood ACAS

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Table of Contents

Part/Section Page

I. The study context 1

I.1. The research framework 1

I.2. The impact of external environmental factors on recruitment and retention 4

I.2.1. Policy environment 4

I.2.2. Commissioning and contracting practices of LAs 7

I.2.3. Labour market conditions 15

I.3. Management and organisational factors in the recruitment and retention of

a social care workforce

19

I.3.1. Management and human resource practices 19

I.3.2. Reward practices 22

I.3.3. The organisation of care work 28

I.3.4. Training and development 34

I.4. Recruitment and retention from the user and employee perspectives 36

I.4.1.What makes a good care service and what makes a good care

worker?

36

I.4.2. Is care work a good job or a bad job? The employee perspective 38

I.4.3. Time and space in the recruitment and retention of a social care

workforce

41

I.5. Key research questions 42

I.6. Research strategy and methodology 45

I.6.1. The project research stages 45

I.6.2 The first stage survey 48

I.7. The research methods for stage two 49

I.7.1. The local authorities 49

I.7.2 The telephone survey 53

I.8 The research methods for stage 3 case studies 58

I.8.1 Rationale for the case study approach 58

I.8.2. Stage three: design of the case studies 58

I.8.3. Stage three: selection, conduct and analysis of the case studies 60

I.9 The plan of the report 64

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II. Commissioning and Contracting in the Selected Local Authorities 65

II.1. Key commissioning and contracting characteristics 65

II.1.1. Extent and form of external commissioning and contracting 65

II.1.2. Provision of fees for externally provided care 72

II.1.3. Role of HR factors in tendering, contracting and monitoring 78

II.1.4. Extent of support for providers through forums and training

provision

80

II.2. Approaches to commissioning and contracting: the qualitative interview

data

83

II.2.1. Making the market 84

II.2.2. Price versus quality. 91

II.2.3. Integration of social care and health 96

II.2.4. User choice 98

II.3. Classifying the strategic approach 102

II.3.1. Typologising the local authorities 102

II.3.2.The coherence, stability and sustainability of LAs‟ commissioning

and contracting practices

110

II.4 The selected LAs and user satisfaction surveys 113

II.5 Summary and conclusions 116

III. The provider telephone survey: Recruitment, retention and employment

conditions

118

III.1. Recruitment and selection 120

III.1.1. Recruitment difficulties 120

III.1.2. Recruitment practices: Attracting a suitable pool of applicants 124

III.1.3. Selection: Choosing the right applicant 129

III.1.4. Selection problems 134

III.2. Turnover and retention 138

III.2.1. Staff turnover 138

III.3. Pay and rewards 143

III.3.1. Level of pay 143

III.3.2. Pay differentials and pay supplements 147

III.3.3. Pay uprating 150

III.3.4. Payment for travel time, overtime and training time 152

III.3.5. Payment for upfront costs of starting work 155

III.4. Flexibility, Working Time and Work Organisation 157

III.4.1. Flexibility, working time arrangements and work organisation in

domiciliary care.

157

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care homes

173

III.5. Employee development and training 177

III.5.1. Induction of new staff 177

III.5.2. Training 178

III.5.3. Appraisal and staff development 184

III.6. Performance management, job autonomy and employee voice 186

III.6.1. Performance management 186

III.6.2. Discretion and autonomy 191

III.6.3. Employee voice and communication 193

III.7. Summary 195

IV. The impact of organisational, commissioning and labour market factors on

HR practices and outcomes

199

IV.1. Organisational characteristics and the management of independent sector

providers

200

IV.1.1. Organisational characteristics 200

IV.1.2. Management in the independent sector 205

IV.2 HR practices and outcomes by provider characteristics 213

IV.2.1. HR practices and outcomes by provider characteristics 214

IV.2.2. HR outcomes by provider characteristics 223

IV.2.3. HR practices and strategies by individual provider 228

IV.2.4. Employer views on the effectiveness of HR strategies 230

IV.3. LA commissioning and contracting and provider HR practices 233

IV.3.1. The influence of LA fee levels on pay 233

IV.3.2. HR practices and outcomes by type of LA 237

IV.4. Labour market conditions and provider HR practices and outcomes 246

IV.4.1. The influence of local labour market conditions on pay 246

IV.4.2. The influence of local labour market conditions on HR practices

and outcomes

247

IV.5. Internal and external environmental factors associated with good HR

practices and HR outcomes

253

IV.5.1. Exploring the factors associated with the adoption of good HR

practices

253

IV.5.2. Exploring the factors associated with good HR outcomes 259

IV.6. Providers‟ views on the social care policy and commissioning

environment

267

IV.6.1. Providers‟ attitudes towards and experiences of local authorities 267

IV.6.2. Providers‟ attitudes towards and experiences of monitoring

systems

273

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IV.6.3. Providers‟ attitudes towards, and experiences of, policy

developments likely to affect social care

280

IV.7. Summary 283

V. Recruitment and Retention in the Care Sector: A Case Study Approach 289

V.1. Case studies in four local authorities: exploring the impact of

commissioning and contracting arrangements

291

V.1.1 Introducing the local authorities 291

V.1.2. Pay practices of providers by local authority. 293

V.1.3. Working time practices of providers by local authority 294

V.1.4. Work organisation of providers by local authority 295

V.1.5. Training and development of providers by local authority 297

V.1.6. Comparing national providers in different LA environments. 298

V.1.7. Overview of HR outcomes for providers by local authority 300

V.2. Care workers‟ perspectives on recruitment 300

V.2.1 Factors that influence entry into the care sector 303

V.2.2. Role of employers versus employees in access to information on

care job vacancies

309

V.3. Care workers‟ perspectives on turnover and retention 313

V.3.1. Care workers‟ intentions to stay or to quit. 313

V.3.2. Factors that may contribute to turnover 318

V.4. Care workers‟ perspective on pay and working time 321

V.4.1 Pay and travel time 321

V.4.2 Working time 325

V.5. Care workers‟ perspective on work organisation and the quality of care 330

V.6. Care workers‟ perspectives on training and development 337

V.6.1 Experiences of training 337

V.6.2 Development and opportunities training 340

V.7 Summary and conclusions 344

VI. Research Findings and Conclusions 347

VI.1. The local authority commissioning environment 347

VI.2. Explaining the variety of HR policies and HR outcomes of providers 352

VI.3. Recruitment and retention from a care worker and user perspective 362

VI.4. Prospects for recruitment and retention under expanding demand: the

policy issues

366

Appendix 376

Bibliography 419

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List of abbreviations

ADSS Association of the Directors of Social Services

CIPD Chartered Institute of Personnel and Development

CQC Care Quality Commission

CRB Criminal Records Bureau

GMB GMB Trade Union

HR Human resource

IDP Independent sector domiciliary care provider

KPI Key performance indicator

LA Local authority

LADP Local authority domiciliary care provider

LPC Low Pay Commission

MaROT Management of recruitment and retention, reward policy, organisation of work

and training and development

NHS National Health Serivce

NMDS National Minimum Data Set

NVQ National Vocational Qualification

PCT Primary Care Trust

PoCLS The policy environment, commissioning practices of local authorities, and

labour supply factors

R2 Coefficient of determination of a linear regression

R&R Recruitment and retention

Sig. Significant ( statistical)

TUPE Transfer of Undertakings Protection of Employment

UKHCA UK Home Care Association

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Notes on coding used through the report

We have used a number of coding systems to provide identifier throughout the report. The 14

local authorities have been given a two letter identifier. This has been used as the first part of

the identifier for the providers interviewed in the telephone survey. After the LA identifier we

use the codes D, H and IH to signify domiciliary, homes or inhouse (LA) provider. The first

number indicates whether they are the first, second, etc; domiciliary provider or home

interviewed in the LA. Other codes have been added to facilitate identification by the

research team of the key characteristics of the provider, but readers may ignore them. In part

V we provide a simplified coding structure for the case study providers and the

correspondence between the two sets of codes is outlined in appendix table V.A1.

Variable codes used in part IV are fully explained in the appendix to part IV.

Part I. The study context

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I. The Study Context

I.1. The research framework

The overall aim of the project is to contribute to the debate on how to recruit and retain a

social care workforce for older adults to meet current and future needs. The specific focus is

on care assistants and on care for older adults. Improvements in recruitment and retention are

critical to enhancing the quality and the availability of care staff, an objective which has been

a long standing policy concern (Cm 4683 1971, Cm 6233 1975). Its importance for policy

has increased as a consequence of the policy emphasis on the provision of care for vulnerable

older people both in their own homes and in care homes (Cm 849 1989). The research project

also responds to an increasing policy focus on quality in domiciliary and residential care

(Department of Health 2000), particularly as perceived by users and carers (Nocon and

Qureshi 1996, Department of Health 2009), and on the regulation of these care sectors

(Department of Health 2000, 2003a, 2003b).

The focus of the research is on the recruitment and retention of care workers in the

independent private and voluntary sectors. The shift from local authorities (LAs) to

independent providers of care, particularly from 1993 onwards, has diminished our

knowledge of the context for recruitment and retention due to the much larger variety of

organisations providing care, the diversity of organisational approaches to HR policy and

practice and the important new role of LA commissioning arrangements.

The starting hypothesis for our project was that the recruitment and retention of the

workforce would be influenced by the environment in which the providers operate – namely

the policy and commissioning environment and the labour supply conditions – and by the

policies and practices of the independent sector providers. Recruitment and retention is also

influenced by the experiences and aspirations of the workforce and an additional emphasis in

our research is to include employee experiences and voice in understanding the current

context. The project design did not allow for extensive engagement with users‟ perceptions of

care quality and the links between their perceptions and quality HR polices. However, as

chapter two makes clear, we have aimed to include user perspectives in survey design and

analysis wherever possible. Also, as the project was designed in 2004, the potential role of

personalised budgets in shaping future patterns of recruitment and retention is only

considered to a limited extent. However, recent policy favouring the development of

individual budget arrangements (Department of Health 2008) makes it even more important

to gather information on the problems of sustaining and developing a social care workforce in

a context of potentially even more fragmented employment arrangements.


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Figure I.1 sets out the overall framework that we have used for understanding the influences

on the recruitment and retention of the social care workforce. The figure depicts first of all

the key external environmental factors (PoCLS) including:

the Policy environment (central government and devolved government policy);

Commissioning practices of local authorities, including inhouse arrangements and

purchaser-provider relations; and

Labour Supply factors, including local market conditions, changing gender relations

and the structure of the care labour market.

We have elaborated the central government policy agendas to include not only the direct

relationships between central government and LAs in the form of budget setting and policies

with respect to care arrangements but also government policy towards the NHS and personal

budgets, thereby bringing the users directly into the picture. A second set of influences on

recruitment and retention are depicted by the role of independent providers in shaping the

conditions of work within the organisation (MaROT), including:

Management of recruitment and retention, including the use of „high performance

bundles‟ of HR practices, and mechanisms for employee voice;

Reward policy, including pay rates, pay premiums and travel pay, and particularly in

relation to part-time work and women returners;

Organisation of work, including the nature of care work, the pace and timing of work,

the skill content and scope for autonomy and discretion; and

Training and development, including formal training provision and the effects of

regulatory standards.

The experiences and aspirations of the care workforce are influenced by the commissioning

and provider policies in social care but also by the general labour market conditions and by

their own experiences of both work and care, both inside and outside the labour market. The

users are shown as having a potentially more active role in the future in both employing the

workforce directly and by using brokers or independent sector domiciliary providers, with or

without LA involvement to commission services.

This figure provides the framework for this review of current literature and knowledge. We

start in section I.2 with the external environment factors that impact on the recruitment and

retention of social care staff including policy, commissioning and labour supply conditions

(PoCLS). This section is informed by government policy documents and academic research

literature but also by the results from a survey of all Local Authorities in England involved in

commissioning social care (sample number 149, achieved sample of 90) conducted as the

first stage of this project but reported separately by the PSSRU research team that had

responsibility for this stage (Hughes et al. 2009). Section I.3 discusses the key organisational

factors (MaROT) likely to impact on recruitment and retention with sections on the

management of provider institutions and approaches to quality care standards, on resourcing

and reward policies, and on the organisation of work and the approach to training and

development. Section I.4 considers recruitment and retention from users‟ and employees‟


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perspectives. Here we focus on what we know about user perspectives on care quality,

namely what makes both a good care worker and a good care service. We then consider the

literature on what makes a good and a bad job from an employee perspective, focusing

particularly on the literature on care work and on low paid work. Drawing on this literature

review, section I.5 identifies the key research questions for the project and the methods

adopted to investigate these questions are outlined in sections I.6 to I.8.

Figure I.1. Framework of influences on the recruitment and retention of care workers

Policy environment

INDEPENDENTSECTOR PROVIDERS

Management,Rewards,

Organisation of work, Training )

Commissioning practices

NHS

Labour

supply

Personal budgets

USERS/ QUALITY OF CARE

Personal and family experience

SOCIAL CARE WORKFORCE


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I.2. The impact of external environmental factors on recruitment

and retention

Figure I.1 above identifies three key external influences (PoCLS) on the recruitment and

retention of the social care workforce for older adults: the Policy environment, the

Commissioning practices of local authorities and Labour Supply factors. We review each in

turn in the following discussion.

I.2.1. Policy environment

The policy environment for social care for older adults is first of all informed by social needs.

Three main factors are increasing the need for social care: the ageing population and

increased life expectancy; the associated need to reduce costs of healthcare for older adults by

speeding up hospital discharge; and the decline in availability of unpaid carers due to changes

in women‟s roles and the trend towards single independent living for the elderly. This general

policy environment which applies across the developed world means that social care is and

will remain a critical area for welfare state policy. A fourth key policy issue is the increasing

demands from users to have greater control over their care arrangements. This is leading to

policies to make care more user-centred and for care commissioning to be assessed not only

on cost but also on quality outcomes as perceived by users.

While this policy context raises a very wide range of issues, including how care should be

funded and the like, our prime concern is with those questions which impact upon the

employment environment for the social care workforce. Of particular salience here are

policies which have an impact upon who employs the social care workforce, under what

conditions and for what types of work. Three main policy developments can be highlighted:

the development of commissioning and contracting to the independent sector; the integration

of health and social care and the current policy of devolving budgets to care users.

Commissioning and contracting to the independent sector: government sets the

policy environment

The foundations for the current high levels of commissioning and contracting to the

independent sector were laid by the 1989 White Paper, Caring for People, which required

LAs to promote „the development of a flourishing independent sector alongside good quality

public services‟. In 1993 the roles of purchaser/commissioner and providers were formally

separated (Department of Health 1990) and the 1998 White Paper required LAs „to plan,

commission, purchase and monitor an adequate supply of appropriate, cost effective and safe

social care provision for those eligible for local authority support‟ (Cm 4169 1998: 111).

Around the same time the Labour government decided to replace compulsory competitive

tendering with Best Value (Cm 4014 1998). In doing so it also decreed that it had „no

preconception about whether the public or the voluntary or private sector should be the


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preferred providers‟ (Cm 4169 1998: 119). Instead the mix of providers was to be

determined by the outcome of Best Value commissioning and contracting. Local Authorities

have also been under pressure to increase efficiency in their procurement policies as a

consequence of the Gershon (2004) review of public sector efficiency. Further pressure for

efficiency in procurement has come from a relatively tight budget settlement for social care,

certainly in comparison to health. A recent report from the House of Commons Health

Committee notes that overall gross expenditure on adult personal social services increased by

57.4% in real terms between 1997–98 and 2007–08 but spending on the NHS doubled in the

same period (House of Commons 2010). Furthermore, central government grants to LAs only

increased by 48% in real terms over the same time period. The impact of this environment on

the commissioning and contracting practices of LAs is explored further in section I.2.2.

Integrating health and social care

Coordination and integration of health and social care services to older people became a

major element of government policy after new Labour made a manifesto commitment in

1997 to bring down the so-called Berlin wall between health and social care. The range of

initiatives since then to promote joint commissioning are outlined in box 1.1. These include

the specification under Best Value that there should be an integrated review of health and

social care. Nevertheless, it is still the case that in most LAs only a minority of social care

services are jointly commissioned. According to this project‟s first stage survey conducted in

2007-8 (Hughes et al. 2009), 77% of LAs were engaged in some joint commissioning and

45% pooled some ring fenced monies but two thirds of LAs said that under 20% of services

were jointly commissioned. A small minority of LAs undertake all their commissioning with

the NHS (5%) and a similar share (7%) pool all their budgets for adult social care with the

NHS.

Although integration of health and social care is claimed to have positive benefits for

reducing waste and promoting better quality services through joined up government, some

research has questioned whether these benefits are automatic. The key concern is that the

NHS tends to be the dominant partner and may use integration primarily to reduce pressures

on the NHS by facilitating early discharge from hospital. This approach may not serve the

interests of those older people who are not recent or prospective admissions to the health

service (Glendinning et al. 2002, Lewis 2001). Too great a focus on early discharge may

distract attention from the other long term cost reduction strategy - that of keeping more older

people in their own homes and reducing admissions to residential homes of people able to

live in their own homes or in extra care facilities (see Challis and Hughes (2002) for evidence

of „too high‟ admission to residential homes). A further concern is whether re-ablement

services will be primarily used to help people return to their own homes after hospital and not

be used to help prevent admissions to homes where the person has not been a hospital

admission (Glendinning et al. 2002). Moreover, research suggests that integration has so far

been rather limited and that without more radical institutional changes such as the integration

of the health and social care information systems significant benefits may not be realisable

(Brown et al. 2003). Hudson (2002), however, found that even where cooperation across


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boundaries was limited it was yielding positive benefits in collaboration across traditional

hierarchical and professional divides.

Box 1.1. Initiatives to promote joint commissioning

Pooled budgets: where health and social services put a proportion of their funds into a

mutually accessible joint budget to enable more integrated care.

Lead commissioning: where one authority transfers funds to the other who will then take

responsibility for purchasing both health and social care.

Integrated provision: where one organisation provides both health and social care.

Introduction of practice based commissioning.

Creation of Care Trusts: to commission and deliver primary and community health and

social care for older people and other user groups.

Duty of partnership: local health and social care planners to achieve both national

standards and local milestones.

Local Strategic Partnerships: councils to work with other local agencies to improve

economic, social and environmental well being followed by the introduction of Local Area

Agreements to facilitate the work of government, local authority and its partners by

agreeing the design and delivery of outcome targets which reflect national and local

priorities.

The introduction of national service frameworks, in partnership with the NHS: to create a

greater level of consistency and fairness in social care.

Requirement for Primary Care Trusts and local authorities to produce a joint strategic

needs assessment of the health and well being of its local community.

Streamline budgets and planning cycles between Primary Care Trusts and local authorities,

based on a shared, outcome-based performance framework.

Sources: adapted from Hughes et al. (2009: box 1.4).

Implementing personal budgets

Currently LAs have main responsibility for commissioning social care services for older

adults. However, since the 2005 Green Paper, Independence, Well Being and Choice, the

government has committed to allow all users to have a personal budget to enable them to

commission and organise their own care arrangements. This has coincided with a renewed

commitment in the 2006 White Paper, Our Health, Our Care, Our Say (Cm 6737 2006), to

increase the use of direct payments to users which started in 1997. These changes introduce

considerable uncertainty into the system as they could in principle significantly reduce the

role of LAs in managing the social care provision and the social care market. It is not only the

likely extent of take-up of personal budgets that is unclear but also their impact on both LAs

and current independent sector providers is unknown. The evaluation of pilot programmes for

individual budgets did find that older adults were more likely to see the additional

responsibilities that come with managing individual budgets as a burden (Glendinning et al.

2008a), suggesting a possible lower take-up than anticipated. These concerns may also

suggest a continuing need for LA involvement in brokering services for individual budget

holders. Other researchers have raised concerns over potential conflicts, for example between


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the choice policy agenda and the safeguarding of vulnerable adults (Manthorpe et al. 2008)

and between choice and the organisation of services to reduce travel times by appointing only

one provider to a particular area (Glendinning et al 2008b). The same research also indicates

that the independent sector providers are concerned about a number of new risks, such as late

or non payment for services and poaching of care staff by users, particularly if they pay

higher wages. However, the risk that a user who was also the employer may only be able to

offer short and uncertain employment may enable agencies to retain their staff. The

independent sector providers also face a further uncertainly that although they need to

develop a wider range of services to meet the more diverse priorities of individual budget

holders, the new services would not be available to all users if only a minority take up the

individual budget option.

I.2.2. Commissioning and contracting practices of LAs

The change in the primary LA role: from direct providers to commissioners

Since the 1989 White Paper, Caring for People (Cm 849 1989), LAs have moved from being

the primary providers of social care services to being enablers and commissioners of social

care services. This change in role has been progressive but has accelerated at certain key

periods. Furthermore the extent and pace of outsourcing has varied between LAs. Withdrawal

from residential care came first in most cases. The first stage survey for this project reports

that three fifths of LAs had moved the majority of their residential care into the independent

sector before 2000, 17% having done so even before 1993 (Hughes et al. 2009).

Figure I.2 displays the rapid expansion of private beds in England throughout the 1980s.

Total provision plateaued and then declined from the early 1990s, while public sector

residential care continued to fall. Figure I.3, also drawing on Knapp et al. (2001), shows that

the overall drop in residential places was in part the result of a shift to domiciliary care

LA withdrawal from domiciliary care came next. Only a quarter of LAs (26%) in this

project‟s first stage survey (Hughes et al. 2009) reported they had moved the majority of their

domiciliary care into the independent sector before 1999. But the pace of externalisation

accelerated in the 2000s so that by 2004 three quarters (77%) of LAs used the independent

sector for the majority of domiciliary care. By 2008 less than one in ten LAs (7%) had 60%

or more of domiciliary care provided by inhouse staff. By comparison, close to one fifth of

LAs (17%) still retained the majority of residential care inhouse. Overall then, with respect to

both types of care services, the majority of LAs by 2008 had become primarily reliant on the

independent sector for their social care provision for older adults.


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Figure I.2. Residential care places for elderly people in the public and private/voluntary

sectors, England 1980-1998

Source Knapp et al. (2001: figure 3)

Figure I.3. Residential and domiciliary care trends, England 1993-1997

Source Knapp et al. (2001: figure 4).


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To explore the impact of these developments we first consider what previous studies have

revealed with respect to the role of LAs in developing the independent sector market through

commissioning, contracting, monitoring, regulating and other forms of engagement and

consultation. These activities in „developing the market‟ have to be understood in the general

context of public sector procurement and public sector budgets. Thus the second topic we

review is how the general budgeting and commissioning environment, characterised by Best

Value principles, on the one hand, and the continuing and intensifying budget pressure, on

the other, has influenced the development of commissioning and contracting for social care.

Developing the market

The making of the market for social care through commissioning, contracting and

engagement involves a number of elements or stages. First, there is an evolving division of

labour or specialisms between the remaining inhouse and externalised activities. This may be

a dynamic relationship as priorities change. In some cases inhouse facilities may be at the

forefront of new initiatives and innovation - for example, in extra care or re-ablement - but in

other cases LAs may look to the independent sector for new ways of working and innovation.

Drake and Davies (2006) in fact identify six different strategies used by LAs, including

outsourcing most domiciliary care but providing specialist services inhouse (primarily re-

ablement), providing the full range of services using both inhouse and external providers and

using outsourcing only as means of topping up inhouse services.1

Evidence from the first stage survey suggests there is now a high level of specialisation in the

inhouse departments. For intermediate care, more than four fifths of LAs use inhouse staff

and less than two fifths use independent sector staff. In comparison, for community care

nearly all LAs use independent sector staff and less than three fifths use inhouse staff. Mental

health care was a more equally shared activity with nearly three fifths of LAs using inhouse

staff and four fifths using independent sector staff. Given the increasing focus on re-ablement

as the route to long-term policy goals such as reducing the share of older adults who are

unable to stay in their own homes, the remaining LA inhouse departments are in an important

strategic position to maintain and/or increase their importance within the older adults care

services. Indeed Drake and Davies report LAs explaining their decision to keep these skills

inhouse in order to retain core skills that are „mission critical‟ (2006: 185). Thus there could

even be a reverse dynamic of increasing the role played by the inhouse departments.

However, some LAs have already outsourced their re-ablement as well as their community

care work. An important issue for research is the extent to which these different governance

models promote or hinder the development of a re-ablement service. Drake and Davies

(2006) demonstrate that while some LAs may have outsourced specialist care simply because

they no longer have inhouse capacities, others exhibit a policy of outsourcing both high and

1 One LA in the Drake and Davies (2006) study that had used the top-up model reported problems that the

independent providers were able to push up their prices when they knew the only reason for the outsourcing was

the exhaustion of in house capacities.


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low skill activities to independent providers - as well as maintaining some inhouse - in order

„to give independent providers the professional integrity to provide specialist services if they

can.‟ (Drake and Davies 2006: 185). In some areas of care –for example smart housing and

xtra care - there is clearly some reliance on partnerships with private or voluntary sector

companies for developing new ways of delivering care. However, there appears to be no

research on whether external providers have engaged in innovative activities related to the

actual delivery of home care or residential services. As external providers are still

infrequently engaged in the assessment and design of care packages (Hughes et al. 2009) it

seems unlikely that they have played a major role in innovation in ways of delivering care or

new ways of working.

A second concern for LAs is to secure an adequate supply of providers; this follows the

requirement in the 1989 Act to ensure a flourishing supply, but is of critical concern where

LAs dominate the social care market, particularly that for domiciliary care but also for

residential care in areas where most beds are funded by the LA. The supply of providers

depends on a host of factors, including:

the overall price or fee level;

the security of work flows and/or fee income;

the availability of information;

undertakings that enable providers to plan their work loads and their staffing policies;

and any hidden or additional costs that are not compensated for (that is the risk

involved in contracting at a given price).

LAs are also expected to take into account the need to foster local and diverse providers to

meet the needs of specific groups and ensure effective choice. This fits with the national

procurement strategy for LAs, which requires them to „confidently operate a mixed economy

of service provision, with ready access to a diverse, competitive range of suppliers providing

quality services, including small firms, social enterprises, minority businesses and voluntary

and community sector groups‟ (ODPM/LGA, 2003 quoted in Hughes et al, 2009: Box 1.10).

However, there may be conflicts between, on the one hand, the provision of security and

planning and the requirement to promote small providers and diverse providers and, on the

other, the requirement to use competition between suppliers to increase public services

responsiveness and efficiency (Kirkpatrick 1999). Furthermore both the LAs and the

Department of Health retain ultimate responsibility for the delivery of care to vulnerable

adults and for ensuring its quality. Although to meet these responsibilities a regulatory regime

external to both LAs and the independent providers has been set up, LAs still assume some

responsibility for ensuring that aspects of the quality agenda can be delivered, ranging from

ensuring continuity of care to ensuring that training is available to independent sector staff.

With respect to securing an adequate supply of care homes, a number of studies in the 1990s

and early 2000s investigated the reasons for home closures. Two studies attribute the closures

to a combination of LAs paying low fees or not raising them in line with an increase in high

dependency residents, coupled with the costs of complying with new national care standards

(Darton et al. 2003, Netten et al. 2003). Most homes closing were small so that overheads


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were high relative to fees but the quality of care provided had been of a high standard. In a

subsequent study, Netten et al (2005) report that fear of an undersupply of care beds, with

implications for hospital discharges, led the government „to retreat on the standards and to

increase funding to local authorities‟ (op.cit: 319). Andrews and Phillips (2000) argue the

long-term outcome of the trend towards both higher dependency and lower residential care

fees will be increasing concentration in the sector (that is, a smaller number of very large

providers) contrary to the apparent policy goal of diversity and choice.

With respect to contracting for residential care the Audit Commission (1997 quoted in

Kendall 2001) recommended a greater use of longer term contracts to foster better working

relations and information flows as well as assisting residential homes providers to engage in

longer term planning. Research also emphasises the need for better information flows

between LAs and independent care homes (Matosevic et al. 2007, 2008). Relatedly, Knapp et

al. (2001) argue that, „Complaints are legion from independent providers about poor

matching of users to services, poor signalling of purchasing intentions and priorities‟ (op.cit:

302). Filinson (1998) also found that most residential home providers did not participate in

the planning of social care. Changes to contracting arrangements are not necessarily the

answer: three quarters of LAs have some block contracting but the share of beds contracted

was below 10% in nearly 50% of cases) (Hughes et al. 2009: table 3.39). However this block

contracting to larger homes has been identified as a factor in the closure of smaller homes

(Netten et al.2003). Moreover, Kendall‟s (2001) research casts doubt on the Audit

Commission‟s view that providers of residential care would welcome more block contracting

as residential home owners were concerned to maintain a balanced client base between LA

contracted and private clients, thereby reducing LA control over their operation. Matosevic et

al. (2008) also suggest that LAs tend to ascribe more purely financial motivations to care

home providers than the care home providers themselves reveal in parallel questionnaires,

suggesting a need for new practices that can develop trusting relations between providers and

LAs.

Very similar issues emerge in relation to developing the supply of domiciliary care providers,

although this market has developed more recently; a survey of providers in 1999 found that

two thirds (64%) had been established during or since 1993 (Ware et al. 2001). The same

study also found that LAs were at different stages in the development of the market with

some still seeking sufficient providers to cover the market while others had already

developed a sufficient supply and were now in a position to start to work closely with

„selected and proven providers‟(op.cit.: 340). The first stage survey for this project found a

relatively high level of satisfaction among LAs with the number of potential providers; three

in four LAs reported the number of responses to their tender was „about right‟ and only 17%

and 7% stated the number was too few or too many, respectively.

With respect to contracting for domiciliary care services, most published research points to

the development of larger block contracts that tend to squeeze out the smaller providers

(Ware et al. 2001, Drake and Davies 2006). In response, some LAs are reported as willing to

pay higher fees to smaller local providers to ensure diversity of supply, despite potential

ethical and legal problems of favouring local providers in procurement (Drake and Davies


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2006). Our first stage survey in fact suggests strong polarisation between LAs with two fifths

(39%) recording no block contracts and a similar proportion (37%) using block contracts for

three fifths or more of their total expenditure on domiciliary care with the independent sector.

However, this division between LAs is likely to change. LAs appear to be moving towards an

intermediate category of preferred providers, in part in response to the personal care agenda

(see section II.2 below).

In addition to securing a reliable supply of providers, LAs have a responsibility to promote

competition between providers. Several studies test the assumption that greater competition

encourages improved responsiveness to user needs. For example, Lewis et al. (1996) find that

care services had become more responsive (measured by the likelihood of a user being put to

bed at a time they prefer) in several LAs following the purchaser/provider split but that it was

too simplistic to attribute this simply to competition. In some LAs it was in fact inhouse

provision that had become more responsive, and in at least one case this resulted from

devolution of budgets to care managers rather than competition per se (op. cit.). Drake and

Davies (2006) comment that block contracting involves fierce competition only at the point

of the contract award, whereas spot contracting encourages continuous competition. They

also point to the danger that large contracts may lead to concentration and a shift of power

back from consumers to independent providers. Nevertheless when LAs seek a step increase

in outsourced provision they often resort to block contracting with large providers to achieve

cost reductions. Another incentive to contract with a small number of suppliers is to reduce

transaction costs (that is, the costs and time of designing and negotiating contracts)

particularly if LAs do not fix a standard price for services (op. cit.).

Effective competition as described in an economics textbook should involve multiple

providers and multiple purchasers. But on the purchasing side, LAs are in fact dominant

clients and may fix prices which providers have to accept or else risk losing the majority of

their business in the locality (Knapp et al. 2001). Fixed prices may also mean that care

services requiring different levels of skill are priced at the same level. Drake and Davies

(2006) report that some providers find it fair to have a fixed price but others argue the price

should reflect differences in costs such as training costs. Another issue is whether there is

only one or more providers for a geographical locality. Drake and Davies (2006) report at

least one LA making a decision to select more than one provider per area to prevent the

formation of monopolies.

Although the issue of quality standards has in part been taken over by national regulatory

standards and inspections provided by the Care Quality Commission, LAs still play a role in

monitoring and regulating standards in their independent providers and have scope to require

particular approaches to both quality of care and to the approach taken to the management of

staff in their tenders, contracts and monitoring procedures. The first stage survey found that

almost all LAs included some HR requirements in their tenders and contracts for both homes

and independent domiciliary providers – particularly related to induction training and training

achievements against national standards. Also, all LAs monitored domiciliary providers

throughout the contract period, with over four fifths monitoring staff development and

training and recruitment practices (Hughes et al. 2009: figure 3.14, tables 3.32-34 and 3.41).


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LAs are also involved in providing support to providers although research suggests there are

problems in information sharing (Wistow and Hardy 1999) and in developing long-term

trusting relations (Curtice and Fraser 2000, Ware et al. 2001), except with voluntary

providers in some areas. Provider forums have become more common (Ware et al. 2001) and

although on balance have been welcomed by providers they are also found to be highly

controlled with clear limits set to the flow of information. LAs also provide support for

training the independent sector workforce, even extending to some higher level skills such as

re-ablement when they have outsourced all their own provisions (Drake and Davies 2006).

However, there is also evidence that LA provision of training is strongly linked to availability

of funds to provide the training (Rainbird et al. 2009). Thus once the ringfenced monies for

training ended in 2004 there was a move to mobilise more general funds such as „Train for

Gain‟ and European Social Fund related monies. But once these alternative funds became

scarce problems of training provision have arisen (Rainbird et al. 2009, Rubery and Urwin

2010). Not all problems of training are attributable to lack of availability of courses or

funding for the training. There is evidence of reluctance on the part of independent providers

to train their staff (Balloch et al. 2004, Fleming and Taylor 2006), caused by both pressures

of workloads and costs. These reasons are in part also the result of the conditions under

which providers are contracted by LAs.

Price versus quality: an issue of budgets?

The increasing budget constraint faced by LAs in relation to social care is illustrated by the

growing gap between expenditures and central government funding. During the ten years

from 1997-98 and 2007-08, real expenditures on social care increased by 57% and central

government funding rose by just 48% (House of Commons 2010). Given the strong pressures

on demand for services, the tendency for commissioning strategies to increasingly rely on the

independent care sector is underpinned by the strong cost differences between inhouse and

external provision. Data from the NHS Information Centre for Health and Social Care show

that the average hourly cost of home care services in 2008 was £23.40 when provided

inhouse by LAs and only £13.00 when provided by other organisations.2 Part of the cost

differential is accounted for by the more specialised services provided by inhouse LA care

workers but this is unlikely to account for the majority of the large cost difference.

In fact the cost difference reflects to a large extent the collectively negotiated terms and

conditions of employment for LA staff that deliver relatively high basic pay levels (Eborall

and Griffiths 2008), as well as more generous benefits and provisions for travel time and

unsocial hours payments. Pay and conditions in the private and voluntary sectors tend to be

determined unilaterally by management and are characterised by lower basic pay and non-pay

benefits typically set at the legal minima. One of the key questions for this research project is

to investigate the degree to which these conditions are the outcome of both LA

2 The average hourly cost was £15.20, indicating the dominance of the private sector in delivery. All data

accessed from the website http://www.ic.nhs.uk/statistics-and-data-collections/social-care/older-people.


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commissioning policies and the HR policies of provider organisations. We know that many

LAs fix the price for the service at tender. Figures vary, including an estimate of around two

thirds of LAs in the study by Forder et al. (2004), just over one third (36%) in our first stage

survey and around one third (32%) in a UKHCA survey (Mathew 2004: table 10). A fixed

price does not necessarily mean a low price; the UKHCA survey idenitifed one LA that

moved from variable to fixed prices and this led to considerable increases for providers that

had entered the market with low tender prices. Research suggests that LAs also operate with a

fixed price system for residential care, although there may be lower prices for block than spot

contracts (Forder and Netten 2000).

Research suggests that LA fees for both domiciliary and residential care have not always

risen in line with costs that providers are unable to avoid. These include:

statutory improvements to employment conditions – the National Minimum Wage

and the working time directive, including the recent extension of guaranteed holiday

entitlements (Andrews and Phillips 2002, Clarkson et al. 2005, Knapp et al. 2001,

Netten et al. 2003, Angel 2007); and

implementation of the National Minimum Care Standards - especially the additional

training costs to meet the 50% NVQ level 2 target and providing higher staffing ratios

in response to higher levels of dependency at the same price (Andrews and Phillips

2000, Darton et al. 2003, Forder and Netten 2000, Netten et al. 2005, Ware et al.

2001).

This accumulating evidence suggests LAs are requiring providers to do more for the same or

even lower prices. The likely outcome is reductions in quality of service or closure of

suppliers. Indeed, Netten et al. (2003) report that three quarters of homes that had closed

claimed LA fees were insufficient to cover their costs following the introduction of higher

care standards. This has particularly affected small homes and small domiciliary care

providers – a further factor promoting concentration in the sector.

Not all problems relate to basic fee levels. Many of the difficulties in covering costs are

associated with the absence of specific fees to cover travel costs or to provide sufficient time

for care delivery. In their study of users‟ perceptions of care services, Francis and Netten

(2004) point to the practice of not paying for travel between appointments and allowing

insufficient time for quality visits as a major perceived barrier to quality of care. Ware et al.

(2003) also comment that the increasing emphasis of LAs on procedure-based care

management subordinates personal relationships between care worker and user to short-term

task delivery, which, in their words, „may threaten patterns of trust and accountability‟ (op.

cit.: 411). A UKHCA survey (Mathew 2004: 37) found that while higher paying LAs were

the least likely to make any adjustment to their hourly fee to compensate for short visits

(thereby providing for more travel time payment), there were also examples of low paying

LAs that also failed to provide any enhanced fee for short visits.

The Best Value framework for commissioning services, along with the national minimum

care standards, are expected to establish a dual focus on quality and price. Drake and Davies

(2006) found some authorities that admitted to having been willing to use low quality


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services to meet excess demand before the passage of the Care Standards Act and the Best

Value regime. However, research also suggests that the Best Value regime has had less

impact on reducing cost pressures on commissioning practices than might be expected, in part

because of requirements for continuous improvements in public service efficiency of 2% per

annum (Cunningham 2008: 382). Cunningham‟s detailed study of the conditions facing

voluntary sector providers of social care suggests Best Value placed additional pressures on

providers to meet both higher quality employment standards and higher care standards

without any relief in cost pressures. Also, LA commissioning focused on improving quality

of care rather than quality of HR practices, with the main HR focus on compliance with

statutory regulations (including CRB checks and equal opportunities and disciplinary and

grievance practices) rather than developing high performance working (op. cit.). Aside from

LA commissioning, other important influences on HR practices in providers derive from the

Care Commission and its focus on training standards.

There is also no evidence that the Best Value regime has fostered long-term relationships

between LAs and independent providers, or contributed to greater stability in employment

relationships in the independent sector (Cunningham and James 2009). Kirkpatrick (1999)

has indeed questioned the feasibility of partnership arrangements between LAs and

independent providers, not only because of the low levels of trust within the sector and the

difficult of building trust but also because of the disconnect between a partnership agenda and

the requirement to „shop around‟ to achieve best value and continuous performance

improvements, and because of the need for probity in the management of public monies, with

strong trusting relationships leading to a risk, in the extreme case, of corruption.

Overall, the research suggests that Best Value may be seen as an additional requirement for

independent providers to meet at the same price. Instead of a move towards a quality

approach through partnership, quality has become a requirement of the competitive tendering

regime in social care. Furthermore where the quality standards are based primarily on care

standards, these may create some problems for HR standards, including the promotion of

employee-oriented flexible working.

I.2.3. Labour market conditions

The adult social care sector now employs around one million workers (Moriaty et al. 2008)

with 900,000 located in the private and voluntary sector. According to the Low Pay

Commission (2008) it is the third largest low-paying sector in the UK economy, with around

one million jobs being paid at or around the level of the minimum wage. Although local

labour market conditions vary across the country 2010 data from the National Minimum Data

Set (NMDS) for Social Care (see www.nmds-sc-online.org.uk/) show a remarkably narrow

range of variation in rates for care workers.


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For example, across the nine English regions, the wage at the 20th

percentile3 only varies

from £5.73 in the North East (equal to the national minimum wage from October 2008-

September 2009) to £6.10 in the South East. If London, the South East and the South West -

the three highest paying regions - are excluded, then the range of variation is only 17p.

Likewise the range of median hourly pay rates varies by just 67p from the lowest in the North

East at £5.95 to the highest in the South East at £6.25; again, excluding the three highest

paying regions leads to a variation of just 50p (see table I.1).

Table I.1 Hourly pay for care workers by English region: 20th

percentile and median

rates.

20th Percentile Median

North East £5.73 £5.95

North West £5.80 £6.10

Yorkshire and Humberside £5.80 £6.15

West Midlands £5.80 £6.25

East Midlands £5.80 £6.30

Eastern £5.90 £6.45

South West £6.00 £6.55

London £6.00 £6.58

South East £6.10 £6.62

Source NMDS online data (June 2010).

This range of pay rates does not reflect the range of variations in labour demand, as is

indicated for example by the strong regional differences in use of migrant workers. A study

by Experìan (2007) for Skills for Care found that over two thirds of care staff in London were

migrants (defined as „born abroad‟) compared to less than a fifth in seven out of nine regions

(figure I.4). Also, the low level of pay has not established a neat equilibrium of supply and

demand. For example, turnover rates are very high for care workers, running at around 22%

(NMDS 2010). Also, vacancy rates were estimated at over 3% in social care compared to

1.4% for all sectors, with 25% of care providers reporting vacancies compared to 12% for all

sectors (2009 National Employer Skills Survey data, cited in Eborall et al. 2010).

Although the level of vacancies has declined with the recession the impact on turnover has

been less, and the differentially higher rates of vacancies compared to the average position

has been maintained. However, high vacancy rates are not attributed so much to actual skills

shortages as to high turnover compared to other sectors with high vacancy rates. The

evidence therefore suggests that the social care market has tended to adjust to shortage not

through pay rates but by use of migrant workers to fill employment gaps in those areas with

greatest recruitment problems. Labour shortage is also acute for senior care workers;

JobCentre Plus data show that the vacancy-to-unemployment ratio for the period February

3 This is the wage level at which 20% of the category of workers earn less.


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2008 to January 2009 is much higher for this group than the ratio for all occupations (1.88

compared with 0.38) (House of Commons 2009).

Figure I.4. Percentage of social workers and care workers born abroad, by region

Source : Experìan (2007) for Skills for Care.

Although turnover is clearly high, there is as yet no conclusive evidence that social care

workers are subject to labour market churning between sectors rather than between different

social care providers. The NMDS finds 13% of care workers leaving for other care sectors

and only 2%, for example, to the retail sector. However, more than half (55%) of worker

departures do not have a recorded destination so these data are not yet reliable.

Social care work is still largely women‟s work and women still account for over 85% of care

assistants and home carers (Skills for Care 2010). Macro level evidence on women‟s

changing employment pattern may therefore provide more solid indicators of future problems

for social care. Research suggests that the tendency for women to stay in employment with

the same employer over the period of childbirth, now supported by the right to request

flexible working, is likely to reduce the number of women trading down the occupation and

pay hierarchy in order to find part-time work (Neuburger et al. 2010). This greater continuity

of employment should in principle allow women to pursue more upwardly mobile careers

which may reduce the labour supply for job sectors with limited opportunities for pay or

career advancement. However, the evidence cited here relates to the period before the 2008-9

recession. Increased unemployment and the overall shortage of jobs may lead to a

postponement of the upgrading of social care jobs which is indicated as necessary by the

employment gaps and the compression of wages at or near to the national minimum wage.


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Beyond these regional and cyclical labour market influences, the locality is likely to have

significance for the recruitment and retention of the social care workforce due to both the

nature of social care work - particularly domiciliary care - and the primary source of labour

supply, mainly mature women. The locality takes on importance because of the delivery of

care work in the users‟ own homes and the need for repeated and short visits to these

locations and for visits to multiple locations. These characteristics are likely to lead to a

labour force drawn primarily from the immediate locality to reduce the costs of travel

between home and workplaces, particularly where work is organised on a split shift basis or

where the hours of work are variable and may involve short shifts. This pattern of work

organisation is likely to reinforce the reliance on female labour, as there is strong evidence

that women in all types of jobs (due to both care responsibilities and less access to private

transport), as well as part-time workers of both sexes, commute a shorter distance to work

and are therefore likely to be attracted by jobs in the immediate locality (Green and Owen

2006, Houston 2005, Yeandle et al. 2006).

However, this apparent matching of demand and supply side preferences is both positive and

negative for the recruitment and retention of a social care workforce. It is positive in that it

may help organisations to recruit workers and also ensure retention, even when wages may be

low relative to the nature of the job and to alternative job opportunities involving longer

commutes. This could be regarded as also opening up an opportunity for providers to exercise

monopsony4 power over the workforce - that is, to rely on their staff‟s commitment to the job

due to its convenience with respect to place and time, even when wages and conditions fall

below relevant rates (Barth and Dale-Olsen 2009, Hirsch 2010, Manning 2003). However,

these work characteristics are also negative for recruiting and retaining a social care

workforce if there is a desire or a need to expand the size of the workforce once the supply of

those for whom the work is convenient is exhausted. It may be difficult to attract similar

workers located in different neighbouring localities as they may also prefer to work in their

own locality and to minimise commuting time. Indeed economic theory would suggest that

monopsonists would tend to keep employment down to maintain low wages even if some

vacancies remain unfilled (Manning 2003). In the UK social care sector, employers do not

have a free choice to raise the wages to solve these supply constraints since to a large extent

the wage levels are shaped by LA fee levels rather than by their internal HR policies.

4 A monopsony employer is one that controls the market for hiring a particular type of worker, defined by skill,

expertise or occupation, for example.


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I.3. Management and organisational factors in the recruitment

and retention of a social care workforce

In this section we discuss the key organisational factors (MaROT), as described in figure I.1

above, which are likely to shape the recruitment and retention of a social care workforce.

These include: first, the formal and informal Management of recruitment and retention,

including consideration of so-called „high performance bundles‟ of HR practices and

provisions for individual and collective employee voice; second, the Reward practices,

particularly in relation to part-time work and women returners; third, the Organisation of care

work, including discussion of the nature of care work, scope for worker autonomy and skill

content; and fourth, evidence of Training and development practices as a factor in shaping

recruitment and retention.

I.3.1. Management and human resource practices

The management of human resources varies by character of organisation, particularly by size

and by ownership. The social care sector is characterised by large numbers of small

establishments with over 40,000 local units employing care staff engaged with adult social

care belonging to over 17,000 organisations (Eborall et al. 2010). There are now 5,319

domiciliary care providers – an increase of over a quarter between March 2006 and August

2009. In contrast the number of care-only homes has declined by 9% over the same period

(although the number of beds increased) and now stands at 14,138 while the number of care

homes providing nursing increased by 4% to 4,303. Overall there is a very high share of

small establishments with three quarters of the 40,000 total employing fewer than 20

employees.

Although the sector is still highly fragmented there is a general trend towards more

concentration of ownership. Published data are only available for the care home sector

(Eborall et al. 2010). Here the concentration is particularly notable among care homes

offering nursing where according to Laing and Buisson‟s definition of a major provider - any

company listed on the London Stock Exchange - the major providers‟ share of private sector

homes increased from 36% in 2000 to 58% in 2009. For care-only homes the increase was

almost as striking but from a lower level – from 8% to 28% over the same period -, while the

share of major providers in the voluntary sector (accounting for around 17% of all homes5) is

even higher, rising from 64% to 73% over the same period. Overall, despite the trend towards

more concentration, the sector is still dominated by small establishments and the practices of

the major providers may still be to treat human resource policies as largely a local issue,

delegated to local management. There is an extensive literature on differences between large

and small firms in recruitment methods, human resource policies and employee voice

5 The 17% figure refers to all care homes while the Laing and Buisson data only refer to homes for the elderly

and physically disabled.


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mechanisms. These characteristics of the employers within the social care sector are thus

likely to be shaping the recruitment and development of the workforce.

Recruitment practices

Larger firms are known to make more extensive use of formal recruitment methods than

small firms where recruitment is often by word of mouth or informal channels. A range of

explanations have been offered for this tendency towards informality. First, there is the

obvious incentive to avoid the costs of advertising and formal procedures (Ram et al. 2004),

particularly if recruiting in this way may reduce turnover further reducing hiring costs

(Carroll et al. 1999). Secondly, small firms and establishments may be more concerned with

ensuring a good fit between the new employee and the established team due to the close

working environment for all employees (Holliday 1995). However, such considerations may

apply less to domiciliary care than to care homes due to the work being undertaken in users‟

homes with staff often working alone. A third explanation is that the use of a network may be

a means of hiring staff with already developed tacit understandings and tacit skills related to

the area of work. The network through which hiring takes place can thus be considered to be

an extended internal labour market (Manwaring 1984). The idea is that employees with the

required skill and experience may be found both inside and outside the organisation, where

employees outside are connected through informal channels and social and family relations to

those inside. Such an approach may suit management‟s need to control the workforce; the

informal channels and social networks can diffuse certain attitudes towards work, such as

compliance with organisational practices, thereby reducing the need for direct management

intervention (Collinson et al. 1990). In many areas of social care, managers are not in a

position to directly supervise the work and therefore may be reliant on social networks to

spread norms and attitudes towards work discipline among potential future recruits.

A key issue is how and when organisations change from informal to formal recruitment

methods. Change may occur because the organisation faces rapid expansion, or reaches a

critical size beyond which the owner or head manager is unable to devote time to informal

methods (Carroll et al. 1999). In social care, there are particular regulatory pressures that

promote greater formalisation. These include the monitoring of minimum care standards and

the inspection processes of both the CQC and the commissioning LA, as well as the

requirement that all social care providers check the references of job applicants and apply for

CRB checks. Research suggests there are mixed attitudes towards the effect of regulations on

recruitment processes in social care: some employers welcome it as a catalyst to a

professionalization process, which should improve the status of care work and, in turn, ease

recruitment in the long term, while others see it as adding to bureaucracy and delays

(especially the wait for CRB checks) thereby inhibiting recruitment (Edwards et al. 2003).


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Human resource practices

Perhaps the most dominant research theme in human resource management over recent years

has been the investigation of bundles of HR practices that might be associated with high

performance or high commitment work systems, whether measured by productivity,

profitability or staff turnover (Appelbaum et al. 2000, Huselid 1995). High performance

bundles of HR practices are expected to provide benefits that outweigh the costs of their

introduction and maintenance by creating the kind of work culture in which workers are

likely to feel both more satisfied and more motivated and committed.

Most research applies to large organisations and there is evidence that small organisations are

less likely to adopt high performance HR practices (Bryson et al. 2007). Nevertheless, to the

extent that small organisations do adopt these practices, there is some evidence that they may

be associated with some performance benefits. One UK study shows that the adoption of nine

specific HR practices – namely, careful selection, formal performance appraisal, performance

related pay, group incentives, multi-skilling, job rotation, quality circles, team working and

disclosure of information - is associated with higher profitability, although no impact was

found on productivity or staff turnover (Stirpe et al. 2009).

Importantly, the simple formula that predicts a positive relationship between a given set of

HR practices and organisational performance is contingent upon (and complicated by) the

sector. Within social care, there are first of all multiple obstacles to the adoption of certain

HR practices. Managers may be unfamiliar with particular HR practices, or sceptical of their

assumed benefits, especially where they involve considerable upfront costs. Other HR

practices may be difficult to implement within a social care environment. For example, the

practice of performance-related pay would raise ethical issues, not to mention the concrete

problem of how to assess and measure performance. A fundamental problem with the HR

bundles approach is its presumption that organisations already apply certain basic HR

practices and provide stability of income and employment. But in the UK social care sector,

such basic stability and protection of pay and employment is often lacking (Rubery and

Urwin 2011). We may therefore need to consider an alternative bundle of HR practices that

differentiates organisational performance in terms of whether employers provide basic

employment conditions such as guaranteed working hours, stable weekly income, payment

for all time spent at work (including, for example, travel time and training time), a decent

level of pay and pay progression in recognition of skill and experience.

Employee voice

The opportunity for employees to exercise „voice‟ in an organisation rather than „exit‟ is an

important factor in improving rates of staff retention. The outsourcing of social care to the

independent sector means that the majority of care workers no longer enjoy the opportunity

for collective voice through trade union representation and collective bargaining. This is both

a result of a shift from the public sector, where collective bargaining is strong, to the

independent sector where it is weak, and a shift from large to small organisations, since


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presence of all types of voice mechanisms and communication channels is positively related

to firm size. Non union forms of employee voice offer a potential alternative but the evidence

suggests that in the absence of strong formal voice mechanisms alternative communication

mechanisms tend to be ineffective (Willman et al. 2006). All of this does not augur well for

voice and communication systems in social care. In addition the highly fragmented work

processes in domiciliary care makes mobilisation and organisation of collective voice

especially difficult.

Nevertheless, while the circumstances of the sector may present obstacles to the formation of

strong collective voice, there are good reasons why social care workers may require a

minimum set of standards that ensure individual voice. Marsden (2007) argues that

opportunities for informal, one-to-one renegotiation of tasks between employee and employer

(or manager) ought to be considered and promoted as a form of employee voice. He makes

this argument in relation to work which may change only periodically; in social care,

particularly domiciliary work, there are changes on an almost daily basis associated with

changing users and user needs, as well as the timing of work, such that there is a need for

individual care workers to negotiate with their manager about whether such changes are

acceptable. Much depends on how the boundaries of acceptability are defined and whether or

not these are mutually accepted be employee and manager - as we learn from the many

studies of the employment relationship and the „psychological contract‟ between employer

and employee. Some research does suggest that it is individual relationships with managers

that matter most and make people feel involved and listened to. McClimont and Grove‟s

(2004) survey of the causes of high employee motivation at work identified good managers

and access to them as very important. Also, in Eaton‟s (2000) discussion of low quality care

jobs some of the most important characteristics of such jobs were a lack of feedback on

effects of their work, little or no supervision and, no information about the condition of

patients. How managers manage the work allocation among staff and how far they are able to

match employees‟ expectations and preferences with respect to the mix of users and tasks, as

well as the available working time, is likely to be a very important factor in improving rates

of retention of the care workforce

I.3.2. Reward practices

We turn now to consideration of how reward practices shape the extent to which care

organisations enjoy a positive experience in their recruitment and retention of workers in the

UK context. We know from general research on pay practices, as well as specific studies of

the social care sector in the UK, that pay practices have a significant impact on the ability of

organisations to recruit and retain staff. Our discussion distinguishes three issues: the relative

level of pay in the social care sector, the influence of upratings in the National Minimum

Wage and use of pay enhancements.


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Relative level of pay

Higher pay places employers in a stronger position relative to competitors and increases their

attractiveness both to prospective employees who are more likely to apply for a job and

current employees who are less likely to depart. Such an assertion is confirmed by well-

known economics models – „efficiency-wage‟ models - which argue it may be rational for

some employers to pay a wage above that offered by competitor organisations since higher

pay can reduce staff turnover and attract a better pool of job applicants (Akerlof and Yellen

1986). Several studies provide an empirical test. Levine‟s (1993) study of a US

manufacturing firm, for example, showed that a higher relative wage improved workers‟ job

satisfaction, their intentions to stay with the company and their willingness to work harder.

Also, Barber and Bretz (2000) demonstrate that higher pay is an effective tool to attract larger

pools of interested job applicants (cited in Guthrie 2007). But to what extent is such a

strategy applicable in the UK social care sector?

Compared to other labour market competitors there is limited evidence of use of higher pay

in the social care sector. Table I.2 presents pay data for the residential elderly care sector6 and

the retail sector, the sector consistently cited as a key labour market competitor (eg. Yeandle

et al. 2006: 24). Pay data are provided for the two dominant groups of care workers, female

part-timers and female full-timers, at different points of the pay distribution, along with the

pay differential between sectors.

Table I.2. Women’s pay in the residential care sector and the retail sector compared,

2009

All sectors Residential care for the

elderly (SIC 873)

Retail trade (SIC 47) Pay differential

between sectors

All male and

female employees

Part-time Full-time Part-time Full-time Part-time Full-time

D10 6.19 5.73 6.03 5.73 6.00 0.0% 0.5%

D20 7.15 6.00 6.48 5.76 6.32 4.2% 2.5%

Median 10.99 6.81 7.96 6.25 7.80 9.0% 2.1%

Mean 14.43 7.88 9.32 7.02 9.74 12.3% -4.3%

Note: Gross hourly earnings, overtime excluded.

Source: Annual Survey of Hours and Earnings, own compilation.

The earnings data in table I.2 show that average hourly pay at the bottom decile of the pay

distribution7 is similar in the social care sector and the retail sector – equivalent to, or a little

above, the national minimum wage of £5.73 that applied in April 2009, the time of data

collection. Further up the pay distribution there is some evidence of higher rates paid to

6 Using the industry classification this category gives the most precise estimate of earnings for workers in the

sector. No separate industry category exists for the domiciliary care sector.

7 That is, the level at which 10% of the workforce earn less.


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women in part-time jobs, up to a premium of 12% at the average point, but the pattern is

reversed among women in full-time jobs where pay is actually 4% lower than the average

hourly wage in the retail sector. Overall, the inter-sectoral comparison suggests employers in

the care sector are not using pay to address recruitment and retention issues, despite the

evident need.

Prior to the recession, the low level of pay in the sector was a major reason explaining

difficulties in recruitment and retention. Surveys of employees in the care sector suggest that

the level of pay falls below expectations, given the required responsibilities, skill and

emotional demands of care work. A Unison survey in 2002 reported more than four fifths

(82%) of domiciliary workers disagreed with the claim that their pay was fair, a higher

proportion than other groups surveyed such as social workers and housing workers (Unison

2003). The detailed study completed by Yeandle and colleagues identifies low pay and the

attractiveness of less demanding jobs in other sectors offering similar pay. The following

quote from the one of the independent domiciliary providers in their study is illustrative:

At the end of the day, [care workers] are going to look at what the salary is, and then they are

going to look at Tescos where they can make a hell of a lot of money without the

responsibility, without being out in the community themselves, in charge, and having to be the

first person in an emergency. It‟s an awful lot of responsibility (Newcastle provider, cited in

Yeandle et al. 2006: 25).

The issue of low pay and problems of comparability with other sectors such as retail is

especially pronounced in the private sector, where pay is lower on average than in the local

authority and voluntary sectors. Estimates from the National Minimum Dataset for Social

Care (NMDS-SC) suggest median pay for care workers in the private sector in 2009 was just

£6.00, compared to £7.03 in the voluntary sector and £7.73 in the LA sector. For senior care

workers the differences are even larger – median rates of £6.70, £8.08 and £10.69,

respectively (Eborall et al. 2010: 111). If we compare pay data from the different sectors of

care work with pay for retail assistants, we see a strikingly divergent pattern of pay premiums

and pay penalties for social care work (figure I.5). At the median pay level, care workers in

the LA sector earn over 20% more than retail sales assistants, those in the voluntary sector

around 10% more but care workers in the private sector 5% less. At the average level of pay,

the penalty in the private sector is even higher at 15%, compared to a premium of 13%

among LA care workers. Overall, therefore, the evidence on levels of pay suggests the

majority of employers are not using pay-setting as a strategy to enlarge the pool of job

applicants or to improve staff retention among existing employees.


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Figure I.5. Pay difference with retail sales assistants among care workers in the private,

voluntary and LA sectors, 2009

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

25%

median average

private voluntary LA

Source: Eborall et al. (2010: 111) for care worker earnings data and Annual Survey of Hours and Earnings for

retail sales assistants data (SOC code 7111). All earnings data are for all adult employees, gross hourly pay

excluding overtime.

Regarding oppotunities for pay progression in the sector, the very small differential between

pay at the bottom decile for care workers and the median pay suggests limited chance for pay

advancement. The median pay for female part-time workers in the residential care sector is

only £1 or so above the bottom decile pay (table I.2 above). This might be expected if care

workers stay for very short periods in the job, and fail to accumulate the stock of experience

and skill that can lead to higher pay. However, estimates from the national minimum dataset

for social care (NMDS-SC) suggest two thirds of workers (64%) have more than five years

experience in social care, and more than a third (36%) register experience of at least 11 years

(Eborall et al. 2010: 93).

The influence of the National Minimum Wage

In low-paying sectors such as social care a statutory minimum wage can play an important

role in shaping pay practices, which in turn influences recruitment and retention. On the one

hand, steady uprating of the statutory minimum wage can provide a valuable benchmark for

employers (by providing a coordinated wage floor to labour market competition) and

employees (by protecting against exploitative wage levels). However, a minimum wage also

presents serious challenges to organisations that operate in product markets where there are

obstacles to increasing revenue, typically achieved by passing on higher labour costs to

clients in the form of higher prices. Grimshaw and Carroll (2006) identify three types of

obstacle associated with particular product markets:

first, in international markets prices are set through international not domestic

competition and are therefore not responsive to trends in national minimum wages;


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second, a product market dominated by one or two client organisations can make

negotiation of price rises difficult; and

third, where a product market includes firms operating in the informal economy there

is a risk that unscrupulous employers undercut organisations that raise prices in line

with the minimum wage (op. cit.).

The second type of product market constraint prevails in the social care sector. Care

providers are strongly reliant on LA fees as a source of revenue. The longstanding disconnect

between annual raises in LA fees (adjusted in line with inflation and average earnings

growth) and the national minimum wage (which was purposefully adjusted above average

earnings growth during 2003-2006) generates a major squeeze on providers‟ income. This, at

a time of new regulations to introduce national minimum care standards, has presented care

providers with a major challenge. The Low Pay Commission (LPC) has repeatedly

recommended that government address this issue (eg. LPC 2009: 73). Also, in light of the

third constraint listed above concerning informal activities, the LPC has also raised a new

concern that personal payment plans risk problems of non-compliance with minimum wage

legislation:

In circumstances of individuals purchasing their own care, both the service user and

those performing the personal assistant role may not be fully aware of their rights and

responsibilities in respect of their employment relationship, including payment of at

least the national minimum wage (LPC 2009: 73).

Because low-paying sectors in the UK have a high proportion of jobs paid at the adult

minimum wage, trends in the minimum wage have a major influence on the setting of pay.

According to the Low Pay Commission (LPC 2009), the cleaning sector has the highest

incidence of workers paid at the minimum wage (22% in 2008, up from 19% in 2007). In

social care, there is a public-private divide; in 2008 nearly one in ten workers (7.8%) were

paid a minimum wage in the private sector, compared to around one in a hundred (1.3%) in

the public or voluntary sectors (LPC 2009: 71). The difference reflects the influence of

collective bargaining and joint agreements for LA employed care workers and their general

absence in the private sector.

National earnings data for the occupational group of care assistants and home carers

demonstrate a very close relationship between nominal pay trends and changes in the

minimum wage. For female part-time care workers, figure I.6 shows that the differential in

pay at three different points of the pay distribution (the bottom decile, lower quintile and

median) has remained very stable since 2005 suggesting a very strong influence of minimum

wage rises on pay-setting.8 The influence is most striking at the bottom pay position (D10)

where care workers‟ pay has fluctuated around 5% higher than the adult minimum wage. The

rising differential from 2002 to 2003 occurred at a time when the minimum wage rise was

very low (10p, from £4.10 to £4.20), and preceded a decision by the LPC to increase the

minimum wage at a pace above average earnings growth.

8 Earnings data for female full-timers reveal a very similar trend as the one shown in figure I.6


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Figure I.6. Pay trends of female part-time care workers relative to the national

minimum wage, 2002-2009

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

2002 2003 2004 2005 2006 2007 2008 2009

% d

iffe

ren

tia

l w

ith

NM

W D10

D20

Median

Source: Annual Survey of Hours and Earnings, gross hourly pay excluding overtime, SOC 6115 „Care assistants

and home carers‟, own compilation.

Pay enhancements

Pay enhancements offer an additional tool to address recruitment and retention issues.

Theories of compensating differentials maintain that pay supplements for night work or

weekend work, for example, are explained by the need for employers to compensate the

disutility experienced by employees working during unsocial hours. However, in many 24-7

areas of the UK economy, pay supplements for unsocial hours working have been eliminated

or reduced, alongside the decline in trade union influence on wage-setting. The trend appears

to have been led by the retail sector. Tesco, for example, abolished a customary 50% pay

premium for overtime work, reduced a percentage premium for night work to a fixed sum

payment, and reduced the premium for Sunday and public holiday working from 100% to

50%.

The representative survey of 502 care workers undertaken by the market research firm, TNS,

provides evidence of the use of pay premiums for overtime and unsocial hours working in the

social care sector. Regarding overtime, 34% of jobs involved paid overtime compared to 25%

with unpaid overtime (TNS 2007: 30). It is notable that those workers with longest

experience in care work are most likely to undertake unpaid overtime, suggesting that long-

serving workers are either more likely to volunteer to cover for absent colleagues without

pay, or more likely to be pressured to take on extra work by managers with the knowledge

their alternative job opportunities are limited, a problem that will be more pronounced now


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during a period of high unemployment. Overall, while jobs in care homes are more likely to

involve overtime work, it is the jobs in domiciliary care that are more likely to demand unpad

overtime – 33% of all domiciliary care jobs.

Shifts are a major feature of care work but only a third of jobs requiring shiftwork pay a

supplement; in private firms this share drops to one fifth (18%) (TNS 2007: 33). Similarly,

nightwork is required in around two fifths of care jobs (43%) but most workers (61%) in such

jobs do not receive any form of pay enhancement, making them worse off than retail

supermarket chains which at least pay a fixed supplement for nightwork. Again, private

providers are least likely to pay a nightwork enhancement – only 28% of the surveyed care

workers employed in the private sector (op. cit.). Any notion of compensating differentials in

the social care sector thus appears to have been abandoned.

One pay enhancement peculiar to the social care sector is payment for travel time, given the

requirement in around one third of care jobs to travel between users‟ homes. The TNS survey

reports that of those care workers in jobs involving travelling, some 37% travel more than 5

hours per week (TNS 2007: 34). Again, around half of workers are neither paid for their

travel time (52%) (in contravention of the national minimum wage legislation) nor

compensated for travel costs (petrol, etc.) (45%) (op. cit.). The issue is an obstacle to

improving recruitment and retention (Yeandle et al. 2006) and recognised as problematic by

the industry employer body, the UKHCA. The following quote illustrates the interlinkages

with commissioning arrangements that focus on precise units of care time, an issue we

explore further in the following section:

[Local authority] commissioners will also use other cost saving mechanisms, such as

only paying for contact time, sometimes as short as 2 to 10 minutes, or using short

care episodes for personal care tasks to reduce costs. As care is generally purchased

by reference to “contact time” (ie the time spent in the user‟s home) the rate paid is

crucial. Providers must be able to reach National Minimum Wage - which must cover

travel time – from increasingly small units of time. In addition, there is an impact on

the wellbeing and job satisfaction of the workforce, and the user‟s satisfaction with

care received. It also constrains providers‟ ability to pass on wage costs for

careworkers undergoing training as they are only able to derive fees for billing for

services provided (UKHCA 2009: 9).

I.3.3. The organisation of care work

In this section we identify the ways recruitment and retention in care work may be affected

by the organisation of care work. The nature of care jobs, how these jobs are designed, the

pace of work, the skill content of the job and the opportunities for workers to exercise

autonomy and discretion when performing the role can all be expected to influence both

recruitment and retention. Likewise, how working time is organised, including shift

arrangements, the flexibility available to meet workers‟ needs and requirements for travel

may be critical to both entry and retention. While low pay exacerbates recruitment and

retention difficulties, wider debates relating to job quality indicate that broader measures of

job satisfaction are also helpful in understanding labour market behaviour such as turnover


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for example. Indeed, Clark (2005) argues that restricting analyses to wages and hours of work

„gives a misleading picture of what makes a good job, and hence of workers behaviour‟ (op

cit: 2005: 12).

The nature of the job

The limited research that has looked at why people choose to work in the care sector reveals

that even when there are pragmatic motivations, such as choosing a job that fits with other

commitments or fits with a chosen career, „the choice is unlikely to be motivated purely by its

extrinsic rewards. Rather, if a care worker feels she has made a choice it will be for reasons

that touch upon the work itself‟ (Himmelweit 1999: 34). McClimont and Grove‟s (2004)

survey of 3,000 care workers found the three most cited reasons for entering the care sector

were enjoying helping others, liking care work and working time flexibility and a survey of

500 workers commissioned by Skills for Care (TNS 2007) found that enjoying working with

people and wanting to enter this type of care work were the most important reasons along

with the desire to work flexible hours (box 1.2).

Case-study research indicates that this predisposition to caring for others is not formed within

the workplace (Cunningham 2005: 4) and in domiciliary care the lack of a fixed workplace

means that management and colleagues in the workplace are less influential on care workers‟

commitment to care work. However, for recruitment and retention it is important to see if

care workers have the opportunity to act on these values once they have entered the sector.

The survey results indicate that these pre-entry values, expectations and motivation continue

to take precedent in explanations of job satisfaction. Job satisfaction is high in the sector with

almost nine in ten (88%) care workers in the Skills for Care survey saying they were happy in

their jobs. Box 1.2 presents the main factors underlying this broad finding of job satisfaction,

and points to the importance of the nature of care work, including the relationships with users

and caring and looking after others.

Social care work can therefore be described as „intrinsically satisfying‟ in the sense that

workers feel they can, in principle, „make a difference‟ in their job (Eborall 2003: 11). If

there are no barriers to care workers making a difference, then „job satisfaction will

automatically be high‟ (Eborall 2003: 11). Yet it is important to recognize that the way the

work is organized may indeed present barriers to care workers making a difference and that

such barriers may impact on care workers‟ propensity to remain in the sector. Likewise,

survey research shows the importance of being able to work flexibly and again if this need is

not met there may be an adverse effect on recruitment and retention. Therefore, a crucial

factor is the way organisations manage and meet expectations in relation to the nature of the

work and the flexibility on offer.


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Box 1.2. Reasons for entering care work and for remaining in care work

Two surveys provide evidence of the reasons people cite for entering care work:

McClimont and Grove‟s (2004) survey reports

the following eight most cited reasons:

The survey for Skills for Care (TNS, 2007: 59)

reports the following commonly cited reasons:

1. Enjoy helping others

2. Like care work

3. Flexibility to fit around other

commitments

4. Easy, quick application process and

rapid start to work

5. Pay

6. It was convenient

7. It provides a way into a career into

nursing

8. Just needed a job

1. Always enjoyed working with people I

care for (40%)

2. Always wanted to enter this area of

work (25%)

3. Convenient/flexible hours (25%)

4. Knew someone that did it (21%)

5. Just needed a job/ to earn money (19%)

6. Someone recommended it (18%)

7. Was unpaid carer for family member

(15%)

8. Was close/ easy to get to (15%)

And the same surveys also report evidence about the factors held to be important by care workers

already in employment in shaping their satisfaction with the job:

McClimont and Grove‟s (2004) survey reports

13 factors cited by care workers:

The Skills for Care (TNS 2007: 64) survey

identified the following ten „favourite things

about work‟:

1. Relationship with clients [users]

2. Good managers

3. Being able to get hold of managers easily

4. Training

5. Being trained before starting work

6. Flexibility to do what client [user] wants

or needs

7. Clear and easily understood contract

8. Opportunity to undertake an NVQ/SVQ

qualification

9. Being involved in decisions about clients

[users] or work

10. Staying with the same clients [users]

11. Being able to say „no‟ to work

12. Opportunity to progress to senior care

worker or higher

13. Clearly defined career path

1. Job satisfaction (14%)

2. Chatting with clients [users] (12%)

3. Meeting different people (11%)

4. Caring/looking after people (1%)

5. Helping people (10%)

6. Knowing you are making a difference

(10%)

7. The people I work with (8%)

8. Keeping clients [users] happy (7%)

9. Flexibility of working hours (3%)

10. Building relationships with/gaining the

trust of clients [users] (3%).


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The organisation of work shapes the nature of care work in three key ways:

the degree of standardization of tasks and the amount of time allocated to perform

these (pace of work);

the job content and specifically the level of skills required to perform the role,

including opportunities to exercise autonomy and discretion (control over work); and

the opportunities for employee involvement and supervisory support (voice at work).

Standardization of care and pace of work

A certain amount of standardization of care work is a requirement in the relationships that

develop between LAs and providers. LAs purchase from providers a specified period of time

to carry out a range of tasks for individual service users (Glendinning et al. 2008b). These

tasks are set out in a care plan where the care needs of users are broken down into specific

tasks and the time needed to carry out these tasks. Care workers have no involvement in the

organisation of care plans and in this sense it mirrors the notion of „service sector Taylorism‟

(Bosch and Lehndorff 2001) characterised by a separation of the planning and execution of

tasks. A key issue for care workers is the extent to which they have enough time to do all the

tasks allocated within the time frame they are given. In other words, is the volume of work

and pace of work acceptable and compatible with care workers‟ expectations and needs about

what the job should involve and what they value from it? Research suggests that when this is

not the case care workers are dissatisfied with their work and this can adversely impact upon

retention. According to McClimont and Grove‟s (2004) survey, commissioning arrangements

that facilitate tightly specified time slots lead to short visits that create feelings of being

rushed and this is a key factor in retention. Staff shortages may require the existing workforce

to accommodate many more visits across a wide area (Francis and Netten 2004).

Cunningham‟s (2005) case-study of a not-for-profit care provider reveals pressure on care

workers to concentrate on the more basic parts of their work rather than aspects they valued

because of limited time.

The current move to more outcomes-based care can be interpreted in part as a response to

these problems and provides some recognition that this model of standardization and

fragmentation of care tasks is „inappropriately rigid when it comes to the needs of people

receiving care‟ (Bosch and Lehndorff 2001: 87). Greater control by the user over the care

they receive may also give some scope for the care worker to respond flexibly to users‟ needs

(Sayer 2005). While the focus has been on what this has meant for users, studies of

outcomes-based services have also identified improvements in staff retention. Sayer argues

that, „It seems that clarity about the results they are trying to achieve, together with the

autonomy to respond flexibly to service users, is making the provision of domiciliary care

services much more fulfilling and satisfying to staff‟ (op cit: 2005: 23).


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Job content: skills, autonomy and discretion

While care work is low paid and is often categorized alongside other routine service work as

a „bad job‟ (Coates and Max 2005) the job of a care worker does not fit a standard

classification of routine work (Rubery and Urwin 2010). It shares with other types of

frontline work the simultaneity of production and consumption (Korcynski 2002) but

management scope for controlling service quality in this sector appears to be more limited

than in other frontline service work such as call centres, hospitality and retail because of the

amount of discretion the role potentially offers workers (Bolton 2004). For the recruitment

and retention of the care workforce a key question is therefore whether the skills and

discretion involved in care work can be considered a positive or a negative aspect of the job.

Gospel (2008) and Gospel and Lewis (2010) identifies three kinds of skills in care work:

technical skills needed to perform physical lifting, bathing, feeding and the administration of

medicine; interpersonal skills or social skills required to interact with older people; and

administrative skills for record-keeping and administration (2008: 22). Despite the required

multiple skills, however, Gospel found that in care homes care workers enjoy limited

discretion. Care workers have little input into personal care plans and have to refer to senior

care workers if they want to change minor aspects of this (op. cit.). Moreover, Gospel‟s

research demonstrates that care workers are keen to take on a wider range of tasks. However

unlike similar jobs in the NHS where a national programme of skill development and job

redesign has been implemented in part in response to shortages of cleaners and assistant

nurses (Cox et al. 2008, Grimshaw and Carroll 2008), there is no such evidence in the care

sector, except with regard to specialist services provision in some LA inhouse providers.

However, the lack of a sector-wide approach appears to have caused a polarisation of job

quality between LA and independent providers. McClimont and Grove (2004) argue the

focus of many LA providers on specialist care restricts the range of job opportunities

independent providers can offer their staff. Sayer‟s (2005) work on outcome-based care also

suggests independent domiciliary providers design jobs that fulfill basic „maintenance

outcomes‟, such as meeting basic physical needs, rather than „change outcomes‟. Sayer

argues the involvement of all providers in the full range of outcomes „is probably an

important step in enabling all providers to build stable, successful workforces‟ (op cit: 23).

The specialisation of activities among LA providers and accompanying process of skill

enhancement has also involved certain costs for the workforce, including enhanced temporal

flexibility (see below). But the general effect, like the pay gap between providers reported

above, is a polarization of jobs in terms of the skill and opportunities available between those

offered by LA inhouse providers and those by independent providers.

Like other types of service work, any depiction of care work that focuses on the more

tangible aspects of skill, such as certified knowledge, training, accredited qualifications and

career progression, misses the relational, or interpersonal, features of the job which are

essential to what constitutes a good care worker and a good care service. The relational

aspects of the work create positive opportunities for a worker to exercise discretion and

autonomy because of the relationships involved in caring and the absence of direct

supervisory control over these. Eaton (2000) cites a range of tasks involved in relational and


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emotional work, and elaborates the types of tacit knowledge required to perform the job well

(box 1.3). The challenges of decision-making in a context of intensive relational work are

perhaps most evident in the domiciliary care sector. Here, care workers often work alone and

have to be able to negotiate with the user all the aspects involved in the delivery of personal

care, including both the preset or routine tasks and the idiosyncratic or changed tasks. This

feature of their job can be a source of satisfaction, as we described above, but can also be a

source of stress. Care workers are expected not only to express empathy with the user but

also simultaneously to negotiate and manage boundaries between their commissioned tasks

and the user‟s expectations (Rubery and Urwin 2010: 3).

Box 1.3. The relational work of care workers

A review of studies by Eaton (2000) and Himmelweit (1999) suggest the following characteristics

of relational work and tacit knowledge are present in care work:

Relational work and emotional labour:

- conveying information

- providing comfort or companionship

- preventing a problem

- the „display‟ of a felt state, such as kindness, compassion and cheer

- ability to complete tasks patiently and gently with tolerance, even if one is being

physically abused or attacked

Tacit knowledge:

- how to lift and turn patients

- how to cheer patients

- to know who has grandchildren

- to know who prefers warm water for bathing.

The extent to which relationship work can be considered a type of skill is disputed (Lloyd and

Payne 2008). However, in contrast to other service areas where there is tight managerial

control over the formation of customer relationships through scripting and prescriptive modes

of behaviour - for example, flight attendants or call centre work - social care workers have

relatively high levels of discretion and freedom in their development of relationships.

However, there are tensions between discretion and control within care work. On the one

hand, managers rely on workers to sort out the changes in care associated with changes in

user needs (Francis and Netten 2004) and to establish positive personal relationships with

users in order to improve the perceived quality of the care delivered. But on the other hand,

managers and LAs seek to increase control over costs by introducing new methods for

monitoring care work, such as electronic monitoring where discretion is limited by increased


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34

pressure on time taken to deliver the care package. Cunningham‟s (2005) case-study research

demonstrates that care workers‟ discretionary behaviour and caring values were indeed

compromised by the work intensification that resulted from specific commissioning practices.

Moreover, the diminished opportunity for care workers to act out their values meant they

were more likely to express the desire to quit. However, the resilience of workers‟

commitment to helping and caring for others may still be enough to ensure this discretionary

behaviour continues despite the rigid targets in place (Bosch and Lehndorff 2001, Hebson et

al. 2003). Research evidence suggests that those individuals who are motivated intrinsically

or by a „calling‟ to their work may engage in more expansive „job crafting‟ – that is, the

exercise of discretion in defining and extending what the job entails - than individuals who

are more extrinsically motivated by financial reward or career advancement (Wrzeniewski

and Dutton 2001).

I.3.4. Training and development

Our fourth organisational factor described by the acronym MaROT (figure I.1 above) is

training and development. High quality provision of training and development of the social

care workforce is a vital aid to recruitment and retention. It can provide workers with much

needed support in their job through expanding their knowledge and skills and also establish

opportunities for career development.

At the national level, the development of minimum care standards9 and LA commissioning

requirements related to induction training and having at least 50% of care workers qualified

at NVQ level 2 (including agency staff and excluding managers) was found to be an

important driver for professionalization of care work and a boost to recruitment and retention

(see Gospel and Thompson 2003: 21-22 for details). In particular induction should ensure that

recruits are aware before they start work what a job in the care sector actually entails; this

might increase turnover in the very short term, but undoubtedly reduces wasteful investment

in new recruits who do not have the appetite for care work.

Training requirements can also exacerbate the recruitment and retention difficulties facing

independent providers. High turnover means not only that more time has to be spent on

training, thereby compromising the ability of providers to deliver services, but also that a

provider may fall below the training target, causing problems with both the CQC and the LA.

Even from the perspective of future or current employees, training is not always welcome;

those already experienced may resent being required to train and those considering entering

social care may be apprehensive about their academic ability to complete the training or

disillusioned by the lack of financial reward in the form of a pay rise (Gospel and Lewis

2010: 16-18). Yet training and development on its own may not be sufficient to improve

either the image or experience of care work particularly if completion of training does not

9 These minimum standards with respect to NVQ training have been discontinued in 2010


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lead to any advantages in terms of pay or future career opportunities. There is now evidence

that the introduction of regulations has stimulated the amount of training in social care

(Gospel and Lewis 2010),even if there are differences in the extent to which providers

actively engage with the training agenda, linked in part to the availability of support for

training from LAs and other agencies (Rainbird et al. 2009). Overall, however, the low pay

rates that still prevail suggest that this has not done much if anything to improve the status or

rewards of care work. Other countries have higher requirements for training for social care

than the UK (Ungerson and Yeandle 2006, Simonazzi 2009, Fagan and Anxo 2005) and these

training requirements are often associated with a greater professionalization and higher status

attached to social care work (Christopherson 1997). These higher training standards are often

implemented in contexts where there are sector-wide pay regulations, often based on

collective bargaining so that it is not the training in and of itself that raises status but training

combined with more regulated pay setting and the opportunity for social partners to engage in

social dialogue.


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I.4. Recruitment and retention from the user and employee

perspectives

The above discussion has shown how some of the ways care work is organized can shape the

quality of the care jobs on offer to a potential and existing care workforce. In this section we

assess the potential linkages between the quality of the care job on offer and the quality of the

care provided. Through a review of existing research on users‟ views of what constitutes a

good quality care service we identify the complementarities between user perspectives and

employee perspectives. Thus poor quality care jobs may not only exacerbate recruitment and

retention difficulties but also curtail opportunities to provide good quality care. In contrast

good quality care jobs have characteristics that improve service quality and job satisfaction,

which is pivotal to improving recruitment and retention. A key issue then is whether there are

complementarities or contradictions between user-centred services and employee-centred

work organisation (Kirkpatrick and Martinez Lucio 1995). The review below suggests a

greater presence of complementarities than contradictions, although only if the interests of

both the workforce and users are taken into account in the design and organisation of service

delivery. A final section considers the importance of time and space in shaping employee

perspectives on care work.

I.4.1.What makes a good care service and what makes a good care worker?

What makes a good care service?

In their summary of Qureshi et al.‟s (1998) research on older people‟s definitions of quality

care Glendinning et al. (2008b) suggest the priorities include change outcomes (such as

improvements in physical, mental and emotional functioning), maintenance outcomes

(prevention of or delay in deterioration in health, wellbeing and quality of life) and process

outcomes (such as feeling valued and respected, being treated as an individual, having a say

over how and when services are provided, perceived value for money and compatibility with

cultural preferences and informal sources of support) (op. cit.: 6-7). In case-study research

examining users‟ views on the care they receive and what they value, it is often process

outcomes that are emphasized which puts the care workforce, and how they are managed

trained and treated, at the centre of explanations of user satisfaction.

Francis and Netten‟s (2004) study of user views identified reliability, flexibility, continuity of

care, communication and good staff attitudes as the most important dimensions. However,

when talking about flexibility, it was flexibility to go beyond the care plan that users valued

most - that is, the attitudes of care workers and their willingness to help and undertake jobs

beyond those stipulated in the care plan (op. cit.: 295). In particular, users believed a „caring

motivation‟ was more important than the skills and knowledge defined in training standards;

Francis and Netten put it simply as follows, „if` care workers care they are good carers, if

they don‟t they are poor carers‟ (op. cit: 300). Two further reports (Henwood 2001, Sinclair

et al. 2000) identify older people‟s dislike of care workers‟ lack of flexibility and autonomy


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to deliver the type of service which users want. Both studies point to the importance of the

relationship between user and care worker, the need for user choice and flexibility over tasks

undertaken, and the need for users to have more control over the tasks undertaken. Such

flexibility may be compromised by organizational and commissioning practices where these

lead to fragmentation of tasks and short task-oriented visits (Sayer 2005).

Furthermore, problems of recruitment and retention directly impact upon the quality of the

service users receive. Users value reliability of care visits because it gives a sense of control

over their lives (Francis and Netten 2004: 295). Missed calls and waiting for calls along with

rushed visits are often the result of staff shortages and all compromise good quality care

standards. However users do not blame care workers for this and understand the pressures

they face (op. cit.). Interestingly, the desire for flexibility in service delivery not only

concerns temporal flexibility but also involves the desire for care workers to be responsive to

individual needs. On the basis of this discussion it is now possible to put forward some

tentative ideas about what makes a „good care worker‟ that is sensitive to the way

organizational and commissioning environments may shape this.

What makes a good care worker?

Caring involves caring for and caring about a person (Himmelweit 1999). A good care

worker must thus not only be able to care for the person to the best of their ability, putting

into practice skills and training they have acquired, but also, and significantly, must care

about the person they are caring for, respond flexibly to the user and their needs and ensure

process outcomes are achieved, including respect and independence and quality of life

outcomes that only come through the relationships that develop between the care worker and

user. To do this the onus is on the care worker displaying „citizenship type behaviour‟

(Hodson 2001) and „voluntarily giving extra effort to ensure production takes place

efficiently‟ (op. cit.: 68). In short, being a good care worker often involves going beyond

what they are expected to do out of commitment to either the user or the service

(Cunningham, 2005).

Significantly, managers may rely on this discretionary behaviour to deliver quality of care but

as we have seen in our discussion about job satisfaction (I.3.3 above), this is also an aspect of

the job care workers value. Relationships with users are a key source of job satisfaction and

helping and caring for users using tacit skills would appear to be a key component

underpinning the pride care workers experience in their job and the dignity they derive from

work. However, this discretionary behaviour and flexibility, so clearly valued by users and

central to definitions of „good care workers‟, may prevail despite organisational factors rather

than because of them. As Bosch and Lehndorff argue, „it is the standards of the employees

themselves that ensure such a system can operate irrespective of the targets set‟ (2001: 87).


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I.4.2. Is care work a good job or a bad job? The employee perspective

The success of any recruitment and retention strategy for the social care workforce is likely to

depend upon whether care work is considered a good or bad job from an employee

perspective. Here we first of all review debates on good versus bad jobs before addressing the

relationship between care work and attitudes towards women‟s employment and women‟s

skills.

Care work and job quality: complementarities, trade-offs and contradictions

A range of dimensions are used in measurements of job quality including pay and benefits,

job security, training and career opportunities, task discretion, job content and pace of work,

employee involvement and voice and ,work-life balance (Tilly 1997, Appelbaum et al. 2010).

However, because some dimensions such as pay are more easily measured compared to

others good and bad jobs are often defined in relation to these (Goos and Manning 2003). Use

of pay as a proxy for job quality is of course only valid to the extent that low pay is

accompanied by other low quality job dimensions. Some studies confirm such an association,

with evidence of „multiple deprivation‟ (Ritter and Anker 2002, Clark 2005) and

segmentation of jobs, such that „some groups of workers may have better jobs than others‟

(Clark 2005: 21).

Efforts to use HR practices to improve job quality need to recognise the potential for

complementarity and positive inter-linkages. Recent comparative research on the hospital

sector suggests that redesigned jobs have limited impact on job satisfaction if they are not

supported by training and compensated by wage increases (Méhaut et al. 2010: 16-17). This

has also been found to be the case in relation to good quality care jobs. Gospel and Lewis‟s

(2010) research on the impact of training regulations in the care sector found that this did not

have the desired impact on job quality because training initiatives were not complemented by

newly designed job roles, the provision of financial reward for qualifications, and

opportunities for workers to pursue clearly defined and managed career pathways. Studies by

Hunter (2000) and Eaton (2000) also identify a bundle of HR practices that make a positive

difference to job quality and quality care.

However, this additive approach to job quality does not sit easily with a workforce that

appears to have accepted a trade-off between different dimensions of job quality. As

suggested above, care work does not fit the picture of routinised, low paid and low status

work since the discretionary content and levels of job satisfaction can potentially be quite

high. For care workers it would appear that their job is not so much a „good job‟ constituted

by a bundle of complementary, „good‟ dimensions, but a job riddled with trade-offs and

contradictions reflecting in part the importance of one or other dimension from the

perspective of providers and care workers.

These trade-offs are found both within a single dimension and between job quality

dimensions. For example, with respect to discretion and control we have seen that care work


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provides for a high level of discretion but the value of this discretion is not necessarily

recognised even though it is contributing to quality of outcomes. Moreover new electronic

monitoring techniques, although introduced by LAs to monitor the provider, are being used to

monitor employee behaviour which could reduce employees ability and willingness to engage

in discretionary work effort. However, Brown and Korczynski (2010) have shown that while

organizational commitment to the employer may decline because of this form of monitoring,

it can lead to higher discretionary effort because of the care workers‟ commitment to provide

quality care despite the constraints such monitoring can place on achieving this.

There also appears to be a trade-off between pay and job satisfaction. A report for the

employer body for provider organisations (McClimont and Grove 2004) highlights the

problem in assessing how important pay is in workers‟ perceptions of the job since most

surveys, including their own, only focus on care workers in employment. These workers

ranked pay fifth out of eight in terms of importance, but this may not reflect the importance

of pay to those care workers who quit to work elsewhere. Therefore, it may be unwise for

policymakers to place too much weight on evidence of high satisfaction and low concerns

over pay among existing care workers when seeking to identify means of expanding the

workforce.

Measures of job dissatisfaction may provide more useful information on where the barriers to

recruitment and retention may lie. In the Skills for Care survey (TNS 2007), of the few care

workers who said they were unhappy, the most commonly mentioned reasons cited were poor

pay, wanting more support from the management, disliking the unsociable or long hours and

not liking the particular company they worked for. McClimont and Grove (2004) also show

how important managerial support is for job satisfaction and how dissatisfaction tends to

relate to the employer rather than the job itself. What becomes clear is that if workers are

dissatisfied with the job, and in particular feel they cannot take pride in their work and act

upon their values and expectations about caring for users, other dimensions such as pay, that

are often cited as relatively unimportant by those working in the sector, become increasingly

more important and low pay becomes a reason to quit (Cunningham 2005, Sayer 2005).

Issues around working hours also seem to be a dimension of job quality that can determine

intentions to enter the occupation or quit (Cunningham 2005).

One area where there is evidence of cumulative poor job quality is in relation to both pay and

pay promotion prospects. Social care not only offers low initial pay but also poor

opportunities for advancement (section I.3.2 above). These combinations of job

characteristics may be tolerated by older female care workers who may expect limited

chances of advancement wherever they move to in the labour market (Grant et al. 2005) but if

new recruits from under-represented groups are to be targeted, for example younger workers

and men, their expectations and aspirations for career and pay promotion will be different.


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Care work and women‟s skills

Care work is often regarded as low skilled by virtue of its low pay and the lack of formal

qualifications required for entry. As we argued above, this latter characteristic is in some

sense specific to the UK as other countries require acquisition of more formal qualifications

and have gone down the route of professionalising care work. However in all countries there

remain residual problems of low pay and status for this kind of work that are associated both

with a general tendency for women‟s work and skills to be undervalued in the labour market

(Grimshaw and Rubery 2007) and with a specific tendency for care work to be undervalued

due to its association with unpaid work undertaken by women in the home.

It is this potential for women (and indeed men) to acquire skills through informal experience

in domestic environments that in part enables the skills involved in care work to go

unrecognised. A third of respondents in McClimont and Grove‟s (2004) survey who were

recruited into care work had previous informal care experience. However, skill in care work

is not primarily technical but involves emotional labour or emotion work or more specifically

described by Bolton (2005) as „philanthropic‟ emotional labour, given as a gift. Moreover,

unlike other frontline service work where connections are transitory, care workers form real

attachments to users and suffer emotional dissonance if the relationship involves dealing

with, for example, abusive service users (Eaton 2000). The outcome is that care workers may

prefer to remain with users even if it is not convenient (Himmelweit 1999: 35) and may

become as England (2005) has suggested „prisoners of love‟ where their attachment to the

user may lead them into more intensive or more extensive work than they have been

commissioned to undertake or are rewarded for.

However, it is open to debate whether the relational and emotional content of this care work

should be emphasised over that of improving technical skills and training and encouraging

the professionalization of care work. The latter approach may make care work more

appealing to a wider range of groups including some men as they are reluctant to enter work

that stresses the need to have communication and social skills (Lindsay 2005). Furthermore,

although generic skills such as social skills and communication are emphasised as important

by employers when recruiting the relational aspects of work are not rewarded financially

(Hebson and Grugulis 2005). In other caring occupations it has been found that care work is

„contaminated‟ by the skill of caring, leading to undervaluation. Findlay et al. (2009) argue

that nursery nurses have much to gain from focusing on the educational element of their role

and a parallel strategy for care workers could be to focus on the emphasis on quality of life

and dignity that is crucial in good quality care. However, as we have seen, care workers and

users prioritise this relational aspect of care. If this aspect of the job is underplayed then there

is a danger of deterring the very people who users want to have care for them, as well as

exacerbating retention difficulties. Fagan and Anxo (2005) show that job satisfaction and

service quality are both adversely affected where staff have insufficient time, training and

other resources to meet the demands of emotional labour.


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I.4.3. Time and space in the recruitment and retention of a social care workforce

Time and space factors are important positive and negative factors in the recruitment and

retention of the social care workforce, particularly in domiciliary care where work is carried

out in a range of locations through repeat visits at key points in the daily and evening cycle.

The workforce is thus likely to be recruited from a localised pool of labour and this tendency

is reinforced by the use of informal methods of recruitment by employers and by the

relatively high job satisfaction found among care staff. In the Skills for Care survey, three

fifths of care workers (59%) said they definitely would recommend their job to a friend, and a

further one in four workers (24%) said they possibly would, meaning more than four in five

workers (83%) overall would recommend care work to a friend.

The mobilisation of local networks for recruitment does not necessarily mean people enter

the profession by chance as Lee-Treweek (1997) suggests. Rather, new entrants may feel they

know more about the job than if they had applied through formal channels without the

insights provided by the recommendation of a friend. But this form of recruitment may itself

set limits to the pool of labour on which the sector can draw.

While there may be a general case for those seeking work to expand their spatial horizons and

seek work outside their immediate area, this approach does not necessarily follow for

domiciliary care work given current patterns of work organisation and employment rewards

and guarantees. Travel to work time is always an issue for those in part-time work but where

the work is fragmented over the day, not necessarily continuous and involves travel within

the work day as well as from home to work the problems of expanding the geographical pool

of workers is even greater. While care homes are more able to recruit staff for regular hours

and for continuous shifts they also face the problem of operating on a 24 /7 basis and the need

for staff to work nights and weekends increases the problems of commuting any distance to

work as public transport may not always be available.

For such a feminised sector, and one so reliant on more mature women often with caring

responsibilities, it is important to recognise that the hours of work do not fit with standard

notions of family friendly or employee-flexible working time. Instead the hours of work are

set more with respect to user needs and may directly clash with family responsibilities,

including early mornings, teatime and evening shifts, weekend work and, in care homes,

night shifts. These working time arrangements further increase the likelihood that the work as

currently organised would only be considered „convenient‟ for local labour and may only fit

with quite specific family arrangements (for example where the partner is able to take the

kids to school or make the supper). This fits with early research on working time

arrangements in women‟s‟ jobs where what constitutes a convenient working time might be

highly family specific and would be reinforced by specific childcare and other arrangements

(Horrell and Rubery 1991a, b). However, in domiciliary care and to some extent in care

homes the workforce has to cope not only with working time patterns that do not conform to

standard family friendly arrangements but also with working time patterns that may be

subject to constant flux.


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I.5. Key research questions

The above review of literature on social care and the social care workforce has revealed a

range of key issues that have been used to inform the design of research questions for this

research project. We divide these into questions related to the LA commissioning

environment, questions related to the HR policies and practices of providers and questions

related to the recruitment and retention of care workers from the perspectives of both users

and care workers. Our final research question relates to the underlying policy issue, that is the

prospects for recruiting and retaining a larger and higher quality social care workforce to

meet increasing demands for social care under current institutional arrangements and

employment conditions.

LA commissioning environment

The LA commissioning environment was explored through an extensive postal survey in the

first stage of this project. The research questions identified for the second stage of the project

built upon this survey information but focused in particular on the following inter-related

issues.

1. How do those in the Local Authorities responsible for commissioning and/or

contracting make sense of the multiple, changing and potentially contradictory

pressures on commissioning policy?

The potential contradictions arise not only because of the need to contain costs while also

ensuring quality and adequacy of supply, but also because short term pressures may conflict

with longer term or strategic objectives to provide a more integrated service for older people

covering social care and health or even housing or to develop more user-centred service

delivery including the involvement of users themselves in the commissioning process.

2. What are the variations and trends in the specific characteristics of LA commissioning

and contracting practices, from price and contract to quality monitoring and provider

relations?

For both questions the key issue is the attention paid by LAs to factors that may impinge on

the recruitment and retention of the social care workforce. This attention may involve on the

one hand LAs monitoring their own commissioning policies to ensure they facilitate rather

than prevent providers adopting good HR policies. On the other hand the LAs may use their

positions in tendering, commissioning on contract monitoring to require providers to offer

good HR practices.


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HR policies and HR outcomes of providers

Our analysis of the role of providers in the recruitment and retention of the social care

workforce requires an initial mapping of the human resource practices in use within the

sector. These practices include:

recruitment and retention practices;

pay and reward systems;

work organisation and working time arrangements;

employee development and training; and

systems of performance management and employee voice.

A related objective is to map the range of approaches to human resource management

deployed by individual providers, measured across all these dimensions to HR practices. This

then sets the foundations needed for our key research questions as follows.

3. What is the current state of HR practices and outcomes in the sector?

What are the current employment practices and employment outcomes in the independent

sector and how do they differ between homes and IDPs.

4. What role do provider characteristics play in shaping HR practices?

In line with the findings from other studies we can anticipate several provider characteristics

to be potentially influential, including ownership (national, local chains, single

homes/agencies), sector (public, private, voluntary sector), size of establishment (eg. by

numbers employed) and different quality ratings, as determined for example by the CQC star

ratings.

5. What is the impact of the external policy and commissioning environment and the

local labour market demand factors on HR practices?

6. What is the combined impact of HR practices, environmental conditions, and

organisational characteristics on the quality of recruitment and retention outcomes?

These fifth and sixth research questions follow the analytical framework set out in figure I.1

by interrogating the inter-related effects of different environmental factors (related to LA

commissioning and local labour market conditions) and internal approaches to human

resource management on the overall outcomes for recruitment and retention.

Recruitment and retention from a care worker and user perspective

Due to the design of the project and to ethical issues relating to access to users, the research

questions that could be explored empirically within the project related primarily to the

experience of work from a care worker‟s perspective, although these were related to the

quality of care and the user experience wherever possible. The key research issues


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highlighted by the literature review and explored primarily through the stage three case

studies involving interviews with care workers were as follows.

7. What factors shape the recruitment of care workers?

8. What factors influence the retention of care workers?

The multiple factors include on the one hand the HR practices of providers and on the other

hand the personal motivations, expectations and experiences of the care staff. Both questions,

however, need to be set within the wider question of the nature of care work and its impact,

both positive and negative, on recruitment and retention, which leads to a further question as

follows.

9. Is care workers‟ job commitment influenced by the nature of the job and does it

involve trade-offs between „bad‟ and „good‟ aspects of the job?

In particular, we aim to identify and explore whether care workers enjoy opportunities to

provide good quality care and whether the relationship between „good‟ and „bad‟ aspects of

the job are in practice synergistic, with good HR practices potentially offering more job

satisfaction and better opportunities for good quality care from the perspectives of users and

care workers. In exploring this question we also consider whether the current care staff‟s

commitment to their work is linked to their particular interests and circumstances that may

not be easily generalised to an expanded labour pool.

Prospects for recruitment and retention under expanding demand: the policy

issues

The final research question relates to the context in which this research was funded, namely

the expectation of increased demand for the social care workforce, in relation to both quantity

and quality. We draw on the answers to all nine research questions to ask:

10. What are the prospects of meeting current and future increased demands for a social

care workforce under present conditions – that is without major changes in

commissioning arrangements, the policies of provider organisations and the

conditions of employment?


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I.6. Research strategy and methodology

I.6.1. The project research stages

The project to explore the recruitment and retention of the social care workforce involved

three main stages as detailed in table I.3: from local authority commissioning practices to HR

practices of providers to the experience of care workers. These are outlined in figure 1.7.

Figure I.7. The project stages

Survey of 92 LAs

Follow up study of

14 LAs

Part II

Telephone survey 115 provider establishments

10 national provider interviews

Parts III and IV

20 case studies

of providers

Part V

98 care staff interviewed

Part V

The first stage – a postal survey of LA directors of social services conducted by the PSSRU

unit in Manchester- has already been reported on (Hughes et al. 2009) and provided a

framework for the first part of stage 2, namely the selection of local authorities for follow up

interviews (stage 2a) and as sites for the telephone survey of providers (stage 2b)-. These

providers include domiciliary care providers (IDPs), residential and nursing homes in the

independent sector (homes) and local authority based domiciliary care providers (LADPs).

We also added a third element to stage 2, a survey of national providers (stage 2c).Stage 3

involved the selection of four LAs from our initial sample of 14 for cases studies of providers

with particular focus on the experience of care workers employed by these providers.

All three stages are described in more detail below. Table I.3 also provides a summary of

how and when user views and issue were taken up and explore within the project, with

further detail provided in the sections below. The project benefitted from the setting up of a

helpful, well informed and active advisory board (see box I.4 for information on the


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composition of the advisory board). This board met annually and an individual member of the

board provided valuable assistance at key stages, in particular in setting up a focus group of

users to inform the development of the case studies. The results of the project were presented

at each meeting and then the board was consulted on issues to bear in mind in developing the

next step.

Box 1.4: Membership of the Advisory Board

Social Care Consultant

Representative from Age Concern

Full-time Officer from Unison

Local Authority Service Director (LA not included in Stage 2)

Owner of a domiciliary care agency

Representative from Skills for Care

Representative from ACAS

2 lay persons


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Table I.3 Summary of project stages

Responsibility and project

stages

Dates/ responsibility /sample frame Sample frame and number

of responses

Inclusion of user perspectives/ user issues

PSSRU and EWERC

Project development

Ethics approval sought from university ethics

committee –stage 1 by PSSRU, stages 2 and 3 by

EWERC.

Agreement form ADASS for stages 1 and 2 secured

by PSSRU.

Formation of Advisory board including representatives

from all key stakeholders including users

PSSRU

Stage 1. January 2008

Postal survey of LA directors of social services 92 responses

(149 LAs surveyed)

Information collected on consultations with users by

LAs and on flexibility in service provision at the level

of service user - one dimension to typology

EWERC Stages 2 and 3

Stage 2a October 2008 to

June 2009

Follow up interview with key actors in LA

commissioning and contracting

14 LAs

(15 LAs approached)

Advisory board including users consulted on follow-up

questions on commissioning.

National user attitude surveys used to explore/validate

typology of LAs (see part II ).

Stage 2b. November 2008 –

February 2010

Telephone survey with independent providers and

LA inhouse departments in 14 LAs

(Targeted sample – 3 to 4 homes /IDPs plus LADP

per LA. Achieved in 12LAs, 2 undersampled)

115

(>300 providers

approached)

Advisory board including users consulted on most

important care standards from a user perspective.

Challenges in meeting CQC care standards, importance

of continuity of care and attitudes to personal budgets

included in questionnaire.

Stage 2c.

January 2010 - May 2010

Telephone survey with national chains Target 10-

all to have a branch within telephone survey – 5

IDPs, 5 homes

10

( 12 chains approached)

Attitudes towards personalisation, care standards etc.

Stage 3

June 2009 to March 2010

Case studies of providers

Target cases studies in 5 providers in each of 4 LAs

- 5 care workers per provider

20 case studies of providers,

(30 approached in total )

98 employee interviews

Focus group of care users to inform themes within case

studies. Two themes highlighted (see Box 1.6)


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I.6.2. The stage one survey

Stage one of the project was designed to provide an overview of commissioning and

contracting practices in local authorities and to use that information to provide the basis for

the systematic selection of sites for stage two of the study. Data was collected from local

authorities with responsibility for social services through a postal survey distributed in 2008.

It comprised questions relating to the commissioning and contracting arrangements for

domiciliary care and care home provision and care management (care coordination)

arrangements for older people. The results of the first stage are reported separately in Hughes

et al. (2009). Ninety two of a total of 149 local authorities returned completed questionnaires,

a response rate of 62%.

To identify local authorities using common approaches to commissioning and contracting the

PSSRU study identified fourteen indicators relating to three domains of interest:

commissioning and contracting arrangements; employment practices; and flexibility in

service provision at the level of the service user. A cluster analysis was undertaken which

suggested the presence of seven types of local authority (table I.4). These were found to vary

in the level of activity in each domain of interest. For example, local authorities in type seven

were seeking to develop their commissioning activities, particularly in partnership with

health, and the processes associated with contracting; sought to reflect employment practices

in this context; and were striving to promote flexibility in service provision. Conversely, the

opposite appears to be the case in type four authorities. The remaining two thirds of the

sample displayed varying levels of activity in each of the three domains of interest.

Table I.4. Typologies of Local Authorities: Stage 1 of the project

Type (No. of

authorities)

Commissioning and

contracting arrangements

Employment practices Flexibility in service provision

at the level of the service user

1 (15) Medium Medium Medium

2 (19) Medium Medium Low

3 (11) High Medium High

4 (15) Low Low Low

5 (6) Medium High Medium

6 (13) Medium Low Medium

7 (13) High High High

Source: Hughes et al. (2009: p.9)


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I.7. The research methods for stage two

I.7.1. The local authorities

The selection of local authorities for the second stage of the research was driven by a range of

factors. These included the typology developed in the first stage; geographical spread; local

labour market conditions; and types of local authorities.

The seven cluster typology of local authorities influenced, first of all, the decision on how

many LAs to include in the second stage of the project. As the aim was to include both

independent sector domiciliary care providers and independent sector residential homes in the

telephone survey in each area, together with, where present, the inhouse domiciliary care

provider, 14 was considered the largest number of LAs that would allow for a normal sample

of six to eight independent sector providers within our target of around 100 to 120 achieved

interviews. Selecting a smaller number of local authorities would have raised two different

problems; first as the number of domiciliary care providers in one area was often quite

limited, we would not necessarily be able to achieve a sample much greater than four in some

cases, particularly if, as could be anticipated given the nature of the industry (see above), we

encountered difficulties in securing responses. Furthermore, as the indicated sample frame for

selection was the seven clusters of LAs generated by PSSRU‟s first stage survey, it seemed

appropriate to select two local authorities from each cluster. We made one variation to this

approach, namely we selected three from the largest cluster accounting for 19 local

authorities and only one from the smallest which included only six local authorities.

Three additional criteria of geographical spread, local labour market conditions and types of

local authorities were also taken into account in the selection to ensure that we covered a

broad range of types of external conditions and local authority characteristics. We contacted

the local authorities in stages as it was thought important to embark as soon as possible on the

telephone survey of providers after agreement had been secured from the local authority to

support their involvement in the second stage. For practical reasons, therefore, the

development of the local authority sample was done on a rolling programme with these

criteria in view. Of the 14 initially selected LAs, one did not agree to cooperate so that we

were able to achieve our initial selection of LAs with only this one exception. This was an

outer London borough and was replaced by another outer London borough in the same

cluster.

The characteristics of the achieved sample are shown in table I.5. Five local authorities were

located in the north, three in the midlands and six in the south including two in outer London.

The types of LAs were also spread over the main categories of shire counties (2), shire

unitaries (4) principal metropolitan (2) other metropolitan (4) outer London (2) with inner

London the main missing category (completion rates for both types of London boroughs were

lower at 50-54% compared to the highest rate of 83% for Principal Metropolitan Authorities

in the first stage survey). This variety of types of LAs is also reflected in the size of


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population: five had populations of under 250,000, five between 250 and 350 and four over

350,000 with two of these exceeding 600,000.

Table I.5. Characteristics of the selected LAs

LA Population

size a

Type of LA Cluster Area Female

employment

conditionsb

Female

part-time

earningsb

Labour

demand

conditionsc

AH small Shire unitary 2 South 5 M Strong

ON medium Other

metropolitan

7 North 3 L Weak

RT medium Outer London 3 South 3 M Medium

RN medium Shire unitary 6 South 5 H Strong

UY medium Other

metropolitan

1 Midlands 4 L Medium

AD small Other

metropolitan

4 North 3 L Weak

AW small Outer London 2 South 3 H Medium

IL medium/

large

Principal

metropolitan

7 North 2 L Weak

OM medium Shire unitary 2 Midlands 2 L Weak

XD large Shire counties 5 South 6 H Strong

HD medium/

large

Principal

metropolitan

6 North 5 M Strong

TE small Shire unitary 1 Midlands 2 L Weak

LK large Shire counties 4 South 6 M Strong

RD small Other

metropolitan

3 North 4 M Medium

a Small <250k, medium 250-350k medium/large >350k<600k large > 600k

b See appendix table I.A1

c See appendix figure I.A1

The local labour market indicators that we focused on were those related to the potential

availability of a labour supply for care work, related to both quantity and wage level. As

most care workers are women we decided to look at the local labour market conditions for

women as the core indicator. The available labour supply for women is not necessarily fully

or appropriately captured by the unemployment rate as many women move directly from

inactivity to employment. We therefore took into account the unemployment rate, the share

of the working age population who are inactive but want a job and the achieved employment


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rate (see appendix table I.A1). We combined these measures to indicate the strength of

demand for female labour in the local labour market. Using a scale of 1 to 6 table I.5 shows

that as an average for the period July 2008 to June 2009 (source LFS NOMIS), the 14 local

authorities were spread rather evenly with each of the possible points 2 to 6 including at least

two of the selected local authorities. We also looked at evidence of pay levels in the LA area,

focusing on the median hourly wage for female part-time workers. We combined this

information to come up with a classification of local labour demand as strong, medium or

weak (see appendix figure I.A1). The two outer London boroughs are located in the medium

category: this reflects the polarised nature of London labour markets, with wide wage

inequalities even among women (median full-timers‟ pay being much higher relatively than

female part-timers‟ pay) and low employment participation by some ethnic groups.

Stage two interviews with Local Authorities

The local authorities selected for further study and for the telephone survey sites were

contacted via a letter to their director of Social Services. The letter drew the LA‟s attention

both to the approval of the project by the Association of Directors of Adult Social Services

(ADSS) (obtained at stage 1 of the project) and to the LA‟s prior participation in the postal

survey. This letter was followed up by a request for an interview with those responsible for

commissioning and contracting domiciliary care for older adults and residential and nursing

home care for older adults. Due to differences in organisational structures and arrangements

for commissioning and contracting, the person or persons interviewed and their

responsibilities varied between the LAs. However, in most cases we were able to interview

officers with responsibility for both commissioning and contracting - either in the same

person or by joint or separate meetings with relevant managers. In most cases only one main

interview was undertaken lasting between 90 minutes and two hours in most cases, and with

two or more officers in nine of the cases. Some follow up telephone interviews were

undertaken where key people – for example on training - were not able to be present. In one

case where contract implementation and monitoring was undertaken by a different

department from commissioning and outside of social services, the main interview was with

the contracting and monitoring group (the staff concerned had previously been located in

social care but had been moved to a general contracting department) and a follow up

interview by telephone undertaken with the officer with main operational responsibility for

commissioning. In one LA (AD) a second visit was made to interview a key actor at a

different site and in another (RN) sequential interviews were held with key actors. In all other

cases the interviews were joint and no attempt has therefore been made to separate out the

views of the different officers concerned. Table I.6 shows the number of interviewees and

area of responsibility in each LA.

The interviews at the LAs focused on two issues. First of all we asked for support for the

research team‟s study of external providers in the area. At a minimum we asked for lists of

current contracted providers and key contact names and email addresses if available. Many of

the LAs, however, also gave more active support by informing their providers through their


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forum, their newsletters or through emails that we would be contacting them and that the LA

was aware of and supportive of the research. In providing this support it was made clear to

the LA that they would not be able to have direct feedback on their own providers in order to

ensure confidentiality but they would be sent a copy of the report. The second purpose was

to follow up on the information already provided in the first stage survey and to explore in

more depth the relationship between LA commissioning and contracting and the recruitment

and retention practices of their providers. A semi structured interview schedule was used.

Table I.6. Local authority managers interviewed in stage two

LA Initial interviews and

follow up interviews

Managers interviewed

AH 1 Manager responsible for commissioning

ON 1 joint + 1 telephone interview Service director

Managers responsible for:

contracts

performance management

training

RT 1 Managers responsible for:

commissioning

contracts

quality

training

RN 2 Service Director

Manager responsible for contracts

UY 1 joint Managers responsible for:

business services

training

commissioning

AD 2 Managers responsible for

commissioning

older people‟s services

AW 1 +1 telephone interview Managers responsible for

commissioning

contracts

IL 2 Managers responsible for

commissioning

contracting

OM 1 + 1 telephone interview Manager responsible for commissioning and contracting

XD 1 Manager responsible for commissioning and contracting

HD 1 joint Managers responsible for:

older people‟s services

commissioning

HR

contract

TE 1 joint Service Director

Manager responsible for commissioning

LK 1 joint Managers responsible for

contracting

quality

training (2)

care homes

RD 1 + 1 telephone interview Service Director

Manager responsible for commissioning


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I.7.2. The telephone survey

Design of telephone survey

For the telephone survey of providers, in each of the 14 LAs we aimed to include three to

four care homes, three to four domiciliary care providers and the LA inhouse domiciliary care

provider (where applicable). Within this sample we aimed for a mix between star ratings,

local and national providers and, in the homes, nursing and residential care.

The survey of providers took the form of a questionnaire administered mainly by telephone.

The questionnaire was designed for the owner, manager or person responsible for the day-to-

day running of the home or independent domiciliary care provider. Because of the differing

nature of work organisation in domiciliary care and care homes separate questionnaires were

drawn up for each, but the greater part of the questionnaire was common to both. The

questionnaire was primarily aimed at three issues: identifying the current situation with

respect to the recruitment and retention of care staff; identifying the range of HR practices

used by the providers with potential relevance for recruitment and retention; probing the

providers‟ views of the influence of the external commissioning and labour market

environment on their HR policies and outcomes. The broad topics covered are:

general information on the establishment,

recruitment and retention of care workers,

pay,

organisation of work,

training and development,

relationship with LA

and experience of the policy and regulatory environment.

Parts of the questionnaire were designed to be filled in and returned prior to the telephone

interview. The rationale for this was twofold; firstly to enable the respondent to gather

certain information, particularly on workforce statistics, in advance, and secondly to cut

down the length of time managers‟ would need to spend on the telephone. A copy of the

questionnaire for IDPs and care homes combined is provided in the appendix to part I. The

shaded sections indicate those parts sent in advance.

Consultation with the advisory board/ users over inclusion of quality questions

During the first meeting of the project Advisory Board held in July 2008 a consultation

exercise was held with the members of the Board, including service users, and the members

of the research team to consider the care standards and associated indicators of best/quality

practice developed by PSSRU. Members each selected the 20 best practice indicators they

considered to be the most important determinants of quality in each area of service. Analysis

of the documents completed by members of the Advisory Board was undertaken to identify

the most frequently reported indicators of quality and best practice. However, this analysis


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suggested that there was no real consensus. A decision was therefore made to include the

whole set of CQC standards as the framework for questions on quality standards in the

telephone survey questionnaire.

Piloting the questionnaire

The questionnaire was piloted with the manager of a care home not situated in any of the LA

areas chosen for the study. The pilot interview took 35 minutes. Following the pilot

interview some minor changes were made to the questionnaire. Further changes were made

following suggestions from a local authority contracts manager.

Conduct of telephone survey

Following each of the local authority interviews we asked for lists of their current providers

of domiciliary care and care homes, with contact details where possible. Table I.7 shows the

numbers on the lists for each LA.

Table I.7. Potential sample of providers for telephone interviews

Homes IDPs

XD 147 41

RN 63 10

AH 37 16

UY 62 10

OM 45 9

RD 35 15

HD 95 14

RT 27 7

AW 29 10

AD 51 10

IL 96 8

ON 40 22

TE 36 6

LK 145 80

Some LAs offered to smooth the way for us by informing their providers of our research, and

letting them know that they supported our project. The researchers made initial contact with

the managers by telephone and/or email to obtain their agreement in principle to take part

and, if possible, arrange a time and date for the telephone interview. Those who agreed were

sent further information about the project, and a factsheet about the implications of taking

part (including issues of confidentiality and anonymity) as agreed by the University of


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Manchester Research Ethics Committee. They were also sent the parts of the questionnaire

that had been designed to be completed in advance.

The managers were telephoned at the agreed time for the interview. If the manager agreed,

then the interview was recorded digitally but the responses to the questions were also noted

on the questionnaire as the interview progressed. The recorded interviews were used to check

responses and for additional qualitative data. Most of the interviews were between 45 minutes

and one hour in length.

Composition of the achieved sample

In practice the quota was obtained by contacting more than the target number of providers in

each LA area and stopping contact once the target number had been achieved. In order to

achieve the sample of 105 providers (excluding the inhouse providers) it is estimated that a

total of 303 providers were contacted. Furthermore it was often necessary to contact each of

these providers on several occasions. Even when an interview had been arranged the

researchers often found that the manager was not available at the allotted time, and the

interview would have to be re-arranged (several times in some cases). To some extent these

difficulties reflect the nature of managerial work in domiciliary care and care homes where

diaries tend to be „fluid‟ and managers are often, for example, required at short notice to meet

with service users and families, deal with practical problems or cover for absent staff. The

composition of the achieved sample is shown in table I.8.

Table I.8. Composition of the achieved sample

Homes IDPs LADPs Total

XD 5 4 1 10

RN 4 4 1 9

AH 4 5 0 9

UY 3 3 1 7

OM 4 3 1 8

RD 4 3 1 8

HD 4 4 1 9

RT 3 4 0 7

AW 2 3 0 5

AD 4 4 1 9

IL 4 4 1 9

ON 4 4 1 9

LK 4 6 1 11

TE 4 1 0 5

Total 53 52 10 115


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The table shows that the target sample for IDPs and care homes was achieved in 12 of the 14

LAs. In the case of TE it was difficult to achieve the target sample of IDPs because of the

limited number contracted by the local authority. On the other hand the target sample was

overachieved in three LAs. Two of the LADPs (AW and RT) had no inhouse domiciliary care

provision, but ten of the remaining twelve were included in the sample.

Additional interviews with national providers

Stage two of the project also included interviews with senior managers of national providers

of care homes and domiciliary care. We decided to aim to interview five national providers of

care homes and five national chains of IDPs. Our priority was to include national providers

that were represented in our telephone survey of providers (all of the ten achieved

interviews). The response rate was relatively high with twelve national providers contacted to

achieve the sample of ten. The interviews were semi-structured; eight of the interviews were

conducted over the telephone, and two were face-to-face interviews. One of the telephone

interviews was conducted with two managers simultaneously by conference call. The

interviewee sample by job title/area of responsibility is shown in box I.5.

Box I.5. National Provider Interviewees

Homes

Recruitment Director

HR Director (2)

Group HR Director

Corporate Services Director

IDPs

HR Director

Commercial Director

Managing Director and Head of Recruitment and

Retention

Managing Director

National Recruitment Manager

Coding and analysis

The responses to the telephone survey were entered into an SPSS data file. Efforts were made

to complete missing data, particularly where the respondents had not returned the advance

questionnaire but a number of the providers still did not complete the information. For those

who did complete the advance questionnaire (96 out of 115) the information was of a higher

quality than could have been achieved in one telephone interview.

Cross-tabulations were used to produce the descriptive statistical tables in part III of the

report to provide an overview of recruitment and retention in the selected providers and to


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document the rage of HR practices in use. To compare the use of HR practices between

individual providers and between groups of providers - by organisational and local authority

characteristics- the data on HR practices and outcomes were converted first into indicators

and then into subindices and indices to represent a range of practices from poor to good with

the value 1 for the best practices. Part IV, including the extensive appendix tables, gives more

detail on how these were constructed and used, and provides further analysis of the telephone

survey data. Multivariate analyses were also carried out using these indicators and indices.


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I.8. The research methods for stage three case studies

I.8.1. Rationale for the case-study approach

The role of the cases studies in the project design was to provide a more in-depth exploration

of how the HR practices of providers influenced recruitment and retention and to do this

through exploring the experience of work among the care staff. While the cases studies were

designed to explore the care workers‟ experience of the providers‟ HR practices it was also

recognised that many factors that shape recruitment and retention may be related to their own

personal and social circumstances. While some of these may be influenced by the employer,

others may not be. An understanding of some of the personal motivations and expectations of

those who enter the sector could help providers to put in place HR practices that can facilitate

a smoother entry into the sector and a more long term commitment to stay. The case-study

data was thus designed to provide more in-depth data on a range of areas including:

firm level practices and their impact on recruitment and retention in the care sector;

the characteristics and experiences of care workers including their entry into the

sector, their desire to stay or leave, and the levels of satisfaction with key aspects of

their employment;

the linkages, where they exist, between commissioning practices, employer practices

and job quality issues for care workers;

differences, where they exist, between the views of established staff and those of new

recruits to gauge potential problems in retention in the sector;

linkages, where they exist, between the provision of good quality care and good

quality care jobs.

I.8.2. Design of the case studies

Focus group with users

Involvement of service users was sought by holding a focus group with users in February

2009 under the auspices of Age Concern. Two researchers from the project and four service

users, including one member of the project advisory group, attended. The aim of the focus

group was to solicit care users‟ views on the most important issues to follow up on the

linkage between recruitment and retention issues and the quality of care. Issues discussed

were:

the attitudes, attributes and quality of care staff

working conditions

the organisation of care delivery

The views of the focus group on these issues were used to inform the case-study survey

design as outlined in Box I.6.


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Box 1.6. Focus group held with care users

During the focus group care users identified a number of issues relating to quality of care, the

working conditions of care workers and the organisation of care delivery and these themes

were integrated into all case study interview schedules. Some of the issues identified relating

to low pay and training were anticipated but other themes were unexpected. For example, the

focus group revealed that care users often have contradictory expectations of care workers;

they expect both the informality of friendship and the formality of a host/guest and

employer/employee relationship. To explore this further in the case study interviews we

included a section entitled „Relationships with users‟ in the interview schedule. This includes

questions that asked care workers whether they find it is easy to meet the expectations of

service users and whether they find it difficult to fulfil the different roles of both a care

worker providing a service and a friend. This theme is explored in part V which reveals that

care workers are constantly having to negotiate this difficult balance and when done well this

appears to improve both the working experiences of the care workers and the feedback they

receive from the care users.

Another important theme that emerged in the focus group with users related to the

organisation of care delivery and, in particular, the care users‟ concern about timekeeping,

timing of visits and care workers‟ capacity to deal with unanticipated events when timings of

visits are tightly defined. These issues were included in a section entitled „Doing the job‟. We

asked care staff about the lengths of visits, any difficulties that arise when carrying out tasks

in defined times and what happens when unforeseen events mean visiting schedules cannot

be met. These are particularly revealing questions as they ensured that care staff gave

concrete examples of what they were expected to do in the times they were allotted and the

problems that could arise because of the unpredictability of service users‟ needs. Specific

stories about the day to day reality of caring may be more informative than generalised views

about „being a care worker‟. Some of the difficulties and frustrations of working as a care

worker are revealed in responses to these questions as well as the good practice in the sector.

We therefore feel involving care users at the preliminary stages proved invaluable in ensuring

that the case studies generated meaningful data on the linkages between quality of care and

recruiting and retaining a quality workforce.

Design of the cases studies

In stage three of the project we aimed to interview five staff in five provider organisations

(two homes, two IDPs and one LA inhouse provider) in each of four local authority areas.

The interviews were semi-structured and separate interview schedules were designed for care

workers and supervisors. The interviews with care workers covered background information


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and work history of the employee, recruitment, pay, working time, job content, relationships

with service users, communication with management, training and development, career

prospects and future plans for working in care or elsewhere. Similar topics were covered in

the supervisor interviews, but we also asked additional questions about their supervisory role.

I.8.3. Selection, conduct and analysis of the case studies

Selection of LA areas for case studies

The selection of LA areas for case studies was done on a „rolling‟ basis which started before

the completion of the LA interviews in stage two. This was necessary in order to ensure

completion of the fieldwork within the project schedule. It was not, therefore, possible to use

the analysis of all 14 LAs as a basis for selection from the outset. We did, however, aim for a

good contrast between the four areas in terms of high/low wage areas, geographical areas,

local labour markets, a variety of LA commissioning approaches and fee levels. The four

chosen were IL, ON, XD and RN. IL was identified as a very low fee payer, RN a medium to

high payer and XD a high payer. These LAs also provided examples across the range of types

of LAs as subsequently classified through our interview material even though this typology

was not available at the time of selection of the first two LAs ( see section II. 3): XD and RN

feel into the partnership category, IL the cost minimising and ON fell into the mixed

category. IL and ON are in the north of England, RN and XD in the more affluent south. IL,

ON and RN are urban, or mainly urban, and XD covers a mixed urban and rural area. Parts II

and V give more details of the selected LAs.

Selection of case study organisations

In stage two of the project we asked the managers at the end of the telephone interview

whether they would agree to their establishment taking part in the project at a later date as a

case study. When selecting the case studies we approached those in the four selected LA

areas who had agreed in principle. We approached 30 organisations at this stage in order to

achieve the target sample of 20.

Selection of staff to be interviewed in each case study

The case studies primarily focused on the experiences of care workers within organisations

where a large amount of information had been collected through the telephone survey with

respect to their working conditions. In each case study we sought to interview two relatively

new recruits, and two longer serving, more senior members of staff. We also interviewed

someone with supervisory responsibilities, in addition to the four care workers. All the

telephone interviews with managers for the case-study organisations were fully transcribed

and analysed in detail to provide the organisational context in which to locate the care

workers‟ interviews. Nevertheless, the case studies were somewhat more employee-focused


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than was originally planned but the problems experienced in gaining cooperation from

managers to give of their own time for the telephone surveys made it very difficult to require

further cooperation from management as a condition for participation in the case study stage.

The stronger focus on the experiences of care workers themselves could be considered a

strength of the case-study data as it was revealing of a range of key issues in recruitment and

retention that is not visible from a management perspective.

Conduct of the case studies

A time and date convenient for the case study interviews was arranged with the manager in

each case. The managers were asked to identify five potential interviewees: we informed the

manager that the interviewees would be offered £ 15 shopping vouchers as an incentive to

take part and this proved very successful in helping to recruit interviewees. One or two

researchers travelled to the case study site on the agreed date, and individual interviews took

Table I.9. Composition of the achieved case studies

Type CQC

Star

rating

Local/

national

Private/public/

voluntary

Total no.

of staff

Established

ON

ON.D.1 DN IDP 2 star National Private 102 2005

ON.D.3 DN IDP 3 star National Private 30 1983

ON.HN.1 BS Home with

nursing

2 star Local Private 24 1979

ON.H.2.ML Home 1 star Local chain Private 52 2001

ON.DIH.1 DP LADP 3 star Local authority Public 128 Registered 2003

IL

IL.D.1 CN IDP 2 star National Private 70 2008

IL.D.2 DL IDP 2 star Local chain Private 210 1995

IL.H.3 BN Home 2 star National Private 25 2004

IL.H.4 BS Home 2 star Local Private 30 1998

IL.HIH.1 CP LA Home 2 star Local authority Public Registered 2003

XD

XD.D.1 CN IDP 3 star National Private 50 2004

XD.D.3 CN IDP 2 star National Private 60 Registered 2004

XD.HN.4 DN Home with

nursing

3 star National Voluntary 113 2006

XD.H.5 BS Home 3 star Local Voluntary 26 1947

XD.DIH.1 DP LADP 2 star Local Authority Public 130 1947

RN

RN.D.1 CN IDP 2 star National Private 60 Registered 2004

RN.D.2 CN IDP 2 star National Private 52 2005

RN.H.1 AL Home 3 star Local chain Private 23 1979

RN.H.3 AN Home 2 star National Private 24 2003

RN.DIH.1 DP LADP 3 star Local Authority Public 150 Registered 2004


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place in a location which ensured privacy. Before each interview the interviewee was given

printed information about the project, an information sheet on ethical issues approved by the

University of Manchester Research Ethics Committee, and asked to sign a form consenting to

be interviewed and for the interview to be recorded. The interviews lasted around 30 to 40

minutes. All recorded interviews were fully transcribed.

Composition of achieved case studies and staff interviewed

In all four of the selected LA areas we achieved the target number of case studies, i.e. two

homes, two domiciliary care agencies and one local authority provider. Four of the LA

providers were domiciliary care providers and one was a local authority care home. Table I.9

shows the characteristics of the case studies by type, star rating, local/national,

public/private/voluntary, total number of staff in the home or branch and date established or

registered.

Table I.10. Composition of staff interviewed

Less experienced

care workers

Experienced care

workers

Supervisor Total

ON

ON.D.1 DN 2 2 1 5

ON.D.3 DN 2 3 5

ON.HN.1 BS 1 2 1 4

ON.H.2.ML 2 3 1 6

ON.DIH.1 DP 2 2 1 5

IL

IL.D.1 CN 2 1 2 5

IL.D.2 DL 2 3 1 6

IL.H.3 BN 2 2 1 5

IL.H.4 BS 2 2 1 5

IL.HIH.1 CP 2 2 1 5

XD

XD.D.1 CN 2 2 1 5

XD.D.3 CN 1 3 1 5

XD.HN.4 DN 2 2 1 5

XD.H.5 BS 2 2 1 5

XD.DIH.1 DP 2 2 1 5

RN

RN.D.1 CN 2 1 1 4

RN.D.2 CN 2 2 1 5

RN.H.1 AL 2 2 4

RN.H.3 AN 2 1 1 4

RN.DIH.1 DP 2 2 1 5

Total 36 40 22 98

Table I.10 shows the numbers of staff interviewed at each organisation. In most cases the

target number was achieved. In two cases we interviewed more than the target number,

because more than the requested numbers arrived for interview, and it would have been


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difficult not to interview them all as they had been promised shopping vouchers. In five cases

we interviewed fewer staff than we needed, or did not achieve the desired mix of experience.

In the IDPs in particular the number and experience mix of interviewees was constrained by

the practicality of staff coming in to the office in their spare time to be interviewed. In one

home one interviewee was working as a cook, but was interviewed because she had daily

contact with residents and had previous experience of care work. This interview is not

counted in the total sample.

Analysis of the case studies

In total we conducted 98 interviewees and the desired split between new recruits and

established staff was achieved (see table I.10 and table I.11). Although we tried wherever

possible to include a mix of care workers in the sample that are underrepresented in the care

workforce, including men, younger workers, care workers from different ethnic background

and migrant workers, the sample was predominantly female and white British and over half

within the 30-49 age category (see Table I.11).

Table I.11. Sample composition by job tenure

Sample No. 2 yrs or under

(%)

2-5 years

(%)

6-10 years

(%)

Over 10 years

(%)

IDPs 381 71 21 3 5

Homes 38 50 26 13 11

LAs 20 25 25 20 30

Total 961 53 24 10 12

1Two IDP care workers- no information

Table I.12. Sample composition by age: all and new recruits

Under 30

(%)

30-49

(%)

50-59

(%)

Over 60

(%)

Sample

No.

No.new

recruits

Total New

recruits

Total New

recruits

Total New

recruits

Total New

recruits

IDPs 40 21 28 33 53 52 18 14 3 0

Homes 38 12 26 42 53 42 16 8 5 8

LAs 20 10 10 10 60 50 30 40 0 0

Total 98 43 23 30 54 49 19 19 3 2

For each organisation we developed a template where relevant extracts and quotations

relating to a number of themes were recorded for each interviewee. An inductive approach

was adopted: while some themes were determined by the interview schedule and the research

questions of the project, others were unanticipated and were generated by the responses of

interviewees. For example, we did not anticipate the extent of the use of family and social

networks in shaping entry into the sector and when this theme started to arise in many of the


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interviews we ensured all interview data had been analysed with this theme in mind. The

template facilitated comparisons between providers within case study local authorities and

across local authorities. It also allowed comparisons between new recruits and well

established staff as well as staff with supervisory roles and coordinating roles. The templates

also allowed us to quantify some of the trends found in the case study data. While the aim of

the case study data was to explore the care workers‟ attitudes and experiences using

qualitative techniques, the number of interviews also allowed us to identify some general

trends. This opportunity was particularly useful because of the limited data on care workers

as a group. While the case studies of each organisation were interesting in their own right, for

this project the comparisons between cases within and across different local authorities was

also significant as this could help tease out any explanatory factors that could account for any

similarities or differences across the sector. Of particular interest here were the two case

studies of national chains operating branches under two different local authorities as this

offered insights into the relative impact of company policy versus commissioning and local

labour market conditions on HR practices.

I.9. The plan of the report

This first part of the project report has described the research framework, reviewed the

relevant literature, formulated the key research questions and provided an overview of the

methodology adopted and the samples achieved. The organisation of the rest of the report is

as follows. Part II describes the commissioning and contracting practices identified in the 14

selected LAs and provides a typology or classification of commissioning practices. Part III

provides a mapping of the current HR practices according to the telephone survey of our

achieved sample of 115 providers, analysed by IDPs, homes and LADPs. Part IV explores the

role of LA commissioning practices, local labour market conditions and characteristics of

providers in accounting for variations in HR practices and HR outcomes. It also explores

relationships between providers and LAs from the providers perspectives, including those of

national chains. Part V also explores the impact of different LA commissioning

environments and different provider HR practices but this time from primarily a care worker

perspectives. Here the role of work organisation and staff recruitment and retention in

providing quality of care is also emphasised. Part VI draws together the different pieces of

evidence to address our nine research questions including the pointers for public policy to

promote the recruitment and retention of the social care workforce.

Part II. Commissioning and contracting in the selected local authorities

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II. Commissioning and Contracting in the

Selected Local Authorities

One of the project‟s key hypotheses is that the commissioning and contracting practices of

Local Authorities shape the environment in which private and voluntary sector providers are

able to seek to recruit and retain the social care workforce. Here we explore the

characteristics of these commissioning and contracting practices in the fourteen LAs that we

selected for further study. The chapter is divided into four parts: in II.1 we combine

information from the first stage survey of LAs with information from the second stage LA

interviews to provide a quantitative analysis of the key characteristics of commissioning and

contracting practices. In II.2 we analyse the qualitative material based on the interviews with

key actors in commissioning and contracting in stage two of the project to explore the

different pressures placed on LAs and to identify the approach taken by our selected LAs. In

II.3 we draw together the two sources of information to provide a categorisation of the

approaches by the selected LAs to be used to inform our analysis of the telephone survey of

providers. Finally in II.4 we use our classification of LAS to explore variations in user

satisfaction scores in the home care survey of LAs 2008-9 (NHS Information Centre 2009a).

II.1. Key commissioning and contracting characteristics

II.1.1. Extent and form of external commissioning and contracting

Extent of outsourcing in domiciliary care

The fourteen LAs all contracted the majority of their domiciliary care work to independent

providers (see table II.1 column 1)10

. The shares outsourced varied between 55% and 100%:

two outsourced under 60%, five between 60 and 80%, five over 80% but still with some

inhouse and two outsourced 100% with no inhouse provision. This level of outsourcing was

relatively new in some cases with 6 reporting that the majority was outsourced only after

2005, five between 2000 and 2004 and three before 1999. There is no link between the date

of outsourcing and current levels: two that started early have relatively low levels of

outsourcing and two that moved late to significant outsourcing have ratios above 80%. There

is also a continuing tendency for the LAs to increase the share of work outsourced with

10 This share is higher by contact hours than by price due to higher unit costs for LA provision. Most of the LAs

when asked in interview gave the information on an hours basis; this difference in measurement in part explains

the higher levels of reliance on external providers in our follow up interviews from the first stage survey.


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increases in several between the stage one survey and the stage two interview and six LAs

had plans for further increases. Only one anticipated a possible reversal of this trend if more

emphasis was placed on re-ablement; this was an LA that currently outsourced over 90% but

its inhouse provision, joint with the NHS, was focused on re-ablement.

Of the twelve still with some inhouse provision, five were providing both specialised and

general domiciliary care from its inhouse provision while seven had already moved towards a

specialised focus for inhouse provision (Table II.1 column 3). Two LAs (OM, TE) had

changed from more general to more specialised inhouse provision between the first stage

survey and the second stage interview. In six LAs only inhouse units were engaged in

intermediate and/or mental health elderly care (table II.1. column five). In the remaining

eight, six recorded involvement by both inhouse staff and independent provider staff while

two, those with no inhouse provision, relied entirely on independent providers.

Involvement in unsocial hours working is common across both LADPs and IDPs. All LADPs

were involved in daytime, evening and weekend work. Likewise, all independent providers

were involved in these forms of work. The majority of evening and weekend work is likely to

be carried out by the independent sector given their high share of total care hours and

expenditure. The main differences among LAs were found in night work (table II.1. column

six). One carried out no night work by either type of staff. A further two had no inhouse

facility and five more undertook no night work, leaving six LAPDs that were involved in

night work. Three of these six did not involve any IDPs in night work. In the 10 LAs where

IDPs were involved, this concerned all providers in five LAs but only some providers in the

other five. Overall, there is a strong reliance on the IDPs for the unsocial hours working but

as inhouse operations have become more specialised, there is also a high involvement among

the remaining inhouse staff.

Among our LAs all but three commissioned jointly for intermediate care with the NHS (table

II.1. column seven). The three exceptions had either no or very limited inhouse provision.

This may suggest that the lower the direct involvement of LAs in service provision, the less

likely their involvement in joint commissioning. While the stage one survey found that three

LAs did most of their commissioning with the NHS all the rest recorded an involvement of

under 20% except for one other at 40-60%. One LA (AH) had become fully integrated with

the NHS between the stage one survey and the stage two interview. In several cases there

were plans for more involvement, even in one case when currently there was no involvement.

Independent care staff were involved in providing jointly commissioned services in half of

our LAs (table II.1. column eight).


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Table II.1 Key commissioning and contracting characteristics for domiciliary care

LA %

Outsourced

Planned

change to

outsourcing

Role of the

LADP

Involvement in

intermediate and/or

mental health care

Involvement in

night work

Integration

with the

NHS*

Independent sector staff involved in joint

commissioned intermediate care

AH 80%-99% Less Specialised Both LA and IDPs IDPs only High Joint commissioning but no IDP staff involved

ON 60%-80% More Specialised LA only IDPs only Low IDP staff involved in more than one area

RT 100% No change None IDPs only IDPs only Very low No joint commissioning

RN 80%-99% No change Specialised Both LA and IDPs LA only High Joint commissioning but no IDP staff involved

UY ≤60% No change Mixed Both LA and IDPs LA only Low IDP staff involved in more than one area

AD 60%-80% More Mixed LA only IDPs only Low IDP staff involved in more than one area

AW 100% No change None IDPs only IDPs only Very low No joint commissioning

IL 60%-80% More Mixed Both LA and IDPs Both LA and

IDPs

High Joint commissioning but no IDP staff involved

OM 80%-99% More Specialised# LA only Neither Low IDP staff involved in one area

XD ≤60% No change Mixed Both LA and IDPs LA only High IDP staff involved in more than one area

HD ≤60% More Specialised LA only IDPs Low IDP staff involved in more than one area

TE 80%-99% No change Specialised# LA only Both LA and

IDPs

Medium No joint commissioning

LK 80%-99% No change Specialised LA only Both LA and

IDPs

Low Joint commissioning but no IDP staff involved

RD 60%-80% More Specialised Both LA and IDPs IDPs only Low IDP staff involved in one area

*Integration with the NHS: High = ≥60% intermediate care joint commissioned

Medium = >20%≤60% intermediate care joint commissioned

Low = ≤20% intermediate care joint commissioned

Very low = no joint commissioning of immediate care

# Recent change from general to specialised


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Number of providers and contract form in domiciliary care

The number of domiciliary care providers that the LAs contracted with at the time of the

stage 2 interview varied w from five to 35 (table II.2. column two). The extent of additional

spot contract arrangements varied between LAs, complicating comparisons of the number of

actual providers. For example, one LA (AW) had intended to use almost exclusively two

main providers for each of its two main geographical areas but due to major post contract

problems with one of the providers, much of the work was being undertaken by providers

with only spot contract arrangements with the authority.

Table II.2 sets out the different types of contracts and number of providers under each type

that were active within the fourteen LAs. One of the major areas of change, both over recent

years and planned for the future, was the switch from block contracts to preferred providers.

The most common form now of contracting is through selected preferred providers but often

contracted under a framework agreement or under a cost and volume contract but with no

guaranteed hours. This applied to nine of the LAs. The five other LAs used block instead of

preferred providers but only four of these put most of their work though block contracts. The

fifth LA had a large rural hinterland served by a large number of spot contract providers.

Compared to the stage one survey results for early 2008, the number of our LAs with block

contracting had reduced by late2008/2009 from six to four. A further four had also recently

moved from block to preferred provider, three of them in 2007/8 (table II.2. column six).

Two of the LAs using blocks in 2008/9 had in fact moved to block contracting in the

relatively recent past (since 2005), so that the direction of travel was not all in one direction.

Furthermore, the move from block to preferred provider was not in all cases associated with

an increase in the number of providers. Two LAs had in fact reduced providers while moving

from block to preferred provider (AH, AW). One of these LAs (AH) also described the new

arrangement as a „new block‟ contract, that is involving similar commitments to block but

without minimum guaranteed hours. Overall there is quite a diversity not only in the number

of providers contracted with but also the direction of change; eight had explicitly sought to

decrease the number of providers it mainly dealt with while four had sought to increase the

number (and only two recorded no change). The outcome of these various strategies had also

resulted in quite a diversity among the LAs in the extent to which they were primarily reliant

on relatively few or quite a large number of domiciliary care providers to deliver the bulk of

their domiciliary care. Thus four relied on five or fewer, four on six to ten providers, four on

11 to 20 and two on more than 20.

All the LAs had divided up their tenders by geographical areas but still had adopted quite

different strategies with respect to the designation of providers by area. In some LAs (at least

seven) there was only one provider per area. In others there was a main provider and one or

more second tier providers (either spot providers or preferred providers who had a main and

one or two more subsidiary areas). Only three had a number of main providers per area (two

had three and one five). The characteristics of the areas had an impact on the tender

arrangements in some cases. For example, XD required bidders to choose an easy to service


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area and a difficult to service area as an explicit means of increasing the supply of services in

the more rural areas.

Table II.2. Characteristics of LAs’ organisation of domiciliary care contracting.

LA Number of

external providers

of domiciliary care

LA contracts with

Number

of block

contracts

Number

of

preferred

providers

Number

of spot

providers

Recent changes in

block contracting

Experience of

TUPE

transfer

AH 5 0 5 10 Away from block none

ON 17 0 10 7 Away from block none

RT 7 1 6 0 No change some

block

LADP to IDP

RN 10 0 10 0 No change no block none

UY 10 0 6 4 No change some

block

none

AD 10 0 4 6 To block none

AW 10 0 2 8 Away from block LADP to IDP.

IDP to IDP

IL 9 0 9 0 Away from block IDP to IDP

OM 17 0 17 0 Away from block none

XD 35 11 0 24 To block none

HD 17 10 0 07 No change some

block

none

TE 5 0 5 0 No change some

block

IDP to IDP

LK 30 30 0 50 Away from block none

RD 14 0 6 8 Away from block none

In three of the LAs, inhouse staff had been TUPE transferred to external agencies and in one

case the same staff had been TUPE transferred a second time to a new agency (Table II.2.

column seven). The TUPE regulations protect the terms of employment of transferring staff,

resulting in continued LA pay and non-pay conditions which are more generous than in the

private sector (see part 1). In all three cases these arrangements were still having a significant

impact upon the fees paid to the providers concerned. TUPE arrangements affected not only

ex-LA employees, but also cover staff moving from one independent sector provider to

another. In at least three LAs there were examples of staff TUPE transferred from one agency

to another due to changes in the providers, either because of outcomes of tenders or because

of closures of providers.


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Commissioning and contracting of care homes

Twelve of the fourteen LAs still provided some residential home care inhouse (table II.3.

column two). Those without LA provision included one which also had no domiciliary care

but the second LA with no domiciliary care was still providing a range of forms of inhouse

residential care. The second LA (XD) with no inhouse provision had transferred its homes to

one specific provider. Ten of the LAs provided short term intermediate care and ten

dementia-specific short term care (though not the same ten as two provided intermediate and

not dementia and two vice versa). Four of the twelve with some inhouse provision only

provided short term care of some kind (including short term care in a resource centre

although this was always combined with either intermediate or dementia short term care or

both) (table II.3 column three). The remaining eight were involved in some forms of long

term care: all eight provided dementia long term care and three provided resource centre

based long term care but none provided short or long term care under the heading of other,

suggesting all had withdrawn from standard residential care provision.

Ten LAs have some block purchase contracts with independent providers for residential care

of various kinds (Table II.3 column four). While the purposes of the block purchases are

spread across dementia, respite and intermediate care- with only two mentioning other

purposes (non specific and carer support respectively), the proportion of the residential care

accounted for by block purchases was most commonly under 10% ( six LAs). Two LAs (IL

and XD) had shares above 40% while two (AW and LK) had shares at 20-29% and 10-19%

respectively. The high share at XD was due to the transfer of its homes to a specific provider.

In IL intermediate care is contracted out through a block contract although consideration is

being given to changing the inhouse provision form long term care to short term care which

might reduce the use of block contracting. With these exceptions, contracting was thus

mostly on a spot basis, usually according to the preferences of the user. LAs usually had a list

of homes that they were prepared to place users in; in some cases they had a policy of only

placing users in homes above a minimum CQC star rating (either one or two star) but

sometimes they would still make exceptions if there was either a shortage of beds or a strong

reason why the user preferred the home even though it had a poor quality rating. Under this

spot contract policy the number of homes that the LA was currently contracting with was

normally quite large although the numbers quoted varied from 30 or so to 400. Where the

area bordered other residential areas- for example in the outer London boroughs- there was

more use of homes outside the area. In some cases (RD) this was a planned strategy as labour

costs were lower across the border so that those not able to pay top up fees were encouraged

to choose a home outside RD.


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Table II.3 Commissioning and contracting of residential care

LA Local authority is a

provider of

residential home

care?

Type of residential care

provided

(all intermediate,

dementia or resource

centre – no ‘other’)

LA has any block

purchase

arrangements with

residential or nursing

homes

Estimate of block

contracting as share of

total beds by external

providers,

Residential care price per

week for older people

provided by others.

PSS EX1 Return for 2007-081

Higher fees for

higher quality

homes

AH Yes Long and short term Yes 1-9% High >£460 No

ON Yes Long and short term Yes 1-9% Low £350-£390 No

RT Yes Long and short term Yes 1-9% Medium £390-£460 No

RN Yes Short term only Yes 1-9% High >£460 Yes

UY Yes Long and short term No N/A Medium £390-£460 Yes

AD Yes Long and short term Yes 1-9% Medium £390-£460 Yes

AW No None Yes 20-29% High >£460 No

IL Yes Short term only Yes 40-49% Very Low <£340 No

OM Yes Long and short term No N/A Very Low <£340 Yes

XD No None Yes 50% or more High >£460 No

HD Yes Short term only Yes 1-9% Low £340- £390 No

TE Yes Short term only No N/A Low £340- £390 Yes

LK Yes Long and short term Yes 10-19% High >£460 No

RD Yes Long and short term No N/A Low £340- £390 No

1Definition- based on unit costs residential care for older people provisions by others Unit Costs Summary Sheet PSS EX1 return 2007-8 annex council tables.

http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-information/personal-social-services-expenditure-and-unit-costs:-england-2007-08

http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-information/personal-social-services-expenditure-and-unit-costs:-england-2007-08


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II.1.2. Provision of fees for externally provided care

Fees for domiciliary care

Six of the LAs set a fixed fee per hour when they published the tender for IDPs and all

providers were contracted at that rate11

(table II.4. column two). In the remaining eight cases

fees varied across providers according to the price at which different providers tendered to

provide services. Those paying fees according to tender price were much more likely to ask

for the wage element to be separated out at tender: this applied to seven of our LAs and an

eighth that asked for it at short list stage. Only one of these eight (LK) paid a standardised

fee. The practice thus seems to be more about the LAs wanting additional information if it

were to pay above a standard rate than a policy to select on the basis of fair treatment of staff.

Only two of the LAs specified a minimum wage to be paid (TE that did not ask for the wage

elements to be spelled out and XD that did). In practice even if the fees were fixed according

to the IDPs‟ tender price, the variation within an LA was quite low, that is at £2 to £3.50

except for one LA (XD) where the range was £12 between the lowest and the highest fee

(table II.4, column four). The LA (LK) that had different prices by area had a differential of

£4 between the most difficult and the easiest to service and it is likely that some of the

variations in the other LAs reflected differences by geographical area. The three LAs which

contracted with agencies where TUPE transferred inhouse staff were employed paid these

agencies a fee that exceeded the median rate for the other IDPs by between £4 and £7.50 per

hour12

.

The average fee paid to IDPs (excluding these TUPE related fees13

) ranged from £10.45 to

£14.50 for 13 LAs. XD was again an exception with a higher implied average fee as well as

large range of £16 to £28; we have classified the average fee for XD as £20. To classify the

LAs by fee level we paid attention to both the lowest fee and the midpoint or modal fee level

(where this was indicated to us). Two paid a fixed fee to all below £11 and we classified

these as very low payers. Two more had average fees below £12 and we classified these as

low payers (one paid a fixed fee14

and the other had variable fees). Those paying between £12

and £14 – both minimum and average fee levels were classified as medium fee payers and

those paying above £14 on average and above £13 as a minimum were classified as high fee

payers (table II.4 column three).

11 In the case of LK there were three fixed prices related to the nature of the geographical area- easy to service,

medium and hard to service. 12

No precise information for RT but a significant differential was paid 13

The fees rates reported for agencies with LA TUPE transferred staff were £22 compared to an average of

£14.50 to other providers (AH) and £16 to £19 compared to an average of £13 to other providers (AW) (table

II.4. columns 2 and 3) 14

In the case of ON there was a move from a fixed flat rate of £11.17 per hour with a higher price for half an

hour contact visit to a fee of £1 per hour plus a proportion of £12.15 per hour depending on the actual recorded

minutes of the visit. The flat rate element was to be reduced in 2010 to 60p.


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Table II.4 Fee levels and fee setting for domiciliary care

LA Standard price or

contract price

Standard price

or midpoint of

price range

Range of price variations

- maximum minus

minimum 1

Source of

variations across

providers

Additional

payments for

unsocial hours

Travel costs Classificati

on of LA

by fee level

AH Varies by tender

offer

14.50 £3

£9 including TUPE

Tender offer,

preferred/spot,

TUPE

Bank holidays

Weekends or nights

No specific provision High +

ON Price set by LA 11.17 £0 None Bank holidays3 Higher price for 30 minute visit.

Require payment in contract

Low+3

RT Varies by tender

offer

13.00 £2 (estimate)

TUPE price not known

Tender offer

TUPE

Higher price for 30 minute visit Medium+

RN Price set by LA 13.10 £0 HR performance Weekends or nights Higher price for 30 minute visit Medium+

UY Price set by LA 13.16 £0 None Monitor for gaps Medium+

AD Price set by LA 10.45 £0 None No specific provision Very low

AW Varies by tender

offer

13.00 £2

£7 including TUPE

Tender offer

TUPE

No specific provision Medium

IL Price set by LA 10.78 £0 Urban/rural No specific provision Very low

OM Varies by tender

offer

12.53 £3.49 Tender offer No specific provision Medium

XD Varies by tender

offer

20.004 £12 Tender offer

Urban/rural

Weekends or nights Rural price High+

HD Varies by tender

offer

11.74 £1.93 Tender offer

Urban/rural

Rural price Low

TE Varies by tender

offer

13.08 £2.60 Tender offer

Performance

No specific provision Medium

LK Price set by LA 14.25 £4 Urban/rural Rural price High+

RD Varies by tender

offer

12.5 £3 Tender offer

Urban/rural

Rural price Medium+

1These ranges exclude fees paid to IDPs with TUPE transferred staff 2 + indicates either some provision for unsocial hours payments, for travel time or for performance bonus 3These were withdrawn between our LA interview and our survey of providers 4This LA had a range of £12- the norm was estimated on the basis of the interview to be closer to the bottom of the range- we thus took the point one third of the way up the range rather than the

midpoint.


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The fee paid per contact hour may not, however, capture all the dimensions of the generosity

of fee provisions. In particular it does not provide us with information on how contact hours

are calculated. Such information is difficult to collect in detail in a comparable form and was

beyond the scope of this project. However, some information was collected on additional

aspects of fee provision, particularly with respect to issues such as type of care, the treatment

of travel time, unsocial hours, etc. The first point to note is that the fee paid for domiciliary

care was a flat rate fee, not normally differentiated by level of care provided, except in some

cases where the LA was commissioning intermediate care in conjunction with the NHS. This

pattern for our selected LAs complied with that found in the stage 1 survey. For the 90

responding LAs over one third, 36%, had a standard price for domiciliary care. Of the

remaining 64%, only 10% of LAs, just over 6% of the total sample, reported variations in fee

by individual user and this did not include any of our LAs. The implication of this policy is

that there are no gains for providers in relation to the fee paid if they have more skilled staff

able to undertake care work for those with a higher level of dependency, unless this work

falls under a different commissioning process.

Very few LAs also provide for travel time explicitly in their pricing and fee policy. Of the

fourteen in our survey only three paid more for short hours visits (usually a higher rate for 30

minutes) and two of these were phasing this practice out (ON, RN). A number of other LAs

said they had paid higher rates in the past but had already phased them out in the interests of

administrative simplicity. One other LA (UY) said it paid for travel time in calculating

contact hours. Four had an explicit policy of paying extra for rural domiciliary visits but this

was normally built into the standard price for the provider who covered the rural area. This

information was confirmed at the stage two interview but also matched answers to the first

stage survey with respect to variations by ease of travel, except for one LA (LK) that

responded to the stage one questionnaire that it had a standard price for domiciliary care but

in practice it had recently introduced three standard prices which varied according to the

travel issues in the area. As eight of the fourteen LAs did pay different rates to providers

there may be more allowances for travel issues than perhaps is captured by these measures.

One LA (TE) paid a higher fee not on the basis of travel time per se but if the provider agreed

to take on a case that was outside their specified geographical area. This may reflect a

tendency to only allow one fee per provider under the contract, unless something unusual

outside the standard terms occurs. Another factor affecting payment for travel time is whether

or not electronic monitoring is used. One LA (ON) moved to payment by minutes based on

electronic monitoring during the period of our telephone survey of independent providers and

this was changing how providers compensated staff for travel time (see part III and part V

below). There was even less evidence of additional payments for unsocial hours in the fees

paid by our fourteen LAs. Two (ON, AH) paid extra fees for bank holidays but one was

considering phasing this out (ON). Only three paid extra for nights or weekend work (AH,

RN, XD).

This low incidence of additional payments is similar to the overall results for the stage one

survey where only just over 20% of the LAs without a standard price said they paid extra for

travel time. Two LAs, both medium fee payers (RN and TE) provided some additional fee for


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providers who met performance targets, with RN specifically setting HR performance targets

and requiring providers to spend the additional fee on their staff.

If we include additional payments for unsocial hours or travel time into the analysis (table

II.5 column five) we find that these additional payments on the whole reinforced divisions

between LAs rather than compensated for low basic fees. The one low payer that was making

additional payments was withdrawing from these as it moved to payment by minutes

recorded by a new electronic monitoring system (although it was also raising the fee level,

potentially pushing it into the medium category). However, the greater incidence of

additional fees for travel among the high payers reflected the rural nature of the areas covered

in the two cases concerned.

Fee levels are related to geographical location: Table II.5 shows that all the very low and low

fee payers are located in the north and all the high payers in the south. Among the medium

fee payers three are southern LAs, three in the midlands and one a northern LA. All the high

fee payers were in areas of high female labour demand (see section I.7 and appendix table

I.A1). Local labour market conditions may explain the positioning of two southern LAs (the

two outer London boroughs) within the median fee category as they scored only three for

female labour demand but the final southern LA had a score of five for female labour

demand. Another outlier is the northern LA that is a low fee payer but has a five score for

female labour demand. The other three low or very low payers were in areas of low or

medium female labour demand. Fee levels in the majority of the LAs thus bear some relation

to geographical position and local labour market conditions but the relationship is not fully

consistent.

Table II.5. LA fees for domiciliary care by geographical area and local labour market

conditions

Total Geographical area Local labour market

conditions:

Additional payments for unsocial

hours, travel or performance

Number of LAs given + in table

II.4 column 8

Low and very

low fee payer

4 4 north 1 strong, 3 weak 1+*

Medium fee

payer

7 1 north, 3 midlands,

3 south

1 strong, 4 medium, 2

weak

4+

High fee payer 3 3 south 3 strong 3+

Note: *These were withdrawn between our LA interview and our survey of providers

Fees for residential care

Table II.3 column six classifies the LAs by the average cost of their residential care for older

people (without nursing or dementia) according to the data provided by the LAs themselves


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in their PSS EX1 Return for 2007-08. We have used these data in preference to that provided

by the LAs in our survey as it became apparent that there were inconsistencies in how these

fees were reported to us. However, the published data corresponds to our information in most

cases, except where we were doubtful of its accuracy. One- that for OM- appears rather low

but there have been changes in its system since 2007-8 including quality uplifts which may

account for this divergence. Only broad categories have been used here to preserve the

anonymity of the LAs. There are major problems in classifying the LAs according to fee

levels as it is clear that the variations in fee levels are very large and reflect differences in

property markets more than in labour markets. For example, the two outer London LAs are

classified here as high and medium payers but both pay below average for outer London.

While this could be an alternative way to classify the LAs for the two cases, there is a very

wide variation in property and labour markets in for example unitary authorities, metropolitan

areas and shire counties so that these average fee data are less helpful for the purpose.

The information that we did gain from our interviews is that many LAs have introduced

quality enhancements. Five of the LAs are currently paying higher fees to higher quality

homes (table II.3. column seven) and ON pays an additional fee for Investors in People award

and is considering a more fully developed quality framework. As we discuss further below,

there are differences in the strategies used by LAs with respect to setting their fee level; some

aim to minimise any pressure for those placed in homes to pay top up fees, while others

expect most to have pay an additional fee or even seek to place those unable to pay additional

fees in homes located in cheaper property areas outside their own boundaries.

Classifying the LAs by fee level: domiciliary and residential combined

To put all this pricing information together we have combined information on domiciliary

and residential care. In Figure 3.1a.we classify the LAs on the basis of average fee for

domiciliary (table II.3. column 8) and the average cost of residential care (table II.3 column

six). We allocate a score of 1 to 4 for very low to high for each category and for overall

categorisations we take high payers as having a score of eight, medium six or seven, low five

and very low four or less. On this basis we have five very low fee payers (IL, HD, AD, OM,

ON ) two low fee payers (TE, RD) four medium (AW, RN, RT, UY) and three high (AH,

LK, XD) (note the squares are shaded from light to dark as one moves from very low to low,

medium and high fees). In Figure 3.1b to capture the extent to which LAs provide additional

payments for quality in the cases of homes we add 0.5 to every LA that has a quality uplift

and for LAs that pay for either unsocial hours and travel to IDPs we add a 0.5 to the score for

domiciliary fees (table II.4 column seven). We then adjust our scoring categories with very

low still 1 to 4, low 4.5 to 5.5, medium 6 to 7 and high 7.5 to 9. On this basis three move

from very low to low (AD, OM, ON) and one (RN) moves from medium to high. Indeed all

but IL, HD and AW increase their scores by 0.5 points.


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Figure II.1a. Categorising the LAs by standard fee levels- domiciliary and residential

Domiciliary care fee

Res

iden

tial

ho

me

fee

Very Low Low Medium High

Very Low IL OM

Low ON

HD

TE

RD

Medium AD RT

UY

High AW

RN

AH

XD

LK

Figure II.1b. Categorising the LAs by standard fee levels and quality enhancements -

domiciliary and residential

Domiciliary care fee

Res

iden

tial

ho

me

fee

Very

Low

Very

Low+

Low Low+ Medium Medium+ High High+

Very Low IL

Very Low+ OM

Low HD ON RD

Low+ TE

Medium RT

Medium+ AD UY

High AW AH,XD

LK

High+ RN


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II.1.3. Role of HR factors in tendering, contracting and monitoring

The stage 1 survey asked whether LAs required providers to conform to up to ten HR policies

in either the tender or their contracts for IDPs. In practice most LAs included the same

number of policies at tender as at contract15

. In practice only three LAs (AH, IL, RD see

Table II.6 column 3) included most or all of the ten policies, at nine or ten policies each. The

majority of LAs (six at tender, five at contract) included six to eight policies while four at

tender, five at contract included fewer than six. (One LA (XD) had missing data). Three

policies were categorised as concerned with pay (pay for training, travel or mileage) and five

with training and development16

(staff development and appraisal, management training,

induction and training, specialist dementia training and training achievement against national

targets). More LAs (11) scored high on training and development (with at least four out of the

five policies) compared to only four LAs who included at least two out of three pay policies.

Only three LAs required payment for training time (AH, ON, IL) and only five for travel time

(AH, ON, RN, IL, RD).

15 One LA (ON) included more policies at contract stage and one (OM) at the tender stage

16 The two excluded were payment for sick pay as it was not clear if this referred to more than statutory sick pay

and supervision of staff as all but one LA included this in their requirements.


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Table II.6 LAs’ monitoring and quality frameworks

Domiciliary care providers Residential homes

Number of policies

In tender/In contract

Quality monitoring by LA Number of policies

In tender/In contract

Quality monitoring by

LA

LA training

policies

Maximum

51

pay

policies

Maximum

32

HR policies

Maximum

103

Own framework

without/ with financial

incentives

Use of electronic

monitoring

training

policies

Maximum

51

pay

policies

Maximum

12

HR

policies

Maximum

83

Own framework with/

without financial

incentives

AH 4/4 3/3 9/9 Yes None 4/5 1/1 7/8 None

ON 0/2 0/2 0/5 Yes Planned* m m m Yes with financial

incentives

RT 5/5 0/0 6/6 No All 5/ 5 0/0 6/6 None

RN 4/5 2/2 7/7 Yes with financial

incentives

None 5/ 5 0/0 6/6 Yes with financial

incentives

UY 4/4 0/0 5/5 Yes Some 0 0 0/n,a, Yes with financial

incentives

AD 5/5 0/0 6/6 Yes Planned 5/ 5 0/0 6/6 Yes with financial

incentives

AW 0/3 3/0 4/4 No All 0/3 0/0 0/4 None

IL 5/5 3/3 10/10 Yes All 5/5 1/1 8/8 Yes

OM 5/3 2/0 8/4 No Some 0 n/a 0/n.a. Yes with financial

incentives

XD m m m Yes All 4/0 0/0 5/0 Yes

HD 5/4 0/0 6/6 Yes Planned 4/n/a 0/n/a 4/0 Yes

TE 4/4 0/0 4/4 Yes with financial

incentives

All 4/n/a 0/n/a 4/0 Yes with financial

incentives

LK 5/5 0/0 6/6 Yes None 5/5 0/0 6/6 Yes

RD 5/5 2/2 8/8 Yes None 3/n.a. 0/n/a 4/n.a Yes


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In relation to tenders with care homes LAs were only asked about eight HR practices as travel

time and payment for mileage were much less relevant. Three LAs specified no policies in

their tenders and for another data were missing. Of the remaining ten, six specified six or

more policies and four between four and five. However, only two specified payment for

training, the only pay policy apart from the ambiguous sick pay question. Most policies were

related to training with nine LAs specifying at least four training policies, not including the

pay for training policy. The question about contracting referred only to block contracting

which only applied to ten LAs. Of these, two did not provide for any HR policies in their

contracts and one had missing data while six specified six policies or more and only one had

a low score at four. Only two LAs specified pay for training while six had at least five other

training policies in their contracts.

The majority of the LAs were also actively involved in monitoring the provider with respect

to HR practices and many were active in developing their own quality framework: only two-

the two outer London boroughs- relied entirely on external monitoring by CQC and one was

planning to introduce its own framework. Of the remaining 12, all but one had a quality

framework for IDPs and nine for homes. Two LAs (TE and RN) offered financial incentives

to IDPs for meeting quality targets, with the target explicitly related to HR issues in one case

(RN). Although quality frameworks were somewhat less common for homes, they had

potentially more impact on providers as they were associated in six LAs with a quality-based

pricing framework. Five however had their own quality framework for monitoring (RD, IL,

HD, XD, LK) without any financial incentives.

Another mechanism for monitoring IDPs was electronic monitoring. This was another area of

rapid change. At the time of the stage two interviews five LAs had already introduced

electronic monitoring for all17

(table II.6 column six) and two were using it with some

providers In almost all cases this was a very recent development and another LA (ON)

introduced it over the period of the survey with a further two having active plans to introduce

it. This left four with no current use or plans for its use.

II.1.4. Extent of support for providers through forums and training provision

Local authorities provide additional support to independent providers in two main ways: first

by providing or organising training for independent sector staff; second by consulting with

providers through forums and in relation to commissioning strategies.

17 AW said it had a mix as not all spot contractors had introduced it but further probing revealed that it was only

those with electronic monitoring that were being actively commissioned.


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Table II.7 LAs’ support for providers through training and provider forums

LA Frequency of

forum

meetings per

annum

High- 6+

M-3 -5

L-1 or2

Organisation of

forums for

domiciliary and

residential homes

providers

Training

partnership

with

independent

providers

1st stage

survey/ 2nd

stage interview

Number of

types of

training1

provided by

LA to

Independent

sector

Stage 2

interview

Assessment of

training

activity by LA

alone or in

partnership

Involvement in

commissioning

: Providers of

social care

services

AH M Combined No/No Low Low Yes

ON M D and H separately No/Yes Low High Yes

RT M D only No/No Low Low Yes

RN H D only Yes/No Medium High Yes

UY H D and H separately Yes/Yes High High No

AD H Combined Yes/Yes Zero High Yes

AW M D and H separately Yes/No Zero Low Yes

IL H D and H separately Yes/Yes Medium High Yes

OM M D and H separately Yes/yes Medium High Yes

XD L Combined No/No Zero None Yes

HD M D and H separately No/Yes Zero High No

TE M D and H separately No/Yes Medium High Yes

LK H D only Yes/yes Medium High No

RD H D and H separately Yes/Yes High High Yes

1Coding Zero-none Low up to 4 Medium 5- 9 High 10 + more

Training support may be provided through training partnerships; in the stage one survey eight

of the LAs said they had formed training partnerships with independent providers but

information from the stage two interviews suggests that this should be nine. In fact three

more said they had partnerships while another two did not currently have a partnership (table

II.7 column four). Of the two who said they had a partnership at stage one but not at stage

two one (AW) did not provide any training themselves, probably because it had no inhouse

staff, while RN did not have a training partnership but was nevertheless very active in the

provision of training for independent staff. Table II.7 column five shows that the formation of

a training partnership was associated with higher levels of support for the training of

independent staff but not in all situations. All who provided medium or high levels of training

to independent sector staff had a partnership according to our stage two interviews – except

for RN that opened up its own LA training to independent staff. Some that recorded a low or

zero incidence of training on the stage one survey were found in the stage two interview to

have high levels of activity (for example ON, HD, AD). In each case the training was

provided by a partnership and the respondent may therefore have decided to answer no with

respect to LA provision. Column six of table II.7 provides an overall assessment of activity of

the LA in training provision based on the stage two interview supplemented with the stage

one information and finds: one LA (XD) not involved currently in training provision due to


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the collapse of a previous partnership when funding sources dried up, three LAs (AH, RT,

AW) with either no or very limited inhouse provision recording low involvement; all

remaining ten have been classified as having a high level of involvement.

With respect to consultative arrangements, all but two LAs involved the providers in

consultation over commissioning (the exceptions were HD and LK table 3.7 column seven).

All also held provider forums for care providers according to the stage one survey. In one

case these forums met only once a year but for the others the frequency was three to four

times a year for seven LAs and up to six times for six LAs. Through the stage two interviews

we gained more information about these forums; in all cases there were forums held for

domiciliary care providers and in three cases these were joint with providers of residential

homes. In seven LAs separate forums were held for domiciliary care and residential care

providers and in three LAs no forums were organised for the residential home providers. In

six LAs the interviews with the LAs suggested that these were not very active bodies,

whether for domiciliary or residential. One of these had only recently re-established the

forum18

. In another (AD) in principle the forum met six times a year but in practice

attendance was low so meetings were often cancelled. A particular problem here was that

many providers worked for more than one LA so that they felt they had too many meetings to

attend (see part IV for providers views in the telephone survey with respect to the usefulness

of the forums).

18 Under the stage 1 survey this was the LA- XD where the forum met only once a year but there were plans for

it to be more active.


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II.2. Approaches to commissioning and contracting: the

qualitative interview data

The qualitative interviews with key actors responsible for commissioning and contracting in

the 14 selected LAs revealed the multiple and potentially conflicting influences on

commissioning practices19

. Not only is social care commissioning taking place within the

wider local authority and is thereby subject to specific local organisational and political

environment but there are also multiple and often competing longer term policy agendas for

the development of social care. In respect of policies towards independent providers there are

competing agendas between the need to support providers and develop the supply base

against the need to take costs out and control price while improving quality. Further

competing agendas stem from the issues of whether LAs should continue to be the drivers in

commissioning or whether this should be developed jointly with the NHS or devolved to

users.

The issues of direct concern for this project were how LAs made sense of and prioritised the

various influences on their commissioning and contracting strategies. The two main current

conflicting pressures were the pressure on budgets and costs on the one hand and the need to

develop capacity in the market on the other hand if both quantity and quality targets in

delivery were to be met. Linked to these cost versus capacity issues was a parallel potential

conflict between pressure to respond to short term factors versus the need for more strategic

longer term changes to the approach to social care provision. Cutting across the traditional

conflicts over cost and quality and the short and the medium term came the new policy

agendas of integrated health and social care provision on the one hand and personal budgets

on the other. These new policy agendas were adding to some of the conflicts between short

term concerns and long term strategic directions, in part because they provided potentially

alternative long term strategic visions of the future of social care and the role of LAs within

that provision. To explore further the nature of these conflicts and how they were being

resolved within our selected LAs we follow the same four themes as identified in the

literature review, namely:

o making the market

o price versus quality

o integrating health and social care, and

o the personal choice agenda

19 Note in this section we attribute quotes to the LA commissioners in general not to specific interviewees. This

is done because most of the interviews involved multiple participants and to preserve the anonymity of the

official concerned. In one LA- IL- we interviewed the contracting and commissioning departments separately

and as they had very different and distinctive positions on the polices pursued we have made an exception and

linked the quotes to either the contracting or the commissioning branches. In other cases we use commissioners

to denote interviewees in contracting and commissioning. For further information on whom we interviewed at

the LA level see section I.7.


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II.2.1. Making the market

The need to develop the supply of independent providers, both to secure an adequate supply

of care hours and to promote the quality of the independent sector, emerged as a repeated

theme within our interviews on commissioning approaches and strategies. The diversity of

issues that came up under this general heading was large and we discuss them below under

three main subthemes: capacity development and managing the spatial market; purchaser-

provider relationships; and interventions on quality.

Capacity development and managing the spatial market

The first concern with respect to capacity related to overall supply. Many of our selected LAs

had been expanding the share of their social care hours that were outsourced and several were

also planning further expansion. However, some LA commissioners were concerned about

the capacity of the independent sector to supply the desired number of hours. For the

contracting department managers in one LA (IL), the problem in their view lay in the fact that

there was a fixed pool of staff and offering more hours to one provider, as the commissioners

suggested as a solution to capacity, just increased labour market churning. In another LA

(AD) interviewees reported that they had expended a lot of effort in encouraging its existing

suppliers to make a step change in their contracting hours from around 400 or 600 to 2000

hours a week. This was to enable the LA to provide better and more guaranteed geographical

coverage and to increase the share of work outsourced. In another LA (TE) commissioners

spoke of the dual problems of both getting existing suppliers to cooperate in delivering

according to their service needs and also in judging just from a tender what a new supplier

would be able to deliver in practice.

The providers are a mix of small local providers and national providers. There is one charity

and one very small local company that the council has had to offer a great deal of support to

to enable them to deliver what the council wanted. ….Some of it was dire, really! TE

While the need to develop supply was a key part of the LA commissioners‟ concerns, these

questions were primarily considered at a local rather than a national level. Thus, for example,

the concerns of UKHCA that a focus on large volume contracts may ultimately reduce supply

nationally by squeezing out the middle level supplier was not an issue that came up in our

interviews. More concern was expressed about the actions of national providers in „asset

stripping‟ the residential homes that they took over, but here the strategies of the national

providers were seen as independent of any specific policy initiatives by the LA.

A second set of capacity concerns related to geographical coverage. These included the need

to ensure an adequacy of supply, particularly in those LAs with a large rural area, the need to

to develop the spatial coverage to reduce travel time and the need to use allocation by

geographical areas to reduce uncertainty over likely volume of demand for contracted

providers.


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Different solutions were used in the two LAs with sizeable rural areas- XD and LK- to ensure

supply. In XD providers were required to bid for a city and a rural area at the tender stage; in

LK where most of the area was rural the tactic adopted was to offer a guaranteed stepped

higher price for difficult to reach and very difficult to reach areas.

It was a real challenge providing service in rural areas as workers don‟t want to travel. So

they have linked urban with rural so providers work in both difficult and easy areas. XD

These rates were agreed with the providers on a parish by parish basis, and will be reviewed

periodically. The result of this has been that recruitment has improved in the agencies – it

was good to acknowledge that providers need extra cash as encouragement. UK

In less rural areas the main concern around geography was to minimise travel time and

reduce inefficiencies (for example IL, HD, TE, RN). For one LA (HD) the move towards one

local provider was said to be part of a wider strategy to „rebalance the market „by establishing

a clearer division of labour between the inhouse re-ablement function and the transfer of

cases to the independent provider selected on the basis of the LA‟s geographical mapping of

the city:

We have mapped every home care client across the city where they live in terms of the street

and which provider, and so from there you can spot a couple of providers who are going to

the same street which kind of doesn‟t make any sense. It adds additional challenges for the

providers. HD

Another LA (TE) had also undertaken a major reorganisation of its supplier network around a

new five area geographical division, with one provider per area. This was partly related to

issues of travel time but more importantly was a response to a user survey indicating

problems of time keeping, rushed visits and inconsistency of care workers, all issues

indirectly linked to operating a city wide rather than a geographically specific service. For at

least two LAs (AD, AW), organisation by geographical area was said to be part of a wider

strategy to guarantee higher volumes of hours to providers.

A third set of capacity issues related to ability to meet specific needs such as care during

unsocial hours or care for diverse client groups. Some LA commissioners were aware that in

order to be able to outsource their social care work, independent providers needed to be in a

position to provide flexible and unsocial hours services. In the case of one LA (AD) the

solution seemed to be one of encouraging cooperation rather than competition between

providers. This illustrates the potentially conflicting motivations in commissioning when LAs

may also be concerned to encourage competition in the interests of keeping costs down.

I said really you need to establish a framework for an evening service. If you are recruiting

people in cars you can work across boundaries. You can come to some agreement with each

other. And really what I was trying to sell them was the whole idea that this does not need to

be businesses in competition. This actually could be businesses working in consensus and

supporting each other. AD


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Promoting a diversity of supply was a major concern of the employers‟ association in this

sector (UKHCA) and a principle of both the best value regime and the personal choice

agenda is that there should be a range of suppliers available in the sector to provide for choice

and to reflect diversity of the population. Some of the commissioners in the selected LAs

were also conscious of these issues- for example, as discussed above, those in TE had

provided support to a small organisation to enable it to fit with its reorganisation. However, it

was one of the outer London boroughs with a diverse population where there was most

recognition of the diversity of supply agenda.

Because we have such a diverse community, and we tend to have more smaller voluntary

organizations rather than great big national ones….I think in terms of working with the

voluntary sector to provide these services if anything we‟re very slightly ahead of the curve,

certainly compared to other boroughs I‟ve worked in. RT

Some LA commissioners did express concern at the increasing role of national chains in the

residential homes sector and the long term impact on both diversity and quality of supply:

The hugely big providers just asset strip, not to put too fine a word on it. So they move in,

they strip the food budget, they strip the training budget, the decorating budget, they cut down

people‟s wages, you know, they do the whole bit really, as their first act, and it never gets re-

instated. RT

Purchaser - provider relationships

The need to develop the market had led commissioners in a number of LAs to make a

strategic decision to change their relationships with their providers. One LA (AH) had

entered into longer term strategic relationships with a smaller number of preferred providers.

A key advantage was said to be benefits in improving access and reducing processing of

people coming into the system. The LA commissioners felt the smaller number of providers

meant that uncertainty over volume of business would be reduced, allowing them to refer to

these new preferred contracting arrangements as the „new block‟ contracts.

The whole idea was that we wanted to create strategic partnership and therefore we would

work with fewer partners and we knew that unless we gave them a reasonable amount of work

they wouldn‟t want to go with it AH

Other LA interviewees also talked about actions to change relationships into more

partnerships.

Our commissioning practices have changed and I very much base this on the relational

aspect of commissioning. ..it‟s about the relationship with providers which is important –

sharing our values, and looking to achieve a principled outcome. Win win for us all.. UY

However, in some LAs the motivation for changing the relationship with providers was more

to reassert LA control over the relationship. Commissioners at XD sought to reduce the

power that spot contract providers had in a context of constrained supply.


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What we were faced with in terms of home support was a position where the balance of risk

and the balance of power firmly rested with the current in county providers. We were starting

to get demands - for 3 successive years we had demands for increases of 10%.... Prior to

2006 we worked purely on the basis of spot contracts, so no guarantee of incomes for them,

no guarantee of service,...

The strategy adopted was one of expanding the number of contractors but then moving to

block contracts and consolidated pricing to include mileage.

The idea behind the block contracts was that providers had told us that they couldn‟t recruit

and retain staff because they hadn‟t got the guaranteed income and they didn‟t have a block

contract like the internal service, so we tried to replicate that [the internal service] …around

salary levels, then our internal service was on a basic of around £7.24 per hour weekdays

and so the bids we generally accepted were those who pitched at around £7 per hour.

Previously it had been around £6 per hour so we knew we were going to take a financial hit

but we compensated for that by looking at how we might address some of the weaknesses

around invoicing by bringing in electronic timed monitoring system and paying from this

system. So this was the whole strategy. XD

However, the ability of the LA to use its provider relationship depended upon their own

power within the market. LAs could face particular problems of limited leverage on care

home providers in more affluent areas due to the rather low share of LA funded clients in the

total client population.

If you have 128 providers with 30 beds and only 5 of those beds are local authority funded,

it‟s very difficult to engage with them as they don‟t necessarily need to engage with the LA.

RN

Quality interventions

As a key aim of „making the market‟ was to improve and to guarantee quality standards, one

way of addressing the issue was to intervene directly in the development of quality standards.

Most of the LAs in our sample had in fact developed their own quality framework for

monitoring both domiciliary and care home providers there were some exceptions. LK which

had a large number of providers on its books because of its highly spread out population. had

adopted a policy of leaving it primarily to CQC to establish standards.

Any provider can go through the accreditation process with the LA, and the LA then decides

whether or not to take them on. …They are registered with CQC, and they agree to work to

our terms, conditions, and service specifications. For a dom care agency we require them to

have either been through 1st key inspection so we have evidence of type of service they

deliver, or they have undertaken a customer survey with at least 6 current customers and

analyzed that. However, we mainly rely on CQC accreditation.LK

Where LAs had their own monitoring, this was often linked for care homes to quality uplifts

on LA fees. Examples of how these quality uplifts worked were provided by three LAs (UY,

OM and AD).


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We have incentivized our contract now with care homes we want to rid ourselves of poor

homes, ….We pay an additional amount of money for excellent care homes if they are

excellent they have had 2.5 % uplift plus the inflation, if good they get 1% plus inflation, and

if adequate they get inflation uplift, if poor they get nothing. This is with national minimum

standards, but we like to think our contract takes this further as we are outcome focused we

have gone way from days of what we want them to do to specifying what we expect the

outcomes to be as a consequence of that engagement.UY

What we now have is a banding arrangement applying to our older persons care homes, and

there‟s a quality banding and there‟s quality uplift and you can sit within one of four or five

bands. …what we have done is we have dedicated £800,000 to the city residential care homes

and our service users within that, and we have said that for every banding uplift that you

achieve, as determined through our quality monitoring, ….you will receive an uplift of X. So

you can lift your unit cost for each …city resident by an appreciable sum. And we‟re not

talking about two percent, we‟re talking about somewhere in the region of twenty percent in

some cases (OM)

Fifty percent of the quality framework will be based upon the quality of the care delivered,

thirty percent of the framework is delivered upon the environmental … arrangements, ten

percent will be based around their CSCI star rating and ten percent will be based upon the

views of carers and service users who use those services. So that‟s the way we‟re doing our

split.AD

Only a small number of LAs provided such uplifts for domiciliary care. In fact only TE

provides a quality uplift in relation to care standards, as explained below.

Our service users told us that there were three things wrong with it. One was that people

didn‟t turn up on time, that they didn‟t stay the allocated time and there was inconsistency of

carers. So using the feedback from our customers we developed contracts aligned to that,

and we put three key performance indicators in it, so that ninety percent of the contract value

would be paid as normal, but they would only get the extra ten percent if they could

demonstrate that the KPIs had been met, which was very painful for them and us... which

were also tortuous! Just so that we could demonstrate to our customers that the service was

being delivered in the way that they wanted it to be, that we were getting value for money. TE

In contrast one LA (IL) had discontinued its quality premium on the grounds that it had

served its purpose in raising the minimum quality threshold so that it was no longer necessary

to reward the good performers.

We used to pay a premium for quality service, but not all organizations met the quality

standards. Presumably, this was to bring up quality, because it was very low. Over time, the

quality of all services improved, so we were paying for quality when we didn‟t need to. ..so, it

was almost a unanimous decision – about one fee and we expect quality to be in there for the

price. IL

In some cases the moves towards improving quality standards through commissioning were

currently aspirational due to a shortage of supply of providers that reached the desired quality

standards as the contracting manager at RN explained.


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For care homes we have just recently introduced a process called fairer contracting and

that‟s about actively encouraging higher quality and we want to work towards only

contracting with good and excellent care homes but if we did that at the moment there

wouldn‟t be enough care homes! RN

Some LA commissioners (for example RT) stated that they were committed to working with

providers to improve their star ratings so that they saw themselves a playing an active role in

developing as well as monitoring standards.

Another way of managing capacity was to intervene in the development of the workforce.

Most of the LAs are engaged in providing training for the independent sector staff whether

through partnerships or other routes.

We‟ve put a lot of time and effort into improving the quality of the product, if you want, and

that includes the staff. So for example, I say we‟ve invested heavily in the training

partnership, which has really been very successful. RD

I think the issue of how people are treated and how they are employed and whether they are

invested in and developed in the independent sector is a concern that we have. [UY area]

partnership forum that we have is about encouraging employers to invest in their staff and

provide leadership training for managers. UY.

A particular attraction in providing training for one LA (ON) was that they had control over

its quality.

I mean I‟m quite interested in that wider debate we‟re having about cost and fees, is there

other things we could deliver that adds value to them that (…) necessarily tied up with what

we pay them for an hourly rate. And training is definitely one of them, cos then we can quality

assure the training that they receive, i.e. we will have delivered it.ON

For another LA (OM) the advantage of involvement was said to be the opportunity to

undertake better planning of training provisions than was possible if it was left up to

individual small providers.

Rather than them saying yes that looks like a good course we can actually evidence base it

through the workforce planning, not got to that stage yet but we are looking to it (OM).

One LA had set a target of 70% NVQ level 2 for its providers compared to the national

standard of 50%.

We target 70% of care workforce to have NVQ. One group of 16 workers, all over 50 had no

qualifications and no learning since leaving school. All reluctant learners – anxiety and

stress of embarking on that as well as a full time job. All got a lot out of it. LK

Beyond interventions on training we found isolated examples of LAs intervening to improve

employment quality along other dimensions. At one LA (AD) commissioners had tried to get

providers to agree to offer guaranteed hours contracts to staff, now that they were in receipt

of block contracts but one national provider had refused, leading to the overall scheme being


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abandoned. In another LA (ON) there was concern to ensure that providers did pay for travel

time and training time. However, although the commissioners said they specified payment for

travel and training time in the tender they felt themselves to be still primarily reliant on good

relations with providers to ensure compliance.

We‟re trying to monitor it to see there is some degree of travel time. So it‟s not just what we

say it‟s what they plan. I mean we don‟t do it in a very precise sense but there is some gap

between the ordered period of time and the next. I suppose … we‟re morally trying to … take

the moral high ground. Obviously we can‟t instruct people to pay…. ON

Another LA, RN, built in differential payments to reflect the type of care and the time

dimension to care but was moving away from this system by the time we undertook

interviews in the area.

The price levels vary by standard/special care (i.e. needing 2 carers, medication, colostomy

etc) by weekday/weekend and length of visit (60, 45, 30 and 15 mins) and then they have

waking nights (though not many of them)

Some LAs such as XD had used its tendering process to identify in detail the HR policies of

the providers and were using this information as a key element in selection and in the price

paid to providers which was highly variable.

So they tried to build provisions within their contracts to meet these challenges. Also when

they assessed tenders they asked providers to give them a build up of their unit costs as they

knew recruitment and retention was a big issue and they wanted to make sure providers were

pitching their salaries at a level were they could recruit, and they also wanted to know that

tenders were viable for the future. So they had a pre-tender conference for providers where

they explained to them what they would be asking for and that the purpose of it was

recruitment around business continuity and viability. XD

Only one LA (RN) was directly rewarding HR performance during the course of the contract.

RN had a policy of monitoring its domiciliary providers against national turnover rates and

rewarding those whose performance was better than the national average but only if the

additional money was used to improve staff conditions.

One of the evaluation criteria is staff turnover, we said the national average is 17.5% we got

that of the DoH website and so we look for anything under that, that would go some way,

though we have to look at size of provider as well

…..They have incentive payments: 4/5 different ones! Continuity of care; take up of work;

NVQ training and whether they‟ve met the 50%; and staff turnover. What they get depends

on these criteria and the amount of work they provide as a company. Each quarter they send

performance indicators and a formula is used to calculate the incentive payment which they

will get each quarter – that‟s paid separately. They have to prove that they use the incentive

money on training, staff bonuses, staff incentives and team building to encourage low staff

turnover. RN


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One particular concern expressed by a manager at AD was that the capacity of LAs to

intervene on quality standards in general might diminish if LAs continued to withdraw from

being providers themselves as much of the monitoring was dependent upon the current

managers‟ knowledge of the sector in operational as well as contracting terms.

I actually think that if we pushed all our work out now there‟s a generation of managers who

all of a sudden are late forties, early fifties, who will be gone within ten plus years time. Now

if we‟ve stopped providing during that time you do have this sort of notion that, actually, we

won‟t have any expertise any more. And if we don‟t have any expertise then, as I say, I have a

real concern about, well, then who will develop that market. AD

II.2.2. Price versus quality.

The outsourcing decision

The explicit reason for increasing outsourcing of domiciliary care in many of our LA cases

was to reduce costs. However, those LAs that had outsourced all their services had found

themselves with a high cost legacy due to the transfer of staff under TUPE to IDPs who

charged a higher fee to cover the protected conditions. Interviewees at these LAs now

regretted the total outsourcing decision, made in haste and no other LAs, according to our

interviews, were planning any TUPE transfers even if planning further shrinkage of the

internal capacity to reduce costs.

Differences in the proportion of domiciliary care outsourced in part reflected both political

decisions and the strategy of the LA with respect to re-ablement. Political decision was also

important in residential care. One LA, LK, had quite a high proportion of inhouse residential

provision and commissioners explained this practice by reference to the fact that there had

always been cross-party support for inhouse provision in the council. In residential care it is

clear that factors other than wage costs influence decisions to maintain or close inhouse

provision; for example in one LA (RT) it was said that said that reducing inhouse provision

was not

„a result of overall policy decision. It‟s much more about the fact that we simply can‟t afford

to maintain the buildings.‟ RT.

Commissioning and contracting for low prices

Although all the LAs were outsourcing to reduce costs, the importance attached to cost

reduction nevertheless varied. For example many appeared to value continuity in their

relations with providers but one LA (AW) made wholesale changes in their preferred

providers at their most recent tender as new providers had come in at lower tender prices.

This complete change of providers also involved a second TUPE transfer of former inhouse

staff to two new agencies. Another LA (IL) had also pursued a strong policy on keeping rates


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low, including removing the quality premium. It pursued a policy of paying at the bottom of

fee levels across the country. The officer responsible for commissioning justified this on

market grounds, even though she recognised that the market may be undervaluing the skills

required for the work.

We have benchmarking information and understand that we‟re not the highest payer, but we feel

it‟s reasonable. The problem with Dom Care is it is a minimum wage skills set, or perceived to

be. I personally don‟t think it is, but that‟s what the market is currently paying. Because of that,

they often lose staff‟. IL commissioning

Several examples demonstrated that LA commissioners were aware of their position as

dominant clients and pursued strategic objectives to achieve lower average cost levels. One

LA (RD) had used the strategy of moving to a single price for all providers to reduce the

average price level, an approach also found in AD.

I think there‟s a standard price now, but we‟ve been through a whole series of getting the prices

down through the tendering process, and we have tried to move to a much clearer pricing

structure. We have moved to a much better, more competitive pricing structure that is a

reasonable one for[our area], and that‟s, you know, the whole tendering process has been around

delivering that.RD

So you really had an absurd situation where some providers were getting £2 an hour more than

other ones, purely and simply because that‟s what they‟d asked for. So we used the opportunity to

consolidate and have one price. And we also wanted to get a way where all the things like

evenings and weekends were just paid an hourly rate, and that‟s it. AD

In one LA (OM) commissioners were concerned that LAs would lose their ability to „keep

the lid‟ on the price level if the personalisation of budgets was widely implemented.

So what we will have is a position where we do not lift the lid off the role of competitive

tendering, and tendering and procurement as a principle for ensuring quality at a good price,

which is the role of the local authority as a procuring body. But if you just suddenly lift the lid off

and go for spot contracts then what are you gonna base your price on,…. you will find then the

providers have a more robust position to just put their prices up irrespective of what the care

needs are and the intensity of the care needs.OM

Even under current conditions commissioners in some LAs – for example RD and IL – felt it

was important to ensure sufficient competition in the market to keep costs down. In one LA

(RD) commissioners were wary of reducing their number of suppliers too far in case this

changed the balance of power within the commissioning environment, again leading to higher

prices.

„from our point of view we get the service at a lower rate because of competition‟. IL

You need, I would say, at least six decent sized providers, otherwise you‟re at the mercy of the

market. There is value for the local authority in having both small and large players in the

market, plus new players …. A really good balance RD


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In another LA (ON) interviewees justified a move to a uniform price from a different

block/spot price system as a way of reducing wasteful competition between providers for

staff.

We used to have a range of prices and that, if nothing else, encouraged the 5, 10, 20p an hour

more which encouraged the movement between agencies. …. It‟s not identical, but I think it‟s

closer. ON

While LAs‟ fee policies varied, commissioners in some higher paying LAs (such as AH)

were worried that they may have pitched their contract at too high a price, given likely future

budgetary constraints.

But in terms of the way the contracts have been set up has restricted us some ways – for

example tied into inflationary uplifts – which are a lot more than other providers might expect

to receive. AH

In one LA fees for residential homes were pitched at a level where top up fees would almost

always be payable. The availability of places in an adjacent lower priced area provided a

rationale for keeping fees below actual residential home care prices in RD.

Quite a lot of people are placed outside the borough where there is available space so RD

would pay their rates under a reciprocal deal. Within the borough many establishments

charge top-ups, so if people want to go into those homes there has to be a third party

agreement. RD

Commissioning and contracting strategies to take cost out

In addition to these pricing strategies there were three commissioning strategies to take cost

out of social care that emerged out of our interviews. The first involved tightening up on the

time paid for through electronic monitoring and other strategies; the second involved moving

from block to spot or call off contracts; and the third involved minimising the skill

requirements of specific services.

The rather rapid spread of electronic monitoring was being used not only to provide more

accurate information on lengths of visits but also to tie payments more closely to time spent.

In practice this also involved removing premia for short visits in several LAs where they had

traditionally paid more for half hour than thirty minute visits. Thus as commissioners in one

LA (OM) explained, the outcome is much tighter costs control over.

We commission to the provider, half hour slots, pay for half hour slots, but.. some of those

care packages are no more than fifteen minutes….. But new care agreements will be -You‟ll

be getting fifteen minute payment for fifteen minute care package.OM

Another LA, HD, had also used retendering to simplify fee systems to one flat rate, removing

block and spot differences for the individual providers (although providers only doing spot

may have different rates) and removing additional payments for short visits. Another LA


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(ON) introduced in the period covered by our survey a move to payment by the minute as

registered by electronic monitoring. Not only did this replace the higher premium per half

hour visit that was in place when we visited the LA but it also introduced penalties for short

visits. As we explore in our case studies (see part V), some providers responded by giving an

incentive bonus to staff who stayed at least 25 minutes for a half hour visits. In the interim

period a flat rate £1 per hour fee was paid in addition to the timed minutes but this flat rate

fee was to be reduced in 2010 to only 60 pence. At XD electronic monitoring was explicitly

used to recoup some of the costs incurred by its policy of raising prices to allow for higher

basic wages among the domiciliary care providers. At IL the tightening of control over visits

was said to have arisen out of the change from block to spot contracting.

Travel time is not included in the price. It was „sort of‟ included in block which was task-

based so they did the jobs and then left to travel. The new tenders show times, for example 15

minutes, so there is no leeway for travel time. Service users are charged for 30 minutes, but

carers HAVE to leave to get to the next call on the rota and there is no time. On the schedule,

one call ends at 10 am and the next one starts at 10 am. Some calls are time critical e.g.

where there are medical needs. All of this is in the care plan, but if you leave a few minutes

early, we get complaints. The new charging went ahead without consulting us….the complaint

is not about the care, but about the charge. IL contracting

The commissioning department thought that travel time should have been factored into the

fee at which organisations tendered for work so that it was not the responsibility of the LA to

be concerned with travel time costs.

I think people should be paid for travel but I think that should be worked out when

organizations are bidding for work – how much they can do their business for per hour – they

should factor in that travel time. I think it should be included in the overall cost – when they

say we can do that for £10 70 an hour, they will factor in say, 70p for travel time. IL

commissioning

A number of LAs had moved away from block to spot or call off contracting in order to

improve the efficiency of use of providers as they were not able to make full use of all the

guaranteed hours ( for example AW, ON). The development of the personalisation agenda

was also increasing concerns among LA commissioners about being tied long term into block

contracts in case they would not have this volume of work commissioned through LAs in the

future. Commissioners at one LA (IL) justified the move from block to spot as giving the

providers an opportunity to prepare for the uncertainties under the personalisation agenda. In

another LA (ON) the move from block to spot was justified as a means of increasing

flexibility and reducing overhead costs but also the change was reinforced by awareness of

the personalisation agenda.

[It‟s] quite expensive to manage the blocks, because with home care people are absent in

hospital, respite, whatever, and you either accept there‟s a higher cost or you manage it at a

cost to make sure you‟re maximising the use, and with spot buying you pay for what you get.

And it used to be an argument, it always was argued that ... dom-care moved to blocks to give

stability and security, but in fact the good providers have either grown or stayed very stable


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since we moved to this, and we haven‟t had providers saying, „Oh, we do need blocks to give

us security.‟ And so on. So it‟s not proved to be a problem. And then with the personalisation

agenda anyway …ON

For the most part LAs did not pay extra for cases requiring more intensive care or more skill

on the part of the workforce. This tended to be different when there was joint commissioning

with the NHS for intermediate care where in principle care staff should be trained to NVQ

level 3 in order that they can carry out instructions from professional (nurses etc) staff. In one

LA (IL) these staff were notably higher paid and at a domiciliary care providers forum

attended by one of the project researchers the possibility of only using NVQ level 2 staff on

lower pay for those cases which were deemed not complex, said to be the majority of cases,

was to be explored by the LA.

Contingent commitments to provider support

Another dimension to the price versus quality trade off was the tendency for support to

providers through training provision to be in some cases contingent on the availability of

external funds to the LA. In one extreme case –XD- the training partnerships had been

entirely closed down due to a drying up of funding streams.

XD has no training partnership currently with independent providers. They used to have

[one]– managed by the LA but a change in funding meant that it collapsed. They are trying

to invest some money into the establishment of an employers‟ forum which they say is needed

because of the move towards self directed support and perceived demand for personal

assistance. XD

LAs with no inhouse unit for domiciliary care were also much less likely to be involved in

training independent providers. The implication of some comments might be that this joint

provision of training would only continue if LA staff still had a significant involvement in the

training.

we just have a huge demand for the basic training, so health and safety, manual handling, so

there‟s just huge demand, and the individual providers find it quite hard to catch up and

….you‟d be running huge programmes wouldn‟t you. Some of them have got 300 carers. We

couldn‟t possibly put that many through. RT


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II.2.3. Integration of social care and health

Perceptions of the need for integration

The LAs were found to be pursuing different agendas and strategies with respect to the

development of a more integrated or holistic approach to social care provision. Some had

moved a long way towards integration with health involving joint commissioning and pooling

of budgets- indeed one LA (AH) merged its adult social car and housing function with the

PCT- between the stage one survey and the stage two interview. The rationale for this

change was explained as:

The big two agendas for commissioning are the transformation of social care and

transformation of community health services- so we have pulled together our commission

intentions for both of those big agendas. AH

Some other LAs had not integrated that far with health but were nevertheless said to be

attempting to develop an integrated approach across for example social care and housing:

We have an approach of promoting universal services, not just about health and social care

and this where the link with housing is very important, because a lot of people have other

needs other than just health and social care, benefits needs, housing needs, general support

needs etc….…. Overall strategic direction is about independence, well being and choice, not

promoting institutional care. We have re enablement team (care at home) – 40% of people

receive 6 week intense re enablement, generally 40% less need for care packages. UY

Whether the integration is with health or with other aspects of social services, one of the

underlying motivations for a change of approach is a recognition that too many resources are

going in to residential care.

We‟re spending about forty percent of our budget on care homes. That‟s too much. It‟s

reducing, I mean we‟ve seen fairly dramatic reductions so I think you are beginning to see a

shift, but personally, I mean I just think that‟s far too much. But we need to do something that

provides a range of stuff at an earlier point. ON

At one LA (RT) commissioners expressed more radical views as to what should be happening

to social care services:

I mean, with residential care, and again, we‟d just stop using it. We‟d close it. It‟s a very

unhelpful model of care. And it makes people poor. It strips them of their assets apart from

anything else. I wish they‟d stop doing that. Again, this is all magic wand stuff. If you take

what we spend on residential care –…it‟s just millions upon millions. Well, if we took it out of

there and put it in our community support we could have a brilliant support. ….for example,

one of the major reasons that older people in particular lose their independence is an

increase in sensory impairment, particularly dual sensory impairment, so you can train a

homecare worker who sees them every day to start noticing sudden deterioration in their


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hearing or their sight and flag it up earlier. Plus they can do all the early stroke warning

stuff. I mean, we could really use this.‟ RT

The identification of the causes of this problem varied. For LK, the LA among our selected

14 spending the highest share of its older people‟s social care budget on residential care

(NHS Information Centre 2009b), commissioners thought the problem lay in the interface

between the hospitals and the care service, a problem in their case exacerbated by the rural

nature of much of the county.

One of the issues, my personal view, is the hospital system - no valid assessment before they

come out of hospital – they will be put into residential because it is hard to get a package for

them to stay at home.….There may be a rural aspect to this – complex packages more diff in a

rural area. You may need two carers, and this isn‟t happening as the providers can‟t or won‟t

provide it. LK

For RT, the LA where the commissioner interviewed would in principle like to close

residential care, the problem is short termism.

Instead all we do is, it‟s just like a sticking plaster job but actually what we could really have

is a real network of workers who are experienced and trained and know their area intimately,

and know the neighbours, and know what the support system is and they could support people

for ages with much better early warning signs of what‟s going on. RT

Hospital discharge as the driver of the care system

Awareness of the long term need for a more holistic approach to social care did not prevent

tensions developing between the social care and the health services. In one case (UY) the

performance regimes attached to a foundation trust were said to be stretching the availability

of care services which was only resolved by bringing in more suppliers on a spot purchase

basis.

We have great pressures at the moment, our district general hospital is a foundation trust so

they want throughput so it means we have to have services and interventions for people to be

discharged so we need to increase our services so we have preferred and then they approved

that we spot purchase.UY

In another LA (AD) the drive towards consolidation of commissioning around four block

contract providers was driven by problems of meeting the demands from the health service.

It was about growth. Like everybody else we were having difficulties with hospital

discharge…., there was basically just a blockage at the front end. So the idea was very much

about trying to create much more fluidity. AD


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Harmonising commissioning strategies

While in some LAs the key driver towards integration was the need for better services, in

other cases the driver was the efficiencies to be gained from joint commissioning and the

avoidance of competing approaches to commissioning within the same geographical space.

It is pretty joined up in that respect…., rather than us going out to tender for something and

them tendering for something similar. HD

„You avoid duplication …and the PCT would be commissioning dom care packages from

providers we had just decommissioned. LA and PCT pay different fee rates, and PCT pay

more than LA, even for cases where there is little health input. IL

In the case of one LA (RN) involvement with the PCT in joint commissioning was in fact

holding back a strategy of implementing a policy of fair commissioning based on financial

incentives for reaching quality standards for residential homes. The NHS staff had had less

experience of commissioning in social care and were convinced, on the basis of information

on lower prices in other LAs that it may be possible to bring down the costs of social care by

more aggressive commissioning strategies.

This procurement hub model [with the NHS] is more cost and block focused and less fairer

contracting! RN

II.2.4. User choice

The fourth policy agenda to impinge on LA commissioning and contracting was that of

personalisation or user choice. At the time of our interviews its main effect was in the

planning of future commissioning rather than on current practice but all LAs were actively

involved in considering the implications. Four types of implications were under

consideration: for the contracting form; for the organisation of care delivery on a

geographical basis; for the inhouse facility; and for the organisation of care assessments and

care delivery.

Form of contracting

The tendency to move away from block contracts that we identified was associated in six

cases (ON, RD, IL, OM, LK, AW) with an awareness of the possible incompatibility

between block contracting and user choice.

Well, there‟s no point signing three or four year contracts at this point, .. because, of course,

in terms of home care people may well start to exert their own personal choice. RD

We‟re just not gonna go near blocks, thinking about the future ON


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We have just tendered for 3 year contract, but built in break clause after 2 years so we can

assess where we are with personalisation agenda. UY

In two LAs (IL and TE) the changing of contractual relations from block to preferred

provider or spot was said to be a means of preparing the providers for the changes, but in one

LA (TE) there were concerns about moving too quickly because of the LAs continuing

responsibility for ensuring the availability of care.

The reason why providers need to build capacity into their organisations, is to prepare for the

personalization. In other words, they will be attracting their own customers, so they won‟t

need them coming from us anymore. ….and that is one of the reasons we didn‟t want to eat

up all their capacity with our own blocks. Apart from the fact that we didn‟t want to pay for

stuff we didn‟t want to use.IL

However we also need to make them aware about the implications of personalization. And

that has massive implications for the domiciliary care market, and particularly block

contracts, which we probably wouldn‟t want to have. So we‟ve got personalization events

with the independent sector – voluntary sector in April and private sector in May. It‟s about

raising awareness of the implications of people having personal budgets, about making sure

that people will be able to choose where they go. What we can‟t do is go the whole hog. We

can‟t afford to destabilize the market and then find that we can‟t fulfil our statutory function.

TE

Care delivery by geographical area

Considerable concern was expressed by LA commissioners over the implications of

personalisation for their contracting by geographical area. These arrangements had been put

in place to reduce travel times but were recognised to conflict with the notion of user choice.

In two LAs (AD and TE) commissioners were concerned that they would have to undo the

recent work they had undertaken to rationalise travel problems.

if one provider‟s working in the centre of AD and you live in the far west but that‟s the

provider you want to deliver your care, personalisation would say you can go and buy your

care from them but that does mean that all the work we did around reducing travel times,

which actually has an impact on the cost, starts to shift and change. AD

So the pain of splitting into the 5 neighbourhood areas was actually not necessary under the

personalization agenda really, because they can go wherever they like. TE

Two more LAs (IL and XD) had already however moved towards more than one provider per

area in response to the choice agenda

We were looking for 10 in order to offer a choice of providers in each geographical area

(ward). This is because if there is only one provider, service users don‟t have a choice and it

becomes a closed shop. Contracts said they could handle 8-10 providers.IL


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Future for inhouse provision

Some LA commissioners believed the personalisation agenda would lead to significant

changes in the inhouse provision of domiciliary care. In one LA (ON) there were concerns

that personal budgets were going to put pressures on the inhouse provision as the key issue

would be „whether the public want to buy our inhouse services and what‟s the unit cost

gonna be... That could be the big tipping poin‟t. ON

In another LA (AD) there were also concerns expressed that the inhouse provision might be

priced out by personal budgets but that the consequence would be a loss of skills and capacity

of re-ablement that would be difficult to replace in the local area. As a consequence more

radical options such a setting up the inhouse facility as a social enterprise were being toyed

with.

I think the issue is around considering whether... because of the quality of our inhouse service

and because of the skill levels of the staff, I think what we feel quite strongly is we would not

want to take that out of the marketplace in terms of a choice that the public would want to

take. ….our stall would be set out in the same way as all the other providers. We might be

more expensive but do we deliver a better quality service? …. it might be that the inhouse

service becomes a different kind of business model, I dunno, social enterprise, whatever. AD

A quite different approach to the impact of personal budgets on the inhouse facility was being

taken by another LA (RD). Here we were told that the change in policy was to be used to

legitimize a complete withdrawal from directly provided long term services.

We have a different plan. They don‟t know it, this is the problem. … Basically, we‟re gonna

allow individual budgets to be a driving force. No need for a workforce. Okay. When people

have choices over costs I think it‟s going to have a significant effect, isn‟t it? ….… It‟s going

to expose big cost differentials that are unsustainable. … This is not a sentimental authority.

There will be no subsidy. RD

Changes in care assessment and delivery of care

For the most part, at the time of the stage two interviews, few changes had been made in the

organisation of care assessments or in the planning and commissioning of care. In two LAs

(AD, OM) interviewees spoke of moving towards more responsibility for the provider, either

in undertaking assessment or in working out how a total block of hours over a week would be

delivered.

It‟s meant to actually specify outcome needs, rather than, she needs a wash at three o‟clock

on a Tuesday afternoon. There‟s an expectation that once they have those needs the provider

goes and works out the detail. I didn‟t want providers having to come back to us because they

thought somebody needed an extra twenty minutes... AD

Now, what we haven‟t done is to move the providers into a position where they are

fundamentally challenged, professionally, to provide assessments, cause the assessment is


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always undertaken by the authority as the local commissioner, and that has to change.….

OM

A third LA (RN) was engaged in a pilot programme on outcome based care, the principles of

which involved moving away from an hours target to outcome based target.

We give the providers a care plan, so rather than saying this is 12 hours and we‟ll pay them

for 12 hours, we say this is what we want for Mrs Smith and she‟ll be in charge of that and its

much more detailed and will be delivered reaching the goals and outcomes of Mrs Smith,

rather than us saying that‟s 10 hours Outcome based pilot RN

However, as we have seen in our discussion of price and costs based commissioning and

contracting above, these developments were very much in the minority of LAs. A stronger

trend was towards more detailed control of care delivery through electronic monitoring and

tight time specification of visits.


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II.3. Classifying the strategic approach

II.3.1. Typologising the local authorities

The LAs in our sample were clearly engaged in addressing four separate but potentially

conflicting agendas. Recognition of the need for provider support and development coincided

with strategies to take costs out and increase competition between providers. Likewise there

was both awareness of the need for LAs to develop a long term strategic approach towards a

more integrated and joined up system of social care provision and a recognition that the

personalisation agenda might reduce or weaken the strategic planning role of LAs in social

care provision in the future.

While all LAs were being pulled in different directions, there were nevertheless differences

expressed between the commissioners in the different LAs in their preferred strategic

approaches and in what they were doing to implement these approaches. Indeed the starting

point for this element of the project was that one might expect to find variations in

recruitment and retention of care staff influenced by differences in the approach taken by LAs

to commissioning and contracting. This hypothesis is backed to some extent by evidence of

divergent practices across LAs as indicated by the stage 1 postal survey and by the stage 2

interview survey. However, as table 3.8 shows the range of approaches pursued by the LAs

makes classification into neat and bounded categories somewhat problematic.

Thus the classification is based around multiple criteria. First we take into account the pricing

strategies of the LAs. Second we summarise in table II.8 the strategic approaches adopted by

the LAs focusing on evidence of an approach to partnership with the providers, in the sense

policies aimed at developing and stabilising the market, rewarding and promoting quality in

care and/or employment. We use these two criteria to classify the fourteen into three

categories:

o partnership focused;

o cost minimisation focused;

o or mixed.

Clearly all fourteen are „mixed‟ to some degree but we classify those as partnership focused

where they are either high payers and have a partnership orientation or medium payers and

have specific policies of promoting and rewarding quality.

Five LAs fall into the partnership category. This includes three of the four LAs classified as

„high‟ fee payers in figures II.1a and II.1b (AH, XD, LK) for both residential and domiciliary

care and all of which also face strong demand conditions for women‟s employment in the

locality (see section 1.7 and appendix table I.A1). All three combine high fees with either a

strategic partnership approach within an integrated NHS/LA unit (AH), a commitment to

allow independent providers to match inhouse basic pay levels (XD) or higher pay in rural


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areas and maintaining a high share of inhouse residential homes (LK). We also include UY

and RN in the partnership category. Both are „medium‟ fee payers when quality is not

included (figure 3.1) but RN moves into the high fee paying category when quality

enhancements are taken into account. RN also faces strong labour demand conditions while

UY is in the medium demand category. They are included here as they also have a forward-

thinking approach to their providers. UY has a strategic approach, linked to its integration

into housing and has developed its own strong quality monitoring and incentive approach;

RN has a commitment to fair contracting and rewards good HR performance with bonuses to

be spent on staff. The quotes in box II.1 illustrate that these five „partnership LAs‟ have

focused on support, innovation, improving quality and developing the market.

Box II.1. The partnership LAs

The idea behind the block contracts was that providers had told us that they couldn‟t recruit and

retain staff because they hadn‟t got the guaranteed income and they didn‟t have a block contract

like the internal service, so we tried to replicate that[the internal service] …around salary levels

XD

For care homes we have just recently introduced a process called fairer contracting and that‟s

about actively encouraging higher quality and we want to work towards only contracting with good

and excellent care homes.

Each quarter they [domiciliary care providers] send performance indicators and a formula is used

to calculate the incentive payment which they will get each quarter – that‟s paid separately. They

have to prove that they use the incentive money on training, staff bonuses, staff incentives and team

building to encourage low staff turnover.RN

We target 70% of care workforce to have NVQ.LK

We have an approach of promoting universal services, not just about health and social care and this

is where the link with housing is very important UY

It‟s about the relationship with providers which is important – sharing our values, and looking to

achieve a principled outcome. Win win for us all - we get the services we want UY

I think the inflationary uplifts have already been agreed for the full duration of the contract which is

5 years, that differs quite significantly from other areas of commissioning .AH

The whole idea was that we wanted to create strategic partnership and therefore we would work

with fewer partners AH

At the other end of the spectrum four LAs fall into the category of „cost minimising‟. Two

(IL and HD) are classified as „very low‟ fee payers (figure II.1a and II.1b) and in fact pay

either very low (IL) or low (HD) fees for both domiciliary and residential homes. Moreover,

they have no quality uplifts; IL has removed its premium for iDPs and accepts that the


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consequence of low fees will be wide use of top up fees for care homes even in a low income

area. The third LA in this category, RD, is a low fee paying authority. It pays medium level

domiciliary care fees but prices its residential fees such that they require top ups, with low

income clients encouraged to use homes out of area that are cheaper. The fourth cost

minimising LA , AW, is a medium fee payer (high for residential but lower than the outer

London average). It has outsourced 100% of domiciliary care and is prepared to change all

suppliers on the basis of costs. Moreover, it has kept residential fees at low or zero uplift for

some time. These four LAS have very different local labour demand conditions, with HD

recording strong demand, AW and RD medium and IL low demand. Neither RD nor AW

commissioners wished to take an interest in the HR policies of providers as this might, they

felt, interfere with competition. The examples provided in box II.2 illustrate that interviewees

at these four LAs made positive comments about the flexibility and responsiveness of the

market, priced residential care at a level that they knew would lead to top up fees being the

norm, distanced themselves from responsibility for the HR polices of providers and treated

quality as an additional requirement, not something to be paid for. One LA, HD, had

previously made an attempt at partnership but had retreated due to conflicts over fees.

Box II.2. The cost minimising LAs

External providers just recruit people, they‟re very quick, they‟re very slick, very flexible.RD

I don‟t think you can be too prescriptive on HR issues [since] it would have a direct impact on the

rates we charged.. RD

Quite a lot of people are placed outside the borough where there is available space so RD would

pay their rates under a reciprocal deal. Within the borough many establishments charge top-ups, so

if people want to go into those homes there has to be a third party agreement. RD

The council doesn‟t really get involved in providers‟ HR issues In terms of conditions of service,

that‟s nothing to do with us in a sense. AW

We used to pay a premium for quality service, but not all organizations that met the quality

standards. Presumably, this was to bring up quality, because it was very low. Over time, the

quality of all services improved, so we were paying for quality when we didn‟t need to.IL

Approximately 82% charge top-up, in some cases this is a small amount (£10-15), sometimes it is

more, e.g. £355 from us, and the charge is £470. IL

The City Council has been committed for some years to working in Partnership. When Building

Capacity came out we did try and secure Partnership based on that. This is about six years ago

now, and at the time mainly with the residential sector there are big issues about fees and fair fees

and stuff, which kind of gets into the way. But we actually do have regular meetings with providers

HD


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This leaves five LAs (ON, AD, TE, OM, RT) that we categorise as „mixed‟ and in each case

there are strong elements of both cost minimisation and partnership. Three of the five are

very low payers, as defined in figure II.1a – ON, AD, OM- but move into the low paying

category (figure II.1b) if quality uplifts are included. One pays very low domiciliary fees

(AD) and one low fees (ON). Four of the five face weak local labour market demand with RT

the exception with medium levels of local labour demand. ON commissioners espoused a

partnership approach, but in practice have not only set low fee levels but also moved away

from their strong commitments to paying for travel time during the course of the project as a

consequence of moving to electronic monitoring (which led to the removal of the half hour

supplement). The authority did pay extra to homes with Investors in People awards but in

general had not progressed very far in thinking about how to promote quality.

„I think the thing we‟re beginning to consider… do we begin to link what we pay

against some level of quality and is that, you know, the kind of CSCI ratings or

something like that. And that‟s only a thought at the moment.‟ ON

AD also pays low domiciliary care fees but at present does not require the outsourced

providers to undertake complex work or indeed evening work with inhouse covering these

areas. Moreover, unlike ON, it pays high residential fees. Commissioners at AD had made

efforts to develop the market (through involving providers in person-centred care) and to

stabilise the market- for example by offering block contracts and then encouraging block

providers to offer guaranteed hours contracts- which were rebuffed.

Interviewees at both ON and AD in fact seemed to be expressing a desire to move to a high

trust approach but in practice were torn between that and ensuring value for money through

for example introducing electronic monitoring. These contradictions are summarised as

follows.

We‟re the local government who hold the service users and the purse strings, and we recruit

these people to do some jobs for us. But we don‟t really trust them. We‟re not really sure

they‟re not going to rip us off. And we‟re not really sure about whether we trust them to turn

up when they say they will. So it‟s still a very unsure market place to be honest. So the degree

to which we actually kind of move away from a task based processes is patchy, I think. AD

The other two low fee payers, OM and TE, pay medium domiciliary care fees, but do not

offer additional fees (for shorter visits or unsocial hours working). Nevertheless, both have

sought to develop a more strategic approach to their providers. OM has been expanding its

providers to use greater competition to boost quality and keep down prices but it also has a

strategy of its providers playing a greater role in assessments. In residential care it is

investing £800,000 in quality uplifts. TE comes closest among this category of mixed LAs to

a partnership approach with its focus on partnership and rewards for quality in both homes

and domiciliary care. However, interviewees reported that the process of change had been „a

very difficult situation, and the providers and the staff here and the service users went

through significant pain‟. The reorganisation had required a lot of TUPE transfer of staff


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between agencies and although the relations may settle down into a partnership approach a

mixed categorisation for the current situation seemed more appropriate.

The fifth LA in this mixed category, RT, is medium authority according to our figure II.1a

and figure II.1b classification. However, it is an outer London borough and therefore could be

considered (along with AW) to be a relatively low fee payer for the area. But it differs from

AW in that its commissioners were seeking to develop a partnership approach based on

longer term and renewed contracts with the providers and a commitment to working with a

wide diversity of organisations reflecting the diversity of the population. On the other hand,

however, it had underdeveloped links with the NHS and no retained specialised inhouse

services provision. RT managers also acknowledged serious contradictions in their approach

towards providers‟ HR practices.

In terms of workforce training and development, I mean, it‟s clear that practices that we

encourage because we want to keep the prices down, militate against having a properly

trained and maintained workforce. RT


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Table II.8 LAs’ strategic approach: from partnerships to cost minimisation

a. Partnership LAs

LA

code

Fee level

Without/

with

quality

Local labour

market

conditions

Strategy towards providers Change within past 3 years plus plans for

change

AH H/H Strong 100% joint NHS- integrated health and social care teams for re-ablement.

Strategic partners in dom care chosen 60/40 quality/cost. High paying but with

no variations by time/care.

Social services and housing merged with PCT

(post PSSRU).

To 5 strategic partners/more outcome based

approach. Away form unsocial hours payments

RN M/H Strong NHS joint commissioning/ 90% outsourced- additional support for providers

increased outsourcing (e.g. fire officer)- also in response to publicity on poor

care Guarantees providers 55% of work in an area.

Fair contracting/quality uplift. HR related bonuses/ pay for weekends etc.

Outcome based care pilot.

Moving away from additional payment by

length of visit.

UY M/M Medium Integrated with housing/ extra care

Specialised inhouse provision

Quality incentives and partnership approach

Quality monitoring now around excellence,

previously qualifications- no relation to star

rating.

XD H/H Strong High and variable prices –costs offset by electronic monitoring and requirement

for services in rural areas. Built in continuity standards into contracts and

ensure wage levels adequate. High inhouse share due to similarity of prices and

problems of supply

2006 introduced block contracts by easy/difficult

area to change power balance and provide more

equitable conditions between independent sector

and inhouse (but end to unsocial hours payments

and costs offset by electronic monitoring).

LK H/H Strong Fixed but variable price by area reflecting variations in availability across area-

maximise recognised suppliers. Specialised inhouse. 70% target NVQ 2.

Political commitment to LA homes but high incidence of top up fees. Too much

capacity in homes/ too little in domiciliary care. Commitment to own

monitoring

Introduced fixed but variable price by area


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b. Mixed LAs

LA code Fee level

Without/ with

quality

Local labour

market conditions


change

ON VL/L Weak Partnership approach to stabilize the market but combined with value

for money. Pay for travel/training but moving to payment by the

minute.

To payment by minute/ electronic monitoring

away from unsocial hours payments and pay

for travel

RT M/M Medium 100% outsourced- strategy to develop the partnership and maintain

diversity of supply

AD VL/L Weak High/specialised inhouse plus unsocial hours- routine out of house

but with person-centred care

Quality fees for homes- top ups only out of borough

Blocks with few providers since 2006-single

price- some personalisation. Plans to transfer

evening work.

High quality inhouse (3*).

OM VL/ L Weak Enhancing role of providers in interests of performance and

personalisation. Increased competition through more providers.

Specialisation for inhouse. Quality fee uplift for homes. Quality

monitoring for both.

Increase in providers, from block to

framework agreement. Providers to make

assessments and more performance/ quality

oriented. Paying by minutes not in half hour

blocks. Plan to increase quality monitoring

with stronger HR focus.

TE L/L Weak High share with NHS. Quality strategy- star rating raises home fees-

10% paid to IDPs if meet KPIs.Response to user survey through

enforced geographical reorganisation

Geographical reorganisation including TUPE

transfers. Fee rises to reflect costs but removed

higher prices for short visits. Large inhouse

redundancies 2006/7- no TUPE transfer as

independent sector expanded later


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c. Cost minimising LAs

LA code Fee level

Without/ with

quality

Local labour

market conditions


change

AW M/M Medium Price focused; prices to reduce over next three years for one IDP; 20

minute time slots and no pay for travel time; sets maximum fees for

homes- existing placements kept at lower levels/ zero increase in fees

for out of area homes. Requirement to meet user needs with respect

to diversity in contract. High number of LA TUPE transferred staff

Moved from 4 to 2 block contracts/ change of

all main providers. TUPE transferred staff had

to change provider.

IL VL/VL Weak Price focused. Removed quality premium once threshold met.

Monitor but do not pay for quality. Allow wide use of top ups

From block to spot.

Removed quality premium.

Split between contracting and commissioning

HD VL/ VL Strong Specialised inhouse plus area block contracts Geographical reorganisation and increased

specialisation of inhouse role

RD L/L Medium Price focused. Use homes outside area as cheaper; fee set at too low

a level for own area .

Brought in new providers . Plans to end

inhouse for regular care.


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II.3.2.The coherence, stability and sustainability of LAs‟ commissioning and

contracting practices

While we have provided a categorisation of the commissioning and contracting strategies of

the LAs, a triangulation of the various sources of information on LA strategies and

approaches casts some doubts on the coherence, stability and long term sustainability of some

of the apparent differences in commissioning and contracting stances.

There was wide recognition of the existence of vicious circles that stood in the way of

developing a coherent and sustainable approach. For example in one LA (RT) interviewees

felt that the competition requirement for repeat tendering ( to comply with EU law) stood in

the way of developing the quality of domiciliary care providers in ways that would enable

them to move forward with the longer term objective of reducing reliance on residential care.

So instead of kind of focusing on really working with providers to try and develop those kinds

of things that we could do, we‟ve suddenly got this dreadful kind of treadmill of block

contracts, tenders, problems, you know, cut the price down. …and you just go round and

round in this awful circle instead of really focusing on what you should spend your money on

to improve the standards.RT

At another LA (LK) officers were concerned that those concerned to reduce hospital

discharge delays were too ready to move patients into residential care, a problem

compounded by the difficulty of putting together care packages in rural areas. At OM the

concern was that personalisation would reduce the strategic role of LAs in managing the

social care market thereby leading to a major increase in the price of care services. Others

such interviewees at TE and AD feared that personalisation would make it more difficult to

minimise the problems of travel and create more problems in guaranteeing supply. Other

concerns included whether specialist re-ablement services built up by LAs inhouse might not

be financially viable under personalisation (AD, ON). Innovative re-ablement services

provided by integrated health and social care teams (AH) might be the strategic way forward

to reduce residential care but whether further development along these lines might require

reducing the share of outsourced work was unclear. At another LA (HD) concerns were

raised over how „extra care‟ specialised housing schemes could be managed under

personalisation.

The model of the extra care scheme is to have the care provider obviously on site and

delivering services as a domiciliary care provider in the individual homes. And for that to

work as it does as the extra care model there‟s always got to be an element of block within

that. But then there could also be an element of people having their own care provider (HD).

Some of the contradictions arose simply out of the different regulations and pace of change

under different budget headings. For example XD had been forced to withdraw temporarily

from supporting providers in their training provision due to the sudden cutting back of

government funds under different budgets to support such training. This decision was at odds

with their more partnership approach.


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In some cases we found examples of incoherence and contradictions in the policy approach

that were already calling into question the longevity of current commissioning approaches.

For example, at one LA (IL) there was some recognition that their flat rate fee and spot

contract system was causing some problems of delivering care for complex cases that they

were having to recognise how far the flat rate system could be maintained.

So we have hot spots around the city where it is really, really difficult to get care, and if you

talk to an agency, they will say it is because we have difficulty recruiting in those particular

areas. And because it‟s spot, they say it doesn‟t enable them to plan very well. IL

Another challenge to current policies might come from the response by providers. For

example one LA (LK) had raised their price significantly for rural providers but

commissioners were not convinced that this increase was being passed to care workers in the

form of paid travel time. If this proved to be the case then support for the higher prices might

wane.

In the case of RN the decision to increase joint commissioning with the NHS was directly

causing a problem with the implementation of RN‟s fair contracting policy. The NHS was

regarded as new to the game and was requiring RN to go through the motions of seeing if

they could reduce prices, while the LA officers felt they had already explored that route and

knew that they needed to do more to improve the quality rather than going for the lowest

priced service. Nevertheless it was unclear whose approach would win out.

The interviews with the LAs also brought out the difficulty of classifying commissioning

approaches by reference to government policy agendas for in a couple of cases the LAs

made it clear that they were openly embracing a particular policy agenda in order to achieve a

specific objective which was independent of the policy agenda itself. The clearest example of

this was in the case of RD where the personalisation agenda was said to offer a justification

for closing down the inhouse social care team for more routine work, a policy which was

being pursued primarily as a cost reducing agenda. And at IL we were told by the contracting

officers that the decision to end block contracts and move to spot contracts was for cost

reason but the commissioning officer legitimised the move as a way of helping IDPs prepare

for personalisation.

One of the most consistent findings from the second stage interviews was that there was a

continuing rapid pace of changes in all aspects. Table 3.8 in its last column summarises the

main changes in policy that had been implemented over the three years prior to our interview

together with any changes that took place after our interview and before or during the

telephone survey and future planned changes. These summarise the high level of change.

Some of the frequent changes that had taken place included moving away from block

contracts, decreasing or increasing the number of providers, moving away from enhanced

payment for short visits to single flat rate minute-based payments through introducing

electronic monitoring, introducing more quality monitoring and more fee enhancement

related to quality, enhancing re-ablement functions, particularly inhouse, movements towards

more user-centred care or more involvement by providers in assessments and stronger


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geographical divisions between providers. As we discussed above, many LAs were said to

have plans for more outsourcing and some were engaged in plans to develop or expand joint

commissioning with the NHS. All were developing some response to the personalisation

agenda and many mentioned possible ways in which they may have to reverse their previous

changes or at a minimum make adjustments to their policies to fit the personalisation agenda.

Examples of significant changes that occurred within the period we were looking at the LA

include the change in payment arrangements and electronic monitoring in ON, the merger

with the PCT in AH (after the stage 1 survey), moves away from additional payments for half

hours at RN, contracting with more providers and moving to payment by minutes rather than

enhance pay for short hours at OM.

In addition to a fast pace of current change it also become apparent that what had seemed the

right strategy in the past had in some circumstances proved to be a disadvantage in the

current policy climate. This was particularly the case where LA had outsourced all or almost

all of their domiciliary care and to do so had TUPE transferred a large number of staff. Not

only was this adding to the cost base for these LAs but the legacy of TUPE transferred staff

was causing problems in developing a pricing structure for personalised budgets as

individuals were unlikely to wish to pay the higher prices that agencies with TUPE

transferred staff typically receive from the LA.

With hindsight we‟d have been better doing what some other councils have done, which is to

take their inhouse workforce, either retain it inhouse, or put it out to one organization but

then to use that for re-ablement AW

Where a high share of domiciliary care work had been outsourced, as in AH, there was the

possibility that this may not provide the best arrangements for the future when cost savings

might in the future come more from specialised re-ablement which may be better developed

by LAs directly or in partnership with the NHS.

The overall finding is thus of a high rate of changes plus a considerable likelihood of change

in different directions over future years. This uncertainty over the future was well captured by

the comment by a TE officer that they had started off developing a ten year strategy for

health and social care for older people in the city but „we soon discovered that that was

completely wrong, that the world was changing too fast for us to have a nice plan for 10

years, so we have reviewed it and we are redoing it.‟ (TE)


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II.4. The selected LAs and user satisfaction surveys

We complete this investigation of the commissioning practices of our selected LAs and their

approach towards the providers of care, whether IDPs or residential homes, by drawing on

published evidence of their relative scores in user satisfaction surveys. These satisfaction

scores were analysed only after we had undertaken the classification of our LAs. They

therefore provide an interesting test as to whether our classifications have any linkage to user

satisfaction scores.

We have computed average scores for both the overall level of satisfaction with care and for

each of a series of eight questions on care quality. The average scores for the overall level of

user satisfaction (a scale of 1 to 10) for the 14 LAs do not vary greatly. The range of scores

for LAs classified by partnership orientation of the LA is as follows:

Partnership (AH, RN, UY, XD, LK): 5.67 – 5.87;

Mixed (AD, RT, ON, OM, TE): 5.47 – 5.84;

Cost minimising s (RD, AW, IL, HD): 5.44 – 5.52.

Further interrogation of the rankings of each LA among the group of 14, however, reveals

significant patterns.20

Table II.9 presents the average rank scores for all nine questions for

each of our three categories of LAs - partnership, mixed and cost minimising. For the first,

overall satisfaction question the data reveal that while the partnership and the mixed

categories have quite similar levels of satisfaction, the cost minimising LAs are clustered at

the bottom of the distribution. A similar pattern also applies to the averages for the other

eight questions as indicated by the very low average ranking for cost minimising LAs,

ranging from 8.0 to 12.0. In contrast the average rankings for the partnership LAs were

between 5.2 and 8.8 and for the mixed LAs between 4.0 and 7.0. This evidence therefore

appears to provide some support for the more partnership oriented LAs generating higher

user satisfaction.

Table II.10 presents the rank scores for each of the LAs separately for the overall satisfaction

question, the average ranking for the other 8 questions and a total rank score. Five LAs stand

out as having very consistent high rankings: two are from the partnership category- AH and

UY and three from the mixed category – AD, TE and OM. It should be noted that AD had a

very large inhouse provision and these ranks relate to the provision by the LADP as well as

the IDPs. The five are in the top five rankings on both measures so that their average ranks

were 4 or less, while the next in line is LK another partnership at 6.5.

20 Use of ranking scores rather than actual satisfaction scores also preserves anonymity of LAs. Scores for the

separate questions were standardised in order to facilitate comparison across answers. This was necessary due to

the use of different scales for questions, including a 1-7 scale for question 1, a 1-5 scale for question 6 and a 1-4

scale for questions 2-5 and questions 7-9. The 14 LAs were grouped into the three defined types of partnership,

mixed and cost minimising and an average score calculated for each question for each type.


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Table II.9. Average ranking of user satisfaction scores by type of LA

Survey questions. Partnership

(AH, RN, UY,

XD, LK)

Mixed

(AD, RT, ON,

OM, TE)

Cost

minimising

(RD, AW, IL,

HD)

Q.1. Q1: Overall, how satisfied are you with the help from

[Social Services] that you receive in your own home?

5.2 6.2 11.8

Q2: Do your care workers come at times that suit you? 7.0 4.4 12.0

Q3: Are you kept informed, by your home care service, about

changes in your care?

5.8 5.8 11.8

Q4: Do your care workers do the things that you want done? 5.2 6.6 11.3

Q5: Are your care workers in a rush? 5.8 7.0 10.3

Q6: Do your care workers arrive on time? 8.8 4.0 10.3

Q7: Do your care workers spend less time with you than they

are supposed to?

5.6 6.4 11.3

Q8: Do you always see the same care workers? 8.4 6.2 8.0

Q9: Overall, how do you feel about the way your care

workers treat you? (e.g. whether they are understanding and

treat you with respect for your dignity)

6.0 6.0 11.3

Note: LAs ranked by average scores with highest satisfaction ranked 1 and lowest 14.

Source: NHS Information Centre 2009a Home Care Survey 2008-2009, own compilation.

Two more partnership LAs - XD and RN - come next at 8.5 followed by ON, a mixed LA, at

9. The lowest satisfaction scores include all four cost minimising LAs along with the mixed

LA, RT. The rank scores are 9.5 for AW and 11 for RT, the two outer London boroughs, and

11, 12 and 14 for the other cost minimising LAs.

These satisfaction scores thus provide support for the categorisation of the LAs as cost

minimising but suggest that there may be some aspects of quality commissioning we are not

capturing particularly for the three mixed LAs with high scores – TE, AD and OM. We have

already suggested why AD may be in this category and TE is the LA we identified as closest

to our partnership category. OM was going through a period of change at interview so it is

difficult to know whether the changes will lead to a reinforcement or reversal of these high

satisfaction scores, if there is indeed a connection between commissioning and contracting

and these user outcomes.


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Table II.10. Ranking of user satisfaction scores by individual LA*

LA Type of LA Rank for question 1 Rank by average of

ranks for questions 2-9

Average of column 2

and 3

UY Partnership 1 1 1

TE Mixed 2 3 2.5

AD Mixed 5 2 3.5

AH Partnership 3 5 4

OM Mixed 4 4 4

LK Partnership 7 6 6.5

XD Partnership 6 11 8.5

RN Partnership 9 8 8.5

ON Mixed 8 10 9

AW Cost minimising 12 7 9.5

RT Mixed 13 9 11

IL Cost minimising 10 12 11

RD Cost minimising 11 13 12

HD Cost minimising 14 14 14

Note: Scores based on responses to 4, 5 or 7 point scale. LAs ranked by average scores with highest

satisfaction ranked 1 , lowest 14.

Source: NHS Information Centre 2009a Home Care Survey 2008-2009, own compilation


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II.5 Summary and conclusions

In line with the findings from the first stage survey of LAs, we found significant variation in

the specific practices adopted by our selected LAs with respect to commissioning and

contracting, particularly in the case of domiciliary care, although some general trends can

also be detected. In both domiciliary and the care home sectors the majority of the service

had been outsourced to the independent sector and further outsourcing was planned.

Nevertheless most interviewees anticipated keeping some inhouse provision, although this

would be increasingly focused on specialised re-ablement services and none were planning

any TUPE transfers of existing LA staff. Indeed those that had TUPE transferred staff in the

past believed this to have been a strategic error. Contracting in domiciliary care had in many

cases moved away form block contracting and instead LAs were establishing a set of

preferred providers, in part as a cost efficiency measure to reduce risks of unused hours but

also in preparation for the personalisation agenda. However, five still used block contracts

and two had recently moved to such contracts. In the care home sector the majority of

contracting was on a spot basis, following the preferences of the user. Twelve of the 14 LAs

did still provide some residential home care inhouse and ten had some block purchase

contracts with independent sector homes.

Pricing strategies also varied between LAs. In domiciliary care there was a general trend

towards simplification of fees around a standard fee with many LAs not making any

differences in payments for shorter visits, unsocial hours, higher dependency of users or

travel time, although some had introduced more differentiation between rural and urban

abased agencies. However, although the trend was towards a single rate, in eight LAs fees

still varied by providers according to their tender price. Nevertheless overall the average fees

only ranged from £10.45 to £14.50 for 13 LAs and the range among providers within a

locality rarely exceed £2 to £3. One LA was an exception on both counts with a range from

£16 to £28. The main motivation for the simplification strategy tended to be to reduce both

direct costs and transaction costs for the LA. Likewise the move towards use of electronic

monitoring was primarily driven by the interest of reducing costs and ensuring clients

received their full visits. Only two LAs offered any IDPs any quality enhancement to their

fees for meeting quality targets.

Variations in fees for residential care were much wider than for domiciliary care between

LAs and reflected regional variations in housing costs, not just wage costs. However, the

level of fees set did not simply reflect local conditions as in some LAs the policy was to set

care home fees at a level where it most LA funded clients would not be faced with requests

for top up fees unless they had a special room of some kind. Other LAs expected most

residents would be asked to pay top up fees because of the low level of their fees relative to

local home fees for private clients. More LAs had introduced quality enhancements for

homes with five currently offering quality premia and a sixth offering extra to those with

Investors in People awards.


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The variation in commissioning and contracting practices was found in our qualitative

interviews with key actors to reflect different priorities and approaches adopted by LAs in a

context where each LA was being required to make sense of a range of potentially conflicting

influences on commissioning practices. We found social care commissioning not only to be

influenced by the specific council‟s organisational, budgetary and political environment but

also influenced by the longer term policy agendas for the development of social care. Policies

towards commissioning were found to generate competing agendas from the need to support

providers and develop the supply base to the need to take costs out and control price even in a

context of policies aimed at driving up the quality of care delivered. Further competing

agendas stemmed from whether commissioning would in the future continue to be dominated

by LAs or either undertaken jointly with the NHS or devolved to users.

While all LAs were being pulled in competing directions, we were able to identify

differences between LAs in their espoused strategic approaches and in their implementation

of policies. We therefore classified LAs according to their concerns to develop partnerships

with independent providers on the one hand and to reduce costs on the other hand. This gave

rise to three groups of LAs: partnership focused; those focused on cost minimisation; and

those falling into a mixed category. This classification was found to have some resonances

with the national user satisfaction scores as recorded by LA, with the cost minimising LAs

assessed by users as providing less good quality care than the partnership or mixed

categories. Some of the mixed category LAs topped the user satisfaction scores and in one

case there was a particularly high share of LA directly employed staff in a 3* rated unit

providing domiciliary care services, suggesting perhaps that it is share of services outsourced

as well as commissioning strategies towards the independent sector providers than may

influence user satisfaction scores.




of these apparent differences in commissioning and contracting stances. Above all there was

a very high rate of change in commissioning policies, some of them implemented during the

course of our project. This rate of change reflected both the changing commissioning

environments and the recognition of potential contradictions between some of the LAs‟

objectives and its current commissioning approach. It was thus not necessarily the case that

the commissioning strategies were sufficiently stable and coherent for independent providers

to be able to act on the practices to develop different approaches to managing the social care

workforce. Furthermore it was also increasingly the case that LAs were becoming reliant on

national providers. Some LA commissioners were concerned about the quality of these

providers and about the impact on of their growth on the local supply chain and their ability

to foster a diversified supply of care provision but nevertheless most LAs were increasing

their contracting with national chains. LA commissioners were also aware that their current

policies were vulnerable to future changes in central government policy which might, for

example, reduce the finance available for social care or even reduce the role of LAs in the

planning and commissioning of care due to the health integration and personalisation

agendas.

Part III. The provider telephone survey

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III. The Provider Telephone Survey:

Recruitment, Retention and Employment

Conditions

This part of the report presents the key findings concerning recruitment, retention and

employment conditions for the social care workforce. The analysis draws on the telephone

survey sample of 105 independent providers, including 53 independent sector residential and

nursing care homes (referred to as homes) and 52 independent sector domiciliary care

providers (referred to as IDPs). The data are complemented by interviews with 10 of the

Local Authority domiciliary care providers (referred to as LADPs).21

This original dataset,

which comprises a quantitative dataset and qualitative open-ended responses to questions,

forms the basis of analysis for this part of the report as well as part IV. Our objective here is

to present an introductory mapping of the descriptive statistics in order to address a set of

first-order questions:

what types of HR practices are in use within the sector?

how much variation of practice is there both between homes, IDPs and LADPs

and within these categories?

do all providers face similar recruitment difficulties and staff retention

problems?

An understanding of both the range of approaches to human resource management deployed

by individual providers and the key employment outcomes and differences therein between

IDPs, homes and the LA sector is a necessary first step in our knowledge before undertaking

a more detailed and complex analysis of the data in Part IV. There, we interrogate the

underlying factors that are associated with good HR practices and good HR outcomes and test

the statistical significance of the impact of provider characteristics on the one hand and

external commissioning and labour market factors on the other in explaining variations in HR

practices and outcomes. As such, it is the combination of results in both parts III and IV that

generate our conclusions concerning the role of internal factors and external environmental

conditions in shaping HR practice and recruitment and retention performance.

21 Two of the fourteen local authorities had no in house provision and interviews were not possible with the

other two due to pressures of restructuring and other issues.


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This part of the report is structured into six sections with each section presenting a map of

results for homes, IDPs and LADPs related to a particular area of employment organisation

as follows:

III.1. Recruitment and selection

III.2. Retention

III.3. Pay and rewards

III.4. Working time and work organisation

III.5. Employee training and development

III.6. Performance management, job autonomy and employee voice


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III.1. Recruitment and selection

Recruitment and selection practices are a core element of what care organisations do and are

instrumental in improving their performance. But to what extent do we find similarity of

approach across the different care organisations? For example, one issue highlighted in our

literature review (see section I.3) is variation in use of formal and informal methods of

recruitment. On the one hand, all organisations are being nudged towards greater formality by

the inspection processes of the CQC and the commissioning local authority. On the other

hand, providers may benefit from an informal approach to connecting with people with a

known reputation. In this section we investigate this issue and other issues related to

providers‟ approaches to recruitment and selection. Throughout we disentangle the variation

between homes and IDPs and, where appropriate, LADPs. We begin with an overview of the

extent of recruitment difficulties reported by the care organisations surveyed.

III.1.1. Recruitment difficulties

Our survey evidence reveals that one third of care organisations reported difficulties in the

recruitment of care staff, ranging from quite difficult to very difficult. The reasons underlying

these difficulties are likely to vary. While much depends on the conditions in the local labour

market – the presence of competitor organisations, the level of unemployment and the

availability of a suitable pool of job applicants – difficulties may also result from poorly

managed recruitment procedures, an inadequate pay offer, or inappropriate working-time

conditions. Here we set out a general assessment of patterns. The analysis in part IV

investigates the underlying causes.

Figure III.1. Percentage of organisations reporting the ease or difficulty of recruiting

care workers

0

5

10

15

20

25

30

35

40

45

very difficult quite difficult neither difficult nor

easy

quite easy very easy

Perc

enta

ge

Homes IDPs LADPs

Note: Total responses: 53 (homes), 51 (IDPs) and 10 (LADPs). Missing responses: 1 (IDPs).


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The type of care organisation matters in explaining the likelihood of recruitment difficulties.

Recruitment difficulties were more likely to be experienced by IDPs than by either homes or

LADPs (figure III.1). Although more homes - at 11% compared to 6% of IDPs - said

recruitment was very difficult, only 17% of homes compared to 33% of IDPs said recruitment

was quite difficult. Among LADPs a far smaller share reported difficulties – just 20%.22

Homes were more likely than IDPs to report recruitment of care staff to be quite easy or very

easy – 56% and 41% respectively. And while only 40% of LADPs fell into this category,

another 40% reported recruitment to be neither difficult nor easy, far higher than the shares

reported for IDPs and homes.

While these results point to significant problems in recruitment of care workers, our evidence

also reveals that the recessionary conditions of 2008-2009 had in fact made matters easier for

around one third of the care organisations surveyed. The UK unemployment rate increased

sharply from 5.5% to 8.1% between the second quarter of 2008 and last quarter of 2009

(ELMR 2010). After a decade of relatively stable unemployment at around 5-6%, employers

therefore suddenly faced a changed set of external conditions with greater numbers of people

applying for vacancies.

I think there‟s been a real shift with the economic climate. A year ago I would have said very

difficult I think at the moment I‟d say it‟s in the middle. (RD.D.2.CL)

I think it‟s very easy … Since last year I think vacancies have gone down mainly because of

the credit crunch affecting overall everybody. (RD.H.1.B.S)

At the moment I would say a 5, very easy, because we‟ve had such a response for our

vacancies. We‟re having to filter them at the moment because we‟ve had so many, there are

just so many people wanting the post, it‟s not always been like that, it‟s changed.

(RD.HN.4.C.N)

Table III.1. Change in recruitment conditions as a result of the 2008-2009 recession

% of homes % of IDPs % of LADPs % of all

No change 63.2 25.6 28.6 42.0

Some change 36.8 74.4 71.4 58.0

Recruitment easier 34.0 62.9 71.4 51.1

Recruitment more difficult 2.8 11.5 0.0 6.9

Total Responses 38 43 7 88

No response 15 9 3 27

Again, however, the experience was not shared equally among all organisations (table III.1).

Domiciliary providers, both independent sector and local authority, were more likely to

experience an easing of recruitment conditions, probably from a more severe situation of

22 In the last 12 months, 3 LADPs and 2 IDPs did not recruit at all while all homes had recruited new care

workers.


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shortage than applied to homes prior to the recession. Thus, the gap reported above between

homes and IDPs would have been even wider were it not for the impact of the recession.

As anticipated, the reasons for recruitment difficulties were varied and encompass both

internal organisational factors and external labour market and other conditions. The

responses from providers surveyed suggest that pay is the most common factor (table III.2),

a result of either too many competitor employing organisations offering higher rates of pay

or the inability of the care provider to offer a rate of pay commensurate with people‟s

expectations of the value of the job. More than one in four respondents recorded pay as a

main reason. Pay was an especially common reason among IDPs, accounting for more than a

third of responses. It was also the most common response among care homes. However, it is

significant that it was not reported as a main reason by the LADPs that responded to this

question – a clear reflection of the higher rates of pay offered by local authorities (see III.3

below). The following quotes illustrate the differences:

It is the price that the LA pays – it is low pay. It is the nature of the contract. If they pay us

more we pass it on. (AH.D.4.DS).

No [pay is not an issue]. To be honest that is because in the local authority we pay manual

grade 5 plus 33.5% enhancement for working anti-social - for example for mobile night

workers - plus they get essential car users and mileage. (IL.DIH.1.CP).

A second important reason for recruitment problems concerns the nature of care work.

Respondents told us they believed that for many people the job of a care worker was too

emotionally demanding. They also emphasised the generally poor status of the work, a fact

that was obviously tied to the low pay.

It is very poorly paid and involves a lot of hard work, including both mental and physical,

with a lot of pressure on people, especially with new legislation demands. (RD.D.1.C.S).

This type of work doesn‟t have a particularly valued reputation among a whole lot of people

… You need a terrific sense of … well, you‟ve got to be an angel (RD.D.2.CL).

Aside from pay, the other HR practice that created problems for many care providers was

the working time schedules. This was reported as a factor by twice the number of IDPs as

homes, reflecting the predominance of far more flexible working-time contracts in IDPs.

The 24/7 demands for work, especially the requirement for regular weekend working were a

particular issue for several organisations, an issue we explore further below (section III.4).

Other reasons set out in table III.2 relate explicitly to changes in the external environment,

usually in the immediate locality. These include problems of local competitors – newly

opened supermarkets were often mentioned by respondents – as well as observations of a

„transient community‟ and the frustrating practice whereby some people registered as

unemployed apply for a job primarily in order to satisfy job search requirements.

My bugbear is that people telephone for the paperwork and you arrange 25 interviews and

only 6 show up. They don‟t come. And they only apply so that they can be seen to be

applying to get the benefits. (TE.H.3.AS).


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Table III.2. Main reasons for recruitment difficulties


Pay 19.9 37.3 0.0 27.1

Nature of care work 10.0 7.9 33.3 10.3

Local Competitors e.g. new supermarkets 10.0 9.8 16.7 10.3

Transport costs 10.0 11.7 0.0 10.3

Working time Schedules 6.0 11.7 16.7 9.4

CRB delays 4.0 9.8 0.0 6.6

High or low local employment 8.0 5.9 0.0 6.5

Not suitable/ Calibre of staff 12.0 0.0 0.0 5.6

Location 6.0 0.0 0.0 2.8

People apply so that they can stay on benefit 6.0 0.0 0.0 2.8

Reluctant to train 4.0 0.0 0.0 1.9

Working conditions 0.0 3.9 0.0 1.8

Its a transient community 2.0 0.0 16.7 1.9

Visas 2.0 0.0 0.0 0.9

Can‟t drive 0.0 1.9 0.0 0.9

Childcare 0.0 0.0 16.7 0.9

Total responses 50 51 6 107

No response 3 1 4 8

While the above results concern general recruitment difficulties faced by care providers,

more specific detail can be ascertained by focusing on particular types of job posts that need

to be filled. Around half the sample of care organisations reported specific shortages. By far

the most common shortages were for jobs requiring weekend work and unsocial hours and for

night work (table III.3). The data show a clear divide between care homes and IDPs; specific

shortages were far more likely to be reported among the latter – 77% of IDPs compared with

25% of homes. The difficulty of finding people to fill weekend work and unsocial hours was

reported by more than two thirds of IDPs compared to less than one in ten homes, and night

work problems were reported by 37% of IDPs and 15% of homes. LADPs fell somewhere

between the other two types of care organisation with 40% reporting specific shortages, again

with respect to jobs requiring unsocial hours working.

Given the range of difficulties reported by the surveyed care organisations, it is important to

investigate what types of recruitment and selection practices are utilised, and how practices

vary across different organisations. We address these issues in the following section.


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Table III.3. Labour shortages for specific job posts


Are there any specific shortages? 24.5 76.9 40.0 49.6

Are there shortages for weekend work and

unsocial hours? 7.5 69.2 20.0 36.5

Are there shortages for night work? 15.1 36.5 30.0 26.1

Early morning 0.0 7.7 0.0 3.5

From particular geographical areas 0.0 3.8 0.0 1.7

Trained staff 3.8 0.0 0.0 1.7

Bank Holidays 0.0 1.9 0.0 0.9

Males 0.0 1.9 0.0 0.9

Day shifts as all on specific courses 1.9 0.0 0.0 0.9

Drivers 0.0 1.9 0.0 0.9


III.1.2. Recruitment practices: attracting a suitable pool of applicants

Organisations in all sectors of the economy can be expected to use a range of informal and

formal methods to fill vacant posts. The organisations surveyed in the care sector as part of

our study fit with this notion of an eclectic approach. In particular, we find that three

practices were relatively common – the informal practice of advertising vacancies by word of

mouth, the more formal method of paying for ads in the local press and the similarly formal

method of contacting Job Centre Plus. Each of these practices was reported by at least three

in four organisations.

Figure III.2 charts the range of responses for homes and IDPs, ranked by the most popular

recruitment practice for each. Both IDPs and homes appear strongly wedded to the informal

practice of advertising through word of mouth – close to 80% of homes and 90% of IDPs.

One domiciliary provider explained that this involved asking people who worked for her to

„recognise people with the kind of personal qualities we are looking for‟ (UY.D.1.C.L) and

another told us that this informal approach extended to „people literally walking through the

door and asking for a job application‟. It was a less frequent practice among LADPs (just

40%), possibly because of the more formalised processes associated with LA HR

departments. The similarly informal method of posting ads in office or shop windows was

less likely to be reported overall, but nevertheless was a regular practice among one in five

homes and, perhaps surprisingly, almost half of IDPs; the popularity of this method amongst

IDPs is probably explained by the fact that many have a shop front. As might be expected,

given the scale of their organisation, the relatively formal practice of using internal

advertisements was especially popular among LADPs; two in three reported this practice.

Many organisations also retained lists of interested applicants, made up largely of people who

had registered interest at a time when the organisation was not recruiting; close to two fifths

of care homes used such lists and one quarter of IDPs.


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Figure III.2. Diverse recruitment methods used to fill vacancies for care work

a. Homes

0

10

20

30

40

50

60

70

80

90

100

Word of m

outhPress advertisingJob Centre PlusInternal advertNotice in windowList of interested applicants

Advertising in collegesUsing other agenciesFee to em

ployment agency

Internet

Drop-ins

Leaflet drops Recruitm

ent open days

UKHCA

Radio

Pe

rce

nta

ge

b. IDPs

0

10

20

30

40

50

60

70

80

90

100

Word of m

outh

Press advertising

Job Centre Plus

Internal advert

Notice in window

List of interested applicants

Advertising in colleges

Using other agencies

Fee to employment agency

Internet

Drop-ins

Leaflet drops

Recruitment open days

UKHCA

Radio

Pe

rce

nta

ge

Note: Total responses: 51 (homes), 51 (IDPs) and 9 (LADPs). Missing responses: 2 (homes), 1 (IDPs) and 1

(LADPs).

Two formal methods also dominate the approach to recruitment among care providers of all

types. First, four fifths of all organisations that responded to our survey said they used adverts

in the local, regional or professional press. The breakdown among type of organisation is

68% of homes, 77% of LADPs and 92% of IDPs. Second, 72% of responding organisations

said they relied on Job Centre Plus as a normal method for filling vacancies. Again, this more


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formal method was more likely to be reported by IDPs than by homes, some 86% compared

to 60%, respectively. A third formal method that was reported only by a small proportion of

organisations was the use of fee-charging employment agencies; 6% of homes reported this

practice, along with 16% of IDPs and 11% of LADPs.

In addition to the prompts we used in our telephone interviews, managers also told us about

other methods they regularly used. These included the internet, informal drop-ins, leaflet

drops, recruitment open days, UKHCA and the radio.

Certain recruitment methods appear to be more effective than others. Our survey data suggest

that informal word of mouth recommendations and the formal practice of press advertising

are the best ways to fill vacancies, although there is by no means a consensus, or even a

majority, view on this (table III.4). Among our small sample of LADPs, three quarters

favoured formal methods as most effective, with two thirds opting for press advertising. The

views of care homes and IDPs were more varied. Homes were far more likely than either

IDPs or LADPs to favour informal methods; the most common response to our survey

question (43% of homes) was that the informal word of mouth method is the most effective

way to fill vacancies. However, the relatively formal methods of press advertising and Job

Centre Plus were also identified as most effective by 28% and 19% of homes, respectively.

By contrast, IDPs (like LADPs) tended to identify formal practices as most effective; 38%

reported press advertising and 30% Job Centre Plus, compared with around 23% favouring

informal practices.

Table III.4. Managers’ views regarding the most effective method for filling vacancies


Informal methods:

Word of mouth recommendations 42.6 23.4 0.0 30.1

Notice in office or shop window 4.3 0.0 11.1 2.9

Mixed methods:

Other agencies 2.1 0.0 0.0 1.0

Internet, open days, other methods* 4.3 8.5 11.1 6.8

Formal methods:

Press advertising 27.7 38.3 66.7 35.9

Jobcentre plus 19.1 29.8 11.1 23.3



Note: * Other methods include the internet, council workforce development and recruitment open days.

A small proportion of providers considered other mixed methods, in the sense of formal and

informal, to be the most effective way to fill vacancies. For example, 2% of homes and 8% of

IDPs believed the internet was the most effective method, while another 2% of homes

believed their local council‟s workforce development initiative was the most effective way.

One LADP reported that recruitment open days were the most effective practice.


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The recruitment of senior care workers was considered an especially important issue among

managers of organisations responding to our survey. However, the filling of such posts is

unlike the filling of vacant care worker posts since it is more usually filled through internal

promotion, and therefore reflective of the organisation‟s approach to training and career

development for incumbent staff. As one manager told us, „I like to encourage people and

know that I have developed them. If you get someone new, they don‟t know the standards‟

(IL.H.4). In an effort to unpack these differences in approach our survey questionnaire

therefore asked respondents whether they normally recruited externally or from within their

existing staff of care workers.

In fact, the majority of establishments in our telephone interview sample recruited senior care

staff from within their existing staff (table III.5). This is a positive practice insofar as it gives

care workers something to aim for and the prospects of career progression. Only two

organisations out of the total sample of 115 relied wholly on external recruitment to fill

vacant senior care posts. It was far more common for care organisations to recruit from

internal applicants; 56% relied on this method exclusively. In addition, slightly more than one

in three organisations recruited from both internal and external routes. It is notable that 6% of

organisations surveyed did not employ senior care workers and therefore did not provide care

workers an internal opportunity for career progression.

Table III.5. Internal and external recruitment of senior care workers


Existing staff 54.7 53.8 70.0 55.7

Externally 1.9 1.9 0.0 1.7

Both from existing staff &

externally

34.0 40.4 30.0 36.5

Don‟t have senior care workers 9.4 3.8 0.0 6.1


The set of management processes used in recruitment was very standardised among the

different organisations. Nearly all managers who responded to the survey used application

forms requiring a full work history (99%), carried out formal interviews (96%) and relied on

formal job descriptions and person specifications (93%) (figure III.3). In addition, nearly all

organisations required character references – with 88% asking for references after the

interview and 18% prior to the interview.

Once again there is variation by type of care organisation. Around two in three IDPs used

initial telephone screening compared to only around one in three homes and one in ten

LADPs. Another difference concerns the requirement for applicants to produce a CV; this

applied to 61% of homes compared with only 39% of IDPs and 22% of LADPs. Finally, IDPs

and LADPs were twice as likely to use aptitude testing as care homes (43%, 44% and 22%,

respectively).


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Figure III.3. Features of the recruitment process in homes and IDPs

0

10

20

30

40

50

60

70

80

90

100

Application

requires full

work history

Formal

interview

Job

descriptions

and person

specifications

References

after

interview

Initial

telephone

screening

CV Aptitude

Testing

Informal

interview

Aptitude test

at interview

References

before

interview

Aptitude test

at induction

Pe

rce

nta

ge

Homes IDPs

Note: Total responses: 51 (homes), 51 (IDPs) and 9 (LADPs). Missing responses: 2 (homes), 1 (IDPs) and 1

(LADPs).

Table III.6. Alternative practices when local recruitment fails


Extend efforts to surrounding areas 52.8 48.1 44.4 50.0

Attempt a more national recruitment drive 18.9 21.2 11.1 19.3

Use other agencies 20.8 11.5 11.1 15.8

Contact other agencies specifically for

migrant workers 13.2 19.2 0.0 14.9

Direct overseas recruitment 17.0 9.6 0.0 12.3

Total No. 53 52 9 114

No response 0 0 1 1

Given the pre-recession difficulties of recruitment, our survey included a question that asked

respondents about their strategies for filling vacancies if unable to recruit locally. Half the

sample reported they would extend efforts to surrounding areas under such circumstances

(table III.6). Use of other agencies was not a popular method, used by just 16%. The option

of contacting agencies, or intermediaries which specialise in providing migrant workers was

also not a very common practice, only reported by 19% of IDPs, 13% of care homes and

none of the LAPDs. However, a surprising 12% of organisations - all from the independent


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sector - did in fact report recruiting care workers directly from overseas, including 17% of

care homes and nearly 10% of domiciliary care providers.

III.1.3. Selection: choosing the right applicant

While different recruitment methods enable organisations to access varying pools of job

applicants, it is likely that there will be variation in organisations‟ approach to what attributes

among job applicants provide the best fit with the job vacancy. Our survey asked respondents

to identify those attributes among job applicants they considered necessary or desirable. The

question included ten prompts and also allowed managers to identify other factors.

Perhaps unsurprisingly, given the intensive personal contact required in the job of a care

worker, close to nine in ten managers in our sample considered a positive attitude and a

friendly nature to be necessary of job applicants (figure III.4). A further two factors were also

very important necessary factors - availability for weekend work (70% of homes and 66% of

IDPs) and availability for early starts or evening work (66% of homes and 54% of IDPs) –

reflecting the 24/7 demands of work in the care sector. Indeed, all LADPs (not shown in

figure III.4) reported availability for both weekend work and for early starts and evening

work as necessary factors.

Figure III.4. Attributes considered necessary among job applicants

0

10

20

30

40

50

60

70

80

90

100

Positive attitude/

friendly

Available weekend

work

Available

earlies/evenings

Own transport Ability to drive Care-related skills Lives locally Experience caring

for family/friend

Qualifications

(NVQ2+) in care

Recommended by

employee

Formal care work

experience

Pe

rce

nta

ge

Homes IDPs

Note: Total responses: 50 (homes), 50 (IDPs). Missing responses: 3 (homes), 2 (IDPs).


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Table III.7. Attributes considered necessary and desirable among job applicants

a. Homes

% of respondents

Necessary Desirable

Positive attitude/ friendly nature 90.0 13.7

Availability for weekend work 70.0 29.3

Availability for early starts or evening work 66.0 27.5

Skills related to care work 28.0 62.7

Experience of caring for family member or friend 10.0 52.9

Recommended by another employee 6.0 51.0

Formal experience of care work* 6.0 70.6

Qualifications - NVQ2 or above in care 6.0 78.4

Lives locally 4.0 52.9

Total No. 50 51

No response 3 2

b. IDPs

Necessary Desirable










Own transport 39.6 58.0

Ability to drive 33.3 61.2

Total No. 50 50

No response 2 2

c. LADPs

% of respondents

Necessary Desirable










Total No. 9 9

No response 1 1

Note: *e.g. care home or other home or agency

By contrast, evidence of skills related to care work or qualifications in general care (at NVQ


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level 2 or higher) were only considered necessary in a small fraction of the independent

sector organisations surveyed. Just one in four (24%) reported skills as necessary and one in

ten reported qualifications. Such factors were instead far more likely to be reported as

„desirable‟ rather than necessary, by two thirds or more of all organisations surveyed. The

results in table III.7 above demonstrate the majority of care organisations do recognise the

value of qualifications in care work, as well as formal or informal experience of care work

and care-related skills (all factors highlighted in italics in the table), but are unwilling to use

these factors to rule out candidates. The exception to this pattern are the public sector

providers. LADPs were far more likely to report care-related skills and qualifications as

necessary factors among job applicants – 56% and 33%, respectively, compared with 28%

and 6% of homes and 14% and 10% of IDPs. On the one hand, this may reflect the lack of an

available pool of ready-skilled job applicants, even during the recession. However, judging

by the comments made by several respondents, it also reflects a genuine prioritisation of

personality attributes over proven skills among public sector LADP managers.

Somebody may come with a string of qualifications but really not be suitable at all. Or,

conversely, zero qualifications but with a lifetime of experience of looking after people that

would be fine. (ON.DIH.1.DP).

Other factors cited as necessary by a small number of organisations were „lives locally‟ (in

fact more than one quarter of IDPs said this was necessary), „recommended by another

employee‟ and „formal experience of care work‟.

The four attributes highlighted in italics in table III.7 refer to skills, qualifications and

experience related to caring work. Across the different providers there was considerable

variation in the extent to which these four skill-related attributes were considered necessary

or desirable among job applicants. Figure III.5 presents the variation among homes and IDPs

using an indicator from 0-8 that assigns 2 points where the provider reported a skill-related

attribute as necessary and 1 point where it was reported only as desirable. Nearly half of both

homes and IDPs score 4 out of 8 on this measure. A surprisingly high share (16%) of IDPs

score 2 or less, meaning that they only reported two out of four skill-related attributes as

desirable or just one attribute as necessary; the same was true of 12% of homes. Only 2% of

homes and 2% of IDPs register the full score of 8, meaning they reported all four skill-related

attributes as necessary among job applicants. Among LADPs, the scores are higher; nearly

two thirds of LADPs score 5 or 6, 13% score 4 and 25% score 3.


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Figure III.5. Measure of providers’ preferences for skill-related attributes among job

applicants

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1 2 3 4 5 6 7 8

Indicator of provider need for skills and qualifications among job applicants

homes IDPs

Note: The four skill-related attributes are qualifications (NVQ level2 and above) in care, skills related to care

work, formal experience of care work and experience of caring for a family member or friend. See table III.7 for

details. 1 point is assigned to each attribute reported as desirable and 2 points to each necessary attribute.

Among all the different attributes that organisations value among job applicants, respondents

were also asked to identify the single most important factor. Unsurprisingly, perhaps,

respondents were most likely to select a positive attitude and friendly nature over any other

factor (table III.8). Two in three organisations cited this factor. All other factors accounted

for fewer than one in ten responses. Nevertheless, among LADPs one in four cited care-

related skills as the most important factor, compared with just 4% of IDPs and 6% of homes.

Interestingly only a handful of respondents considered availability for early starts or evening

work (8%) and availability for weekend work (4%) as the most important factor in applicants

when recruiting. This is somewhat paradoxical as we saw above that many managers reported

staff shortages for weekend work and evening work. Nevertheless, some comments by

managers did highlight this juggling of priorities:

I suppose if the positive attitude and friendly nature presents itself, they‟ve still got to have a

good availability. Just because somebody‟s really really friendly and really really nice, if

they‟ve only got the availability of 10am until 2pm Monday, Tuesday, Wednesday, we are not

going to take them on … So if they say, „Yes, I can start early three days a week because

that‟s all I want‟, and they‟re dead bubbly, then you are going to take them on. Because we

don‟t look for full-time workers. We are looking for people that work - 25 hours is a good

number for people to work. (ON.D.1 DN).


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Table III.8. The most important attribute required of job applicants

% of homes % of IDPs % of LADPs % of All

Positive attitude/friendly nature 76.6 56.5 62.5 66.3

Availability for early starts or evening

work

6.4 10.9 0.0 7.9

Skills related to care work 6.4 4.3 25.0 6.9

Availability for weekend work 0.0 8.7 0.0 4.0

Recommended by another employer 0.0 4.3 0.0 2.0

Formal experience of care work 2.1 2.2 0.0 2.0

Own transport 0.0 0.0 12.5 1.0

(Other) Reliability 0.0 8.7 0.0 4.0

(Other) Communication skills 4.3 0.0 0.0 2.0

(Other) Willingness to learn 2.1 0.0 0.0 1.0

(Other) Commitment 2.1 0.0 0.0 1.0

(Other) Honesty 0.0 2.2 0.0 1.0

(Other) Understanding 0.0 2.2 0.0 1.0



As well as looking for a particular mix of personal attributes – a friendly nature, a caring

attitude towards elderly people and a commitment to wok different hours – our survey was

also designed to identify whether or not managers also sought to compose a particular mix of

care workers, differentiated by gender, age, ethnicity and so on. One reason care

organisations may seek to do this is to reflect the demographic composition of their users;

male care workers may be in demand by elderly men in need of care and similarly there may

be a demand for care workers from particular ethnic backgrounds. We began by asking

managers if they were satisfied with the composition of their care workforce.

In relation to the numbers of young and old workers, male and female and ethnic mix, most

organisations responding to our survey– over 80% - reported that they were satisfied. The

degree of satisfaction was far higher among care homes – some 96% - compared to 74% of

IDPs and only 40% of the 10 LADPs. Of the 23 organisations that reported dissatisfaction,

we further queried the particular reasons for this (see table III.9). Ten organisations reported a

preference for a more ethnically diverse profile (which may include wanting more white

workers) and a similar number desired more male care workers. Three organisations stated

they wished to have more young workers. The difficulties of extending the recruitment pool

to these particular groups were articulated by some of the managers we interviewed:

I‟d like to see more men in this area of work, I feel frustrated at times that our staff don‟t get

the recognition that they deserve they are considered at the lower end of the scale in terms of

the working classes, … And I‟d like to see a better representation of minorities. Now that‟s

very difficult because of cultural differences and requirements which make it hard to recruit

and also for some of the minority cultures to work in this field. (OM.D.2.DN).

Ethnicity is an issue in terms of recruitment, there are a number of Chinese speaking and

Somali speakers; but this changes and we may lose staff with these languages. Sometimes we


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can‟t match specific requests. I don‟t know how we have managed to cope because it can be

a problem. (IL.DIH.1.CP).

Men are thin on the ground. We have a lot of male service users who prefer a man to come in

to them. Having male staff limits you, as you can‟t send a male into a female service user.

(IL.D.3 CL).

Table III.9. Reasons for dissatisfaction with the composition of the workforce


Happy with composition of

workforce

96.2 74.5 40.0 81.6

Not happy with composition

and would prefer:

3.8 25.5 60.0 18.4

More younger employees 0.0 7.7 28.5 13.0

More men 33.3 53.8 28.5 43.5

More ethnically diverse profile 66.7 38.5 42.9 43.5


No response 0 1 0 1

III.1.4. Selection problems

In an effort to explore further the consequences of the recruitment and selection context, we

wanted to test the extent to which organisations were forced to hire people who perhaps did

not quite meet the selection criteria. Conversely, mindful of the effects of rising

unemployment during the period of our fieldwork, we also wanted to assess the degree to

which organisations felt they enjoyed the luxury of selecting from a pool of numerous

suitable candidates.

Our first finding concerns the extent to which organisations sometimes hired a person who

was known at the point of hiring to be less than the ideal match for the vacant job post. Quite

surprisingly, more than two in five care organisations in our sample (41%) reported they

occasionally, often or very often employed staff who did not possess as many of the desirable

qualities as they would like (table III.10). Open-ended responses to this question suggest that

organisations sometimes took on people without the desired experience, or without the

desired NVQ qualifications. Others employed the person on a temporary basis or used them

to cover staff on sick leave. The results suggest this was more of a serious problem for IDPs,

17% of which said this situation occurred „often‟. It is possible that the varying responses

relate to labour market conditions, such that those providers experiencing recruitment

difficulties (as reported in Figure III.1) would conceivably be more likely to make a less than

ideal hire. However, interrogation of the data suggest there is not a strong relationship,

neither for homes nor IDPs; those facing difficult recruitment conditions were as likely to

report occasionally or often hiring people without the desirable skills as to never or almost

never hiring such people. Only among homes that reported easy recruitment of care workers

do we find some evidence of an influence, with twice as many saying they never or almost


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never hired individuals without the desirable skills. Another factor that might help explain the

variation in hiring practices is the provider‟s preference for skills and experience among job

applicants (as reported in Figure III.5 above). Again, there is little evidence of a strong

relationship. And once again only among homes do we find that for those with a medium to

strong preference for skill-related attributes (a score of 4 of more on the 1-8 scale), the

likelihood of never or almost never hiring individuals without the desired skills is twice that

of occasionally or often hiring such individuals.

Table III.10. Percentage of organisations that knowingly hire people who lack the full

set of desirable qualities


Very often 1.9 0.0 0.0 0.9

Often 3.8 17.3 0.0 9.6

Occasionally 34.0 32.7 0.0 30.4

Almost never 34.0 15.4 40.0 26.1

Never 26.4 34.6 60.0 33.0


In contrast a significant minority of organisations did not face problems in attracting

sufficient numbers of suitable care workers and in fact often had to turn away people who

were suitable for the job. Approximately one in three care organisations reported that they

occasionally, often or very often were in the position of having to reject applicants who

would nevertheless be acceptable care workers (table III.11). For one in ten organisations this

occurrence happened often or very often, especially among independent sector and LA

organisations providing domiciliary care. To some extent this finding is likely to reflect the

impact of the recession with an increasing number of people seeking jobs. Nevertheless, the

majority of organisations reported that this happened never or almost never. This finding

suggests that most organisations simply do not experience the luxury of selecting from

several candidates who are all suitable for the job post. At the same time, however, some

organisations may be able to find alternative means of fitting such candidates into the

organisation, as the following quote illustrates:

If we thought we had found somebody good then we would always look at our other care

company because I think if we felt that we had found a genuinely suitable person then we

wouldn‟t want to lose them. (UY.D.2.B.S).

All organisations delivering care to the elderly must apply for Criminal Records Bureau

(CRB) checks on selected job candidates in order to ensure those individuals are eligible to

work with vulnerable adults.23

We investigated two recruitment issues associated with CRB

23 The administrative success of CRB checks has been subject to criticism over recent years. The system was

renovated and relaunched with a new IT system under a contract with the IT firm Capita in 2002, but was

subsequently plagued by problems which led to the delayed opening of schools and unfilled vacancies in many

care organisations.


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checks – whether or not organisations had not recruited applicants because of delays in the

CRB checks and whether or not applicants had failed CRB checks. In both cases, we were

interested in identifying the extent to which these problems caused organisations to lose

potential recruits over a two-year period.

Table III.11. Percentage of organisations that reject suitable applicants for care work


Very often 0.0 1.9 0.0 0.9

Often 5.7 13.5 20.0 10.4

Occasionally 30.2 7.7 50.0 21.7

Almost never 35.8 34.6 20.0 33.9

Never 28.3 42.3 10.0 33.0


In fact, a majority of organisations, 55% of the 115 surveyed, had experience of not recruiting

qualified job applicants due to delays in their CRB checks in the previous two years. A

smaller share, 36%, had a similarly negative experience as a result of an outright failure of

CRB checks (table III.12a and b). With respect to CRB delays, a far higher share of IDPs

reported problems than homes. Indeed, 28% of IDPs failed to recruit between 11 and 30

individuals in the previous two years as a direct result of CRB delays, and in 2% of IDPs

more than 30 individuals are said to have been lost. A similar pattern is true of reported

problems arising from CRB failures with around half of IDPs experiencing a loss of potential

recruits compared to only 21% of homes.

Many of our respondents took the opportunity as part of the telephone survey to voice

criticism over the administrative process of submitting CRB checks. The following quotes are

illustrative:

This is one of the bones of contention with me. It is a little bit better now. It used to take up to

4 months last year … We consequently lost staff. Now it is a little better and we can get them

in 3 weeks. Others take 8 to 10 weeks. This is just unacceptable. When it comes in they have

found another job outside care. (LK.D.6.CL).

We have a lot apply but they want to start work straight away. As we have a 7-week wait for

CRB we lose people. (HD.D.1).

We have to wait two months and people take other jobs. It is a real problem here. So we now

ask them [job applicants] to foot the bill for the CRB. (AH.D.1.BL).


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Table III.12. Recruitment failures caused by problems with CRB checks

a. Number of people not recruited in previous 2 years due to CRB delays


0 64.0 23.3 50.0 45.5

1-5 28.0 30.2 50.0 30.3

6-10 6.0 16.3 0.0 10.1

11-30 2.0 27.9 0.0 13.1

Over 30 0.0 2.3 0.0 1.0



b. Number of people not recruited in previous 2 years due to CRB failures


0 78.8 48.9 50.0 63.8

1-5 19.2 27.7 50.0 24.8

6-10 1.9 12.8 0.0 6.7

11-30 0.0 8.5 0.0 3.8

Over 30 0.0 2.1 0.0 1.0




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III.2. Turnover and retention

The care sector faces considerable challenges in managing staff turnover and retention.

Estimates for England for 2010 suggest turnover rates as high as 22% for all care workers.

Across the different provider types turnover rates of 24% are recorded in the domiciliary care

sector and among homes with nursing provision and 21% in homes without nursing provision

(NMDS 2010). Such high rates are problematic. Organisations may be forced to deliver care

services without the adequate quota of staff. They will have to commit time and money to

what may feel like a continuous process of managing recruitment and selection. And high

staff turnover clearly limits the ability of managers to cement together an environment where

experience, loyalty and careers add up to a committed staff. In this section, we map the

patterns of staff turnover and staff retention for IDPs, homes and LADPs.

III.2.1. Staff turnover

Evidence from a range of datasets and studies of the care sector suggests there is an acute

problem with staff turnover. In our survey of care providers we sought to provide alternative

measures of turnover, utilising both self-reported, subjective measures, as well as staffing

data on quits and retention among new starters and all care workers.

Figure III.7. Managers’ subjective views about the level of staff turnover

0

5

10

15

20

25

30

35

40

45

50

very high quite high about

right/acceptable

quite low very low

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 52 (homes), 52 (IDPs) and 10 (LADPs). Missing responses: 1 (homes).

Figure III.7 presents managers‟ assessments of the level of turnover among their care

workers, disaggregated by type of care organisation. Four in five providers (79%) were

satisfied that the level of staff turnover was acceptable or low. This was especially true of

LADPs, none of which reported high turnover among care workers, and to a lesser extent

among homes, among which just 15% reported high turnover. IDPs were most likely to report


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high staff turnover – some 31% - and IDPs were the only type of organisation to report „very

high‟ staff turnover. Some of the open-ended answers to our survey provide a glimpse into

the different causes of staff turnover among these IDPs.

We have quite a high turnover. We have some staff who have been with us for 10 years but

some go to a career in nursing. Some are new to the work and they may leave. We had quite a

high level of turnover when the LA contract moved from block to spot last year. It meant that

the work patterns changed and the work became less secure. … Otherwise it is because of the

work times and the low pay. (IL.D.2.DL).

There are obvious problems in comparing subjective opinions about staff turnover; what is

high for one manager may be interpreted as low for another, for example. Hence, we also

collected staffing figures and present below alternative quantitative estimates of turnover

among care workers. The first refers to the ability of the organisation to retain new starters

hired in the previous 12 months. Figure III.8 presents the percentage share of homes, IDPs

and LADPs that registered different levels of retention of new starters. The total number of

responses to this particular survey question is considerably below the full sample of 115,

reflecting the difficulties in providing accurate information on staffing; the data refer to 45

homes, 37 IDPs and 5 LADPs.

Figure III.8. Percentage retention of recruits hired in the previous 12 months

0

10

20

30

40

50

60

100% 90-99% 80-89% 70-79% 60-69% 50-59% 40-49% 30-39% 20-29%

Percentage retention of new recruits

Pe

rce

nta

ge

of p

rovid

ers

Homes IDPs

Note: Total responses: 45 (homes), 37 (IDPs). Missing responses: 8 (homes), 15 (IDPs). The measure of

retention of new recruits was calculated as the number of new recruits retained divided by the number of recruits

hired in past 12 months.

The key finding is that homes are far more successful at retaining new starters than are IDPs;

nearly 60% of care homes managed to retain all new starters over the previous 12 months

compared to just 22% of IDPs. Nevertheless, a significant proportion of both homes and IDPs


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reported a failure to retain more than half of new recruits – 22% of homes and 32% of IDPs.

The evidence from LADPs is that new staff retention rates are much higher, although our

evidence is only from 5 respondents.24

Our second quantitative measure estimates the level of staff turnover among care workers

excluding new recruits. Average turnover rates of 18% were recorded for homes, 22% for

IDPs and only 10% for LADPs. Overall 86% of LADPs, 62% of homes and 53% of IDPs had

turnover rates below 20%. At the other end of the scale, a significant minority of IDPs (nearly

one in three providers, 31%) experienced staff turnover in excess of 30%, far higher than the

13% of homes; no LADPs registered such high levels of staff turnover.

Figure III.9. Level of turnover of care workers excluding new recruits

0

5

10

15

20

25

30

35

40

0% 1-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60%

Percentage staff turnover

Pe

rce

nta

ge

of P

rovid

ers

Homes IDPs

Note: Total responses: 45 (homes), 36 (IDPs). Missing responses: 8 (homes), 16 (IDPs). The measure of staff

turnover is estimated as the number of care workers who quit in the past 12 months (excluding those recruited in

the past 12months) divided by the care workforce in post twelve months earlier (calculated as the current total

number of care workers minus any new starters still in post plus the number of care workers who quit

(excluding quits by new recruits)).

Our third measure estimates overall total staff turnover by including both the number of new

starter quits and other staff quits in the calculation. The results are reported in figure III.10.

These results show even stronger variation by type of provider with average turnover rates

reaching 31% and 24% in homes and 11% in LADPs. Three fifths of homes (60%) had staff

turnover below 20%, compared to only half of IDPs (51%). All LADPs reported turnover less

than 30% (albeit applicable to a sample of just 7). At the other end, 30% of IDPs reported

very high staff turnover among care workers of 50% or more; the comparable share of homes

is just 13%.

24 Only eight of the ten LAs in the survey had undertaken recruitment in the previous 12 months. Of these eight

we have data for five LADPs. The evidence suggests two of the five LADPs experienced 100% staff retention

and three of the five reported 80-89% retention.


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Figure III.10. Percentage staff turnover of all care workers

0

5

10

15

20

25

30

35

40

0% 1-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% 90%+

Pe

rce

nta

ge

Homes IDPs

Note: Total responses: 45 (homes), 37 (IDPs). Missing responses: 8 (homes), 15 (IDPs). Measure of total care

workforce turnover in the last 12 months defined as (number of new starters in last 12 months minus number

retained plus number of other staff who left) divided by current number of care workers.

There are many reasons explaining turnover among care workers. Among all care providers,

the most common reason, reported by around one third of organisations surveyed (35%), was

family responsibilities (table III.13). Some managers suggested family issues were a

particular problem given the highly feminised nature of the occupation (OM.HN.2).

However, this reason also interacted with several „push factors‟ related to the working

environment and HR policies of the organisation, particularly the desire for more convenient

working time, which registered as the most important factor among IDPs (33%). In open-

ended answers, managers talked about the difficulties care workers faced working weekends

and long hours while raising young children; for example, at one provider (TE.HI.DL) each

shift was 11 hours long and care workers were required to work alternate weekends. As such,

staff quits to look for a job with more convenient working time was for many workers both a

reflection of inconvenient working hours and family responsibilities.

Leaving for improved job prospects was a relatively common reason. The push factor, „better

pay‟, was cited by 25% of homes and 21% of IDPs (and notably no LADPs), and entering

nurse training was reported by 26% of homes and 14% of IDPs. Also, many care workers

were said to leave to work in another care organisation, for the NHS, local authority or

another sector altogether. Finally, as might be expected, some reasons related to other push

factors, such as dissatisfaction with the manager or other colleagues and lack of support in the

job.


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Table III.13. Push factors and other reasons for the turnover of care workers


Push factors:

More convenient working times 15.1 32.7 10.0 22.6

Better Pay 24.5 21.2 0.0 20.9

Unhappy with manager/office

staff/team

11.3 1.9 0.0 6.1

Lack of support /no promotion 3.7 3.9 0.0 3.5

Other factors:

Family responsibilities 37.8 30.8 40.0 34.8

Nurse training 26.4 13.5 10.0 19.1

Relocation 26.4 7.7 0.0 15.7

Work for the NHS 18.8 11.5 10.0 14.8

Work for another care provider 7.5 19.2 10.0 13.0

Full-time education 13.2 15.4 0.0 13.0

Not suitable – dismissal 7.5 15.4 0.0 10.4

To work in a different sector 5.7 11.5 20.0 9.6

Car/petrol/travel issues 3.7 9.6 0.0 6.1

Health problems 3.7 3.9 10.0 4.3

To work for the Local Authority 0.0 5.8 10.0 3.5

Job too hard 1.9 1.9 0.0 1.7

Don‟t want to/ like to train 3.7 0.0 0.0 1.7

Other ambiguous 5.7 13.5 20.0 10.4


Note: Question allows multiple answers by each respondent.


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III.3. Pay and rewards

III.3.1. Level of pay

One of the key issues in the recruitment and retention of the social care workforce is the rate

of pay for the job. For each provider we have identified the minimum, or starting rate of pay

for care workers, and also a „normal‟ rate of pay, which refers to the modal rate of pay in the

organisation for care workers. For example, where most workers were qualified to NVQ level

2 we took the rate paid to this group, but where only a minority were qualified we took the

rate paid to the non-qualified. In some cases where a range was given, we have taken the

mid-point for the normal rate of pay25

.

When we look at the distributions of both minimum and normal hourly pay rates for care

workers it is clear that there are two significant dividing lines in the data. The first is the

divide between wages paid by LAs and the wages paid by the independent sector, whether

domiciliary providers or care homes. The average minimum pay across the sample of LADPs

is £8.54 compared to means of £6.40 for IDPs and £6.05 for homes. Similar variation can be

seen with respect to the median level of minimum pay offered: £7.90 in LADPs, £6.35 in

IDPs and only marginally above the national minimum wage at £5.81 in homes. The second

dividing line lies within the independent sector between the voluntary, not-for-profit homes

and the for-profit homes. For example, median pay in voluntary sector homes is £7.55,

significantly higher than the £5.75 median pay paid by for-profit homes. The pay gap is in

part due to the differential proportion of users who are local authority funded since homes

can charge their private clients higher rates and thereby fund higher pay. Our data reveal that

61% of users are LA funded in private homes but only 49% on average in voluntary sector

homes. By way of an economy-wide benchmark for pay, it is notable that the median level of

pay for all female part-time employees in the whole economy was £7.86 in 2009 at the time

of data collection.

Figure III.11 displays the range of minimum pay rates for care workers with box plots that

depict the inter-decile (top and bottom points), inter-quartile (top and bottom of box) and

median pay points (thick horizontal line). It is clear that minimum rates of pay are

significantly higher in LADPs; the range of pay is not presented due to the small sample size.

By contrast, within the for-profit independent sector there is a very high concentration of

minimum pay rates at just above the national statutory minimum wage in both homes and

IDPs. In the not-for-profit voluntary sector, IDPs display a narrow range of minimum pay

rates but homes pay a wider range of rates at a higher level – significantly higher than the

independent for-profit homes. Table III.14 presents the precise share of providers that pay a

25 Where pay data was collected after the upgrading of the national minimum wage in October 2009 we have

deducted the increase of 7 pence from all wage rates. Obviously this is only a rough and ready adjustment to

ensure comparability across time periods as not all rates will have been adjusted upwards. However, this is a

relatively low adjustment and the data would provide a similar picture of relatively low pay, with or without the

7p adjustment.


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minimum rate of just £6.00 or less. („low‟ or „very low‟). This accounts for 53 organisations -

almost half of the 111 independent providers that provided the necessary pay data. Moreover,

22% of all independent providers (for-profit and not-for-profit) set their minimum rate at the

level of the national statutory minimum wage (4% of IDPs and 38% of homes).

If we look at „normal‟ pay rates we find an even larger gap between LADPs and the

independent sector with mean normal pay of £9.16 in LADPs and means of £6.65 in IDPs

and £6.31 in homes. Differences in median pay are similarly varied at £8.61 (LADPs), £6.51

(IDPs) and £6.08 (homes). Figure III.12 presents box plots of the pay distributions in a

similar fashion to the previous figure. Again, we see a strong compression of normal pay

rates in the independent sector, particularly among for-profit homes and voluntary IDPs.

Nevertheless, there is a clear differentiation between for-profit and voluntary independent

organisations; median pay is higher in voluntary organisations than for-profit organisations,

whether homes or IDPs. Overall, however, the wage distributions in all parts of the

independent sector are at such a low relative level that there are no overlaps between the

upper decile pay level and the median level of pay in the public sector LADPs. This is also

true of minimum pay rates. Compared to the setting of minimum pay rates, fewer

independent sector organisations paid a „normal‟ rate of pay at the national minimum wage –

9 homes (a 17% share) and no IDPs. But the share of both IDPs and homes paying £6.00 or

less as the normal rate of pay for care work was still substantial at 23 homes (44%) and 10

IDPs (20%) (table III.15).


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Figure III.11. The range of minimum pay rates for care workers in private and

voluntary sector homes, and private, voluntary and public sector domiciliary care

providers

Notes: The box plots represent the following points of the pay distribution: lowest point (D10), bottom of box

(D25), thick line (D50), top of box (D75), upper point (D90). Only the median pay level is presented for LADPs

because of the small sample size. See table III.14 for sample sizes.

Table III.14. Variation in minimum pay rates

Public Private for-profit Voluntary

% of

LADPs

% of

IDPs

% of

Homes

% of

IDPs

% of

Homes

% of

all

Very low (£5.73) 0 4.5 46.3 0 9.1 19.8

Low (£5.74-£6.00) 0 27.3 39.0 33.3 9.1 27.9

Medium (£6.01-£6.90) 11.1 47.7 14.6 66.7 45.5 33.3

High (£6.91-£7.90) 44.4 18.2 0 0 27.3 13.5

Very high (£7.91- £10.90) 44.4 2.3 0 0 9.1 5.4

Total responses 9 44 41 6 11 111

No response 1 2 1 0 0 4


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Figure III.12. The range of normal pay rates for care workers in private and voluntary

sector homes, and private, voluntary and public sector domiciliary care providers

Notes: The box plots represent the following points of the pay distribution: lowest point (D10), bottom of box

(D25), thick line (D50), top of box (D75), upper point (D90). Only the median pay level is presented for LADPs

because of the small sample size. See table III.17 for sample sizes.

Table III.15. Variation in normal pay rates

Public Private for-profit Voluntary

% of

LADPs

% of

IDPs

% of

Homes

% of

IDPs

% of

Homes

% of

all

Very low (£5.73) 0.0 0.0 19.5 0.0 9.1 8.1

Low (£5.74-£6.00) 0.0 20.5 34.1 16.7 0.0 21.6

Medium (£6.01-£6.90) 0.0 47.7 39.0 83.3 36.4 41.4

High (£6.91-£7.90) 11.1 25.0 4.9 0.0 36.4 16.2

Very high (£7.91- £10.90) 88.9 6.8 2.4 0.0 18.2 12.6

Total responses 9 44 41 6 11 111

No response 1 2 1 0 0 4


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III.3.2. Pay differentials and pay supplements

The care sector appears not only to be characterised by low pay but also by very limited

opportunities for pay progression. This is particularly so among IDPs where 52% paid the

same rate as minimum and normal pay for care workers. In homes the tendency to pay rather

lower minimum rates than in domiciliary care has led, perhaps, to more common provision of

some pay increase between minimum and normal pay, with only 34% not offering any

upgrade. The mean values of the pay differential were only 26 pence in homes and 24 pence

in domiciliary care including those offering no increments. Of those offering some

increments the mean value was 40 pence in homes and 50 pence in domiciliary care. Only 2

homes and 4 IDPs offered increments of £1 or more. The opportunities to progress beyond

„normal pay‟ were usually very limited; in most cases these were limited to opportunities for

promotion to senior care worker or team leader.

We have information on maximum pay levels for senior care workers in 43 cases (15 IDPs,

28 homes). The information suggests there are very wide variations in the increments offered

for seniors. For IDPs and homes the majority paid an extra £1.00 or less (7 IDPs, 20 homes).

Of these, over half (3 IDPs and 10 homes) were paying below 50p, with the lowest rates

being 25p extra per hour. Those offering the very lowest rates for seniors tended to be low

payers for all staff – in 17 of these cases, the normal rate was £6 50 and below, and six of the

eleven were paying the national minimum wage as the normal rate – all of these were homes.

The three IDPs that paid seniors less than 50p extra all paid over £6 50 as the normal rate.

Some of the managers commented on how low the pay enhancements for senior grade staff

actually were:

The amount of workload and responsibility they have on them is a lot.... For a minute amount

of money for the amount of responsibility, it‟s just not worth it. (IL H4 BS).

In fact, as shown in table III.16, fewer than half of the respondents in either homes or IDPs

said that they rewarded experience/length of service with extra pay (38% of homes and 42%

of IDPs). Most of these variations by experience/length of service are limited as has already

been found in the small gaps between minimum rates and normal pay levels. Even fewer (8%

of homes and 4% of IDPs) claimed to have variations in pay based on incremental scales. The

most common factors associated with variations in pay rates were qualifications (over 60% of

homes, and 67% of IDPs) and, for IDPs, weekend work (73% compared to 28% of homes).

Again, these variations tend to be limited with many of the increments for qualifications at

least up to NVQ level 2 more in the range of pence. Of the 25 which specified rates, the

increments ranged from 7 pence to £1.02 per hour above the minimum pay rate; 23 out of the

25 paid under 50p extra, and over half of these paid less than 25p. Even for NVQ level 3,

where rates were specified, some of the increments above minimum pay rates were in the

range of pence. Of five IDPs, two paid 30p or less, and three paid above £1; of six homes five

paid 90p or less and the sixth paid £1.27 above the minimum rate.


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Table III.16. Main reasons for differences in pay rates for care workers


Experience/length of service 37.7 42.3 33.3 39.5

Incremental pay scales 7.5 3.8 40.0 8.7

Qualifications 60.4 67.3 44.4 62.3

Weekend work 28.3 73.1 55.6 50.9

Night work 24.5 32.7 88.9 33.3


No response 0 0 1 1

Note: Multiple responses possible.

Only one quarter of home managers (25%) cited night work as a source of pay variations

even though all will operate night shifts on a regular basis. A third of IDPs (33%) cited night

work even though not all were engaged in night work, and this suggests that where night

work is undertaken by IDPs a supplement is paid. Some of the providers gave us examples of

supplements for weekend work or night work, but most were a matter of pence. Home

managers also paid less than IDPs for night work. Home rates varied from 20p to £1.60,

while IDP rates varied from 70p to £2.02. The higher rates paid by IDPs may reflect the

unpopularity of being out late in the evening in the community. Where IDP rates were given,

they were commonly for work up until 10pm, although in one case it was for work up until

midnight26

.

For weekends, the majority of rates ranged from 8p to £1.45 extra, excluding three outliers

which paid a percentage of the hourly rate for weekend work – in two cases, this was 100%

and resulted in extra pay of over £6 50 per hour. A few organisations (12 IDPs and 1 home)

offered the additional information that they paid higher rates for Bank Holidays. Although

this is likely to undercount the number making such payments, it was notable that amongst

this group not all Bank Holidays were paid for: in one case only Christmas counted, another

only Christmas, Boxing Day and New Year‟s Day27

. Among the „other factors‟ associated

with pay differentials cited by providers, the most common were senior or team leader roles,

particularly among homes (30) but also IDPs (13). As we saw in Section III.1.2 (see table

III.5), an overwhelming majority of providers recruited seniors from existing staff or from a

combination of externals and existing staff (only one home and one IDP stated that they

solely recruited seniors externally). These additional payments for seniors thus provided

internal care staff with some limited prospects of pay promotion through upgrading.

A much less commonly cited factor influencing pay was the needs of the client, mentioned

only by 8% of IDPs. Rising dependency levels are increasing the complexity of work but so

26 No information was given on rates for those IDPs offering 24 hour service.

27 Only three organisations cited the premia paid: in two of the cases double time was paid, in another the rate

was £1.51 above the minimum pay.


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far this is not reflected frequently in pay levels. Indeed only a minority of the IDPs (26%) and

LADPs (38%) that undertook intermediate care/hospital discharge work paid a different rate

for this type of work (table III.17). These findings suggest that pay does not vary in line with

variations in skills required in the actual work tasks, although it should be noted that some

LADPs specialise in this type of work, and these results for the LADPs need to be considered

in conjunction with the generally higher pay rates in local authorities.

Table III.17. Payment of different rates for those providing intermediate care (where

applicable)

% of IDPs % of LADPs % of all

Yes 25.9 37.5 28.6

No 74.1 62.5 71.4

Total responses 27 8 35

No response/not applicable 25 2 27

The majority of IDPs did not make a distinction in pay rates between care work and domestic

work but 14% did pay a lower rate for domestic work along with half the LADPs (table

III.18). All those providers paying lower rates to domestic staff were paying a minimum rate

to care staff that exceeded the national minimum wage.

Table III.18. Payment of different rates for personal and domestic work


Yes 13.7 50.0 80.3

No 86.3 50.0 19.7




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III.3.3. Pay uprating

Regular uprating of pay was common but not universal. All LADPs had a regular uprating of

pay but 8% of homes and one fifth of IDPs did not have a regular uprating of pay (table

III.19). Failure to increase pay could be a serious source of dissatisfaction which could

impact upon staff retention, as the following quote illustrates:

Well, they [care workers] didn‟t get a pay rise for two years so they weren‟t very happy and a

lot threatened to leave so they [managers] had to take notice. (RN.D.2.CN).

Table III.19. Provision of a regular uprating of pay


Yes 92.5 80.0 100.0 87.4

No 7.5 20.0 0.0 12.6


No response 0 2 2 4

There were some marked differences between homes and IDPs in what triggered an uprating

(figure III.13). The impact of LA fee levels was more important for IDPs with nearly half

(43%) citing this as the most important factor compared to less than one in ten (8%) homes.

In contrast changes in the statutory National Minimum Wage were more important for homes

(52% citing this compared to 20% of IDPs). These findings reflect the higher share of homes

using the National Minimum Wage as a minimum pay rate and the lower influence of LAs on

total income for homes. Profitability was another important factor in uprating but more so for

IDPs than for homes (33% compared to 19%). Performance factors also acted as a trigger in a

significant minority (15% of homes and 14% of IDPs).

Of those homes citing changes to the National Minimum Wage as a main factor influencing

pay uprating, 85% paid under £6.00 and 65% paid the national minimum wage (figure III.14)

compared to 39% for the sample of homes as a whole (see Table III.14 above). In contrast of

those IDPs who cited the National Minimum Wage as a main factor, only 40% had a

minimum rate below £6.00 and only 20% had the National Minimum Wage as their lowest

rate (but this was a higher share than the 4% for the IDP sample as a whole).


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Figure III.13. Main factors influencing pay uprating in homes and IDPs

0

10

20

30

40

50

60

Change in NMW Completion of

qualifications

LA fee levels Profitability Performance

Related

Employee

Request

Pe

rce

nta

ge

of p

rovid

ers

Homes IDPs

Note: Total responses: 52 (homes), 51 (IDPs). Missing responses: 1 (homes), 1 (IDPs). Multiple responses

possible.

Figure III.14. Minimum pay rates in homes and IDPs that cited change in the National

Minimum Wage as a main factor in pay uprating

0

10

20

30

40

50

60

70

£5.73 £5.74 - £5.99 £6.00 or over

Pe

rce

nta

ge

of p

rovid

ers

Homes IDPs

Note: Total responses: 26 (homes), 10 (IDPs). Question only applies to those providers that cited change in the

National Minimum Wage as a main factor in pay upgrading (see figure III.13).


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III.3.4. Payment for travel time, overtime and training time

Payment for all time spent at work or on work related activities is clearly an important aspect

of working conditions, as is receiving additional premia for working extra hours. The extent

to which the conditions apply to the care staff in our sampled organisations is explored here.

One of the key issues for domiciliary care workers is how travel time between clients is

compensated. The actual time spent travelling may be paid for by travel time being included

in work time or by staff being expected to complete tasks in under the allotted time to allow

themselves time to reach the next client. The variety of practices was indicated by some of

the additional responses to the question on travel costs. One provider paid a flat rate:

We pay 15p per call, whether workers travel by foot, bus, or car, it is the same. (IL.D.3.BN).

Another provider clearly includes a variable element into the work schedule according to

estimated and actual travel times between service users:

We look at the run, and we allow 7 minutes, 10, 15 minutes etc., So it‟s all factored into the

run, so they are paid for the complete time. We pay travel expenses based on the mileage of

the run. (TE.D.1 CN (V)).

Others regard it as a relatively trivial issue due to proximity of services users:

The travel is included in the hourly wage. Because we‟re quite unique here ….because ninety

nine percent of the carers walk. The service users are very close to the office. (RN.D.2.CN).

Travel time for some people – not for foot or bike - if people go out of their normal area to

work we pay for that travel time. We only pay travel costs if they are doing something that the

client needs – for example, taking them to hospital or going shopping for them. If it‟s travel

between jobs, we don‟t pay, but we help with the tax claims. (LK.D.3.DS).

Yet another provider pointed to the problem of comparing rates of pay across IDPs as some

pay a lower rate but pay for actual travel costs and travel time while others pay a higher basic

rate but no compensation for travel time:

Also what our competitors tend to do is to include their mileage cost rates within their basic

rates, which make them look higher when in actual fact they‟re not. (OM.D.2.DN).

With these problems of interpretation in mind, the responses to the question on travel time

suggest that only 20% of IDPs paid any kind of supplement whether flat rate, percentage or in

one case a higher rate for a shorter visits. A higher share, 54%, paid a mileage allowance, or

reimbursed petrol or public transport costs (figure III.15). Those not reimbursing out of

pocket expenses may include those IDPs that rely on „walkers‟. Nevertheless, several said

explicitly that they did not pay petrol or mileage but instead would volunteer to help staff

claim the tax back on their tax returns. Furthermore, 38% of IDPs and 30% of LADPs said

the compensation was included in the hourly rates. However, while in LADPs work time is

organised in continuous shifts without unpaid breaks so that time spent travelling is paid for,


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IDPs tended to pay just for the scheduled visit time. If travel was undertaken outside these

times it was unlikely to be paid for.

Figure III.15. Payment for travel among IDPs and LADPs

0

10

20

30

40

50

60

70

80

90

100

Supplement (flat

rate/%/higher rate for

short calls)

Reimbursement

(mileage/petrol/public

transport costs)

Included in hourly rate

Pe

rce

nta

ge

of p

rovid

ers

IDPs LADPs

Note: Total responses: 50 (IDPs), 9 (LADPs). Missing responses: 2 (IDPs) and 1 (LADPs). Multple responses

possible.

Table III.20. Compensation for time spent training

a. Payment for time spent training


Yes 88.7 84.6 100.0 87.8

Not all courses 9.4 5.8 0.0 7.0

No 1.9 9.6 0.0 5.2


b. Time off to attend training


Yes 77.4 86.5 70.0 80.9

Sometimes 18.9 7.7 30.0 14.8

No 3.8 5.8 0.0 4.3



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Another call on staff time that is related to work but which is not direct caring work is time

spent training. The majority of providers said that staff were paid for training time - all

LADPs paid, as did 85% of IDPs and 89% of homes. Even those that did not pay all the time

may pay some of the time, but 2% of homes and 10% of IDPs said they did not pay for

training (table III.20a). An even higher share of IDPs – as we see in table III.22b below - did

not pay for induction training. When it comes to time off from care duties to attend training

rather than attending in their own time, the pattern was somewhat different with more homes

not always providing time off – nearly one in five (19%) only did so some of the time and 4%

none of the time compared to 8% and 6%, respectively, of IDPs. Around a third of LADPs

also did not always provide time off (table III.20b).

Only a minority of independent providers (26% of homes and 29% of IDPs) ever pay

overtime premia to staff compared to more than two thirds (70%) of LADPs (figure III.16).

Moreover, when this minority were asked whether this applied to all staff, or only those

contracted to work a certain number of hours per week, one out of the 15 IDPs paying a

premium said it was discretionary, one paid it only to TUPE transferred staff, and one only

paid when staff were required to work „out of area‟. Five LADPs referred to overtime premia

that only applied above a certain number of hours – one for over 36 hours, three for over 37

hours and one for over 148 hours in a four week period. Among the 14 home managers who

mentioned overtime premia for extra hours, three said they only applied over full-time hours,

for example, over 37 hours per week.

Figure III.16. Payment of overtime premia to staff working extra hours

0

10

20

30

40

50

60

70

80

Yes No

Pe

rce

nta

ge

of p

rovid

ers

Homes IDPs LADPs

Note: Total responses: 53 (homes), 51 (IDPs), 10 (LADPs). Missing responses: 1 (IDPs).


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III.3.5. Payment for upfront costs of starting work

There are three elements of upfront costs that staff considering entering care work may have

to pay for; these include the costs of CRB checks, the purchase of uniforms and the cost of

attending induction training if this is not paid for (this latter cost is more an opportunity cost

but there may be also out of pocket costs such as travel or childcare). While most

independent sector providers meet these costs there is a significant minority of providers who

do not (table III.21). This is particularly true with respect to CRB checks, where only one

third of IDPs paid for CRB checks up front with no strings attached and a further 2% paid but

required staff to reimburse the costs if they left within twelve months. A further 12% of IDPs

shared the costs 50/50 and 16% required staff to pay but reimbursed the costs if they stayed.

In more than a third of IDPs (37%) prospective employees had to pay themselves for the

checks. In LADPs, eight out of ten paid for the staff and only one shared the costs 50/50, but

one LA did require the applicant to pay. For homes the situation was more favourable to

potential employees than with IDPs with 64% of homes paying for the check and only one in

four homes (26%) not paying; the remainder either shared the costs (2%) or reimbursed if the

staff stayed (6%).

Table III.21. Percentage of organisations that pay for CRB checks


Yes 64.2 33.3 80.0 51.8

50:50 1.9 11.8 10.0 7.0

Employer pays but staff pay if they leave

within 12 months

1.9 2.0 0.0 1.8

Staff pay but are reimbursed if they stay 5.7 15.7 0.0 9.6

No 26.4 37.3 10.0 29.8


No response 0 1 0 1

Payment by the employer for uniforms is more common with just under a fifth of homes, just

under a tenth of IDPs and no LADPs saying that staff had to pay for uniforms, although 6%

of homes and 22% of IDPs only provided one uniform and expected staff to pay for extra

uniforms (table III.22a). One IDP provided protective clothing and another gave a clothing

allowance for TUPE transferred staff. All but one home and all LADPs paid staff for

induction training but 24% of IDPs did not pay staff for attending induction. A further two

said they did not pay for part of the training (i.e. initial „orientation‟ and classroom training),

and two more said they only paid if staff stayed in employment for a certain period of time

afterwards (table III.22b). A summary of shares of employers not paying for the upfront costs

of starting work is shown in Figure III.17.


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Table III.22. Percentage of organisations that require staff to pay for:

a. Uniforms


No 74.5 68.6 100.0 74.1

Yes1

25.5 31.4 0.0 25.9


No response 2 1 0 3

Note: including those who only pay for extra uniforms.

b. Induction training


Yes 98.1 68.6 100.0 85.1

Partly 0.0 3.9 0.0 1.8

Yes if staff stay 0.0 3.9 0.0 1.8

No 1.9 23.5 0.0 11.4


No response 0 1 0 1

Figure III.17. Percentage of providers not paying for upfront costs of starting work

0

5

10

15

20

25

30

35

40

CRB checks Uniforms Induction

Pe

rce

nta

ge

of p

rovid

ers

Homes IDPs LADPs

Note: For missing responses see tables III.21 and III.22.


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III.4. Flexibility, working time and work organisation

While care homes and IDPs in the independent sector offer relatively similar pay levels and

conditions, there are greater differences in the employment context and employment

conditions between homes and IDPs once we consider the organisation of work and working

time. Both segments of the care sector face challenges; in domiciliary care the challenge is to

organise work and working time to fit a fragmented and time-specific demand for care for a

variable set of users located in their own homes rather than in a workplace, and to cover these

demands at least from early morning until evening and into weekends. When asked about

hours of care provision we found that all but seven of the IDPs (87%) provided cover until 10

pm or later with nearly one in four (23%) providing 24/7 cover and one in three (31%)

finishing cover after 10pm. Moreover, seven IDPs (13%) started cover before 7 am. The

LADPs also provided extended cover with all operating until at least 10pm, three out of ten

providing cover until later than 10pm (another saying that in practice they operated 6-11

while in principle it should be 7-10) and three provided 24 hour cover.

For care homes the challenge is always to deliver care on a 24/7 basis but with this being

delivered in a fixed workplace; here the main unpredictable factors are related to bed

occupancy and the needs of the service users on the one hand and the availability of staff on

the other. These differences led to tailored questions being asked as well as common

questions across the two subsectors. We therefore explore these arrangements separately for

domiciliary care and care homes, although drawing in many places on similar questions and

tables.


domiciliary care

Employment contracts

The first and distinctive characteristic of domiciliary care is the extensive reliance on zero

hours contracts. We were aware that providers may make use of zero hours contracts (Rubery

and Urwin 2010) and that indeed such contracts had also been widely used in LA provisions

until trade unions pressed for better employment conditions (Horrell and Rubery 1991).

When asked about contracts for care workers we found that the practice was overwhelmingly

dominant with 69% of IDPs only offering zero hours contracts to their staff and only 12%

offering all staff some guaranteed hours, with the remainder (20%) offering a mix of zero

hours and guaranteed contracts (figure III.18). This practice of zero hours contracts reflected

the variability and uncertainty of workloads. By comparison, only one of the LA providers

offered a mix of guaranteed and zero hours with all the other LADPs offering only

guaranteed hours contracts.


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Figure III.18. Types of employment contracts offered to care workers

0

10

20

30

40

50

60

70

80

90

100

Zero hours only Mix of zero and guaranteed hours Guaranteed hours only

Pe

rce

nta

ge

IDPs LADPs

Note: Total responses: 51 (IDPs) and 10 (LADPs). Missing responses: 1 (IDPs).

Reasons given for offers of guaranteed hours within the independent sector to specific staff

members included the need to retain staff who were, for example, car drivers:

Zero hours only for all staff unless they drive a vehicle, in which case we offer guaranteed hours.

IL.D.2.DL

Or as a means of recruiting and integrating migrant workers:

We had a mix. We offered guaranteed hours to overseas workers for the first year. Then they all

work full time, in fact, excessive hours because they have a very good work ethic. After the first

year, there is no need for guaranteed hours, because they will work full time. (LK.D.3 DS).

The lack of fixed contract hours clearly gave providers discretion in their allocation of work,

and their ability to determine access to enough work seemed in some cases to be used as a

form of control over the staff.

People who are not flexible, they don‟t get so many hours. Now we have more staff we have more

control. It is important. (TE.D.1 CN (V)).

In particular the zero hours contracts left staff vulnerable to loss of work and pay when their

clients went into a home or hospital or died. The provider may seek to replace the work but

does not guarantee so to do if new work is not immediately available.

Zero hours only? All. We provide continuity of care – workers build up service users and if they

lose one, we replace them as quickly as possible. We have picked up ten care plans in the last one

and a half weeks. Before that all the agencies were scrambling for work. It is steady now.

(LKD.6.CL).


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Working time patterns

Although most staff in domiciliary care were only offered zero hours contracts, in practice

most staff in the domiciliary sector worked more than short part-time hours and many were

involved in long hours working (figure III.19; table III.23). Only 4% of IDPs had the majority

of their staff regularly working less than 16 hours. At the other extreme 59% of IDPs said

short part-time work accounted for less than 10% of all staff (33% having no staff in this

category and 27% up to 10%). Long part-time hours - between 16 and 30 - were more

commonly used, with over 59% of providers having more than 50% of staff in this category

and 17% with ratios of 80% or more. One in four (24%) providers had less than 20% of staff

in this category, including 8% with no such staff, while at the other end 16% had 70% or

more working at least 30 hours. This suggests considerable scope for varying the working

time mix within domiciliary care providers. LA providers were most likely to make extensive

use of long part-time work, with relatively low proportions of either short part-time or full-

time hours.

Very long hours working (over 45 hours) was also far from uncommon in this sector: even

though no provider primarily used long hours work over 38% of domiciliary providers had

some staff working long hours. Even excluding those providers where working very long

hours occurred only on occasions for emergency cover, over 34% of IDPs recorded some

long hours working.

Figure III.19. Proportions of staff working different hours in IDPs

0

10

20

30

40

50

60

70

80

Under 16 hours 16-30 hours 30-45 hours Over 45 hours

Usual weekly hours

Pe

rce

nta

ge

of p

rovid

ers

0%

1-10%

11-20%

21-30%

31-50%

51-70%

71-80%

81-90%

91-99%

100%

Note: See table III.23 for responses.


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Table III.23. Working-time patterns of care staff

% of staff % of homes % of IDPs % of LAPDs % of all

Under 16 hours? <50 100.0 95.9 100.0 98.1

>50 0.0 4.1 0.0 1.9

16 – 30 hours? <50 58.8 40.8 14.3 47.7

>50 41.2 59.2 85.7 52.3

30 – 45 hours? <50 39.2 67.3 100.0 56.1

>50 60.8 32.7 0.0 43.9

Over 45 hours? <50 100.0 100.0 100.0 100.0

>50 0.0 0.0 0.0 0.0


No response 2 3 3 8

There is further evidence of extensive engagement by staff in the information on maximum

numbers of days worked. Here 28% of IDPs recorded a seven day maximum working week

and a further 49% had a six day maximum with only just over a fifth having a five days

maximum. In contrast over half of LA domiciliary providers had a five day maximum (table

III.24).

Table III.24. The maximum number of days a week worked by care staff

Number of days

per week


3 1.9 0.0 0.0 0.9

3.5 1.9 0.0 0.0 0.9

4 9.6 0.0 0.0 4.5

5 53.8 21.6 55.6 39.3

5.5 0.0 2.0 0.0 0.9

6 23.1 49.0 33.3 35.7

7 9.6 27.5 11.1 17.9


No response 1 1 1 3

This use of six and seven day maxima reflected the prevalence of weekend working (figure

III.20). Nearly three fifths of independent domiciliary providers and 89% of LADPs said that

all their staff were engaged in regular weekend working. However, there appeared to be some

choice in the way weekend working was organised as around 28% of IDPs had less than half

the staff regularly working weekends.


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Figure III.20. The percentage of care workers who regularly work weekends

0

10

20

30

40

50

60

70

80

90

100

0 – 25% 26 – 50% 51 – 75% 76 – 99% 100%

Percentage of staff

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 50 (homes), 49 (IDPs) and 9 (LADPs). Missing responses: 3 (homes), 3 (IDPs), 1

(LADPs).

Even when an organisation had a policy that all staff should work weekends the reality might

prove different. Some providers claimed that staff were apparently prone to backtracking on

their agreement to work weekends at recruitment.

They work alternate weekends. We try to make them all work weekends, but it is really hard to get

people to work weekends. We have to look closely at applicants. They say that they will work

weekends, then two months in, they say they can‟t work weekends. (LKD.6.CL).

All our carers, when they come for the job, they‟ll do anything. It‟s once they‟ve got in and then

they say, „I can‟t do these evenings, or I can‟t do that day.‟ That‟s when it starts, once they‟re in

the job. Because when they‟re interviewed they are told it‟s mornings, afternoons evenings,

weekends and all that, and it‟s „Oh, yes, it‟s fine, I‟ll do anything.‟ And then you find out that they

won‟t. (ON.D.2 AS).

The problems of staffing weekends led some providers to try a range of different systems:

We struggle to find staff who will work weekends, as everyone wants these off. We did run

alternative weekend work, but now we offer one day at weekends, so that staff have to work

either Sat or Sun to relieve the existing staff and give cover. Some of the extra staff only work

weekends. ( IL.D.2.DL).

Or they recruited specifically for the unpopular time periods:

We‟ve also got carers who just want evening work, so you‟re looking around eight hours a

week for them. And the same at weekends. We‟ve just got weekend workers who just want, you

know, say ten hours a week. (ON.D.3 BN).


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Working time scheduling

Work scheduling is highly complex in domiciliary care because of the number of clients,

their geographical spread, the need for repeat visits and the fluctuating mix of clients and

demands. In this context there may be tensions between the need to provide continuity of care

for service users - where the same care worker or team of care workers is always provided -

and the need to organise the care work into a work schedule for individual employees. To tap

into these tensions we asked first about how important it was to provide continuity of care for

service users. All providers responded that it was either very important or important, with

94% of independent providers, in fact, saying it was very important (table III.25). This

suggests that in principle, at least, providers recognize a need to schedule work around

existing allocations to users.

Table III.25. The importance of organising working hours to provide continuity of care


Very important 94.2 77.8 91.8

Important 5.8 22.2 8.2

Neutral 0.0 0.0 0.0

Unimportant 0.0 0.0 0.0

Very unimportant 0.0 0.0 0.0


No responses 0 1 1

We then asked about how important it was to schedule work to fit employees‟ circumstances.

Although there was, again, strong support for this being an important factor, with 89% of

IDPs saying it was important, or very important, the share saying it was very important was

significantly lower, at 64%, compared to the 94% who considered continuity of care for users

to be very important (table III.26). The share was even lower for LA providers with only 44%

of inhouse providers saying it was important or very important. These answers may reflect

the changes in LA practice where they have moved from offering domiciliary care workers

fixed hours within a limited window - often school hours - to asking staff to cover hours over

a more extended period including early mornings and evenings.

We explored further the consequences of the variability of demands and the priority to

continuity of care by asking whether staff were able to get work schedules that fitted their

preferences all the time or most of the time. It is likely that they interpreted this question as

referring to the range of what was possible rather than in relation to absolute preferences, as

one provider noted:

I think that‟s a tricky one because people‟s preferences might be working Monday to Thursday

ten till two, but they know that isn‟t an option, so its whether people think the rotas are

reasonable, I mean we get the occasional „I‟ve done more weekends than … ,‟ and that‟s

obviously worth listening to. (RD.D.2.CL)


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Table III.26. The importance of organising working hours to fit employees’

circumstances


Very important 63.5 22.2 57.4

Important 25.0 22.2 24.6

Neutral 9.6 44.4 14.8

Unimportant 0.0 11.1 1.6

Very unimportant 1.9 0.0 1.6


No responses 0 1 1

Figure III.21 shows that the vast majority of IDPs – 98% - said their staff were able to get

schedules that fitted their preferences all, or most of the time, but only a quarter said it was all

of the time, suggesting some requirements for staff to adapt to schedules that do not match

their preferences.

Figure III.21. The overall matching of work schedules with care workers’ preferences

for particular hours

0

10

20

30

40

50

60

70

80

90

100

All of the time Most of the time Some of the time Occasionally

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 52 (homes), 52 (IDPs) and 10 (LADPs). Missing responses: 1 (homes).

We also asked IDPs whether they would expect care staff to have to tolerate working longer

than scheduled due to unanticipated needs of service users or to tolerate variations in hours or

location at short notice (figure III.22). On working longer than scheduled only two providers

thought this would never happen and 15% of independent providers and 30% of LA providers

felt it was indeed something care workers would need to tolerate; the majority, however –

over four fifths of IDPs and 70% of LADPs - saw this as only an occasional requirement On

variations in hours or location at short notice 85% of IDPs said that they would expect them

to tolerate it often or occasionally although the majority of these put it down as occasional


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(77%) and only 8% regarded it as a regular issue. LA providers expected more variability

with 20% saying they did expect staff to tolerate such changes and 70% saying yes,

occasionally.

Figure III.22. The requirement for care workers to tolerate longer working hours or

variations in hour due to unanticipated needs

a. Tolerate longer working hours

0

10

20

30

40

50

60

70

80

90

100

Often Occasionally Never

Pe

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IDPs LAPDs

b. Tolerate longer working hours or variations in hour due to unanticipated needs

0

10

20

30

40

50

60

70

80

90

100


Pe

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IDPs LAPDs

Note: Total responses: 52 (IDPs) and 10 (LADPs).


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Table III.27. Staffing arrangements to cover for absences/vacations/unfilled vacancies

Ask existing

staff to work

extra hours

Use external

agencies

Use list of staff

available for

temp cover

% of IDPs sole method 90.4 1.9 0

combined with other methods 7.7 0.0 7.7

All using the method 98.1 1.9 7.7

% of Homes sole method 56.6 3.8 0



% of LADPs sole method 80.0 0 0



% of all sole method 73.9 2.6 0



Note: Total responses: 53 (homes), 52 (IDPs), 10 (LADPs).

These requirements for flexibility were further exacerbated by the reliance of domiciliary

care providers on their existing staff to cover extra shifts: 80% of LA providers and 90% of

IDPs only used existing staff to cover extra shifts and only one IDP from our sample of 52

used an external agency exclusively for cover. All others relied on existing staff with 8% of

IDPs using a list of temporary staff in addition to existing staff to provide cover. The pattern

for LA providers was similar with all using existing staff and only one combining this with an

external agency and one with a list of temporary staff (table III.27).

To probe further on how flexibility was managed we also asked about how easy or difficult it

was to find staff willing to work extra hours, either on the day itself or with two to three days

notice. The majority of providers found it easy, or very easy to find staff willing to work

additional hours at 2-3 days notice (86% of IDPs and 70% of LADPs). Only 8% of IDPs and

20% of LA providers found it difficult, or very difficult to find staff willing to work

additional hours with this amount of notice (table III.28). Even on the same day, the majority

found it easy, or very easy to find staff to work additional hours (77% of IDPs and 70% of

LA providers). However, the number recording difficulties increased when the notice was

very short with around a fifth of IDPs finding it difficult, or very difficult to find staff willing

to work extra hours on the same day.

The comments from providers indicated that the difficulty in part depended upon how

familiar staff were with the users:

I suppose it depends on what you‟re asking them to do. If it‟s working with someone that they

know, it‟s almost always that they will sort that out between themselves because that‟s, you know,

about your commitment and knowing that person. If you want someone to do something that they

are less familiar with then that might need more discussion. (RD.D.2.CL).


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It depends on their mood and what you are asking. If it is to work extra time with an existing

client, that might be okay, but if you are asking them to go out for another slot…that might be

difficult. (LK.D.6.CL).

Table III.28. Finding staff willing to work additional hours at short notice


2-3 days notice Very easy 9.8 10.0 9.8

Easy/quite easy 76.5 60.0 73.8

Neither difficult nor easy 5.9 10.0 6.6

Quite difficult 7.8 10.0 8.2

Very difficult 0.0 10.0 1.6

Same day Very easy 2.0 0.0 1.6

Easy/quite easy 74.5 70.0 73.8

Neither difficult nor easy 3.9 10.0 4.9

Quite difficult 17.6 10.0 16.4

Very difficult 2.0 10.0 3.3


No response 1 0 1

It also varied according to the different ways in which staff might assess the opportunity for

extra work:

People will accept the rota if it‟s got the times that they can work, so they accept it but then they

start to plan other things in the gaps, and then they don‟t want to give those gaps up, rightly so or

wrongly so, depending on your point of view. (ON.D.1 DN).

Sometimes it‟s okay, sometimes not. Before Christmas people want money. If the husband‟s laid

off they want extra hours. It depends. They know holiday pay depends on the amount they work,

so know if they work more their holiday pay goes up. (LK.D.3 DS).

Some providers offered inducements to overcome these problems:

Very easy, we pay enhanced rates, so they are knocking on our door. (LK.D.5 CN (V)).

Work organisation and working time

Behind the working-time patterns and schedules lies the organisation of work and, in

particular, the organisation and duration of visits to clients. All the interviewees said that visit

lengths were tightly defined except for one manager of an LADP who answered no to this

question. We asked managers what was the minimum and average length of a visit and the

modal response to this question was 15 minutes minimum and 30 minutes average where

both figures were given (20 out of 29 responses). Figures III.23a and b show that short visits


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to clients were the norm. Seven in ten IDPs (68%) had minimum length of visits below 30

minutes (including around 3% with no minimum). This includes 60% of providers reporting a

minimum of 15 minutes. Only 5% of IDPs recorded minimum visits above 30 minutes.

Figure III.23b shows data on average visit lengths, although the data are less complete with a

total of only 28 valid responses. The most popular average duration was 30 minutes (76% of

respondents) with 14% citing an average length of longer than 30 minutes and under 10%

giving an estimate of average duration at less than 30 minutes. A similar pattern was found

for the LADPs, with all giving either no minimum or 15 minutes but average visit lengths

were said to be 30 minutes in five out of the seven cases reporting an average duration, with

the two remaining cases reporting longer averages, at 45 minutes and one hour respectively.

Figure III.23. The minimum and average lengths of visits to clients

a. The minimum length of a visit

0

10

20

30

40

50

60

70

80

90

100

No minimum 15 minutes 20 minutes 30 minutes 45 minutes or over

Pe

rce

nta

ge

IDPs LADPs

Note: Total responses: 37 (IDPs) and 8 (LADPs). Missing responses: 15 (IDPs) and 2 (LADPs).

b. The average length of a visit

0

10

20

30

40

50

60

70

80

90

100

20 minutes 27 minutes 30 minutes 45 minutes 60 minutes

Pe

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nta

ge

IDPs LADPs

Note: Total responses: 21 (IDPs) and 7 (LADPs). Missing responses: 31 (IDPs) and 3 (LADPs).


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This highly fragmented structure of visits is also reflected in the approach taken to minimum

working time periods (table III.29), with four in five IDPs (81%) operating a minimum

working time of only two hours or less (including 63% with no minimum). Only 8% and 4%,

respectively, had minimum work periods of between 2 and 4 hours and over 4 hours. In

contrast LADPs were fairly evenly split between those that had no minimum work period and

those that had minimum work periods in excess of two hours (14% in excess of 4 hours) with

only one case having a minimum between 15 minutes and 2 hours.

Table III.29. Approach to minimum length of work periods


No minimum 62.5 42.9 60.0

15 minutes – less than 2 hrs 18.8 14.3 18.2

2 – 4 hours 8.3 28.6 10.9

Over 4 hours 4.2 14.3 5.5

Depends/varies 6.3 0.0 5.5


No response 4 3 7

When asked about how working time was organised, a wide variety of responses was

obtained, in part because the organisation within an individual provider was complex and

varied among staff. One issue was whether staff worked split shifts: overall only 12% of IDPs

and 11% of LADPs said that this was their main pattern of working, with the vast majority

saying they operated a variety of shifts (table III.30).

Table III.30. Types of shift working arrangements


Continuous shifts 7.8 11.1 8.3

Split shifts 11.8 11.1 11.7

Variety of shifts 80.4 77.8 80.0


No response 1 1 2

Many referred to the hourglass demands for care with peak demands in morning and

evenings; others divided the work into four main periods - mornings, lunch, teas, bed, and

either allowed staff to work mixes of these periods or joined mornings with lunches and teas

with bed, or allowed for split shifts between mornings and evenings on the grounds that this

suited some staff to have a break in the middle of the day:

They don‟t do continuous shifts. They may do a four hour stint in the morning, you know, with

travel time between the calls, then have a break for a couple of hours and then work from two till

eight in the evening. (RN.D.2.CN).


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One provider recognised that this practice caused problems as it lead to perceptions that the

working day was very long even if paid hours were much shorter:

Because these people are having, like, four visits a day, the carers are getting tired doing the

four visits because they seem to be at work all the time, even though they get a break in

between. They are thinking, „Oh, I‟ve done a twelve hour day‟ – So what I want to do is do a

morning run where they do the mornings and the dinners, and then they do a tea come bed

run. … So if they do a morning run they won‟t be on till the following evening so they are

getting like a full day, a night and a morning off aren‟t they? (ON.D.2 AS)

One provider had four shifts – two short morning and evening shifts and then two longer

mornings, plus lunch and teas plus evening shifts (i.e. 7 a.m. to 10 a.m., 8 a.m. to 1 p.m., 4pm

to 7 p.m. and 4 p.m. to 10 p.m.). One said they organised work in four to six hour blocks

while seven said they operated a shift arrangement, in some cases involving permanent shifts

but in others rotating shifts. In other cases the working time arrangements appeared to be

even more variable – dependent upon both the mix of users and the availability of care staff.

Four providers referred to the use of computer software to generate the working time

schedules. Patterns of variability were also found in the LADPs, with rotas known at most

one week or in one case two weeks in advance and more variable hours for those engaged in

more specialised work such as EMI or reablement. One LADP tried to overcome the

problems of split shifts by alternating shift patterns:

It depends on availability. Depends. Can be split shifts – depends on carers availability – so it

can be any of these. If there were split shifts we might roster it so that they worked mornings

one week, then evenings the next week. (LK.DIH.1 DP).

The fragmentation of work organisation raises the issue of whether or not staff are paid or not

for a break between service users in their work schedules. Figure III.24 clearly demonstrates

that in general staff are not paid with only 8% of IDPs saying they would provide a paid

break and 88% saying the break would be unpaid.

Figure III.24. Payment of non-travel breaks between service users

0

10

20

30

40

50

60

70

80

90

100

Paid break Some paid, some unpaid Unpaid break

Pe

rce

nta

ge

IDPs LADPs

Note: Total responses: 50 (IDPs) and 9 (LADPs). Missing responses: 2 (IDPs), 1 (LADP).


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There are clearly variations between providers, but also among different types of staff within

providers. 4% of IDPs and 22% of LADPs said there was a mixture of paid and unpaid

breaks. Car drivers were more likely to be found replacement work, and all TUPE transferred

staff were more likely to be paid:

We arrange a block of clients. The TUPEd staff are all paid. The „walkers‟ (as opposed to

drivers) are expected to come into the office and work on some training books or do some paper

work in the office e.g. updating the client care plans – we usually can find the drivers other work.

(AH.D.3.CN).

If they are in Respite, we pay them. If there is a huge gap, we try to fill that for them. If they have

a half hour gap, we might make them take half an hour unpaid break. (TE.D.1 CN (V)).

The payment of breaks for TUPEd staff reflects current practice within LADPs where two

thirds (67%) said they would provide a paid break compared to just 8% of IDPs, although

efforts are made to redeploy staff when breaks occur:

If [there is] no work, we bring them into the office or offer them to care schemes to work and

recharge for their time. (LK.DIH.1 DP).

The issue of paid or unpaid breaks appears to be related to the extent to which the labour

force is very local; one factor in the acceptability of the working schedule may be not just

time scheduling but also how manageable the round offered was in relation to distance.

We just try to keep them as locally as possible. When we do the rotas, well, before we send the

rotas out we‟ll make sure they‟re in one area and they‟re not being sent backwards and forwards.

So hopefully that‟ll reduce the amount of petrol they‟re going to be using. (ON.D.3 BN).

It may also be that where there is a close meshing of work with family and home

responsibilities that providers feel able to ask staff to take unpaid breaks and staff may be

willing to accept the arrangements. However, this may restrict the pool of labour supply on

which a provider may easily draw to those where opportunities to return home for part of the

day are at least seen as having some positive benefit.

Only one agency normally organised work in pairs while 28% of IDPs and 10% of LADPs

said care workers worked alone all or most of the time. Over 90% of LADPs and over 70% of

IDPs said work in pairs might be used around half the time to reflect the specific needs of the

user (table III.31).

One particular type of work that may be done in pairs is care in the late evening or night time

We asked whether care workers might be expected to tolerate working late at night on their

own and while the majority of providers said no (64% of IDPs and 70% of LADPs), well

over a third of IDPs said yes or occasionally (37%), as did 30% of LADPs (table III.32).

One factor limiting the use of pairs was said to be the changing mix of clients:

[Care staff work] mostly alone, some doubles. We have some double runs, but it‟s hard to keep

this going as clients change frequently. (LK.D.3 DS).


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Table III.31. The organisation of care work in pairs or alone


Alone or mostly alone 27.5 10.0 24.6

Half and half; Depends on needs

of service user

70.6 90.0 73.8

In pairs or mostly in pairs 2.0 0.0 1.6


No response 1 0 1

The issue of safety of staff – by both area and time of night - was one that some providers felt

was not solely their responsibility:

One of the things that we were discussing only yesterday was the effect of lone working in the

current climate, asking the council whose liability is our staff‟s safety. Is it solely ours or are they

going to share the liability? … But we have actually done [„double-up‟ calls] where we feel that

areas are pretty unsalubrious. We put in two care workers just purely for their safety. (ON.D.1

DN).

Table III.32. Working alone at night as an expected part of domiciliary care work


Yes 11.5 20.0 12.9

Occasionally 25.0 10.0 22.6

Never 63.5 70.0 64.5


No response 0 0 0

In addition to the risks associated with night work, particularly alone, there are other risks or

potentially unpleasant or dangerous conditions associated with care work. To tap into this

dimension of work we asked care providers to what extent they would expect staff to tolerate

working in insanitary conditions and to what extent they would be expected to tolerate

working with aggressive service users.

While only one provider said care workers should have to tolerate insanitary conditions on

more than an occasional basis, the frequency of this problem was indicated by the 42% of

IDPs and 70% of LADPs who suggested they would need to tolerate it occasionally (figure

III.25 and III.26).

You wouldn‟t believe the way that some people do live. Obviously what we can do is, we can take

responsibility for that household and ensure that cleanliness is brought up. But it‟s very, very

difficult. You can‟t go in and upset somebody and tell them that they are living in a pigsty. But

you might be able to… So the answer to it is occasionally its bloomin‟ awful. It‟s smelly, it can be

dirty, it can be dark and dingy. The place that they may go to might not be very salubrious.

(ON.D.1 DN).


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Figure III.25. Toleration of insanitary working conditions

0

10

20

30

40

50

60

70

80

90

100


Pe

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IDPs LADPs


Figure III.26. Aggressive service users as an expected part of domiciliary care work

0

10

20

30

40

50

60

70

80

90

100


Pe

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IDPs LADPs


Working with aggressive service users was an even more common part of the job with only

15% of IDPs and 10% of LADPs saying that staff would not need to tolerate it and indeed

30% of LADPs regarded it as more than an occasional problem, compared to 11% of IDPs.


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This may reflect the more specialist nature of LADPs work in some LAs. However, the

majority of both sets of providers said it had to be tolerated occasionally.

III.4.2. Flexibility, working time arrangements and work organisation in care

homes

Employment contracts and working time

Working time in care homes is not only more guaranteed than in domiciliary care but also

more often full-time. Figure III.27 plots the percentage of providers that employ care workers

for different numbers of weekly hours (see, also, table III.23 above). Over three fifths of

responding homes had at least 50% of staff working 30-45 hours and none had a majority

working short part-time hours. Nevertheless, the share of part-time working is significant

considering that these homes need to provide 24 hour, 7 days a week care. Over 41% of

responding homes had more than 50% in long part-time. If we look at the distribution of

homes by shares of long part-time and more full-time hours we find quite a wide variation in

patterns; thus over 40% of responding homes had less than 20% of staff in long part-time

work but at the other end of the spectrum 25% had 70% or more in this type of working time

category Similarly 16% of homes had fewer than 20% in full time work while 44% of homes

had more than 70% in this category.

However, although more workers are in full-time jobs than in domiciliary care, fewer work

very long hours (that is, over 45 hours per week); only 25% of homes had any staff in this

category compared to 38% of IDPs. Excluding those working very long hours only on

occasions for emergency cover reduces the share of homes with anyone on more than 45

hours to 17%. Moreover, under 10% of care homes had a seven day maximum working week

and only 33% had either a six or seven day maximum compared to 77% of IDPs (Table

III.24).

However, when it comes to weekend working it is equally the norm in care homes for all staff

to be regularly involved in weekend work, with 70% of care homes, over ten percentage

points more than IDPs, involving all staff in regular weekend working (see figure III.20

above). The pressures of staffing weekends nevertheless remained considerable. Some homes

sought to solve the problem through stipulations at interview:

They are expected to work weekends. It‟s a 365 day a year job. You know, weekends, Bank

Holidays, Christmas Day because it‟s a 24/7 service, and at interview we ask that question. It‟s

about flexibility.( HD.HN.1.C.LV).

Nevertheless the problems of scheduling sometimes meant that staff might be under pressure

to work more weekends than they had signed up for:

Always difficult at weekends, because I like to give staff alternate weekends off, but sometimes it

is difficult.(OM.HN.2.A.N).


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Figure III.27. Proportions of staff working different hours in homes

0

10

20

30

40

50

60

70

80

Under 16 hours 16-30 hours 30-45 hours Over 45 hours

Usual weekly hours

Pe

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nta

ge

of p

rovid

ers

0%

1-10%

11-20%

21-30%

31-50%

51-70%

71-80%

81-90%

91-99%

100%

Note: see table III.23 for number of responses.

Working time scheduling

As in domiciliary care the majority of homes (96%) claimed to be able to give staff work

schedules that fitted their preferences all, or most of the time and a higher share of homes –

almost a third rather than a quarter - were able to meet preferences all of the time compared

to domiciliary providers (see figure III.21 above). In homes the problems related not so much

to changes in service users but to the need to cover 24/7 particularly in holiday periods or

when there is a high rate of sickness:

[We have] a four-week rota. It is very difficult to organise. We always try our best to give people

what they want, but at holiday times, it is very difficult. They request, and we try our best. We

rota so that all have the same number of weekends off and the number of hours they want. Some

work nights only, the rest work days, sometimes earlies, and sometimes lates. Staff tend to be very

flexible. If someone leaves suddenly or is off sick, then we are under-staffed. We are flexible, and

they are flexible and will fill in. (TE.H.4 AS).

Care homes, as with IDPs, were primarily reliant on their existing staff for temporary cover

with 57% relying on existing staff only and 96% using existing staff at least in combination

with other methods (see table III.27 above). Only 4% used external agencies as their only

source of cover:


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It varies. Staff are usually flexible. The new Filipinos are keen to earn money to send home and

they volunteer for extra shifts – they sometimes switch between housekeeping and care work. We

are lucky, but they can all say no to extra work. (LK.H.4 AL).

Other methods were much more common in care homes than domiciliary care, however, with

23% making use of external agencies and 33% using a list of temporary workers.

Work organisation and working time

The main question we asked about work organisation and working time related to first of all

minimum staffing levels and secondly how working time was actually organised. The

adoption of minimum staffing levels was common, with 87% of responding homes claiming

to have minimum staffing levels. Further probing of what these minimum staffing levels

amounted to revealed differences in ratios between day and night shifts (often with further

variations for afternoons and early evenings but, as mornings had the most staff and nights

the least in all cases, we concentrate on the morning to night ratio). Of the 19 cases where

sufficient detail was given of variations across shifts we found that 11 had night ratios in

excess of 50% of the morning shift but in eight cases the night time staffing ratios were half

or less. Some homes gave us the ratios in relation to occupied beds with, for example, the

ratio varying from 1 in 5 in the morning to 1 in 8 at night. In some cases the minimum

staffing ratios were given as a constant over the 24 hours and therefore probably referred to

night time ratios. Quite a number of homes gave ratios not just overall but in relation to

number of senior or qualified staff. These minimum staffing ratios thus clearly create

scheduling constraints both by numbers of staff but also qualifications and seniority. Most

ratios are implicitly related to bed occupancy but adjustments to bed occupancy occur in

rather large lumps as one provider with 27 beds noted that a reduction of occupancy of three

lead to a reduction in staffing levels by a quarter.

Because we‟re three patients down the owner has reduced numbers, reduced [staff] numbers,

so I‟m not too happy about that, but that‟s the way it goes at the moment. …(ON.HN.1 BS).

When it came to shift patterns the homes had different strategies as to whether they used

permanent or rotating shifts with half using rotating shifts and around a third (37%) using

permanent shifts. A mixture of permanent and rotating shifts was used by 14% of homes.

While permanent shifts were often used to meet preferences some homes recognised that this

created problems in reducing staff experience and understanding of the work of the home:

And the shifts, some of the staff here ….work so many nights but we‟re trying to get away

from that and have the rotated shift pattern so that everyone understands what happens 24/7.

(HD.HN.1.C.LV)

Further variations related to length of shifts. Most used a three shift system but at least four

homes operated long shifts of 11 or 12 hours. Two homes offered long days as a choice to

staff. As most involved all staff in working weekends and nights it was only a minority of


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homes that employed some weekend only staff. Other ways of fitting hours to preferences

included one home that allowed staff to choose their day off. Many also mentioned that

breaks were paid although one said the home did not pay breaks for new staff and another

specified that full-timers were granted a 30 minute paid break but part-timers only ten

minutes.

Table III.34. Use of rotations between shift arrangements in homes

% of homes

Rotate 50.0

Stay on same shift 36.5

Half and half 13.5

Total responses 52

No response 1


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III.5. Employee development and training

An important element in human resource management is staff development and training. This

starts with induction but continues with opportunities for training and for development

through systematic appraisal systems. We address these three inter-related issues in this

section in turn.

III.5.1. Induction of new staff

When asked about the length of induction training for new staff there was a variety of

responses ranging from one day to six months. However, many respondents distinguished

between an initial induction period of a few days followed by a number of weeks shadowing,

working under supervision, probation and mandatory training courses. Others said the length

of induction could vary according the previous experience and qualifications of the new

recruit, or the length of time taken for the CRB check.

The majority of providers carried out the induction training themselves. Only 3% said the

training was provided by an external training organisation and a similar share reported using

the local authority. A further 10% said the training was provided by themselves and the local

authority, or other organisation, or a combination of all three.

Table III.35 reports managers‟ perceptions of how long new staff need to become competent

in the role. There is a good deal of variation of perceptions between IDPs, LADPs and

homes. Over one quarter of IDP managers said new recruits would be able to do the job as

well as existing staff in one week or less, compared to 15% of home managers and none of

the LADP managers. At the other end of the scale only around a fifth (21%) of IDP managers

thought this would take between one and six months compared with half of the LADP

managers and two fifths (40%) of home managers.

Table III.35. Length of time needed for new staff to do the job as well as existing staff


One week or less 15.4 26.9 0.0 19.3

More than one week - up to 1 month 36.5 36.5 30.0 36.0

More than 1 month up to 6 months 40.4 21.2 50.0 32.5

Depends 7.7 15.4 20.0 12.3


No response 1 0 0 1

Some respondents observed that the length of time taken to become as competent as existing

staff depended on the individual (8% of homes, 15% of IDPs and 20% of LADPs). Previous


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experience did not necessarily mean that the new member of staff would become competent

in a shorter period of time:

This depends on the person. Some fit in very well. Some with a lot of experience might have

developed poor practice, so sometimes it‟s better for people not to have any experience. (TE.D.1

CN (V)).

Working in a care home would not necessarily prepare someone to undertake domiciliary

care:

It depends what their experience has been because if they‟ve worked in a very sort of institutional

way then it takes a long time to undo that so it depends what the individual experience has been.

(RD.D.2.CL).

III.5.2. Training

All establishments in the survey had some staff trained to NVQ level 2, but there was a wide

variation in the proportions (between 15% and 100%). Table III.36 and figure III.28 show

that attainment of NVQ level 2 was significantly higher in the homes than the IDPs, with

53% of homes having 70% or more staff trained to NVQ level 2, compared with only 33% of

IDPs. On the other hand, over half the IDPs (52%) had fewer than 56% of staff trained to

NVQ2 compared with under 30% of homes.

Table III.36. Proportion of care workers trained to NVQ level 2


45% or less 13.7 30.8 22.2 22.3

46 – 55% 15.7 21.2 0.0 17.0

56 – 69% 17.6 15.4 22.2 17.0

70% or more 52.9 32.7 55.6 43.8


No response 2 0 1 3

Managers were asked how likely they were to meet the Care Standards Act (2000).target of

50% of staff trained to NVQ Level 2. Close to nine in ten homes (89%) and eight in ten

LADPs (80%) had already met this target (figure III.29). Although the majority of IDPs had

also met the target the proportion is lower, at only 65%. However, a further 21% of IDP

managers felt that they would be able to meet the target soon. In line with these findings,

14% of IDPs were experiencing difficulties meeting the target, compared with only one

LADP and just under 4% of homes.


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Figure III.28. Share of care staff in homes and IDPs with NVQ level 2 by share of

providers in sample (cumulative percentage of providers)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% o

f st

aff

wit

h N

VQ

2

Homes IDP's

Figure III.29. Likelihood of meeting the 50% NVQ level 2 target

0

10

20

30

40

50

60

70

80

90

100

Already met Will meet soon Experiencing difficulties

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 52 (homes), 51 (IDPs) and 10 (LADPs). Missing responses: 1 (homes), 1 (IDPs).

We probed this question further by asking the managers who said they were experiencing

difficulties meeting the 50% NVQ level 2 target, what factors were contributing to these

difficulties. The responses are categorised in Table III.37. The two biggest problems for the

IDPs were staff turnover and training-related problems (with providers, assessors or funding)


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with almost 39% of responses in each of these categories. Problems concerning staff

motivation and pressure of work accounted for just over 22% of responses from IDPs. Staff

turnover and motivation were the biggest problems for the homes, with 38% of responses in

each of these categories. One specifically mentioned having older staff who were very

experienced but did not want to take qualifications. Training-related problems accounted for

one quarter of responses from the care homes.

Table III.37. The factors that make it difficult to meet the 50% NVQ level 2 target


Staff turnover 37.5 38.9 50.0 39.3

Staff motivation 37.5 16.7 0.0 21.4

Pressures of work (e.g. scheduling, fatigue) 0.0 5.6 0.0 3.6

Training provider/ assessor/ funding problems 25.0 38.9 50.0 35.7


No response/not applicable 45 34 8 87

Figure III.30 shows the percentages of staff trained to higher levels – NVQ level 3 or NVQ

level 4. As with the NVQ2,, the proportions attaining these qualifications were significantly

higher in the homes, with 40% having over 20% of staff trained to these levels. The

corresponding figures for the IDPs and LADPs are 16% and 20%, respectively. At the other

end of the scale, only one quarter of homes had 10% or fewer staff trained to these levels,

compared with 59% of IDPs and 60% of LADPs.

Figure III.30. Proportion of care workers trained to NVQ levels 3 and 4

0

10

20

30

40

50

60

70

10 percent or less 11 – 20 percent 21 – 29 percent 30 percent or more

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 45 (homes), 50 (IDPs) and 5 (LADPs). Missing responses: 7 (homes), 3 (IDPs), 5

(LADPs).


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We followed this question up by asking whether any staff actually needed to have NVQ

Level 3 and, if so, which staff, and whether they were recruited externally or internally

trained. Table III.38a shows that 54% of IDPs and 88% of LADPs did need to have some

staff trained to NVQ level 3. The most frequently mentioned role requiring NVQ3 was that of

senior care worker (18 responses). In many cases it was apparent that, on attaining this

qualification, the care worker would automatically become a senior care worker and receive a

pay increase. Other higher level roles were also mentioned as requiring the jobholder to be

trained to NVQ3 level, such as supervisors and team leaders (6 responses) and care

coordinators (6 responses). Some specialised types of care were also said to require an

NVQ3 trained care worker, such as hospital discharge and care for people with specific

medical conditions such as diabetes.

Providers‟ requirements for seniors and supervisors to have NVQ3 were sometimes not

matched by [training] providers‟ willingness to accept initially people who did not already

have supervisory responsibility:

It‟s quite difficult to get them on Level 3 because they don‟t have supervisory responsibility, it can

be difficult to get providers to take them at Level 3. (LK.D.3 DS).

Table III.38. Staffing issues for care workers needing NVQ level 3

a. Requirement for some staff to have NVQ level 3


No 46.2 12.5 41.7

Yes 53.8 87.5 58.3


No response 0 2 2

b. Use of external recruitment of NVQ3 trained staff or internal training


Internally trained 66.7 100.0 73.5

Recruited externally 7.4 0.0 5.9

Both 25.9 0.0 20.6



We asked those managers who said they needed to have some of their care workers trained to

NVQ Level 3 whether these staff were recruited externally or internally trained. The majority

(two thirds of responding managers from IDPs (67%) and all the responding LADP

managers) said they were internally trained. Just over one quarter of IDP managers (26%)

said they would fill these roles both with new recruits and/or internally trained staff. Only 7%

of IDP managers said these roles would be filled exclusively with new recruits (table III.40b).


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One employer mentioned the difficulty of recruiting people who were already qualified at

NVQ level 3:

Usually [we train staff] internally, as it is very hard to attract people with NVQ 3 externally.

(IL.D.2.DL).

Some IDPs and LADPs provided more specialised types of care, including intermediate care.

Again, we asked managers whether staff providing specialised care needed extra

qualifications (Table III.39). More than half of IDPs (55%) and close to three quarters of

LADPs (71%) that responded said they did not. Where extra qualifications were required,

two respondents said staff would need NVQ level 3, two mentioned shared protocols with

NHS nurses, one mentioned a course on intermediate care provided by the local authority and

others mentioned additional training units such as PEG feeding, risk assessment and

palliative care.

Table III.39. The requirement for staff providing intermediate care to have extra

qualifications


No 54.5 71.4 58.6

Yes 45.5 28.6 41.4



Managers were asked what training courses were offered to staff and whether they were

optional or compulsory. In each case they were asked whether specific courses were optional

or compulsory and then to identify any other courses which were offered. Table III.40 shows

the results for compulsory courses with the corresponding results for optional courses in

brackets. Firstly, it will be noted that the percentages for „compulsory‟ and „optional‟ total

more than 100 in some cases. This is because some respondents indicated that some courses

were compulsory for some staff and optional for others (e.g. training in „Use of Equipment‟,

which may depend on the needs of the service users that the individual cares for, or the „NVQ

level 2‟ course which may be compulsory for new staff but not for longer serving staff).

Secondly, we know there are some courses which are mandatory for all staff („Health and

Safety‟, „Service User Handling‟ and „Infection Control‟), but the responses for „compulsory‟

for these courses in some cases amount to less than 100%. We assume this is an oversight.

The first five specifically-mentioned courses were offered by all, or at least 90% of

employers, with similar results across the three sectors. Of the other specifically named

courses, „First Aid‟, „Medication Management‟ and „Parkinson‟s Care‟ were more likely to

be compulsory in IDPs than homes, possibly reflecting the fact that those care homes with

nursing would have a trained nurse on duty at all times. NVQ2 was said to be compulsory in

82% of homes, 84% of IDPs and 89% of LADPs. Eighty three respondents mentioned other

compulsory courses. The most frequently mentioned were those related to „Protection of


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Vulnerable Adults‟ and „Safeguarding‟ (16 homes, 11 IDPs and 3 LADPs), followed by „Fire

Safety‟ (13 homes). Other courses mentioned related to specific conditions or specialised

types of care which some staff may have to undertake, or courses undertaken to comply with

the Skills for Care Common induction standards.

One provider mentioned that more courses were becoming compulsory as the needs of

service users changed:

All staff are now being trained in dementia care as there are many more referrals of those with

dementia and numbers are increasing. (IL.D.2.DL).

Table III.40. Compulsory and optional courses offered (optional courses in brackets)


Health and Safety 92.0 (12.0) 97.9 (0.0) 100.0 (0.0) 95.3 (6.5)

Food hygiene 92.0 (14.0) 93.8 (12.5) 88.9 (22.2) 92.5 (14.0)

Service user handling 98.0 (4.0) 100.0 (2.1) 100.0 (0.0) 99.1 (2.8)

Use of equipment 94.0 (6.0) 95.8 (12.5) 88.9 (0.0) 94.4 (8.4)

Infection control 94.0 (8.0) 91.7 (12.5) 100.0 (0.0) 93.5 (9.3)

First aid 72.0 (32.0) 91.7 (8.3) 44.4 (55.6) 78.5 (23.4)

Medication management 52.0 (38.0) 95.8 (10.4) 100.0 (0.0) 75.7 (22.4)

Dementia care 52.0 (48.0) 43.8 (56.3) 44.4 (55.6) 47.7 (52.3)

Diabetes care 16.0 (74.0) 14.6 (75.0) 11.1 (88.9) 15.0 (75.7)

Loss and depression in elders,bereavement 20.0 (72.0) 16.7 (70.8) 11.1 (77.8) 17.8 (72.0)

Parkinson‟s care 4.0 (80.0) 18.8 (72.9) 11.1 (88.9) 11.2 (77.6)

NVQ 2 82.0 (24.0) 83.3 (25.0) 88.9 (0.0) 83.2 (22.4)

When asked which specific courses were optional the pattern of responses reflected the

responses to the question on which courses were compulsory. A wide range of other courses

were mentioned as being optional, including NVQ3 and NVQ4. One respondent said the

courses on offer were too numerous to mention. Optional courses were said to be especially

valuable as staff had specifically requested to do them:

There is lots and lots of training apart from induction. They are sent a questionnaire asking what

they want and there are lists on the training board and they can sign up. It is very fruitful if they

specifically ask for training. They get a lot out of it. (LK.D.6.CL).

Figure III.31 shows that the shares of providers having attained the Investors in People

award, or working towards it, were similar for homes and IDPs, but were only around a third

for all providers. In contrast, the majority (83%) of LADPs had attained the award.


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Figure III.31. Achievement of the Investors in People Award

0

10

20

30

40

50

60

70

80

90

100

Yes, or working towards No

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses:45 (homes), 47 (IDPs) and 6 (LADPs). Missing responses: 8 (homes), 5 (IDPs), 4

(LADPs).

III.5.3. Appraisal and staff development

Staff appraisal systems seem to be widely established in independent as well as LA providers

with only one home and one IDP saying they did not carry out appraisals. Most carried out

appraisals annually, with one even saying once every 18 months; a slightly higher percentage

of IDPs (27%) than homes (21%) carried out appraisals more frequently than annually (table

III.43). In over half of cases appraisals were carried out by the manager alone in both homes

(58%) and IDPs (51%) and were involved in the appraisals in over three quarters of homes

(79%) and 59% of IDPs. This close involvement by the manager is reflective of the relatively

small size of the establishments. The higher share of „other‟ staff carrying out appraisals in

IDPs at 41% reflected the more widespread use of care coordinators or team leaders and

supervisors in domiciliary care to manage a more dispersed and indeed often larger

workforce. To probe further on approaches to staff development, we asked how training

needs were identified, first whether they were assessed by appraisal and second if they were

identified by employee request. A sizeable minority answered no to both (14% of homes and

23% of IDPs) and a further 10% of homes only identified needs through employee request.

Overall over three quarters identified needs through the appraisals system, with 56% of those

homes and IDPs using appraisal also using employee requests as a means of identification.


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Table III.41. Staff appraisal arrangements

a. Frequency of appraisals


No appraisal or only casual 1.9 1.9 0.0

Regular but less frequently than annual 0.0 1.9 0.0 0.9

Yearly 77.4 69.2 55.6 71.9

Six months to one year 7.5 5.8 22.2 7.9

3 to 6 months 3.8 17.3 22.2 11.4

More frequently than 3 months 9.4 3.8 0.0 6.1


No response 0 0 1 1

b. Who carries out appraisals


Manager 57.7 51.0 33.3 52.7

Other 23.1 41.2 66.7 34.8

Manager and Other 19.2 7.8 0.0 12.5


No response 1 1 1 3

c. Identification of training needs


Neither 13.5 23.1 10.0 17.5

Employee request 9.6 0.0 0.0 4.4

Appraisal alone or appraisal plus

employee request

76.9 76.9 90.0 78.1

Total responses

52 52 10 114

No response 1 0 0 1


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III.6. Performance management, job autonomy and employee

voice

Important issues for recruitment and retention are how staff are managed within the

workplace; how performance is managed, the autonomy and discretion offered to employees

and opportunities for employee voice and communication. We consider the telephone survey

data corresponding to these issues in this section

III.6.1. Performance management

The most common practices used for performance monitoring were through the medium of

supervisors in all three types of providers - homes (81%), IDPs (85%) and LADPs (70%). For

IDPs and LADPs we also asked if there was any direct observation of staff and 69% of IDPs

and 80% of LADPs said they did undertake direct observation (figure III.32). We also asked

those involved in domiciliary care whether they used electronic monitoring and 31% said it

was currently in use; however we know from the interview data with LAs that this share is set

to rise. User surveys by providers were used to monitor performance in 29% of homes, 47%

of IDPs and 30% of LADPs. User surveys by the local authority were used by half of LADPs,

but only 6% of homes and 22% of IDPs. However, 74% of homes, 55% of IDPs and 40% of

LADPs said they used other methods to monitor performance. These included investigations

of monitoring, CQC inspections, appraisals and spot checks.

Figure III.32. Types of staff monitoring

a. Homes

0

10

20

30

40

50

60

70

80

90

100

No Yes No Yes No Yes No Yes

Supervisors? User surveys by care

provider?

User surveys by LA? Other methods?

Pe

rce

nta

ge

of p

rovi

de

rs


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b. IDPs

0

10

20

30

40

50

60

70

80

90

100

No Yes No Yes No Yes No Yes No Yes No Yes

Electronic

monitoring?

Supervisors? Observation? User surveys by

care provider?

User surveys by

LA?

Other methods?

Pe

rce

nta

ge

IDPs LADPs

Note: Total responses for different questions: 53, 49, 48, 50 (homes); 51, 52, 51, 51, 51, 51 (IDPs) and 10 for all

questions (LADPs).

For some managers electronic monitoring was used solely because of contractual

commitments and they were concerned about the impact on both staff and their own revenues

of moving to paying by the minute or even five minute blocks:

Instead of paying per care call they are only now going to pay per minute. So we are actually

moving now to paying people in five minute pay bands rather then per minute because I think

it‟s a bit childish. So if they do 26 minutes they‟ll get paid 30. So it will be rounded up. But

also if they spend 90% of the scheduled time in a service user‟s home we will also pay the

travel time. So that‟s an incentive for them to keep our income levels high, because the less

they do the less we get and it soon spirals out of existence. (ON.D.1 DN).

Table III.42. Managers’ perceptions of the most effective method for dealing with

performance monitoring


Disciplinary only 6.7 12.2 11.1 9.7

„Soft‟ measures plus disciplinary 8.9 28.6 33.3 20.4

Training and „soft‟ measures only 84.4 59.2 55.6 69.9

Total responses

45 49 9 103


However, one IDP commented on how it had enabled them to tighten their control of the care

workforce:

Now [performance problems] it is people running late or leaving early before the full amount

of the call. ….We have investigated, and it is usually people arriving late for their first call


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and then never catching up. They leave early – maybe 15 or 10 minutes early and tell us it is

because the client told them to leave early. We now have a system that they have to call into

the office if the client tells them to leave early. If it‟s someone with dementia we follow this

up; it may be the same person always reporting that their clients tell them to go. Call

monitoring has helped us analyse these issues. (IL.D.1).

Most providers preferred to use „soft‟ measures such as training, one to ones, supporting

staff, changing schedules etc. to deal with poor performance (over 80% of homes, almost

60% of IDPs and over 55% of IDPs), rather than disciplinary procedures (Table III.42).

We also asked what were the most common problems of poor performance (table III.43). The

most frequently mentioned were absenteeism and sickness (18% of homes, 37% of IDPs and

10% of LADPs), timekeeping (8% of homes, 40% of IDPs), and skimping on time spent with

service users (8% of homes, 27% of IDPs and 10% of LADPs). These findings reflect the

nature of work in domiciliary care, where staff usually work unsupervised. Other problems

mentioned were complaints from service users, not following correct procedures, lack of

skills and training, personal or family problems affecting work, poor team working and

language skills.

Table III.43. Managers’ views on the most common problems of poor performance

% of Homes % of IDPs % of LADPs % of all

Absenteeism, sickness 18.0 36.5 10.0 25.9

Timekeeping 8.0 40.4 0.0 22.3

Skimping on time or services provided 8.0 26.9 10.0 17.0

Poor attitude, motivation 20.0 7.7 10.0 13.4

Complaints from service users 0.0 13.5 30.0 8.9

Not following correct procedures 14.0 0.0 20.0 8.0

Lack of skills, training 4.0 5.8 10.0 5.4

Personal or family problems 8.0 0.0 0.0 3.6

Poor teamworking 6.0 0.0 0.0 2.7

Poor language skills 4.0 0.0 0.0 1.8

No problems 12.0 3.9 10.0 8.0


No response 3 0 0 3

Note: Multiple responses possible.

In their additional comments on the nature of performance problems we encountered a range

of responses, with some attributing the main problems to gaps in training or understanding of

procedures while others felt the problems lay mainly with attitudes:

It‟s about practice issues not using the right techniques with moving and handling and not

following procedure. (HD.HN.1.C.LV).


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Not understanding professional boundaries, it‟s never meant, it‟s never malicious but most of

the problems that we do encounter tend to be around staff overstepping boundaries.

(OM.D.2.DN).

Another talked about the difficulties of disentangling poor performance from problems of

meeting users‟ expectations:

I think it‟s a bit of both at this moment in time. We have staff going in with guidelines, service

users wanting over and above and we do have a bit of racism and the others are staff not

getting to their shifts on time. (RD.D.1.C.S.).

To link issues of performance management directly back to issues of recruitment and

retention we asked whether providers felt obliged to put up with poor performance because of

problems of staff shortage (figure III.33). As might be anticipated, most said they did not put

up with poor performance (70% of homes, 57% of IDPs and 70% of LADPs) - as to do so

would reflect negatively on their organisation. However, the remaining 30% of homes, 43%

of IDPs and 30% of LADPs admitted that they were forced to put up with poor performance,

at least sometimes.

Figure III.33. Share of providers who said that recruitment difficulties sometimes

forced them to put up with problems of poor performance

0

10

20

30

40

50

60

70

80

90

100

no yes

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 53 (homes), 51 (IDPs) and 10 (LADPs). Missing responses: 1 (IDPs).

Absenteeism featured as a particular concern. The majority of providers (94% of homes, 84%

of IDPs and all LADPs) said they collected figures on absenteeism (Table III.44). Some of


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the national providers had specific regulations and procedures that were used to manage

absenteeism:

The company does it on a regional basis. After 4 periods of absenteeism, then staff go through

disciplinary proceedings. (IL.D.1 CN).

More than one quarter of organisations surveyed believed rates of absenteeism were quite

high or very high (figure III.34). The evidence suggests the problem is particularly acute in

IDPs (35%), compared to just over 15% of homes. More surprising, however, is the very high

share of LADPs who report high absenteeism – 70% - but this may be related in part to more

generous sick leave provision in the public sector.

Table III.44. The collection of figures on absenteeism


Yes 94.0 83.7 100.0 89.7

No 6.0 16.3 0.0 10.3


No response 3 3 2 8

Figure III.34. Managers’ views about rates of absenteeism among care staff

0

10

20

30

40

50

60

Very high Quite high Acceptable Quite low Very low

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses: 53 (homes), 51 (IDPs) and 10 (LADPs). Missing responses: 1 (IDPs); Question asked

was, „What do managers consider rates of staff absenteeism to be?‟ (Q173).

The differences in views as to whether the level of absence was too high, low or acceptable

may reflect different perceptions and attitudes as well as different levels; respondents were

asked to tell us how they measured absenteeism and to give us the data but the methods used

were too variable to report here. One IDP was particularly adamant that absenteeism would

not be tolerated:


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I don‟t tolerate it. I have had one or two people who are always having sickies. It goes into

their files and I get a pattern. They forget what reasons they have given, and how many days

they have had off, but we write it down. My deputy has had one day off in 20 years, I have had

one week off in 19 years. (TE.H.3 AS).

Others saw absenteeism as a problem related to the age of the workforce and the nature of the

job – including the impact of problems in relationships with users.

Where it is sickness, we have a system of letters and dates that are trigger points. I speak to

them one to one and then it goes to HR. They have not helped much so far. But workers are

old, and they are tired and prone to infection. (AH.D.3.CN).

Absenteeism; [its] low confidence; personal chemistry. (TE.H.2 BS).

Yet others stressed the problems of managing sickness for a dispersed workforce:

Three field care supervisors actually spend time with the staff and we‟ve tried return to work

interviews, but … somebody that works four miles away from here that doesn‟t have a car

finds it very difficult to come in to the office for a half hour to be told that they shouldn‟t be

having sick but, you know, „I‟ve had gastroenteritis‟, what can I do?‟(ON.D.1 DN).

To assess the approach to managing performance we asked about what methods they had

found most effective in managing poor performance. We have recoded those responses into

three categories: those that mentioned disciplinary methods only; those that mentioned softer

measures such as training alongside disciplinary measures and those that only mentioned

softer measures such as training, one to ones, supporting staff, changing schedules and so on.

The vast majority of homes (84%) mentioned only soft measures. IDPs were more varied

with around three fifths only mentioning soft measures but 28% mentioned disciplinary

measures alongside soft measures (with LADPs showing a similar pattern). Only a minority -

12% – mentioned only disciplinary approaches.

III.6.2. Discretion and autonomy

Opportunities to exercise discretion and autonomy at work have the capacity both to

contribute both to the quality of the jobs and to the quality of the care provided. However, the

granting of discretion may provide challenges for management, particularly in a context of

tightly specified commissioning. To probe these issues we asked a series of questions related

to both time constraints on tasks and autonomy in tasks. As the work environment is quite

different between domiciliary and care homes we discuss the results in turn (table III.45).

Although all IDPs said that client visits were tightly defined, a majority still expressed the

view that staff did have time to carry out their work to a high standard with 79% saying yes

and a further 17% agreeing that this applied to some extent. In practice only two IDPs said

this was not the case. LADPs were, in fact, less positive with only 60% saying yes, 30%

stating to some extent and 10% - that is, one provider- saying no. There was more recognition

of time constraints on a specific dimension of care, that is developing good relationships with

clients; again although the majority were positive, 15% of IDPs said they were not able to do


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this and a further 17% only to some extent. For LADPs the shares were quite similar at 10%

and 20% respectively. This aspect of care may be regarded as more voluntary by some

providers but one provider emphasised its importance:

Because they may be the only person that they have seen all day or all week. People are elderly,

lonely, don‟t have any other social contact. They see this as a part of social contact so we do

encourage it. (ON.D.1 DN).

Table III.45. Types of opportunities for staff to improve their performance


Having enough time to carry out

the work to a high standard?

Yes 90.4 78.8 60.0 82.5

To some extent 9.6 17.3 30.0 14.9

No 0.0 3.9 10.0 2.6

Having the opportunity to put into

practice the training qualifications

they have gained?

Yes 94.3 100.0 90.0 96.5

To some extent 5.7 0.0 10.0 3.5

No 0.0 0.0 0.0 0.0

Being free to prioritise and carry

out tasks in ways to improve the

quality of care?

Yes 73.6 40.4 60.0 57.4

To some extent 26.4 44.2 40.0 35.7

No 0.0 15.4 0.0 6.9

Having the opportunity to develop

good relationships with service

users?

Yes 94.3 67.3 70.0 80.0

To some extent 5.7 17.3 20.0 12.2

No 0.0 15.4 10.0 7.8

Being encouraged to exchange

ideas with other carers of new

ways of working/best practice?

Yes 90.6 84.6 100.0 88.7

To some extent 9.4 11.5 0.0 9.6

No 0.0 3.9 0.0 1.7


Both IDPs and LADPs were universally positive about opportunities to put training into

practice within the care work environment with none answering negatively and only one

LADP answering to some extent. An almost similar positive response was found for

opportunities for care workers to pass on ideas to others to improve care. There was more

doubt, however, about whether care staff were free to prioritise and carry out tasks in ways to

improve care; only 40% of IDPs agreed and a further 44% said to some extent with 15%

saying no. None of the LADPs said no and three fifths said yes and two fifths to some extent.

Thus there was some recognition of constraints on the autonomy of care staff to determine

priorities or change ways of carrying out tasks.

The same questions were posed to the home managers. The responses from homes were even

more positive than for the IDPs. There were in fact no negative answers to any of the

questions and the share saying to some extent rather than simply yes fell below 10% in all

cases, except for the question about freedom to prioritise and carry out tasks in ways to

improve the quality of care. Even here almost three quarters of homes said yes (74%) and


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over a quarter to some extent, with the yes response well above the share of IDPs answering

yes (40%). This apparent lower degree of discretion for domiciliary care applies in a context

where most domiciliary care workers operate unsupervised while care workers in homes are

often working in teams. In a fixed workplace with senior staff always on duty, care home

managers may feel it less necessary to specify priorities and ways of working than in the

unsupervised domiciliary care context.

III.6.3. Employee voice and communication

In contrast to local authorities, most independent sector providers do not recognise trade

unions or follow collective bargaining (figure III.35). In our sample only 15% of homes and

8% of IDPs recognised trade unions. However, voluntary sector providers were more likely

than for-profit providers to recognise unions – 24% and 9%, respectively. But in general,

outside the public sector, opportunities for employee voice depended more on management

initiatives than formal provision for voice.

All the providers in the sample held at least annual staff meetings and over 90% held them at

least quarterly (table III.46). Homes were more likely than IDPs to hold meetings every

month or more frequently. The reason for this was undoubtedly the greater difficulty of

arranging staff meetings for domiciliary care staff who work in the community rather than in

a fixed location but on the other hand the need for staff meetings may be consider greater in

IDPs.

Figure III.35. Union recognition and use of staff attitude surveys

0

10

20

30

40

50

60

70

80

90

100

Recognise a trade union Carry out staff attitude surveys

Pe

rce

nta

ge

Homes IDPs LADPs

Note: Total responses to the two questions: 53 and 52 (homes); 51 and 52 (IDPs); 9 and 9 (LADPs).

Perhaps reflective of the greater difficulties of direct communication IDPs were more likely

than homes to carry out staff attitude surveys - 83% compared to 58% (figure III.35). Some


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comments made by interviewees for the telephone survey indicate, however, that these

surveys did not always generate a high response rate.

Yes, but the one I did, no-one filled it in and returned it to me. (IL.H.2).

[Company X] do [undertake a staff survey] after you have been on contract for 9 months. I

am not involved and have no idea of the result. I think that not many responded.

(AH.D.3.CN).

Table III.46. Frequency of staff meetings


Between every three months and yearly 10.0 9.6 0.0 8.9

Between one and three months 44.0 63.5 40.0 52.7

Every month or more 46.0 26.9 60.0 38.4


No response 3 0 0 3


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III.7. Summary

In this part of the report we presented a general mapping of the HR practices and employment

conditions in the social care sector, paying special attention to the similarities and differences

between our two main categories of care providers – residential and nursing care homes

(referred to as homes) and independent sector domiciliary care providers (referred to as IDPs)

– as well as a third category of local authority domiciliary care providers (referred to as

LADPs). The results draw on the combined quantitative and qualitative data from our

telephone survey. In exploring the types of HR practices deployed across the sector, the

variety of practices between IDPs, homes and LADPs and the patterns of employment

conditions, this part of the report has set out the descriptive statistics required for the

subsequent more detailed statistical analysis presented in part IV. Therefore, before turning to

the next stage of our interrogation we summarise the key results from this preliminary

mapping exercise.

The six sections of this part of the report were organised around key areas of HR policy and

practice. Beginning with the key area of recruitment practices, the survey evidence

underlined the problems facing all care providers with one in three reporting difficulties

recruiting care workers. IDPs were more likely than homes to report difficulties but were also

more likely to have witnessed an easing of problems during the recession, suggesting that the

gap in experience has narrowed in the last couple of years. Respondents to our survey,

especially from IDPs, believed the most important reason they faced difficulties was the low

level of pay. And the need to fill weekend and unsocial hours shifts was a real challenge for

all providers, but again especially for IDPs, 70% of which recorded shortages in this area.

As anticipated, section III.1 found that care providers use a range of formal and informal

recruitment methods, although homes were more likely than IDPs and LADPs to prefer

informal methods over formal methods. In the selection process, again the data point to a

wide range of practices, with evidence that IDPs were more likely than homes to utilise

aptitude tests and pre-screening telephone interviews. Perhaps surprisingly – although again

this may reflect the recessionary conditions at the time of data collection – providers were

unlikely to use external agencies to fill vacancies. Nevertheless, 17% of homes and 10% of

IDPs had recruited from overseas directly.

While providers sought a wide range of attributes among job applicants, the most common,

reported by nine in ten providers, was a positive and friendly attitude towards care work; this

was said to be the single most important attribute by three in four homes and over half of

IDPs. Availability for weekend work, as well as early and evening shifts, was also required

by a majority of providers, with strong similarity among homes and IDPs. There was a

notable difference of views among public and private sector provider managers such that

LADP managers placed more emphasis on skills associated with care than did providers in

the independent sector. While providers have a clear notion of what they required in a recruit,

a significant proportion – some four in ten – reported occasionally or often having to hire

people (with full knowledge of what they were doing) who lack the full set of desired


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attributes – a result that is all the more striking given the relatively loose labour market

conditions during 2008-2009. At the same time, a third of providers reported often or

occasionally rejecting candidates who were suitable for the advertised job. This result points

to the likelihood of differential local labour market effects in shaping HR practices, an

important issue that is interrogated in detail in part IV.4. A further external factor that

impinges upon recruitment practices is the need to apply for CRB checks; more than half our

sample of providers had lost one or more job applicants as a result of delays in CRB checks

and a third as a result of CRB failures.

The mapping of turnover and retention conditions in section III.2 showed that while a

majority of providers expressed satisfaction with levels of staff turnover, the data point to

high levels: the turnover of care workers averaged 24% for homes and 31% for IDPs. Homes

were better than IDPs at retaining new recruits but 22% of homes and 32% of IDPs had lost

more than half of their new recruits in the past year. Homes were less likely to report very

high levels of staff turnover; close to a third of IDPs reported turnover of care workers

excluding new recruits of more than 30%. Average rate of turnover, excluding new recruits,

were 22% for IDPs and 18% for homes. Reasons for worker quits are varied and again

differed among homes, IDPs and LADPs. The search for more convenient working hours was

a strong underlying factor at one third of IDPs and the search for better pay at close to one

quarter of both homes and IDPs – although this was not an issue at any of the LADPs in our

survey. Many care workers quit for career reasons, with one in four homes citing nurse

training, and a very common reason was family responsibilities, reported by more than a third

of providers.

The evidence on pay and rewards in section III.3 demonstrates the very low value assigned to

the work of adult care in the UK independent sector and especially so among for-profit

organisations. Homes pay lower minimum rates than IDPs with a third of homes in fact using

the statutory minimum wage, despite its role in the labour market as a floor to wages, not as a

going wage rate. Those paying above the statutory minimum do not pay significantly more –

seven in ten homes and one in three IDPs paid a minimum of less than £6.00 (just 27 pence

more than the national minimum wage). It is notable that no LADPs set such a low minimum

rate for care workers, a reflection of the stronger collective wage bargaining power of trade

union representing care workers in the public sector.

Our analysis of „normal‟ pay rates – the rate paid to most care workers in each organisation -

revealed very low levels and little variation across independent sector homes and IDPs with

the exception of voluntary sector homes where the average normal pay was relatively high.

At nine of the 52 homes surveyed the normal rate was in fact the same as the statutory

national minimum wage. This finding underlines a more general finding of limited

opportunity for pay progression in these organisations. In more than half of IDPs the

minimum rate paid to care workers is exactly the same as the normal rate. Even where

providers pay more for promotion to a senior care worker, the rate of pay is usually no more

than £1.00 higher. And these employers do little to encourage investment in skills; reward for

the NVQ level 2 qualification in care varied from as little as an additional 7 pence per hour to


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£1.02 above the minimum rate of pay; indeed, 23 of the 25 providers that offered a higher

rate set an hourly rate at no more than 50 pence higher than the minimum. The results are a

disappointing reflection of the unwillingness and/or inability of these employers to reward

more complex work appropriately.

Regular uprating of pay was common but not universal. Factors influencing the decision to

uprate pay included changes in the statutory national minimum wage, especially among

homes which is directly related to their greater likelihood of setting minimum rates at the

minimum wage floor. Important influences on IDPs‟ uprating of pay, by contrast, included

the level of LA fees and the profitability of the organisation.

There were variable practices for paying travel time to domiciliary care workers. A small

share of IDPs and LADPs (less than one third) paid a supplement; most opted to reimburse

petrol or public transport costs; and a significant share claimed the compensation was

included in the hourly rates. By contrast, there appeared to be a near universal approach

towards paying care staff for time spent training; only around one in ten providers (all in the

independent sector) failed to compensate all training time. However, there is no standard

practice of paying a premium for overtime work. Most LADPs do follow this practice, but

only around a quarter of IDPs and homes. Finally, the data reveal a surprisingly high

incidence of independent sector providers that are unwilling to fund the upfront costs of

starting work, such as paying for CRB checks, uniforms and induction training.

Section III.4 examined HR practices of flexibility, working time and work organisation.

Among IDPs, there is a very strong flexibilisation of employment characterised by very

limited use of guaranteed hours (just one in ten IDPs), strong prioritisation given to user

needs in scheduling work and a near universal expectation that workers must tolerate longer

hours at short notice (occasionally or often). The data suggest providers use work scheduling

as a major form of control over the workforce; the near standard practice (nine in ten IDPs) of

offering zero hour contracts may in part explain the finding that nine in ten IDPs find it easy

or very easy to find staff willing to take extra hours at short notice. Some providers made it

clear that staff were expected to cooperate in variations to schedules if they hoped to be

allocated their desired number of hours in the future. By contrast, the practice of offering zero

hours contracts has been abandoned by public sector providers where nine in ten offer

guaranteed hours.

Behind the working time practices lies the organisation of work, scheduled around visits to

clients. The minimum duration of visits tended to be 15 minutes and the average length no

more than 30 minutes. Three in five IDPs failed to set any minimum working time and a

further fifth set a minimum time of less than two hours. The fragmentation of work into very

short blocks of time created further problems for staff because nine in ten IDPs did not pay

for breaks.

Among homes, care workers were more likely to work full-time than in IDPs and to be

offered guaranteed hours. Nevertheless, there was still a significant share of part-time

working in homes and fewer care workers worked very long hours than in IDPs. Overall, a


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higher share of homes than IDPs claimed to be able to match employees‟ working time

preferences all of the time, suggestive of a somewhat weaker employer-led approach to

flexibility. A major issue in homes was matching staffing working hours with bed occupancy

with evidence of change occurring in lumps rather than incrementally as homes lost or gained

occupants.

Section III.5 found that most providers were strongly engaged in training provision,

including induction training and training to NVQ levels 2, as well as regular staff appraisals.

Even where staff required NVQ level 3 or 4 skills, three in four providers provided the

training inhouse rather than buy in external provision. There is nevertheless variation in

approach towards staff development. For example, the results suggest IDPs were more likely

than homes or LADPs to believe a newly recruited care worker ought to be competent in their

job within a week‟s induction training. Homes and LADPs were more likely to allow a period

of one to six months for induction. Similarly, attainment of NVQ level 2 qualifications was

higher in homes than in IDPs. More than half of homes and LADPs had more than 70% of

care workers qualified to level 2 compared to a third of IDPs. Also, nine in ten homes had

already met the now abolished national target of having at least half the staff trained to level

2 compared to just two thirds of IDPs. Two key factors explaining the failure to reach the

target were high staff turnover and training related problems such as funding.

The final section III.6 covered inter-related practices towards performance management, job

autonomy and employee voice. Use of appraisals was frequent throughout the sector and most

providers favoured soft over hard methods to improve performance, but poor performance,

including absenteeism, had at times to be tolerated in four out of ten IDPs. With regard to

monitoring, a third of IDPs use electronic monitoring and a significant share of both homes

and IDPs rely on user surveys conducted by both the LA and the care provider. Timekeeping

issues were also a cause of poor performance, again especially notable among IDPs.

The management approach towards encouraging workers to exercise discretion and autonomy

at work is covered in great detail in part V of this report. Here, we only reported the very

basic, descriptive data. Most providers were confident their care workers enjoyed the

opportunity to deliver high quality services, to develop good relations with users and

exchange ideas about good practice care delivery. However, a significant proportion

expressed doubt. For example, more than four in ten IDPs and one quarter of homes believed

workers were not fully able to prioritise and undertake tasks in ways to improve the quality of

care. Also around a fifth of IDPs and LADPs recognised that workers were not fully able to

take the time needed to develop better relationships with service users.

Finally, the survey results confirmed expectations that in the independent care sector the

employment relationship is highly individualised; our survey data suggest only 15% of homes

and 8% of IDPs recognised collective representation through a trade union, albeit with

slightly higher figures among not-for-profit voluntary sector providers. In its place, providers

held staff meetings, with most organising such meetings every one to three months.

Part IV. The impact of organisational, commissioning and labour

market factors on HR practices and outcomes

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IV. The Impact of Organisational,

Commissioning and Labour Market Factors on

HR Practices and Outcomes

This part of the report brings together the various factors identified in the research framework

for the project that could be expected to impact upon the recruitment and retention of the

social care workforce. Following the mapping of HR practices and HR outcomes in Part III,

the analysis here uses statistical methods to interrogate the patterns in more detail. The main

data source used in this part is again the telephone survey of providers but we also

supplement this establishment-based survey with information from interviews with HR

directors or equivalent at the headquarters of ten national chains of providers.

There are six sections to this part of the report, organised as follows:

Section IV.1 presents the organisational characteristics of the sample of providers - by

size, ownership and quality star rating - and identifies the management capacities and

support structures within the independent sector;

Section IV.2 identifies the HR practices adopted by type of provider and creates an

index of „good‟ HR practices by which to compare the range of poor to good HR

practices, including for separate HR practices and for a summary measure;

Section IV.3 uses these indices together with detailed wage data for the providers in

the sample to explore the linkages between LA commissioning practices and good HR

practices and outcomes;

Section IV.4 undertakes a similar exercise in relation to local labour market factors

and explores the association between local pay levels and other measures of local

labour market demand with the likelihood of providers adopting good HR practices

and enjoying good HR outcomes;

Section IV.5 interrogates these divergent influences on HR practices and HR

outcomes through multivariate statistical analysis and considers the relationships for

IDPs and homes between organisational characteristics, LA commissioning practices,

local labour market factors, good HR practices and good HR outcomes;

Section IV.6 explores providers‟ views on the social care policy and commissioning

environment drawing on both the telephone survey and the survey of national

providers at headquarters.



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IV.1. Organisational characteristics and the management of

independent sector providers

A key issue for the recruitment and retention of the social care workforce is the capacity of

the independent sector to recruit, retain and manage a skilled and committed workforce, now

that the local authorities have, for the most part, outsourced the majority of service delivery.

The capacities of the independent sector will depend upon their organisational and

management characteristics and their business strategy and position. We thus start this

chapter by identifying the key organisational and market characteristics of our sample of

independent providers and also introduce into the analysis the national chains that we have

interviewed at national level (section IV.1.1). In section IV.1.2 we explore the organisation of

the HR function and associated issues such as approaches to performance management within

our telephone survey of establishments and our survey of ten national companies.

IV.1.1. Organisational characteristics

Table IV.1 shows the key organisational and market characteristics of the telephone survey

sample of 115 providers. The sample of 105 independent providers was relatively evenly split

between homes and IDPs, with 53 and 52 respectively, complemented by interviews with 10

LADPs. Among the 53 homes 56% were offering only residential care and 43% were

offering nursing care.

Size of establishment is often regarded as a characteristic with significant implications for the

management of HR. These implications may be both positively and negatively related to size

with the smaller workplaces more able to manage through informal and „friendly‟ work

relations, which may have positive benefits for retention. Larger establishments may be in a

better position to professionalise HR and possibly to make step changes in volume or quality

of service delivery. However, size of organisation may also matter, with small establishments

as part of larger organisations able to rely on regional or headquarter assistance to

professionalise. As the target sample was specified at local level, it was not possible to

include type of organisation as a specific characteristic - particularly in view of the problems

of securing access discussed in part I (section I.7). However, the sample was reviewed as a

rolling total and, as table IV.1 reveals, it covers a wide range of both size of establishment

and type of organisation. The most frequent size category for homes was 25 to 49 staff while

for IDPs it was somewhat larger, at 50 to 99.

IDPs were also more likely to be part of a chain, particularly national chains (as opposed to

local chains, which are defined as having more than one establishment, but usually less than

ten, situated in one, or in neighbouring local authority areas). Nearly half the sample of

establishments were in fact part of national organisations; this fits with evidence from LAs

and from UKHCA that there has been a marked increase in the role of national organisations,



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particularly in domiciliary care. However, most of the national providers included in the

sample here have been in operation for at least two years and generally longer. Overall only

three IDPs were newly established.

Table IV.1. Organisational characteristics of the telephone survey providers

Homes IDPs LADPs Total

Total sample size 53 52 10 115

Size Very small 0-24 15 5 0 20

Small 25-49 24 9 0 33

Medium 50-99 12 24 0 36

Large 100+ 2 14 10 26

Chain (local or national) or

single agency chain - local 14 10 0 24

chain - national 19 31 0 50

single home/agency 20 11 10 41

Is it a private, public or

voluntary organisation?

Private 42 46 0 88

Public 0 0 10 10

Voluntary 11 6 0 17

Star rating 1 Star 9 5 0 14

2 Star 31 37 4 72

3 Star 13 10 6 29

How many local authorities

engaged with 1 council only 28 32 10 70

More than 1 25 20 0 45

What proportion of your

service users are local

authority funded

0-25% 13 1 0 14

26-50% 8 3 0 11

More than 50% 32 48 10 90

Are any, of your service users

are partly or wholly funded by

the PCT?

Yes 25 34 6 65

No 28 18 1 47

Missing 3 3

What % of beds are currently

vacant? 0% 13

Not asked of

IDPs

Not asked of

IDPs 13

1-10% 29 Not asked of

IDPs

Not asked of

IDPs 29

More than 10% 11 Not asked of

IDPs Not asked of

IDPs 11

What proportion of hours are

done under block and spot

contracts

Spot only Not asked of

homes 25 3 28

Mainly spot (>50%) Not asked of

homes 3 0 3

Mainly Block (50% &

>) Not asked of

homes 12 0 12

Block only Not asked of

homes 5 7 12

Missing Not asked of

homes 7 0 7

How long has the

Home/IDP/LADP been

operating?

< 2 years 0 3 0 3

> 2 < 5 years 8 14 0 22

>5 years 45 35 10 90

Do you belong to an

Employers‟ Association?

Yes 25 23 2 50

No 12 18 5 35

Missing/don‟t know 16 11 3 30



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The majority of homes and IDPs were private, for profit organisations, but Table IV.1 shows

that 21% of homes and 12% of IDPs were run on a voluntary, not-for-profit basis. Less than

half the organisations - 50 out of 115 - definitely belonged to an employers‟ association and

35 said they did not but there was a high share of managers who were not able to answer (30

out of 115). Table IV.1 also gives data on the sample by star rating awarded by CQC. The

most popular category is 2* with 72% of the 115, but 14% are 1* providers and 29% are 3*.

To explore the role of national organisations further, we decided to undertake a separate

survey of 10 national organisations at headquarters level; table IV.2 provides the details of

their organisational characteristics. These also showed a range of different size characteristics

with the number of homes in ownership varying from 40 to over 700 and the number of

branches of IDPs varying from 15 to over 60 (or around 150 if franchised branches for one

national chain are included). All but the smallest of the domiciliary chains operated with a

regional as well as a national structure.

The importance of LAs in shaping the markets for the independent sector is confirmed by the

information for the sample, particularly for domiciliary care where all but four IDPs relied on

LAs for more than 50% of their business. The picture was more mixed for homes where 21

recorded sources other than LAs as accounting for more than 50% of their business and 13 of

these said that LAs accounted for less than a quarter of their activity. The likelihood of

relying primarily on private funding was much higher in some parts of the country than

others. As one home manager commented in a southern location in respect of her owner‟s

policy:

They are unusual in the area as they take local authority people – most don‟t because of the

money. (LK.H.2 AS (V)).

Responses to the question at the end of the telephone survey on levels of fees charged

revealed quite wide differences among some providers between the fees charged to private

clients and those received from the LA especially for homes in all the southern LAs (see

section IV.3.1 for further details).

Concerns over dependence on LAs were expressed by some of the national providers, both

in relation to the low fees paid by LAs and in relation to the likelihood of reduced business

from LAs in the future due to budget constraints. One national provider of homes shared a

presentation on their business plan where it was clearly stated that in the south they were

mainly concentrated on servicing private clients and it was only in the north where their focus

was on relationships with LAs.

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Table IV.2. Characteristics of national providers

a. Domiciliary care providers

NATDOM1 NATDOM2 NATDOM3 NATDOM4 NATDOM5

Size Large Large Large Large Small

National/local terms and

conditions

Local. Local. Local. Local. Local.

National/local training

and induction

Standard induction.

Training company and

local.

Standard induction.

Training company- based.

Standard induction

Training company-

based

Standard induction

Training company-based

Standard induction.

Training company

and local

Centralised/decentralised National recruitment

policies and procedures.

Regional structure

National recruitment


Regional structure



Regional structure

National recruitment policies

and procedures.

Regional structure


policies and

procedures

Performance

targets/bonuses

Bonus scheme for

managers. Traffic light

system based on quality,

financial and HR targets

For company branch

managers, based on the

contribution of the branch

to the centre

Performance bonus for

managers based on

KPIs (HR and business

targets)

Bonus scheme for managers

based on achieved targets

(KPIs red-amber-green).

Currently emphasis on R&R.

Bonus system for

managers. Targets

on quality, business

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b. Care homes

NATHOME1 NATHOME2 NATHOME3 NATHOME4 NATHOME5

Size Large Large Small Very large Medium

National/local terms and

conditions

Local. Local. National salary scale,

local determination of

position.

National pay rates for

care staff negotiated

with GMB.

Local but aiming to

standardize by region.

National/local training

and induction

Company based with

regional support.

Standard induction.


local.


area based.

Company and local

based.

Standard induction.


local.

Centralised/decentralised National recruitment policies

and procedures.

Regional structure


policies and

procedures.

Regional structure



Area structure



Regional and area

structure



Regional structure

Performance

targets/bonuses

30%bonus scheme for

managers based on targets set

by themselves – main ones

are marketing, occupancy

and care delivery.

Bonus scope for

managers of 25% based

on financial

performance and

quality.

Quarterly and year-end

bonus scheme for

managers. KPIs for care

and financial

performance.

Bonus for managers

based on financial

performance and

quality (including HR).

Annual bonus for managers

based on Balanced

Scorecard approach (incl.

ability, people management,

finance).

Role of LAs v private

clients

60% of business from LAs

and PCTs. South dominated

by private fee payers but

north more mixed.

Decreasing number of

public funded referrals.

Fee freezes and

reductions from LAs.

90% of business from

LAs and PCTs.

80% of business from

LAs and PCTs.

Pressure on fees.

Looking to grow

private side.

80% of business from LAs

and PCTs. Both under

economic pressure.

Anticipates less business

coming from them.



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Sixty of the 105 independent providers dealt with only one LA but 45 were engaged in working

for more than one local authority; for homes this was unsurprising as many placements are

made out of area but nearly 40% of the IDPs also worked for more than one LA. In addition

well over half of the sample did at least some work for the NHS through Primary Care Trusts.

The contract arrangements for the IDPs varied with 28 working on an only or mainly spot basis

and 17 on a mainly or only block basis (7 missing answers). A further indicator for homes of

the state of the market is the number of bed vacancies; here we found a wide range of situations

with 13 recording no vacancies, 29 had vacancies of up to 10% but 11 had vacancies in excess

of 10%.

Box IV.1. National providers’ comments on private versus LA funded clients

The south [of England] seems to be very private fee funding driven, whereas the north is sadly

more blurred and Scotland is a different funding altogether. Recruitment Director, NATHOME1

One of the challenges for us is that a huge proportion of orders come from local authorities and

PCTs. So nearly 80% of our business is from local authorities and PCTs and only 20% from

private paid. So when you look at challenges, I mean, at the moment the sort of fees that one gets

from local authorities and PCTs are significantly lower than the fees that you can charge to

private individuals and, obviously, in the present financial climate, one of the big concerns is

that‟s going to come under even more pressure if those PCTs and local authorities are challenged

in terms of their own budget. Group HR Director, NATHOME 4

I suppose the key business challenge really arises from the state of finances of the country as a

whole. We are certainly noticing fewer public funded referrals. Corporate Services Director,

NATHOME2

IV.1.2. Management in the independent sector

As most IDPs and homes are small at the establishment level, a key issue for the development

of capacity in the sector is the availability of either inhouse expertise or external support - for

establishments that are part of chains. We did not investigate directly the capacity or calibre of

managers via the telephone survey as it would have been difficult to address this subject with

the managers as interviewees and the value of the information collected would have been

questionable. However, we did explore the issue of management capacity and calibre,

including sources of management recruitment and issues of training and turnover, with the ten

national providers. This was seen as a key issue for the quality of the care service, including in

turn the recruitment and retention of the care staff, by both the LA interviewees (see part II)

and by the national providers themselves. Recruitment of managers was identified as

problematic by some of the national providers, leading in some cases to the use of agencies to

search for applicants.



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I am finding increasingly that we are having to use recruitment firms because people are not

responding to adverts. Managing Director, NATDOM 5

Others were also stressing the need to standardise and professionalise their recruitment

policies.

Historically, all recruitment, there was certainly no central HR control over it. It was all really

done locally. … And what they have been doing is working with line managers, the area

managers now, to help them with things like home manager recruitment and just simple things

like you know let‟s get an up to date role profile with some competencies and let‟s actually look

at standard things to ask at interviews, things to find out about the person, which we didn‟t

have before. So we‟ve brought a bit more standardisation into that. Group HR Director,

NATHOME 4

There was a particular focus on the development of more standardised, more extensive and

more professional training for managers, to improve retention of the managers in the first place

but also to improve their employee relations skills to improve recruitment and retention of the

social care workforce (see Box IV.2).

Box IV.2. National providers’ approach to training managers

What we‟ve actually tried to do is to pull together a more standardised home manager induction

programme because that had also previously been run largely locally and, to be honest, was a bit

hit and miss in terms of what people got or didn‟t get…. Because when we‟ve been doing some

analysis of turnover, quite a lot of our staff turnover happens within six months or certainly within

the first two years and we think that a lot of that is linked to, are we getting the recruitment right

in the first place? And having done the recruitment, are we inducting and sort of embedding

people into the organisation properly? And right now we‟re probably not.

So our staff turnover, for example, as at November last year, was standing at sort of 27%, 28%

which meant that last year 12,000 left and joined this organisation. That‟s like 1,000 people a

month. …..If you could get to grips with turnover, then actually there would be an enormous

benefit to the business because there would be money to be saved in terms of recruitment fees,

agencies, adverts that sort of thing, but also the amount of time that home managers could have to

actually spend on looking after their residents, as opposed to recruiting and inducting new

people, would be of massive benefit… So we‟ve kicked off a project to run a lot of training in

employer relations issues for home managers, because as a business we haven‟t really invested in

training people beyond what I think of as the operational training. We spend a lot of time and

money on things like NVQs in care but we don‟t do much in terms of management development.

So, a home manager is really running quite a complicated difficult little business and we‟ve done

really very little to equip them to do that. Group HR Director. NATHOME 4

So when [managers] start with the business there‟ll be an induction into the business, who we are,

our values, how we operate and the training and managing teams, managing IT systems,

managing budgets and all the finance. So there‟s a fairly extensive induction covering all of those

areas. We have a directory of training courses available in more specialist areas. So there‟s a



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wide variety of clinical specialist courses, right the way through covering more specialist courses

in finance, HR. So managing people and then through to some just simply looking at management

training and their management expertise. We offer ILM qualifications at both level three and

level four to our managers and we‟re also about to launch an undergraduate level course in

Dementia, which will be available for people to apply For. So there‟s a very wide range of

training. HR Director NATHOME 3

However, while national providers were seeking to improve their policies with respect to

recruitment and development of managers, they were also aware that a dedicated local

manager, or indeed owner, could add to the effectiveness of the organisations through

additional commitment and local knowledge (see box IV.3). However, they also stressed that

many managers of establishments owned by national chains were appointed locally and

brought local knowledge to the post. Overall the national providers felt that they were better

placed to help managers through periods of change and restructuring and that the level of

turbulence in the sector might spell the end for committed, local but less professional

management. However, some still felt that they had not yet built upon the advantages of being

a national organisation offering better and more structured career opportunities to their staff,

including managers.

Box IV.3. National providers’ views on the advantages and disadvantages of being a

national organisation

i) Local has its advantages

What you find with the smaller independent provider is that - local services for local people. And

it is very important for the commissioners that there is that local feel. And when you‟re a national

provider that is difficult. (HR Director, NATDOM 1)

What you tend to find with smaller operations ….is that there is a different emotional connection

to the employer. And higher quality. Because these people have built businesses, what you do find

is that some of the branch managers are of a higher calibre. So some of our best branch

managers have come via acquisitions of small independent providers. (HR Director, NATDOM 1)

What you will find is that us and [a competitor] are less responsive to the local market and the

local providers will be much more aligned in terms of what they‟re offering, against the bigger

providers. So they‟re more nimble it would appear. (HR Director, NATDOM1)

ii) But national organisations have more resource and provide more support for change

I guess we‟ve got more resource to put it in, in terms of training, developing people. And we‟ve

got more of a communication network and we can use tools to help, more than a small business

could. But I think the big challenge with the larger organisations is sometimes the scale of



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operation is that sometimes there are gaps in getting things done the way you‟d like. And I think

we‟ve done a lot to improve that. But I‟m not sure it‟s small versus large, I think it‟s mixed.

(Managing Director, NATDOM 4)

I think if you‟re a national provider with a good reputation then it‟s so much easier. They‟re still

local; they may be national but they‟re still very local. …. (HR Director, NATHOME 5)

I myself have run a care home for a single provider and I think they do have a battle to get

properly skilled people because you don‟t have the support structure. So it‟s quite a scary thing to

be on your own managing a home (Recruitment Director, NATHOME 5)

Easier [for national providers to recruit] because we can be more competitive with salaries. We

have more resources than smaller business and because we have more branches, we can look at

regional recruitment opportunities as well. (National Recruitment Manager, NATDOM 3)

I think the larger providers, you‟ll certainly see within the next 12 to 18 months, a much more

sophisticated use of things like websites to recruit and pre screen staff and channel them through

to the right branch thus in fact reducing the manpower required to recruit but delivering as good

or better results. So I think there will be a widening there of efficiency but I don‟t see massive

differences at this point. (Commercial Director, NATDOM 2)

iii) Changes to the policy environment may be having particularly negative effects on

small providers

The change to effectively straight line or pro rated, minute by minute charging or payment is

really having a fairly substantive impact on the underlying profitability of domiciliary care

businesses. So at the moment I think, because the recruitment market is benign, the impact has, in

fact, been less dramatic. I think when recruitment gets tighter and the training and recruitment

costs start to lift, that is going to hammer domiciliary businesses and I think where we‟ll see the

pain first will be in the smaller providers. (Commercial Director, NATDOM 2)

I think the challenges for the next couple of years are going to be working within the budgetary

constraints. I think that‟s going to be major issue. I think the implementation of personalisation

will bring its own challenges. I think that [there will be] a lot of turmoil at the smaller provider

level because they will just not be able to cope with all these challenges, I think, that‟s going on.

(Managing Director, NATDOM 5)

Small local providers which are a dying breed with all the legislation and everything else.

(National Recruitment Manager, NATDOM 3)

iv) But national organisations are still not leveraging their advantages

I don‟t think we‟re seeing any of the benefits of being a big national organisation. …So well

designed induction and well designed training programme, some of the things that you could

maybe sell at interview, aren‟t really currently in place. And … we ought to be able to offer a way

of potential career progression than if you go and work in a little local home that‟s only got, I



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don‟t know 360 staff and that‟s their total business. But because we haven‟t really thought like a

big national employer, we haven‟t actually got all the things in place that you would expect us to

have. (Group HR Director, NATHOME 4)

When we consider management structures at the establishment levels, it is of course the case

that those that belong to chains, particularly national chains, are more likely to have access to

support from a specialist HR department or manager (table IV.3). Around one third of IDPs

and close to half of the homes did not have access to such expertise. However, of those that had

this external support, only 30 to 40 percent reported that this expertise was based either inhouse

or locally with three fifths to two thirds saying it was further afield (table IV.4). Where such

support is available it is said to be very wide ranging by around one third of respondents (table

IV.5). A similar percentage refers to assistance with grievance and discipline while recruitment

and absence management are explicitly mentioned by around one tenth of the respondents

respectively.

Table IV.3. Presence of a specialist HR manager or department

a. IDPs

All Very

small

&small

medium large Local

chain

National

chain

Single

site/agency

1* 2* 3*

% with a

specialist HR

manager or

department

69.2 64.3 70.8 71.4 90.0 83.9 9.1 60 70.3 70

% without 30.8 35.7 29.2 28.6 10.0 16.1 90.9 40 29.7 30

b. Homes

All Very

small

Small Medium

& Large

Local

chain

National

chain

Single

site/

agency

1* 2* 3*

% with a

specialist HR

manager or

department

52.8 20.0 58.3 78.6 50.0 100.0 10.0 44.4 54.8 53.8

% without 47.2 80.0 41.7 21.4 50.0 0.0 90.0 55.6 45.2 46.2

However, even among national providers the extent of HR support may be limited. One home

that was part of a national chain commented that monitoring of absence had only really just

started in its organisation.

We‟ve just started doing that, we‟ve got a HR department and all of our staff are required to

complete a return to work form if they‟ve been off sick or off with their children or whatever



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reason then they have to complete that, and so the HR department are starting to collate that

information. (OM.H.1.B.NV).

Table IV.4. Location of the specialist HR manager or department

% of Homes % of IDPs Total

On-site 7.1 0.0 3.2

Local 32.1 32.4 32.3

Further Afield 60.7 67.6 64.5


No response 0 2 2

Box IV.4 provides examples of the support provided to their branch managers according to the

interviews with national providers at headquarters. Some of the managers interviewed in the

telephone survey revealed how important such external support can be:

We‟ve got now, only in the last 3 months, we have an HR business partner and they‟re CIPD

qualified and she‟s just about saved my life as I was doing it all before. So yes we do have a

specialist, and in fact we did have one person but now that‟s developing into a team. I mean

they don‟t necessarily do all the work but they oversee everything right down to career

development and training that sort of thing. (OM.D.2.DN).

Another manager commented on the importance of external support for non standard activities

such as recruiting migrants:

I am now in a position to recruit foreign nationals, so they give me advice about what I need

for somebody from Poland or Hungary for example. And disciplinary and sickness issues and

they will come up and sit in on interviews with staff if necessary. (AH.D.3.CN).

Table IV.5. Types of support provided by specialist HR manager/department

% of Homes % of IDPs % of LADPs % Total

Responses

Everything that we ask 31.9 38.6 33.3 35.0

Grievance and disciplinary 36.2 25.0 44.4 32.0

Recruitment 8.5 11.4 0.0 9.0

Contracts/Legal/Policy 10.6 11.4 22.2 12.0

Attendance and sickness 6.4 4.5 0.0 5.0

H&S and welfare 2.1 0.0 0.0 1.0

Training 4.3 4.5 0.0 4.0

Immigration 0.0 4.5 0.0 2.0



Note: of those who have a specialist HR manager or department, 53 providers responded (some gave multiple

answers) and 20 providers did not respond.



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Box IV.4. HR support services

They all have identified regional support. And again, if you compare the quota of HR people per

head, if you look at the healthcare environment you would invariably be looking at one HR person

per 110 to 140 staff. For us, and we‟ve got the biggest HR resource that we‟ve ever had, and in

the 12 months that I‟ve been in post we‟ve doubled the size of our department, we‟ve got one per

496. So there is access to the support, but I suppose it‟s indicative of the industry. HR Director,

NATDOM 1

From a people perspective, I mean there were only 11 people in the HR team so their impact on

the business was really absolutely minimal. They were doing the best they could in the

circumstances in terms of they were creating policies and management guidelines but actually

being able to engage with management and help them with their people management issues, they

just really weren‟t able to do…..We‟re going to have HR Managers on the ground, three or four

per region, and at the moment we‟ve just got one interim in each region promoting some help, and

then we‟re recruiting for some specialist roles, resourcing, learning and development, employer

relations and so on. So that‟s the second strand. The third strand is what I call people

management framework. Basically, as a business, we have never spent any time saying what kind

of employer do we want to be? What is the deal between us and our employees and if they bring

all their skills and capabilities and competencies to work, what can they expect in return in terms

of things like appropriate working environment, tools to do the job, support to do the job, training

and development, reward and recognition? So we started quite a big piece of work on that. Group

HR Director, NATHOME 4

So specifically with HR we have a central, not a distributed HR team, where any manager can

ring, email for advice, but also that team does a lot of dedicated training on things like disciplinary

and grievance procedures. So every manager will have had the opportunity to have a full day

understanding some basics of employment law, how they translate into our procedures and how we

operate those procedures, and we repeat that to pick up new starters, maybe every six months or

so. Corporate Services Director, NATHOME 2)

We have an HR helpline, which is monitored from our support centre and it‟s an advice line for

managers to call about any operational HR queries. But then in the division there is a HR business

partner to deal with anything that‟s more complex and perhaps to help coaching the manager, an

area manager that needs further support in an issue or the more strategic work. So the immediate

support is available on the end of a phone via the advice line but there is personal contact for the

more complex issues. (HR Director NATHOME 3)

One managerial task that was particularly burdensome for IDPs was the scheduling of work.

This managerial problem was being addressed in some organisations by the application of

software (see example below from a local chain) but we did not collect systematic evidence on

the extent to which there were differences in the use of technology to assist in key managerial

tasks by type of organisation, although this could be an area of interest for future research.



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We use the care manager system (computer) and this takes 75% of the nightmare out of putting

together the jigsaw. We assign customers to care workers, and the computer does this

according to whether they are walkers, bike riders, or car drivers. We split [X] into two areas –

North and South and once the jigsaw is in place, using Care Manager, it all seems to work

quite well. Most care workers are flexible. We do some work outside of [X] in the boundaries,

and go into agricultural areas. Care Manager tells us if we are overloading one care workers,

if they say they will only work X number of hours or only up until 12 noon – it doesn‟t let us

overload them with work. LKD.6.CL



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IV.2. HR practices and outcomes by provider characteristics

Part III provided an overview of the range of HR policies pursued by both homes and IDPs. In

this section we explore the telephone survey results for evidence first of variations in HR

strategies by type of provider, focusing on issues of size, ownership, CQC star quality and

public/private or voluntary status. Second, we explore the range of variations in the set of HR

strategies adopted by these individual providers: that is how far we find some providers

adopting sets of good HR practices across the range of dimensions and at the other end of the

spectrum whether there are some providers who have poor or weak HR practices across the

spectrum. Third, we report on providers‟ views on what would do most to improve recruitment

and retention in social care.

To simplify the analyses we have streamlined the questionnaire data as presented in part III by

transforming the variables into indicators, sub-indices and indices, as described in appendix

table IV.A1 and in box IV.5 all taking values between 0 and 1. Depending upon the nature of

the indicator/index, we use the relative level of the mean values to identify whether policies are

more favourable to employees or indicative of more professional and/or high performance

practice (closer to one) or alternatively less favourable to employees or indicative of either

more informal or lower trust HR practices. The direction of measurement for each

indicators/sub index/index is set out in the appendix tables IV.A1 to 4. We include in our

discussion not only the quantitative evidence but also the qualitative material both from the

telephone survey of providers and from our interviews with national providers.

Box IV.5. The dataset

We further divide the data into what we have termed the standardised dataset. This refers to 33

indicators of HR practices and 6 indicators of HR outcomes for 102 providers. These indicators

apply to both homes and IDPs and meet the criteria that missing values should not exceed 10%. A

similar 10% cut off was used to eliminate three providers from the standardised data set. For these

providers and indicators we have then imputed the relatively small number of missing values as the

mean for the sub index across all selected providers (see appendix IV.A.1 for details). The 33 HR

practice indicators have been further subdivided into 18 sub-indices and 6 indices covering pay

levels, pay strategies, recruitment; employee development, working time and work organisation.

The six outcome indicators have been combined into 4 sub-indices and 2 indices covering

recruitment and retention outcomes and skill and training outcomes.

For all other data that we use in the analysis we do not include imputed values. These include in

particular: i) data collected specifically about domiciliary care, due to the difference in the

questionnaire; and ii) turnover data, for which due to the difficulties we had in requesting providers

to give us the detailed information needed to calculate these data we have had to analyse the

turnover data separately and for a maximum of 82 independent sector providers instead of 102 for

the standardised data set. Also for other indicators excluded where the missing values exceeded

10% we have not imputed any values.



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IV.2.1. HR practices and outcomes by provider characteristics

Box IV.6 provides an overview of the construction of indicators, sub indices, and indices of

HR practices. We present the full information on variations in HR practices measured by the 18

sub-indices and 6 indices by size, ownership and star category in appendix IV.A.2. We also

provide appendix tables on the individual indicators where significant28

differences between

types of providers have been identified. These tables present some indicators additional to the

standardised set (those excluded for too many missing variables and some specific domiciliary

HR practices) (see appendix table IV.A3).

Box IV.6. Indices (X) and sub-indices (SI) from the standardised dataset

HR PRACTICES INDICES AND SUB-INDICES:

XPAYLEVELS Index of pay levels

SIPAYLEVEL Pay levels SIPAYUNSOCIAL Pay for unsocial hours

SIPAYUPGRADE Regular upgrading of

pay

SIPAYTRAIN Pay for training

XPAYSTRAT Index of pay strategies

SIPAYIMP Opportunities for pay

improvement

SIPAYUPFRONT Payment of upfront costs

SIPAYOPPCAR Opportunities for career

XEMPDEV Index of employee development practices

SIEMPVOICE Employee voice

practices

SIEMPAPP Employee appraisal

XRRPRACT Recruitment and retention practices index

SIRECRUITPR Formality of

recruitment process

SIRECRETEN Role of push factors in staff quits

SIRECRSELEC Selection by skills,

qualifications or

experience

XWT Index of working time practices

SIWTSTFFPREF Work schedules that fit

staff preferences

SIWTLHOURS Long hours/long weeks

SIWTWEND Weekend working SIWTTOFFTRAIN Time off for training

XWO Index of work organisation practices

SIWOTIME Time discretion at work SIWODISCRET Task discretion at work

XHRPRACT Overall index of HR practices

28 Specifically, we calculate the probability that the results we have obtained occurred by chance or not. When we

say that a statistical test is significant at the 95% confidence level, we mean that we are at least 95% certain that a

result is genuine (i.e. not a chance finding), or that there is less than a 5% probability of something occurring by

chance.



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Overall the picture is one of limited variation across these different provider characteristics,

certainly when compared to the large differences found between LAs and the independent

sector, as we discuss further below. This puts the discussion of good and bad HR practice

within the independent sector into context; on the whole, as we already saw in part III, few

providers are conforming to standard HR practice, particularly in domiciliary care where

contracts are primarily on a zero hour basis and not all time at work is paid for. With these

caveats in mind, we turn to the evidence of variations by provider characteristic.

Size of establishment

The categories we use for the analysis for size of establishment are different for homes and

IDPs due to differences in the sample distribution: very small and small categories are

separately identified for homes but combined for IDPs and medium and large separately

identified for IDPs to reflect the sample distributions – see table IV.1.

Box IV.7. Significant differences between providers in HR practice indicators by size of

establishment

(Standardised dataset)

Homes:

XEMPDEV: medium/large establishments significantly higher score on employee development

and voice than small establishments

SIPAYOPPCAR: very small establishments significantly greater career opportunities

than for medium/large establishments.

SIEMPAPP: medium/large establishments significantly higher utilisation of

appraisals than small establishments

SIWTWEND: significantly less extensive use/ requirements for weekend working in

small than medium/large establishments (10% sig. only)

IP15: very small establishments significantly more likely than medium

/large to offer opportunities for progression to senior care worker

IWO4: very small establishments significantly more likely than medium

/large to offer opportunities to prioritise and carry out tasks in

ways to improve the quality of care

IDPs:

SIPAYTRAIN: large establishments significantly more likely to offer time off for

training than the very small and small establishments (at 10% level)

SIRECRSELEC: large establishments significantly more likely to use more formal

methods of recruitment than the very small and small establishments

IP13: very small/small establishments significantly more likely to pay

for induction than large establishments (at 10% only)

IWT4: large establishments significantly less likely to have all staff

working weekends than both medium and very small/small

establishments

IWT8: very small/small establishments significantly less likely than

medium establishments to have higher shares of staff working

long hours



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Looking first at sub-indices and indices we find very few notable differences in HR practices

by size of establishment for either homes or IDPs. For homes some of these relationships were

in the expected direction - for example, larger establishments making more use of appraisals.

But others were more counter-intuitive- such as very small establishments being more likely to

offer opportunities for promotion to senior care workers. Other relationships were significant

but not linearly related to size (see box IV.7). For IDPs again there is some evidence of more

formal HR practices among large establishments particularly with respect to recruitment

methods and time off for training. However, there are also some counter-intuitive findings,

particularly that large IDPs are less likely to pay for induction training. On working time, large

establishments appear to have more freedom not to have all staff working weekends (although

this is the opposite to homes). It should also be noted that we found no significant differences

by size of establishment in relation to the specific indicators that only apply to domiciliary

care.

Ownership

There is perhaps a greater expectation of differences by ownership structure, particularly as the

national chains have made significant advances into the market over recent years and may be

doing this in part on the basis of differences in HR practices.

For homes there are some important differences, but they are not all consistently in one

direction (box IV.8). Three pay variables show significant differences but in two cases national

chains provide the best conditions: they are more likely than single agencies to have regular

pay upgrades and more likely to cover upfront costs of entering work than single homes and

local chains (including specifically being more likely to pay for uniforms), but national chains

are the least likely to pay for unsocial hours. National chains are more likely to have long

working hours or 6 or 7 day weeks (and the indicators on long hours working also shows a

similar pattern). One indicator, one sub index and one index suggested that local chains were

significantly less likely to provide for various types of autonomy at work also showed some

significant differences by but in this case the values were lower of local chains than both

national chains and single home and the overall variation in values were low so these are not

included in the graphics illustrating the most significant variations by indicator.

However, for IDPs there are virtually none of the standardised indicators that show any

significant differences between national chains, local chains and single agencies. National

chains and local chains were more likely than single agencies to carry out staff attitude surveys.

Beyond this indicator which could be expected to be related to organisations with more

resources, the only other indicator showing any significant differences suggested that long

hours working was made more use of by national chains. One indicator not included in the

standardised set due to missing variables was found to have a significant difference: single

agencies were less likely to have the Investor in People award than local chains. Again no



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significant differences by ownership were found in relation to the specific indicators for

domiciliary care.

Box IV.8. Significant differences in HR practice indicators between providers by

ownership

Standardised dataset

Homes:

XWO: local chains significantly less likely than single homes and national chains (latter

10% sig. only) to provide autonomy over time and task in work organisation

SIPAYUNSOCIAL: national chains significantly less likely than single homes to make

unsocial hours payments (10% sig.only)

SIPAYUPGRADE: single homes significantly less likely to have a regular upgrading of

pay than national chains (10% sig.only)

SIPAYUPFRONT: national chains significantly more likely than single homes and

local chains (latter 10% sig.only) to pay for upfront costs of starting

work

SIWTLHOURS: national chains significantly more likely than local chains (10% sig.

only) to have staff working long hours/ more than 5 days

SIWOTIME: local chains significantly less likely than single homes and national

chains (latter 10% sig. only) to provide time autonomy in work

organisation

IP12: national chains significantly more likely than local chains and

single homes (both 10% sig. only) to pay for uniforms

IWT8: national chains significantly more likely than local chains to

have staff working long hours (10% sig. only)

IWO5: local chains significantly less likely than national chains and

single homes to provide opportunities to exchange idea with

other carers

IDPs:

IHR3: single agencies are significantly less likely than national chains

or local chains (latter 10% sig. only) to carry out staff attitude

surveys

IWT8: national chains significantly more likely than local chains to

have staff working long hours

Non standardised dataset

IDPs:

IOUT3: local chains were significantly more likely to have the investor

in people award than single agencies

These limited findings on differences between national chains and more local organisations in

homes, but particularly in domiciliary care, chimes with the information we obtained through

our survey of national providers with respect in particular to pay. All national domiciliary care

providers stressed that they fixed pay at the local level according to the policy of the LA (see



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box IV.9) and in one case even paid different rates to staff in the same branch according to

which LA they were working for under subcontract. There was thus no attempt by any of the

national IDPs to establish a national pay policy. This was also the case in two of the national

chains of homes but two did have a national pay scale, one of which was negotiated with a

trade union and another was working towards that objective. One of the national chains

stressed that location within the national pay scale depended, nevertheless, on local factors.

Some national providers stressed that they did try to standardise on more indirect forms of pay

even if they had to vary actual pay levels in line with the LA.

Even the one national provider that recognised a union did not guarantee either a negotiated

wage increase or pay significantly in excess of the minimum wage as this quote reveals:

This year we had a lot of difficulty with the pay review and we ended up imposing the pay

review because the union were looking for a lot more. We were only paying about 11/2% across

the board. We pay around 10 or 15p an hour more than the minimum wage rate at the moment.

Group HR Director, NATHOME 4

Box IV.9. National providers’ pay strategies: the main influence is the local authority

[Payment for travel time, travel costs] - That‟s generally included in the rates as things which we

do. Depending on the contract and the area, we would pay mileage or travel expenses. But it

varies. Managing Director, NATDOM 5

[Pay] also varies - the contact is with the local authority and they are only willing to pay a

certain amount ... there‟s only so much scope you have to pay to the care workers. So again some

of it is determined by how much you could afford to pay the care workers. Managing Director,

NATDOM 4

We don‟t have any national rates. We have purely local rates, and so some parts of the country

it‟s national minimum wage, in other parts it would be significantly higher than that and London

South East would be the obvious candidate just because that‟s what the market demands. But

also, in London you do get higher fee rates and again, there‟s got to be a match between money

coming in and money going out. Corporate Services Director, NATHOME 2

Local pay - we tried to look at standardising but it‟s impossible. National Recruitment Manager,

NATDOM 3

We can‟t pay the same rates everywhere. Because we get paid differently in different places. But

as a company we have certain basics. So our bank holiday rates are double across the country,

whatever we get paid here. We pay for all the training, it doesn‟t matter what the local

authorities, and we provide uniforms, it doesn‟t matter what the local authority said. Managing

Director, NATDOM 5



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Working time and contract arrangements were also not significantly different on most

dimensions. One branch manager of a national chain indicated that zero hours contracts were

the widely accepted industry norm when s/he described a plan to move to guaranteed hours as

„a bit radical‟.

We are doing an analysis at the moment to see what would happen if we put all of our care staff

on salaries, a bit radical I know but what we are looking to do is to see if it‟s viable…I think

that could ultimately change the face of the social care system and in terms of the status of the

staff it would raise them up (OM.D.2.DN)

However, one of the national domiciliary chains in our national provider survey blamed

variations between LAs for their inability to have standard working time conditions.

It‟s difficult to standardise across the country. For example, you can‟t have a standard start

time. In some authorities they start at 7 in the morning or 8 in the morning and finish at 8 at

night. In others, it‟s 6 to 6. This kind of thing. Managing Director, NATDOM 5

However, one area where we might anticipate more marked difference in the future is in the

use of more formal or systematic recruitment methods. The national chains already had

national recruitment procedures and policy advice but while most recruitment was still done at

local and branch level there was evidence in a number of the interviews of moves towards

providing more active support at regional level. However, this greater centralisation might not

be at the expense of informal methods as we also found some evidence in the case studies of

national chains formalising word of mouth recruitment patterns through the development of

voucher schemes as incentives to staff to recommend new recruits.

Box IV.10. Recruitment of care staff in national providers

[Recruitment previously done at branch level]. But we‟ve changed that model to what we call a

regional resourcing lead network. What it was like was that we would have a recruitment co-

ordinator in each branch, and the recruitment co-ordinator was basically an ex care worker

who‟d done his or her backing and who knew how to turn on a computer. And there was

insufficient technical knowledge and insufficient understanding of the link between capacity and

quality, and capacity in grants. So we changed that and we said, well let‟s remove that model and

put in a career recruiter, so a professional recruiter who would cover a cluster of branches.

They‟re called regional resourcing leads. HR Director, NATDOM 1

So very much it‟s locally engaged with national support. That‟s our philosophy on a number of

things, like when we come on to recruitment and retention, it‟s - again, you can‟t do this centrally

alone. You need the local buy in and local management, owning the situation. Managing

Director, NATDOM 4

it would be a local management decision about who they recruit. We don‟t force the hand of the

local management, we expect they would meet certain criteria and if they want a second opinion

they can involve people from the centre. Managing Director, NATDOM 4



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[Setting up] new Regional Recruitment teams: Branch managers had no time to focus on

recruitment. It was the last of their priorities. They had no time or resources for recruitment so

they were reactive the whole time. Interviews [are held] at branch level - it is down to the

individual manager to make the ultimate decision. National Recruitment Manager, NATDOM3

The personnel manual in the recruitment procedure spoon feeds all of the managers. So here‟s the

steps you take, these are the forms you need to use, here‟s the standard letter, standard contract.

So it‟s all there. Corporate Services Director, NATHOME 2

The need for support to local establishment managers in the area of recruitment is indicated by

this account of the efforts a local chain manager had to go to secure an increased workforce

after a successful tender:

I‟ve had to recruit a lot really especially since January so what I‟ve done is take a PowerPoint

presentation and use that to give people an understanding of what we do, how we do it, our

approach to staff and then they can make an informed decision about whether we‟re a) what

they hear floats their boat in terms of coming to social care but also it‟s about making an

informed decision about the kind of employer we are and if they like how we go about and

present things. Anybody who has responded to the Jobcentre Plus advert or to the newspaper

advert that I put out in January where we said if you can tick some of these boxes or aspire to

tick some of these boxes then we would be interested in talking to you because we are looking

for support workers, we‟re looking for supervisors, we‟re looking for mentors, and so since

January we have had over 600 people make contact with us over the phone, my business

development manager who took the post on the 25th January and started working on the 26

th we

have seen over 300 people in small groups of up to a maximum of ten, we have today offered 27

people jobs. (UY.D.1.C.L)

This case illustrates both the sheer scale of the recruitment effort and the management

challenges this poses for single or small chain organisations.

CQC star rating

When we look at HR practices by CQC star rating we find that there is fairly systematic

evidence that 3* homes provide better pay and pay related conditions than 1* and 2* homes (2

indices, 4 sub-indices and 4 individual indicators on pay all show this relationship). However,

when it comes to recruitment practices it is 2* homes that seem to have the best practices and

when it comes to employee voice indicators, 3* homes have less developed practices than

either 1* or 2* homes. There is thus only clear evidence in relation to pay indicators that higher

rated homes have higher quality HR practices (box IV.11).

For IDPs there are no significant indices or sub indices by star rating and those individual

indicators that show some significant differences tend to indicate somewhat counter intuitive

relationships. Thus, although 3* IDPs are more likely to pay extra for qualifications and are

less likely to have all staff working weekends, indicators that we take to be indicative of HR



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quality, they are also less likely to carry out staff surveys. When indicators from outside the

standardised data set are considered, we find that 3* homes are also less likely to pay for travel

or provide paid breaks, although they are more likely to offer a longer minimum work period,

None of this suggests a vey strong relationship between quality of HR practices and the star

rating attached to the IDP.

Box IV.11. Significant differences in HR practice indicators between providers by star

rating


Homes:

XPAYLEVELS: 3* homes offer significantly higher pay than 1* and 2* (latter 10% sig. only)

XPAYSTRAT: 3* homes offer significantly better pay strategies than 1* and 2*

XRRPRACT: 1* homes have significantly lower quality recruitment practices than 2* homes

XEMPDEV: 3* homes offer significantly worse employee development and voice practices

than 1* and 2* homes

SIPAYLEVEL: 3* homes offer significantly higher pay than 1* (10% sig. only)

SIPAYUNSOCIAL: 3* homes significantly more likely to make unsocial hours

payments than 1* and 2*

SIEMPVOICE: 3* homes offer significantly worse employee voice practices than

1* and 2* homes

SIRECRUTPR: 2* homes have significantly better recruitment practices than

either 1* or 3* homes

IP1: 3* homes offer significantly higher minimum pay than 1*

IP6: 3* homes significantly more likely to pay more for

qualifications than 1*

IP8: 3* homes significantly more likely to pay extra for weekend

work than 2* (10% sig.only)

IP9: 3* homes significantly more likely to pay extra for night work

than 2* and 1* (latter 10% sig. only)

IDPs:

IP6: 3* IDPs significantly more likely to pay more for

qualifications than 2*

IHR3: 3* IDPs significantly less likely to carry out staff attitude

surveys than 1*

IWT4: 3* IDPs significantly less likely to have all staff working

weekends than 1* (10% sig. only)


IDPs:

IPDOM1: 1*significantly more likely to pay for travel than 3*

IWTDOM2: 1*significantly more likely to provide a paid break than 2*

IWTDOM3: 3* significantly more likely to provide a longer minimum

work period than 2* (10% sig.only)



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Public, private or voluntary status

Part III has already provided considerable evidence of the divide between the HR practices in

the independent sector and those prevailing in the local authorities, primarily LADPs. To bring

this information together table IV.6 provides a summary of the overall scores within the six

areas of HR practices and for the overall index of HR practices29

. First of all, in comparing

homes and IDPs, we find that homes score slightly better overall, but the difference for the

summary index is not statistically significant. The only statistically significant difference

between them is in work organisation where homes score more strongly than IDPs; otherwise

differences add at most 0.03 to the score.

When LADPs are considered, not only is the summary index of HR practices for LADPs more

than 19% higher than for the independent sector IDPs they also score on average over 16%

higher than the independent sector homes (table IV.6a). These differences are significant and

the same applies for higher scores for LADPs compared to both homes and IDPs for pay levels,

recruitment practices and employee development. However, for pay strategies, although

LADPs score higher than both homes and IDPs, there is only a significant difference with

IDPs. For working time LADPs score worse than both IDPs and homes (difference significant

only with IDPs), possibly reflecting the problems that LADPs have experienced in moving

their staff from standard hours to more flexible and unsocial hours working, such that they

place more stress on requiring staff to be flexible. For work organisation LADPs score

somewhat better than IDPs but lower than homes (neither difference is significant), suggesting

that these scores reflect the different nature of the work between homes and domiciliary care.

It is notable that voluntary, not-for-profit providers score higher than for-profit providers on all

the indicators of HR practices. Considering the aggregate index for homes and IDPs combined,

the difference between voluntary providers and for-profit providers is statistically significant

and represents a gap of some 10% (Table IV.6b). Two other results are statistically significant:

the score for the index of pay levels is 20 per cent higher for voluntary providers than for

private for-profit organisations (reflecting our analysis in part III); and voluntary providers

score substantially higher on the index of recruitment and retention practices.

Finally, when we look at the indicators that are specific to domiciliary care providers (table

IV.6c), we find again that LADPs are significantly more likely to pay for travel time, to offer

guaranteed hours, to provide a paid break but are significantly less likely to attach importance

to matching staff preferences for working time. Other differences are not significant.

29 In order to produce an estimation for LADPs we imputed 16 missing values out of 280, which represent 5.7% of

total values. This translated as 3 imputed values for the indicator IWT8 (30% of the sample of 10 LADPs), 2

imputes for the indicator IP3 (20% of the sample) and 1 impute for 11 different indicators (10% of the sample).



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IV.2.2. HR outcomes by provider characteristics

By HR outcomes we refer to the ability of providers to recruit and retain a skilled and

committed workforce. Thus indicators of HR outcomes relate to ease of recruitment, ability to

retain staff, avoidance of high absenteeism, and ability to meet training targets.

Table IV.6. Differences in indices and indicators of HR practices by provider type

a. X indices of HR practices and outcomes

Homes IDPs LADPs LADPs score

as % of

homes

LADPs score

as % of IDPs

XPAYLEVELS Index of pay levels 0.61**

(L)

0.63**

(L)

0.90**

(H,I)

147.5 142.9

XPAYSTRAT Index of pay strategies 0.68 0.65*

(L)

0.78 *

(I)

114.7 120.0

XRRPRACT Index of recruitment

and retention practices

0.61**

(L)

0.63**

(L)

0.81**

(H,I)

132.8 128.6

XEMPDEV Index of employee

development

0.58**

(L)

0.59**

(L)

0.77**

(H,I)

132.8 130.5

XWT Index of working time 0.65 0.64*

(L)

0.55*

(I)

84.6 85.9

XWO Index of work

organisation

0.95**

(I)

0.84**

(H)

0.88 92.6 104.8

XHRPRACT Index of all HR

practices

0.68**

(L)

0.66**

(L)

0.78**

(H,I)

116.2 119.7

XRROUTCOMES Index of recruitment

and retention

outcomes

0.68**

(I)

0.45**,*

(H,L)

0.58*

(I)

85.3 128.9

XTRAINSKILDEV Index of training

outcomes

0.81**

(I)

0.63**

(H)

0.78 96.3 123.8

b. X indices for public, private for-profit and private not-for-profit providers

Public Private

For-

profit

Private

Voluntary

Voluntary

score as % of

public

Voluntary

score as % of

private

XPAYLEVELS Index of pay

levels

0.90**

(F,V)

0.60**

(P,V)

0.72**

(P,F)

80% 120%

XPAYSTRAT Index of pay

strategies

0.78**

(F)

0.65**

(P)

0.73 94% 112%

XRRPRACT Index of

recruitment and

retention

practices

0.82**

(F)

0.60**

(P,V)

0.71**

(F)

87% 118%



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XEMPDEV Index of

employee

development

0.77**,*

(F,V)

0.57**

(P)

0.62*

(P)

81% 109%

XWT Index of working

time

0.55*

(F)

0.64*

(P)

0.65 118% 101%

XWO Index of work

organisation

0.88 0.89 0.91 103% 102%

XHRPRACT Index of all HR

practices

0.78**,*

(F,V)

0.66**

(P,V)

0.72**,*

(F,P)

92% 110%

XRROUTCOMES Index of

recruitment and

retention

outcomes

0.58 0.56 0.60 103% 108%

XTRAINSKILDEV Index of training

outcomes

0.78 0.71 0.76 98% 107%

c. Indicators of HR practices

Sample size

IDPs LADPs IDPs LADPs

IPDOM1 Compensation for travel costs/travel time 0.38* 0.61* 51 9

IHRDOM1 Performance monitored by electronic monitoring 0.69 0.80 51 10

IWTDOM1 Domiciliary care workers expected to tolerate

variation in hours or location at short notice

0.55 0.45 52 10

IWTDOM2 Paid break between service users 0.12** 0.78** 50 9

IWTDOM3 Minimum length of a work period 0.23 0.56 45 8

IWTDOM4 Important attached to organising working hours to

fit employees‟ circumstances

0.77** 0.39** 52 9

IWTDOM6 Staff required to work alone late at night 0.76 0.75 52 10

IWTDOM7 Contracts offered to care staff 0.23** 1.00** 51 10

Note: A single * indicates a minimum 90% confidence level (p < 0.1), ** indicates a 95% confidence level (p <

0.05). For table IV.6a, I, H, L are used to indicate differences with IDPs, Homes, LAPDs respectively For table

IV.6b, P, F, V are used to indicate differences with Public, Private for-profit, Private not-for-profit respectively

For the standardised dataset we were only able to include a restricted set of outcome measures

due to problems of missing data on staff turnover. The measures (see box IV.12) include

perceptions of recruitments difficulties (including questions on ease of recruitment and on

presence or otherwise of a labour shortage); perceptions of level of staff turnover; perceptions

of level of absenteeism (data on actual absenteeism was presented by managers in too many

diverse ways to be usable for comparisons); and ability to meet NVQ2 training targets (actual

share trained and position in relation to the 50% targets).

For non standardised indicators we have used three indicators of staff retention: these include

indicators of the share of new recruits retained, of overall staff turnover and of staff turnover

excluding new recruits over the past 12 months (with baseline staff level 12 months

previously).



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Box IV.12. Indices (X) and sub-indices (SI) from the standardised dataset

XRROUTCOMES Index of recruitment and retention outcomes

SIRECDIFF Recruitment difficulties SIABSENT Perceptions of

absenteeism

SITO Perceptions of staff

turnover

XTRAINSKILDEV Index of training outcome

Size

For homes, appear larger size to be disadvantageous with respect to HR outcomes. The overall

index for recruitment and retention outcomes shows medium and large establishments faring

significantly worse than both very small and small establishments (box IV.13). Medium and

large establishments also have worse perceived levels of both absenteeism and staff turnover.

Training outcomes are also worse in medium/large homes when compared to very small

establishments. However, recruitment difficulties are perceived to be worse in very small

establishments. For IDPs large establishments also have worse perceived problems of

recruitment and retention but the significant differences are primarily with medium

establishments. This also applies to perceived staff turnover rates and to the presence of labour

shortages. As with homes, very small/small establishments consider recruitment difficulties to

be more severe than is the case for large establishments. None of the indicators on actual staff

turnover in the non standardised data set were found to yield any significant differences with

size of establishment.



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Box IV.13. Significant differences in HR outcome indicators between providers by size


Homes:

XRROUTCOMES: perceived recruitment and retention outcomes significantly worse in

medium/large establishments than small and very small establishments

SIABSENT: absence rates in medium/large establishments significantly

worse than in small or very small establishments

SITO: perceived turnover rates significantly worse in medium/large

establishments than small and very small establishments ( latter

10% sig.only)

SITRAINSKILDEV: training outcomes significantly worse in medium/large

establishments than very small establishments(10% sig.only)

SIRECDIFF: recruitment difficulties significantly worse in very small than

small establishments ( 10% sig. only)

IDPs:

XRROUTCOMES: perceived recruitment and retention outcomes significantly worse in large

establishments than medium establishments

SITO: perceived turnover rates significantly worse in /large

establishments than medium establishments

SIRECDIFF: recruitment difficulties significantly worse in very small/ small

establishments than large establishments

IRC7: large establishments significantly more likely to have staff

shortages than medium

Ownership

For both homes and IDPs the only significant results relate to training outcomes: for homes the

single homes score highest and have significant differences with both national chains and local

chains but for IDPs it is local chains that score highest and have significant differences at 10%

with national chains and also a higher value than for single agencies although this difference is

not significant. Again the staff turnover data are not significantly related to ownership for

either homes or IDPs (see box IV.14).

Box IV.14. Significant differences in HR outcome indicators by ownership


Homes:

SITRAINSKILDEV: single homes have significantly better training outcomes than

national chains or local chains ( latter 10% sig.only)

IOUT1: single homes have significantly better training outcomes than

national chains



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IDPs:

SITRAINSKILDEV: local chains have significantly better training outcomes than

national chains (10% sig.only)

IOUT1: local chains have significantly better training outcomes than

national chains

Star rating

Neither homes nor IDPs recorded any significantly different HR outcomes by star rating.

Public, private or voluntary sector status

Table IV.6a shows that homes have the best and IDPs have the worst scores on the recruitment

and retention index and on the training index with LADP scores falling in between. The

differences are significant on recruitment and retention outcomes between IDPs and both

LADPs and homes, and on training between homes and IDPs.. The better performance on HR

outcomes for homes even compared to LADPs where HR practices were superior to both IDPs

and homes, suggests that it is more difficult to recruit and retain workers in domiciliary than

residential care. That is for the same standard of HR practices the nature of the work in

domiciliary care may lead to worse HR outcomes than in homes. The overall difficulty of the

job may thus be considered to require a higher standard for employment practices in

domiciliary care than residential care. Table IV.6b also shows that HR outcomes in the

voluntary sector are close to or above those in the public sector LADPs, but as our sample of

not for profit organisations is weighted towards homes this result may reflect in part the better

outcomes in general for homes. The voluntary sector scores are clearly better than the for profit

sector, however, and while there is still an issue of oversampling of homes in this case the

results refer to the combined private sector sample of homes and IDPs and is thus more

indicative of better outcomes for the voluntary sector (see section IV.5 for our multivariate

analyses which untangle some of these effects)



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IV.2.3. HR practices and strategies by individual provider

Figure IV.1 shows the range of scores among individual providers by the six indices of HR

practices (separately for homes and IDPs), and figure IV.2 portrays an overview of the overall

HR practices index, comparing homes, IDPs and LADPs. The spread of values for the

individual indices is relatively large, amounting to 42% to 83% of the available value range for

homes and 65% to 83% for IDPs. Only the work organisation index has a range below 50%

and this is only for homes.

The spread of values for the six indices is wider than that found for the HR practices index, the

mean of the six, where the range is only 28% for homes and 33% for IDPs, indicating that there

is some balancing between low and high scores across the range of HR practices for the

individual providers. The range for LADPs is even narrower at 16%; thus not only do LADPs

score higher on average than independent sector providers but also they all tend to be

concentrated towards the top end of the distribution.



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Figure IV.1. Range of scores of providers for the six indices of HR practices

a. Homes

b. IDPs

Note: Standardised data set



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Figure IV.2. Summary measure of index of HR practices for homes, IDPs and LADPs

IV.2.4. Employer views on the effectiveness of HR strategies

Overall the scope for differences in HR strategies is limited within social care, a condition that

was clear to many of the providers whom we interviewed in the telephone survey. We asked

the providers what HR policies they thought would do most to help recruitment and retention.

The option which was chosen that had the highest percentage of providers at saying it would

improve (over three fifths of independentsector providers) and the lowest share saying that they

had already been able to implement such a policy was „pay increases‟ (Table IV.7). LADPs, in

contrast, felt they had already implemented this policy.

It is clear from these answers that many providers are of the view that they are paying less than

they ought to for care staff. They attribute this to the limited fee levels available for care work.

Well I mean again with the care staff it‟s to do with economics can we afford to do it, because

that is our biggest cost area because even if we just give 10 or 20p extra an hour across our

care staff that is a phenomenal amount of money, and as we‟re a not for profit charity so we‟re

in a difficult situation as our margins are very tight (OM.D.2.DN)

The care staff] should be on eight pound an hour really, shouldn‟t they? No, it‟s true though.

[If I could] pay their wages, I would love to give them that. … And it‟s quite sad you know,

because it‟s a hard job, a tiring job. They‟ve got to have a lot of patience and compassion with

them. (ON.H.2 ML)



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The next most popular HR improvement for homes was recognition of variations in service -

time of day/weekends/type of care/skill etc. However while many more homes than IDPs felt it

would improve retention (35% to 14%) a relatively high share of both sets of providers (26%

of homes, 21% of IDPs) did not think it would improve matters. The next most popular way of

improving recruitment for IDPs was increased opportunities for internal promotions – but,

while a fifth of IDPs thought this would help, a quarter thought it would not; a fifth of homes

also thought more internal promotion would help and a lower share, 15%, thought it would not,

with the balance made up by a higher share of homes saying they had already implemented this

policy.

There were also mixed views over more flexible hours to suit employee preferences; the

majority thought they had already implemented this policy and those that had not mainly

thought it would not help. Training was the main policy improvement that around four fifths of

all independent sector providers felt they had already implemented; more homes than IDPs felt

there was scope for further improvements but few felt it would not help.

Two policies were relatively unpopular with the providers; the first was improved non pay

benefits where they were more – up to 44% in the case of IDPs - who did not think this would

help. The second was more discretion and autonomy in their job. The homes were much more

likely than IDPs to feel they had already implemented this as a policy but those who had not

were much more likely (2:1) to believe it would not help rather than it would help. Hostility to

increased discretion was very evident from the IDPs: 45% did not feel it would help, only 37%

had implemented such a policy and only 18% felt it would help. LADPs took a similar line,

with two thirds saying they had implemented it and one third saying it would not help. These

views were reinforced by some of our interviewees:

No [more discretion] – this would spell disaster, if you have knowledge of people….if have

variation and don‟t work to a high standard. (TE.D.1 CN (V))

No [more discretion] – that might help but it wouldn‟t help service provision – people would

make the wrong judgements. (LK.D.3 DS)

Well, yes, they are shown how to do the job and how they done is done to the best of their

ability – we don‟t want robots working here. But I wouldn‟t want them straying off the correct

way of doing things. (LK.H.3 BL)

That said, a few commented on the restrictions on autonomy and on time to do a good job that

came from the contracting arrangements.

… it would be nice to give them more autonomy, it‟s dictated by social services. (HD.D.1)

Providers were also given the opportunity to cite other HR policies that they could implement

to assist recruitment and retention. Most of the other responses referred, however, to changes in

external policies (see section IV.5 below for questions that explicitly tapped into external

changes by LAs in particular). The main additional HR policies referred to improving the status



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of the job and making staff feel valued (through recognising staff efforts, arranging social

events, providing mobile phones etc).

Table IV.7. HR policies most likely to improve recruitment and retention

% of homes % of IDPs % of LADPs % of All

Would improved opportunities for training

improve recruitment and retention 20.4 7.7 0.0 13.0

Have already implemented 77.6 86.5 100.0 83.3

would not improve 2.0 5.8 0.0 3.7


No response 4 0 3 7

Would pay increases

improve Recruitment and retention 62.0 64.0 12.5 59.3




No response 3 2 2 7

Would recognising variations in service -time of day/weekends/type of care/skill etc.





No response 7 0 2 9

Would improved opportunities for internal promotion






Would more flexible hours to suit






Would improved non-pay benefits






Would more scope for care workers to exercise discretion over how to provide care?








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IV.3. LA commissioning and contracting and provider HR

practices and outcomes

IV.3.1. The influence of LA fee levels on pay

Domiciliary care

If we plot the level of fees offered by LAs against the normal rates of pay paid by the IDPs in

our survey (Figure IV.3) we find that for IDPs, the level of LA fees is an enabler but not a

determinant of higher pay for care staff. Nevertheless, normal pay rates above £7 an hour were

only found in LAs where the fee level was at least £13 an hour. In Figure IV.4 we plot a trend

line of best fit between the normal rate of pay and the level of LA fees. The implication of the

trend line is that for every pound in increased LA fees, normal pay increases by 19p an hour.

This may not be considered a very good return on higher fees given that that majority of IDPs

costs are labour costs, the worker‟s normal pay rate. For this model, the R2 value is 0.37, which

means that the LA fee level accounts for 37% of the variation of workers‟ pay across providers.

Figure IV.3. A comparison of LA fees and normal rates of pay in IDPs



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Figure IV.4. Trend line of best fit between LA fees and normal rates of pay in

IDPs

y = 0.186x + 4.19R² = 0.367

£5

£6

£7

£8

£9

£10

£10 £11 £12 £13 £14 £15 £16 £17 £18 £19 £20

No

rma

l ra

tes

of

pa

y

LA fees

Homes

For homes there is an even less clear cut relationships between LA fees and normal pay rates.

To provide an estimate of LA fee levels that has more relationship to an hourly wage we have

divided the weekly fee by 40, giving a fee ranging between £8 and £14. Wages paid are low

and relatively similar between £8 and £10 an hour; they are somewhat higher at £12 and £14

an hour though not at £13 an hour (Figure IV.5). Plotting a trend line between fees and normal

pay rates shows that for every £1 extra in fees paid normal pay increases by 14p per hour

(figure IV.6). Not only is this a lower boost to pay even than for IDPs but LA fees also explain

less of the variation in normal pay rates: the R2 value is only 0.20, which means that the LA fee

level accounts for just 20% of the variation of workers‟ pay. For homes a lot of the costs relate

to housing costs not just labour costs so this weaker relationship between fees and wages was

not unexpected.



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Figure IV.5. A comparison of LA fees and normal rates of pay in homes

Figure IV.6. Trend line of best fit between LA fees and normal rates of pay in IDPs

y = 0.137x + 4.85R² = 0.197

£5.5

£6.0

£6.5

£7.0

£7.5

£8.0

£8.5

£7 £8 £9 £10 £11 £12 £13 £14

No

rma

l ra

tes

of

pa

y

LA fees



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Figure IV.7 plots the level of wage rates in care homes against the percentage of service users

funded by LAs. This shows a tendency for normal pay by provider to be concentrated at the

bottom end of the distribution- under £6 an hour- where the residential home is primarily

dependent upon the LA. Where more than 50 per cent of the business comes from non LA

sources only 18 percent of providers pay at this level compared to 77% of those homes where

more than 85% of the business comes from LA supported clients.

Figure IV.7. Composition of homes paying different normal pay rates by proportion of

LA funding

18% 18%

36%

77%

53%

64% 27%

15%29%

18%

36%

8%

<50% 50-70% 71-84% >=85%

% of service users funded by LAs

< £6 £6 - £6.50 > £6.50

These variations in the business are of course linked to the income levels in the area and thus

indirectly to wage levels The evidence we collected on the differences in the prices charged by

providers to private versus LA clients is summarised in box IV.15. The pattern of charging

varied by region for both homes and domiciliary care but many fewer of the IDPs compared to

homes relied on private clients for a significant share of their markets (see table IV.1).



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Box IV.15. Comparison of LA and private fees levels

The gap between private and LA fee levels was much greater for homes and especially for homes

located in the southern LAs. This gap was found to be in hundreds of pounds per week- from

£100 to £300 and more in a few cases. In the northern and midlands LAs there was much less

evidence of differences between the LA rate and the rates charged to private residents; several

said they had no private residents and some said they charged the same even though rates were

low. We identified a few examples of higher fees in excess of £100- one in AD where the LA had

said top up fees were rare and another, less surprisingly, in RD where the LA fee was known to be

below the going rate in the area, with those without capacity to pay top ups placed in cheaper

homes located in areas bordering the LA.

The pattern for domiciliary care was more varied with some IDPs even in more depressed and

areas also charging top ups to private clients while some southern IDPs would only add a modest

top up or around £1 an hour or so. Only one IDP said it charged more than a £3 an hour top up to

private clients (one in XD where the private rate was £7.50 above the LA rate). This varied pattern

may reflect tighter pricing policies by LAs in some depressed areas. A few IDPs gave a range of

fees that were lower than the LA rates but these may have included fees for basic cleaning. Only

one in a midlands LA- OM- said they charged less to private clients but several said they charge

the same rate. Practices varied within an LA- for example in one of the low fee LAs IL , three

IDPs effectively charged the same rate to private as well as LA funded clients while a fourth

asked for a top up of £2 an hour.

IV.3.2. HR practices and outcomes by type of LA

We have used two alternative classifications of LA commissioning policy to explore links with

the HR practices and outcomes for independent sector providers. Our first classification

involves the partnership, mixed and cost minimising categories developed in part II of this

report. Our second classification defines categories of LAs according to the level of LA fees.

Table IV.8 provides a summary of the overall X indices by homes and IDPs by the partnership

categorisation and table IV.9 provides a similar summary using the LA fees categorisation. Full

details of indices and sub-indices for the standardised dataset are presented in appendix tables

IV.A11 through IV.A.14.

Partnership, mixed and cost minimising local authorities

To summarize the overall results for the partnership categorisation, a number of significant

differences in sub-indices and indices were found for homes although the direction of the

relationship did not always accord with expectations that partnership would promote good HR

practices or outcomes. However, for IDPs there are almost no significant differences except for



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the summary index of HR practices where providers in partnership LAs score significantly

better than those in cost minimising LAs.

Pay sub-indices and indices were the most frequently found to be significant for homes (box

IV.16); pay levels, pay for unsocial hours, opportunities for pay improvements and the

aggregate Xpay levels all revealed significant differences in the expected direction with

partnerships having the best conditions but the differences were sometimes only significant

with mixed and sometimes only significant with cost minimising LAs. Similar patterns were

found for the individual indicators on normal pay, extra pay for qualifications and for weekend

work. Furthermore, paid time off for training was, contrary to expectations, significantly more

common among providers in cost minimising areas, although the aggregate differences were

not large.

Box IV.16. The significance of LA commissioning strategy (partnership, mixed, cost

minimising) in explaining differences in HR Practice indicators among providers


Homes:

XPAYLEVELS: pay levels significantly higher in partnership than mixed LAs.

XEMPDEV: employee development and voice practices significantly better in cost

minimising than in partnership or mixed LAs (10% sig.only).

SIPAYLEVEL: pay levels significantly higher in partnership than mixed and cost

minimising LAs

SIPAYUNSOCIAL: pay for unsocial hours significantly more common in partnership

than mixed LAs

SIPAYIMP: opportunities for pay improvements significantly higher in

partnership than cost minimising LAs

SIPAYTRAIN: pay for training significantly higher in cost minimising LAs than

in partnership and mixed LAs (10% sig.only)

SIWTWEND: weekend working less common/ less of a requirement in

partnership than mixed LAs

SIWTLHOURS: staff less likely to be working long hours or long weeks in mixed

than in partnership or cost minimising LAs

SIWTTOFFTRAIN: staff least likely to be given time off for training in mixed

compared to partnership or cost minimising LAs (latter 10%

sig.only)

IP2: normal pay levels significantly higher in partnership than

mixed (10% sig. only) and cost minimising LAs

IP6: extra pay for qualifications significantly higher in partnership

than mixed LAs (10% sig. only)

IP8: extra pay for weekend work significantly higher in partnership

than mixed and cost minimising LAs

IP14: pay for training significantly higher in cost minimising than

mixed LAs(10% sig. only)

IWT4: staff less likely to be all working weekends in partnership than

mixed LAs

IWT8: staff less likely to be working long hours in mixed than in

partnership LAs



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IDPs:

XHRPRACT: significantly higher scores in partnership than cost minimising LAs

IHR2: frequency of staff meetings significantly higher in cost

minimising than partnership LAs


IDPs:

IWTDOM1: staff in cost minimising LAs significantly more likely to be

expected to tolerate changes in hours or location at short

notice

The only other sub-index where partnerships were clearly associated with higher HR practice

scores was that related to requirements for weekend working in homes, although providers in

the mixed areas scored the lowest, a pattern reaffirmed in the indicator on share of all staff

involved in weekend working. The sub-index on working long hours and 6/7 days found

providers in partnership and cost minimising LAs to have lower scores than providers in

„mixed‟ LAs. The indicator for working long hours shows a similar pattern with mixed having

the fewest staff in this category. When it came to time off for training, however, those in the

mixed areas scored the lowest. Finally, for employee development and voice we find those in

cost minimising LAs scored the highest, with the score significantly different from both of the

other two categories (box IV.16). This has parallels to the other apparently perverse result

where 3* providers had worse employee voice and development than 1* categories by CQC

(see box IV.1 above).

For IDPs, as we have already noted, it is only the overall HR practices index that reveals any

significant differences and here the pattern is for providers in partnership LAs to have

significantly higher scores than those in cost minimising LAs. Even at the level of indicators

there is only one significant result, with this time providers in cost minimising LAs more likely

to carry out staff attitude surveys.

Box IV.17. The significance of LA commissioning strategy (partnership, mixed, cost

minimising) in explaining differences in HR Outcome indicators among providers


Homes:

SITRAINSKILLDEV: training outcomes significantly better in mixed than in partnership

or cost minimising LAs

SIRECDIFF: recruitment difficulties significantly worse in partnership than

cost minimising LAs (10% sig. only)

IOUT1: shares of staff trained to NVQ2 significantly better in mixed

than in partnership (10% sig. only) and cost minimising LAs



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When it comes to HR outcomes, again there are no significant results for IDPs. For homes

those in partnership LAs face significantly greater recruitment difficulties than those in cost

minimising LAs and those in mixed LA areas have significantly better training outcomes than

either of the two other types of areas (box IV.17). None of the indicators of actual staff

turnover were found to be related to this classification of LA commissioning.

Table IV.8. Summary indices for homes and IDPs by partnership, mixed and cost

minimising type of local authority (mean values of indices)

a. Homes

All Partnership

LAs

Mixed

LAs

Cost minimising

LAs

HR PRACTICES

XPAYLEVELS Pay levels 0.61 0.67

(**M)

0.54

(**P)

0.61

XPAYSTRAT Pay strategies 0.68 0.72 0.67 0.65

XRRPRACT Recruitment & retention

practices

0.64 0.65 0.67 0.59

XEMPDEV Training & development 0.58 0.55

(*C)

0.55

(*C)

0.66

(*M P)

XWT Working time 0.65 0.67 0.62 0.66

XWO Work organisation 0.95 0.94 0.96 0.93

XHRPRACT Index of all HR practices 0.68 0.69 0.66 0.68

HR OUTCOMES

XRROUTCOMES Recruitment & retention 0.68 0.68 0.67 0.68

XTRAINSKILDEV NVQ training targets 0.81 0.75

(** M)

0.94

(** P C)

0.73

(** M)

b. IDPs

All Partnership

LAs

Mixed

LAs

Cost minimising

LAs

HR PRACTICES

XPAYLEVELS Pay levels 0.63 0.66 0.64 0.55


XRRPRACT Recruitment & retention

practices

0.63 0.66 0.66 0.55

XEMPDEV Training & development 0.59 0.61 0.60 0.55

XWT Working time 0.64 0.64 0.60 0.67


XHRPRACT Index of all HR practices 0.66 0.68

(** C)

0.66 0.62

(** P)

HR OUTCOMES


XTRAINSKILDEV NVQ training targets 0.63 0.55 0.73 0.63

Note: Full details in appendix tables IV.A11 and IV.A12. P, M, C used to indicate difference from partnership,

mixed and cost minimising LAs respectively



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High, medium and low fees local authorities

To explore the influence of LA fees on HR practices and indicators we have collapsed our four

categories of fee levels developed in Part II into three categories. This was to avoid having only

two LAs in each of the very low categories. Note that in comparison to the partnership, mixed,

cost minimising classification we have different measures for LAs between homes and IDPs.

This classification of LA influences revealed many more significant effects for IDPs compared

to the partnership classification above; for homes, the number of significant indicators is very

similar. For IDPs the summary index of HR practices is also still significant, with providers in

low fee areas having significantly lower aggregate HR practice scores than those in high fee

areas; the medium fee areas have a medium score but the difference is not significant.

A high share of the consistent relationships apply to pay indicators (box IV.18). For homes the

pay level, pay improvements and the overall pay index all show significantly higher pay levels

in high fee areas compared to low fee areas. High fee areas are also best for unsocial hours

payments but medium fee areas are the worst. At the individual indicator level we also find

significant differences between high and low fee areas for minimum pay, normal pay and extra

pay for qualifications or weekend work. For IDPs indicators for pay levels and pay

improvements are significantly lower in low fee areas compared to either medium or high fee

areas. Pay for unsocial hours is significantly higher in high fee to low fee areas. Again at the

individual indicator level, we find significant differences between high and low fee areas for

minimum pay, normal pay and extra pay for qualifications but extra pay for weekend work is

lowest in medium fee areas.

Box IV.18. The significance of LA fees (high, medium, low) in explaining differences in

HR practice indicators among providers


Homes:

XPAYLEVELS: pay levels significantly higher in high than low fee LAs

SIPAYLEVEL: pay levels significantly higher in high than low fee LAs

SIPAYUNSOCIAL: pay for unsocial hours significantly more common in high than

medium fee LAs

SIPAYIMP: opportunities for pay improvements significantly higher in high

than low fee LAs

SIWTWEND: weekend working less common/ less of a requirement in high than

low fee LAs (10% sig. only)

SIWTLHOURS: staff more likely to be working long hours or long weeks in high

than in medium or low fee LAs

SIWODISCREET: staff significantly more likely to be able to exercise discretion at

work in low than in high fee LAs

IP1: minimum pay significantly higher in high than low fee LAs

IP2: normal pay significantly higher in high than low fee LAs

IP6: extra pay for qualifications significantly higher in high than

medium or low fee LAs



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IP8: extra pay for weekend work significantly higher in high than


IWT4: Staff less likely to be all working weekends in high than low or

medium LAs (latter 10% sig. only)

IWT8: Staff less likely to be working long hours in medium fee than in

high fee LAs

IWO4: Staff in low fee LAs significantly more likely to be able to

prioritise tasks to improve care than in high fee LAs

IDPs:

XWO: staff in high and low fee areas significantly more likely to be able to exercise

discretion at work than in medium fee LAs (latter 10% sig. only)

XHRPRACT: significantly higher scores in high than low fee LAs

SIPAYLEVEL: pay levels significantly lower in low fee LAs than in medium or

high fee LAs

SIPAYUNSOCIAL: pay for unsocial hours significantly more common in high than

low fee LAs (10% sig.only)

SIPAYIMP: opportunities for pay improvements significantly lower in low

fee LAs than in medium or high fee LAs

SIWTTOFFTRAIN: significantly less likely to have time off for training in low fee

LAs than in medium or high fee LAs

SIWOTIME: significantly more likely to have time discretion at work in low

and high fee LAs than medium fee LAs

IP1: minimum pay significantly lower in low fee LAs than in

medium or high fee LAs

IP2: normal pay significantly lower in low fee LAs than in medium

or high fee LAs

IP6: extra pay for qualifications significantly higher in high than


IP8: extra pay for weekend work significantly lower in medium fee

LAs than in low or high fee LAs

IWO1: staff in low fee LAs significantly more likely to have time to

carry out tasks to a high standard than in medium fee LAs

IWO2: staff in low fee LAs significantly more likely to have time to

develop relationships than in medium fee LAs


IDPs:

IOUT3: significantly more likely to have investors in people award in

medium than low fee LAs

IHRDOM1: significantly more use in low fee LAs than medium fee LAs

For homes, as with our partnership classification above, we again find the potentially

inconsistent results that high fee areas score best on not requiring full weekend working but

worst on the share with long hours and working 6 or 7 days (box IV.18).30

One relationship

30 These results are confirmed at the indicator level for the share working weekends and for long hours working

although the significant difference is only between medium and high fee areas in this instance.



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works in a potentially perverse direction with low fee areas offering significantly higher worker

discretion and autonomy than high fee areas (particularly in relation to opportunities to

prioritise tasks) but the differences in aggregate scores are small.31

Table IV.9. Summary indices for homes and IDPs by low, medium and high fee paying

local authority (mean values of indices)

a. Homes

All Low fee

LAs

Medium

fee LAs

High fee

LAs

HR PRACTICES


(**H)

0.59 0.69

(**L)


XRRPRACT Recruitment& retention practices 0.61 0.56 0.61 0.67


XWT Working time 0.65 0.65 0.63 0.66



HR OUTCOMES



(** H)

0.95 (** H) 0.68

(** M L)

b. IDPs

All Low fee

LAs

Medium

fee LAs

High fee

LAs

HR PRACTICES



XRRPRACT Recruitment& retention practices 0.63 0.56 0.65 0.66


XWT Working time 0.64 0.58 0.68 0.63

XWO Work organisation 0.84 0.87 (* M) 0.75

(**L *H) 0.91

(** M) XHRPRACT Index of all HR practices 0.66 0.62

(** H)

0.66 0.70

(** L)

HR OUTCOMES


XTRAINSKILDEV NVQ training targets 0.63 0.71 0.67 0.49

Note: Full details in appendix tables IV.A13 and IV.A14. H, M, L are used to indicate significant differences with high,

medium or low fee LAs respectively

31 The results detailed in appendix table IV.A13 show mean aggregate scores of 0.93 (all homes), 0.96 (Low fees

homes), 0.93 (Medium fees homes) and 0.89 (High fees homes).



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For IDPs low fee area providers are significantly less likely to provide time off for training

than either medium or high fee LA providers. The two remaining practices that are significant

relate to work organisation – namely, time allowed to complete tasks and form relationships

(SIWOTIME) and the aggregate work organising index (XWO). However, here the main

finding is that providers in medium fee LAs are less likely than those with either higher or

lower fees to provide sufficient time for high quality work (box IV.18). At the individual

indicator level the significant differences in either time for carrying out tasks or time to develop

relationships are between low and medium fee LAs only. None of the specific domiciliary

variables were found to be significantly related to fee levels. Among the other non standard

indicators, for IDPs medium fee LA providers were more likely to have the investor in people

award than low fee LAs.

Providers explicitly identified the level and form of LA fee as a major factor in their HR

practices decisions. For example one provider explicitly linked the upgrading of staff pay to

whether or not there was an upgrade in fees paid by their LA.

They [the LA] haven‟t offered enough over the last year, so we have not upgraded staff for 18

months. Prior to that they got one regularly each year. (LK.D.3 DS).

Another regarded their decision not to pay mileage as a direct reflection of the lack of a

mileage allowance in the LA fee.

I do think care workers should be paid more than what they do get paid, especially because

they don‟t pay mileage, it‟s very difficult. And they are needed, you know, care workers are

essential. So I think if they did contribute towards mileage that would be definitely beneficial.

(ON.D.3 BN).

However, for some providers it is the general change in labour market conditions - for

example, the increased legal minimum holiday entitlements – that have increased costs.

This year and last year, it was an increase in holiday hours, because we‟ve got a large staff and

staffing costs are about I think 70% of our turnover and so increased holiday hours makes a big

difference to that so what we‟ve had to do in considering this year and last year, so holiday

hours have gone up from 4 times your contracted hours to 5.6, which is obviously quite a leap.

(RD.H.3.A.L)

As most independent sector providers are operating at the bottom of the set of employment

conditions, any raising of minimum standards for the labour market as a whole is likely to have

a disproportionate effect on the organisation and it is not clear that LA fees are always

upgraded in line with such changes to minimum labour market conditions of employment.

With respect to HR outcomes, we found that among homes, providers in high fee areas had the

worst outcomes in regard to meeting NVQ training targets; medium fee area providers

performed the best but there were significant differences between both low to high and medium

to high fee area (box IV.19). These findings are confirmed by each of the indicators making up

the sub-index - that is, the measure of the actual share of staff trained to NVQ level 2 and the



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likelihood of meeting the 50% NVQ level 2 target. For IDPs the only outcome variable to be

significantly associated with LA fees was that relating to subjective evaluations of staff

turnover which were worse in low fee areas. This is perhaps the first result indicating that more

positive commissioning might act to provide better absolute outcomes (where results are in the

opposite direction, LA commissioning may still be helping if the alternative of a low fee might

be even higher turnover).

For homes, high fee areas had the best overall turnover rates but none of the paired

comparisons by fee level were significant. For IDPs the share of new recruits retained was

significantly lower in low fee LAs compared to medium fee LAs, and the average for high fee

LAs was similar to that for medium fee LAs even if there was not a significant difference (box

IV.19). Other staff turnover indicators did not yield any significant results.

Box IV.19. The significance of LA fees (high, medium, low) in explaining differences in

HR outcome indicators among providers


Homes:

SITRAINSKILLDEV: training outcomes significantly worse in high than medium or low

fee LAs (latter 10% sig.only)

IOUT1: shares of staff trained to NVQ2 significantly higher in medium

than high fee LAs

IOUT2: providers in high fee areas significantly less likely to

meet NVQ target than in medium (10% sig.only) or low

fee areas

IDPs:

SITO: significantly worse perceptions of staff turnover in low

fee paying LAs than in medium fee areas


IDPs:

IRT2: Share of new starters retained significantly lower in low

fee to medium fee LAs (10% sig.only)



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IV.4. Labour market conditions and provider HR practices and

outcomes

IV.4.1. The influence of local labour market conditions on pay

Figure IV.8 compares the level of normal pay in our sample of providers to the median hourly

pay for female part-time workers in the specific LA labour market. LAs listed along the

horizontal axis are ranked by the level of the local labour market median female part-time pay

rate (from high to low reading from left to right). The first point to observe is that for the two

LAs with the highest local median rates (AW and RN), the relative level of normal pay for care

workers in the surveyed providers is the lowest for all the providers in our sample. A second

point to observe is that, where pay levels reach a high percentage of the local labour market

female median rate or even exceed it, this applies to only some of the providers in the area so

that the effect is to spread out the ratios, suggesting wide variations in pay strategies between

providers. This mirrors the findings for local labour market fees (section IV.3.1) that not all

providers react in the same way either to LA fees or to local labour market conditions.

Figure IV.8. Providers’ normal pay for care workers by LA, relative to the local market

median for female part-time workers

50%

60%

70%

80%

90%

100%

110%

0 1 2 3 4 5 6 7 8 9

10

11

12

13

14

AW

RN

XD

HD

AH

AD

RD

LK

OM

RT

TE

ON

UY

IL

Note: The different points on the vertical lines represent the ratio of normal pay for each provider organisation to

the median hourly pay for female part-time workers in the specific local authority labour market.



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In general we can observe a high concentration of pay levels between 75% and 90% of the

relevant median. This finding underlines the low level of pay in the sector as the median level

of female part-time hourly pay is only 65% of male full-time hourly pay at the national level.

There are only 6% of providers paying above the local labour market median for female part-

timers and only16% paying above 90%. At the other end of the spectrum 21% of the sample

paid below 75% of the median and all providers in one LA, classified as a „cost minimising‟

LA but located in a high wage area (outer London), paid rates below 60% of female part-time

median pay.

IV.4.2. The influence of local labour market conditions on HR practices and

outcomes

To explore the impact of local labour market conditions on HR practices and outcomes we use

the combined measures of labour market demand and local labour market pay conditions

developed in part I (see section I.7 and appendix table I.A1 and appendix figure I.A1).On this

basis we have divided the LAs into weak, medium and strong labour demand.

Labour demand leads to the highest number of significant differences between providers for

homes, although for IDPs variation in LA fees (section IV.3.2) generated a wider range of

significant results. Not all relationships are in predictable directions but most suggest that

providers do have to improve their HR practices when located in local labour markets

characterised as strong demand areas. Table IV.10 summarises the results for the different

summary indices.

For homes, labour demand is significantly associated with four overall indices: for pay levels,

working time and the summary index of HR practices it is the strong labour demand areas

where the scores are highest. By contrast, the index for work organisation suggests that

discretion at work is lower in strong demand areas, perhaps suggesting that workers are more

under pressure in these areas (box IV.19). There are less strong relationships at the aggregate

index level for IDPs: only the index for work organisation is significant but here it is the

medium demand areas that offer less discretion than either weak or strong demand areas.

Notably no significant differences among IDPs in different local labour markets were found for

the overall HR practices index even though they were found for LA fee levels (see box IV.15

above).

Local labour market demand is significantly related to pay levels for both homes and IDPs. As

anticipated, pay levels are highest in strong demand areas. For homes the main differences are

between strong and weak areas32

while for IDPs it is low wages in weak demand areas relative

to both medium and strong demand areas that stands out. Unsocial hours payments are also

more common in strong demand areas and this time for both homes and IDPs the main

32 The sub-index measures for pay levels among homes are 0.46 (strong demand areas), 0.31 (medium) and 0.20

(weak) (see appendix table IV.A15).



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differences are between strong demand and other areas. Homes also record significant results

for pay upgrade opportunities and the overall X pay levels index also has significant

differences between both strong and medium with weak demand areas. At the indicator level

both homes and IDPs record minimum and normal pay to be lower in weak demand areas and

extra pay for weekend work to be higher in strong demand areas, although the exact pattern of

significant differences varies. For homes extra pay for qualifications is also significantly higher

in strong demand areas but for IDPs there is a somewhat perverse result that staff are more

likely to have to pay for their own uniforms in medium compared to weak demand areas. There

is also one significant result for a pay indicator that applies specifically to IDPs (IPDOM1),

which suggests that those providers in strong demand areas are more likely to pay for travel

than those in medium demand areas.

Box IV.19. Significant differences among providers in HR practice indicators by

labour demand (weak, medium, strong)


Homes:

XPAYLEVELS: pay levels significantly lower in weak than medium or strong demand areas

XWT: working time arrangements significantly better in strong than weak demand

areas (10% sig.only)

XWO: opportunities to exercise discretion significantly lower in strong than in weak or

medium (10% sig.only) demand areas

XHRPRACT: overall high practices score significantly higher in strong than medium or weak

demand areas.

SIPAYLEVEL: pay levels significantly higher in strong than medium (10%

sig.only) or weak demand areas

SIPAYUNSOCIAL: pay for unsocial hours significantly more common in strong than

weak demand areas

SIPAYUPGRADE: regular pay upgrading less common in weak than strong or

medium demand areas.

SIWTWEND: weekend working less common/ less of a requirement in strong

and medium than weak demand areas

SIWTLHOURS: staff more likely to be working long hours or long weeks in strong

than in weak demand areas

SIWODISCREET: staff significantly less likely to be able to exercise discretion at

work in strong than in medium or weak demand areas

SIWTSTFFPREF: working time significantly more likely to be matched to employee

preferences in weak than strong demand areas

SIWTTOFFTRAIN: staff significantly more likely to be given time off for training in

strong compared to weak demand areas

IP1: minimum pay significantly higher in strong than weak

demand areas

IP2: normal pay significantly higher in strong than weak demand

areas

IP6: extra pay for qualifications significantly higher in strong than

weak demand areas (10% sig.only)

IP8: extra pay for weekend work significantly lower in weak than



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strong or medium demand areas (latter 10% sig. only)

IWT4: staff less likely to be all working weekends in strong than

medium or weak demand areas

IWT5: availability for weekend work more likely to be a recruitment

requirement in weak than strong or medium demand areas

IDPs:

XWO: opportunities to exercise discretion significantly lower in medium than in weak

or strong demand areas

SIPAYLEVEL: pay levels significantly lower in weak than medium or strong

demand areas

SIPAYUNSOCIAL: pay for unsocial hours significantly more common in strong

than medium or weak demand areas

SIWOTIME: significantly more likely to have time discretion at work in

weak and strong than medium demand areas

IP1: minimum pay levels significantly lower in weak than medium

or strong demand areas

IP2: normal pay levels significantly lower in weak than medium or

strong demand areas

IP8: extra pay for weekend work significantly higher in strong than

medium demand areas

IP12: staff significantly more likely to have to pay for uniforms in

medium than weak demand areas (10% sig.only)

IWT4: staff less likely to be all working weekends in strong and

medium (10% sig.only) than weak demand areas

IWO1: staff in medium demand areas significantly less likely to have

time to carry out tasks to a high standard than in weak or

strong demand areas

IWO2: staff in medium demand areas significantly less likely to have

time to develop relationships than in weak or strong demand

areas


IDPs:

IPDOM1: staff significantly more likely to be paid for travel time in

strong than medium demand areas

IHRDOM1: significantly more use of electronic monitoring in weak than

strong demand areas

IOUT3: significantly more likely to have investors in people award in

medium than strong demand areas

IWTDOM5: minimum lengths of visits significantly more likely to be

longer in medium than strong demand areas

For IDPs there are few strong relationships with local demand conditions other than for pay.

The only other HR practice areas for IDPs to reveal significant differences at the sub-index

level are those related to work organisation (as found for LA fee levels, box IV.17) and again

here it is the medium demand area that scores significantly worse than strong or weak demand

areas (a finding mirrored in two of the individual indicators in this area, IWO1 and IWO2, box

IV.19). With regard to working time, the indicator on staff working weekends suggests that it is



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more common among providers in weak labour demand areas for all staff to be working

weekends. Another finding from the specific domiciliary indicator list suggests that minimum

lengths of visits tend to be longer in medium than strong demand areas. Finally, IDP providers

in medium labour demand areas are more likely to have the Investors in People awards than in

strong demand areas.

For homes weak demand areas were less likely to provide time off for training than strong

demand areas and this relationship was significant.33

We also find a series of working time

indicators that are significant, including the overall working time index, XWT. However, the

directions of effects are mixed. The summary index for working time suggests working-time

arrangements are significantly better in providers located in strong than weak labour demand

areas (although only at the 10% level, table IV.10). Strong and medium labour demand areas

are significantly less likely to require all weekend working than weak demand areas. This is

demonstrated by the sub-index, SIWTWEN, as well as by the individual indicators on the share

of care workers working weekends (IWT4) and the recruitment requirement for weekend

working (IWT5) that also suggest that weak areas are more likely to impose this requirement.

On other measures, however, homes in weak labour demand areas score better – specifically,

on matching working time preferences, on long hours and 6/7 day working. Homes in strong

labour demand areas also score worse than medium or weak demand areas on two work

organisation variables: namely, the sub-index of the extent of discretion allowed in the job and

the summary index of work organisation (box IV.19).

Finally, we find that certain HR outcomes are associated with labour demand conditions in the

local labour market (box IV.20). Achievement of NVQ targets, captured in our sub-index of

training (SITRAINSKILLDEV), is negatively associated with labour demand: for homes it is

weak demand areas that have better training outcomes than those in medium or strong demand

areas but for IDPs it is more that strong demand areas have by far the worst outcomes. For

IDPs, medium labour demand areas were also significantly less likely to perceive problems of

absenteeism than was the case in weak or strong demand areas. As with our analysis of

variation in local authority commissioning arrangements (section IV.3.2), the results again

reveal no significant relationship between differences in labour demand and actual staff

turnover levels.

33 The scores on the 0-1 sub-index are 0.93 (strong labour demand) and 0.76 (weak labour demand), with a

significant difference at the 5% level (table IV.10).



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Table IV.10. Summary indices for homes and IDPs by labour market conditions (mean

values)

a. Homes

All Strong

demand

Medium

demand

Weak

demand

HR PRACTICES


(**W)

0.64

(**W)

0.50

(**S M)


XRRPRACT Recruitment & retention practices 0.61 0.65 0.57 0.59


XWT Working time 0.65 0.68

(**W)

0.67 0.60

(**S)

XWO Work organisation 0.95 0.91

(**W *M)

0.97

(*S)

0.97

(**S)

XHRPRACT Index of all HR practices 0.68 0.70

(**M W)

0.69

(**S)

0.64

(**S)

HR OUTCOMES



(**W)

0.76

(*W)

0.94

(**S *M)

b. IDPs

All Strong

demand

Medium

demand

Weak

demand

HR PRACTICES



XRRPRACT Recruitment & retention practices 0.63 0.65 0.66 0.57


XWT Working time 0.64 0.66 0.68 0.57

XWO Work organisation 0.84 0.87

(* M)

0.72

(**S W)

0.88

(** M)


HR OUTCOMES



(**W *M)

0.73

(* S)

0.78

(** S)

Note: Full details in appendix tables IV.A15 and IV.A.16. S,M.W are used to indicate significant difference from

strong , medium and weak demand areas respectively.



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Box IV.20. Significant differences among providers in HR outcome indicators by

labour demand (weak, medium, strong)


Homes:

SITRAINSKILLDEV: training outcomes significantly better in weak than medium(10%

sig.only) or strong demand areas

IOUT1: shares of staff trained to NVQ2 significantly higher in weak

than strong demand areas

IOUT2: providers in high fee areas significantly less likely to meet

NVQ target than in medium (10% sig.only) or low fee areas

IDPs:

SITRAINSKILLDEV: training outcomes significantly worse in strong than

medium(10% sig.only) or weak demand areas

SIABSENT: significantly worse perceptions of staff turnover in weak and

strong demand areas than in medium demand areas (latter

10% sig.only)

IOUT1: shares of staff trained to NVQ2 significantly higher in weak

than strong demand areas

IOUT2: providers in strong demand areas significantly less likely to

meet NVQ target than in weak demand areas



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IV.5. Internal and external environmental factors associated with

good HR practices and HR outcomes

The above sections have investigated the way in which the quality of HR practices and

outcomes among homes and IDPs vary by a range of key factors, including organisational

characteristics (the size and ownership status for example, considered in part IV.2), LA

commissioning environment (level of fees and partnership orientation, for example, considered

in part IV.3) and local labour market conditions (considered in part IV.4). Considering each set

of factors in turn, our analysis so far suggests a number of significant associations between

these internal and external factors and the propensity of providers to adopt good HR practices

and enjoy good HR outcomes. To explore these associations further, this section reports the

results of multivariate statistical analyses. The first set of analyses was designed to identify the

factors associated with the adoption of good HR practices. The second set aimed to explore the

relationships between environmental factors, organisational characteristics and good HR

practices on the one hand, and good HR outcomes on the other.

IV.5.1. Exploring the factors associated with the adoption of good HR practices

In this section, our aim is to identify, using multivariate analysis, those factors that help explain

differences among homes and among IDPs in the quality of different HR practices –

specifically, pay practices, recruitment and retention practices, employee development

practices, working time practices and work organisation practices. In line with our over-arching

analytical framework for this project (figure I.1) our proposition is that these HR practices are

likely to be influenced by key external environmental factors that vary across provider and

local authority, namely the commissioning and contracting practices of LAs and local labour

market conditions. In addition, we know from our analysis above (section IV.2), as well as

from an extensive literature on the factors shaping the design of „HR bundles‟ (eg. Kepes and

Delery 2007, Purcell 1999), that organisational characteristics of the sample of providers are

likely to influence the ability and willingness of providers to adopt better HR practices. As

such, we also include factors such as size, ownership and profit-making status.

We carried out two types of multivariate analysis. First, we undertook a cluster analysis based

on the standardised dataset of HR practice indicators in an attempt to identify distinctive

clusters among homes and IDPs in their approach to HR. However, the cluster analysis

produced relatively unstable and not very distinctive groupings and is therefore not presented

here.

The second type of multivariate analysis consisted of a number of regressions. We used the

method of backwards regression. Details of this method along with explanatory notes for our

style of presentation of regression results are included in appendix IV.A3. In order to

investigate the effects of environmental and organisational factors on the different HR practices



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we entered seven independent variables consisting of two LA commissioning variables (three

for homes), two labour demand variables and three organisational characteristics. Box IV.21

provides the full details of each independent variable. The labour demand variables consist of a

measure of local labour market demand and the median level of pay for all female part-time

workers in the local labour market, both derived from national statistics (see section I.7.1 and

appendix table I.A1 and appendix figure I.A1). There are also two LA commissioning

variables, the categorisation of partnership, mixed or cost-minimising LA (as derived in part II

above) and the actual fee level paid to the provider.

Box IV.21. Description of the dependent and independent variables used in the regressions on

HR practices

For each regression the effects of a number of independent variables were tested on the different

HR practices among homes and IDPs separately. The six HR practices variables, plus a summary

index variable, are as follows (see, also, box IV.6 above):

HR practices:

XHRPRACT: Overall summary index of HR practices

XPAYLEVELS: Index of pay levels

XPAYSTRAT: Index of pay strategies

XRRPRACT: Index of recruitment and retention practices

XEMPDEV: Index of employee development practices

XWT: Index of working time practices

XWO: Index of work organisation practices

And the seven independent variables (eight for homes) are as follows:

LA commissioning variables: Details of measure:

Partnership LA partnership=3, mixed=2, cost minimising=1

LA fee levels Actual £ fee levels

% dependency on LA For homes only, the proportion of service users

LA funded

Labour demand variables:

Local labour demand Scored 2 to 6

Female part-time pay Actual £ median pay rates for locality

Organisational characteristics:

Size Actual size, number of employees

Ownership: national chain,

local chain, single establishment

National chain is the reference category

Private for profit or voluntary

sector

Voluntary sector is the reference category



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The regression results are presented from two models in each case. This is because there is a

high correlation between two independent variables, LA fee levels and local labour market

demand34

. Consequently we ran the regressions twice - first with the LA fees but not labour

demand (model i) and again with the labour demand variable, omitting the LA fees variable

(model ii).

Tables IV.11 and IV.12 present the results for IDPs and homes, respectively. We only report

here the results for those indices of HR practices where the explanatory power of the

independent variables is relatively strong, using the measure of the adjusted R2 as a benchmark

(see IV.A.5).

For IDPs, several environmental factors and organisational characteristics appear to have a

significant association with the quality of HR practices (table IV.11). As anticipated, the local

authority commissioning policy appears to have a strongly significant influence on HR

practices. Both LA fee levels and the partnership orientation of the LA have a positive and

significant influence on HR practices. The partnership variable has a significant positive

association with the summary index of HR practices (model ii), the index for pay levels (model

i) and the index for pay strategy (model ii). And the LA fee level variable has a similarly

positive and significant relationship with the summary index (model i) and the pay strategy

index (model i). For IDPs, therefore, HR practices are significantly associated with the local

authority environment. Relations with a more partnership-oriented and high fee paying LA, as

opposed to a cost minimising and low fee payer LA, are beneficial for the adoption of better

HR practices.

Three organisational characteristics are also helpful in explaining the variance of HR practices

among IDPs. These are whether or not the IDP is a private profit-making organisation (as

opposed to a not-for-profit IDP), whether or not it is part of a local chain (rather than a national

chain) and the size of organisation. Holding all other factors constant, HR practices in profit-

making IDPs are inferior to those in the voluntary not-for-profit sector. The results presented in

table IV.11 suggest this result is significant for the summary X index (models i and ii) and for

the index of pay strategy (models i and ii), with confidence intervals of more than 99% in all

cases. Being part of a local chain, on the other hand, exerts a positive influence on the index for

pay strategy (model i) compared to IDPs that are part of a national chain. The size of workforce

of IDPs has a negative effect, insofar as larger IDPs are significantly associated with a worse

index for pay strategy (models i and ii).

Local labour market factors appear to play a less important role in explaining variance of HR

practices among IDPs. The variable for female part-time earnings exerts a significant positive

effect on the index for pay strategy (models i and ii), such that IDPs in areas of relatively high

female part-time earnings are more likely to register a better index for pay strategy.

34 LA fee levels are highly and positively correlated to local labour market demand factors, with a coefficient r =

0.66, which is also highly significant at p < 0.001.



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Table IV.11. The effects of environmental factors and organisational characteristics on

different indices of HR practices for IDPs

a. Summary index of HR practices (XHRPRACT)

i) With LA fees Coefficient Significance ii) With labour demand Coefficient Significance

Partnership LA 0.23 n.s. Partnership LA 0.32 **

LA fee levels 0.24 * --

-- Female part-time pay 0.19 n.s.

Single establishment 0.17 n.s. --

Private for profit -0.46 *** Private for profit -0.45 **

-- Size -0.169 n.s.

Note: OLS regression, sample 50 (IDPs). Adjusted R2 of 0.32 (model i), 0.32 (model ii).

b. Index of pay levels (XPAYLEVELS)


Partnership LA 0.334 ** Partnership LA 0.22 n.s.

Female part-time pay 0.13 n.s. --

-- Local labour demand 0.18 n.s.

Private for profit -0.20 n.s. Private for profit -0.22 n.s.


c. Index of pay strategies (XPAYSTRAT)


-- Partnership LA 0.32 **

LA fee levels 0.24 * --

Female part-time pay 0.24 * Female part-time pay 0.31 **

-- Local labour demand -0.19 n.s.

Size -0.30 ** Size -0.30 **

Local chain 0.23 * Local chain 0.20 n.s.

Private for profit -0.39 *** Private for profit -0.37 ***


For homes, the overall results of the regression models suggest that the same environmental

factors and organisational characteristics (plus the additional measure of dependency on LAs)

offer weaker explanatory power for the variance of HR practices (table IV.12). Moreover, the

LA commissioning environment appears to play a less significant role in influencing HR

practices in homes than in IDPs. This is most apparent for the summary index of HR practices

where we find neither the LA fee variable nor the LA partnership variable appear as significant

variables. These variables are nevertheless both significant (strongly significant in the case of

LA fees) for the index for pay levels for homes (model i). The regression suggests a 99%

confidence interval for the result that homes contracting with high fee paying LAs have a

significantly higher index for pay levels. The result for the LA partnership variable runs



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counter to the result for IDPs since it suggests a negative association (albeit at a less strong

level of significance than our result for IDPs).

Like IDPs, a key variable is the private for-profit organisational characteristic. When a home is

a private sector profit-making organisation, its summary index of HR practices and its index of

pay levels are significantly worse than those for voluntary sector homes (models i and ii).

Another organisational characteristic, the size of the home, is negatively associated with the

index of pay levels, which compares to its negative influence on pay strategy for IDPs.

A key difference with the results for IDPs is that the local labour market factor of median

female part-time earnings emerges as an important variable for explaining the variance in the

summary index measure (models i and ii). The results suggest that the higher the pay for

women in part-time jobs in the local area, the better the overall measure of HR practices in

homes. This factor is not significantly associated with pay levels in homes (although it exerts a

positive influence in model ii), but does display a strongly significant association with the

index of pay strategy (models i and ii) and the index of recruitment and retention practices

(model ii); neither result is reported in table IV.12 due to the low overall explanatory power of

the regression models.

Table IV.12. The effects of environmental factors and organisational characteristics on

different indices of HR practices for homes

a. Summary index of HR practices (XHRPRACT)


-- Partnership -0.13 n.s.

Female part-time pay 0.32 ** Female part-time pay 0.25 *

-- Local labour demand 0.24 n.s.

Size -0.15 n.s. Size -0.14 n.s.

Private for profit -0.28 ** Private for profit -0.27 **

Note: OLS regression, sample 52 (homes). Adjusted R2 of 0.15 (model i), 0.15 (model ii).

b. Index of pay levels (XPAYLEVELS)


Partnership -0.29 * Partnership -0.21 n.s.

LA fees 0.50 *** --

-- Female part-time pay 0.12 n.s.

-- Local labour demand 0.45 **

% dependent on LA -0.14 n.s. % dependent on LA -0.14 n.s.

Size -0.31 ** Size -0.25 **

Local chain 0.19 n.s. Local chain 0.14 n.s.

Private for profit -0.35 *** Private for profit -0.35 **




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The regression results provide a surprisingly contrasting set of explanations for the two indices

of pay practices for IDPs and homes. In terms of the conventional measure of explanatory

power (the adjusted R2), the selected environmental factors and organisational characteristics

provide a relatively good explanation of the variance of pay levels among homes but a poor

explanation for IDPs. Indeed the opposite holds for the index of pay strategies where we only

report the results for IDPs since the regression models for homes had very poor predictive

power.35

For homes, three factors have a significant negative association with the index for pay

levels (model i) - being a private sector organisation (a 99% confidence level), being in a

partnership LA (only a 90% confidence level) and being of large size. LA fees work in the

anticipated opposite direction with higher fees having a positive and strongly significant effect

on pay levels. Two other variables remain in but are not significant: that is, being in a local

chain compared to a national chain which has a positive effect on pay and having a high

dependency on the LA for clients which has a negative effect. Model ii yields very similar

results except that the significance of the partnership variable disappears and local labour

demand has a strongly positive and significant effect, providing an effective substitute for LA

fee levels (as anticipated given its strong positive correlation).

These relatively plausible results, where fee levels and labour demand have strong positive

effects on pay levels, are not replicated for IDPs. Nevertheless, for IDPs partnership does have

a positive impact on pay levels (significant in model i). No other variables are significant;

median female part-time pay in the area has a positive effect on the pay level index (model i)

while being a private sector organisation has the usual negative effect (models i and ii).

In terms of the index of pay strategies, for IDPs we find the same negative influence of

organisational size and being a private for-profit organisation (strongly significant for models i

and ii) as we found for the index of pay levels for homes. Positive effects derive from the

labour demand variable, median female part-time earnings, along with LA fees and being a

local chain rather than a national chain. Partnership-oriented LAs also have a positive and

significant association in model ii.

The regression models generated poor levels of prediction for four indices of HR practices,

namely recruitment and retention practices employee development, working time and work

organisation. For all four indices the adjusted R2 measure consistently fell below 0.2.

In sum, these multivariate statistical results lend support to one of the main propositions of this

research, namely that the LA commissioning environment plays a strong and significant role in

shaping the quality of HR practices. IDPs that contract with high fee paying LAs and

partnership-oriented LAs display a better overall index of HR practices than other IDPs. And

for homes, while the LA commissioning environment does not appear to be associated with the

35 For the regression estimating the effects on the index for pay levels the adjusted R

2 measures for homes are 0.36

(model i) and 0.41 (model ii) and for IDPs are 0.11 (model i) and 0.12 (model ii). For the regressions on the index

for pay strategies the measures of R2 for homes are 0.07 (model i) and 0.07 (model ii) and for IDPs, 0.31 (model i)

and 0.31 (model ii).



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overall measure of quality of HR practices, it has a strongly significant association with pay

levels such that those homes contracting with high fee paying LAs are more likely to register a

high index of pay levels than other homes. Conditions in the local labour market also matter;

homes in areas where the median pay for women in part-time employment is relatively high are

likely to provide high quality HR practices; for IDPs the same variable has an important,

similarly positive, association with the index of pay strategy. And finally, certain

characteristics of the organisation also facilitate our explanation of variance of HR practices.

The size of the workforce and the for-profit status appear to exert a negative effect on key HR

practices among both IDPs and homes, and IDPs that are local chains benefit from a higher

index of pay levels than IDPs that are part of national chains.

IV.5.2. Exploring the factors associated with good HR outcomes

In addition to exploring the factors associated with the quality of HR practices, we also used a

similar regression method to interrogate HR outcomes. Again, following the analytical

framework set out in part I of this report, we sought to test the impact of the external

environment – the type of LA commissioning and the local labour market context – and

organisational characteristics (as above). In addition, given that the bundle of HR practices

deployed in a particular organisation is likely to have a significant effect on the quality of HR

outcomes, we expanded the number of independent variables to include the seven indices of

HR practices (see appendix table IV.A17).

Drawing on the data from the telephone survey of providers, we constructed four measures of

HR outcomes that exploit both the subjective views of managers and the quantitative workforce

data. A first measure of recruitment and retention outcomes (XRROUTCOMES) is an

aggregate index of managers‟ subjective views about recruitment difficulties, staff turnover and

staff absenteeism. A second measure of training outcomes (XTRAINSKILDEV) combines

workforce data on the proportion of the care workforce qualified to NVQ level 2 and

managers‟ views about the future likelihood of their training at least 50% of their staff. The

third and fourth outcome measures are alternative quantitative measures of staff turnover – the

overall staff turnover rate for care workers (RT3) and the turnover rate excluding new recruits

(RT9).36

Tables IV.13 and IV.14 present the results for the first two measures of HR outcomes –

recruitment and retention outcomes and training outcomes – for IDPs and homes, respectively.

Across all regressions, the equation of association between the selected independent variables

and outcome variables provides a relatively low level of explanation; the adjusted R2 varies

from 0.10 to 0.29. Nevertheless, a number of variables appear to be significantly associated

with variation in these two HR outcomes.

36 While we have near complete data from providers for the first two outcome measures, it proved very difficult to

obtain reliable staff turnover data and as a consequence we have run regressions on smaller samples than we

would have liked – 37 IDPs and 45 homes.



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A first finding is that a key set of HR practices represented by the index of working time,

which reflects a mix of indicators such as the requirement for weekend and long hours working

and time off for training, exhibits a strongly significant and positive association with

recruitment and retention outcomes for IDPs (table IV.13). In both models (i and ii), this

finding suggests that the more IDPs are able to offer attractive (and less demanding) working

time schedules the better are the outcomes for recruitment and retention. Here is strong

evidence, therefore, that recruitment and retention outcomes can be shaped through attention to

what is perhaps one of the most important areas of HRM in IDPs given the complex nature of

work schedules. Two further significant variables are the organisational characteristics of size

and ownership. IDPs that are part of a local chain (model i) are significantly associated with

recruitment and retention outcomes that are higher than those of national chain providers. The

size of a provider‟s workforce tends to lower HR outcomes (models i and ii) with larger

providers significantly associated with lower scores for recruitment and retention compared to

smaller IDPs. As might be anticipated, strong local labour market demand appears to have an

adverse impact, with IDP managers in areas of strong labour demand more likely to register

negative views about recruitment difficulties and staff retention.

Table IV.13. The effects of environmental factors, organisational characteristics and HR

practices on indices of HR outcomes for IDPs

a. Index of recruitment and retention outcomes (XRROUTCOMES)


-- Partnership 0.26 n.s.

-- Local labour demand -0.29 *

Size -0.31 ** Size -0.30 **

Local chain 0.22 * Local chain 0.20 n.s.

XWorking Time 0.35 ** XWorking Time 0.39 ***


b. Index of training outcomes (XTRAINSKILDEV)


-- Partnership 0.17 n.s.

LA fees -0.31 ** --

-- Local labour demand -0.49 ***

Local chain 0.29 ** Local chain 0.27 **

XPay Levels 0.15 n.s. XPay Levels 0.14 n.s.

XEmployee

Development

0.14 n.s. --


Being part of a local chain is also significantly associated with better training outcomes among

IDPs (models i and ii). In other words, holding all other variables constant, IDPs that are



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members of a local chain are more likely than national chain members to report high levels of

NVQ trained care workers and/or to have high expectations about the share of staff who will be

trained. The variable that registers the strongest significance is the local labour market demand

variable (a 99% confidence interval). As with recruitment and retention outcomes (and also

similar to our evidence on pay strategies, above), labour demand displays a negative

association: IDP managers in areas of high labour demand are significantly less likely to report

favourable training outcomes compared to IDPs in areas of weak labour demand. This might be

considered surprising since providers in areas of high demand facing strong competition for

labour might be expected to seek to improve the bundle of employment conditions on offer to

workers, including the opportunities for skill formation. However, what appears to be

happening is that where providers experience poaching of skilled workers, they are less

inclined to invest in training provision or their investments may not yield as high outcomes due

to higher rates of staff turnover. A further surprising result concerns the nature of association

between LA fees and training outcomes for IDPs. While our results for HR practices above

suggest a clear positive association with the level of LA fees to providers, here we find instead

a negative association. The result is confirmed by a correlation test on the two variables which

shows a negative correlation, -0.29, significant at the 95% level.

The results for homes suggest the same independent variables provide a very weak explanatory

model for the measure of recruitment and retention outcomes but a relatively strong

explanation for the index of training outcomes (table IV.14). Only one variable is significantly

associated with recruitment and retention outcomes among homes, that of workforce size. As

with IDPs, the larger the home the worse are managers‟ views about recruitment difficulties

and retention outcomes (models i and ii). More variables are associated with the measure of

training outcomes; also, the results are the same for models i and ii due to the weak explanatory

value of LA fees and local labour demand. Homes that are single establishments are

significantly more likely to be associated with better training outcomes compared with national

chains. Competition for female labour in areas with relatively high levels of median earnings

for part-time jobs has the apparent effect of reducing training outcomes among homes, much

like the labour demand measure for IDPs. And, like our results for IDPs, we find a strongly

significant (99% confidence level) and positive association between the training outcome and

the set of HR practices that constitute our index of work organisation. Thus, training outcomes

are likely to be better in those homes that have a positive approach towards giving staff the

time to deliver quality care and to develop relations with users, as well as the opportunities to

exercise discretion in improving the way they work. This may suggest that when time is

squeezed in general, so are opportunities for training.

The regressions for the third and fourth measures of HR outcomes, namely overall staff

turnover (RT3) and staff turnover excluding new recruits (RT9), draw on a more restricted

sample of respondents to the telephone survey(37 IDPs, 45 homes) due to difficulties in

obtaining detailed turnover data from all respondents (see section I.7 and III.2). The results

explain a very high proportion of observed variance among IDPs (the adjusted R2 measure is

greater than 0.60 for both measures) but a comparatively lower proportion of variance among



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homes (with R2 values of around 0.20, similar to the above results).

37 Corresponding with this

overall finding, the regressions suggest that many more variables are significantly associated

with measures of staff turnover in IDPs than is the case for homes. Table IV.15 presents the

results for IDPs with separate columns identifying those factors that are significantly associated

with a lower rate of staff turnover and those associated with a higher rate of staff turnover. We

only present the results for model i (with LA fees and without the variable for local labour

demand) since the results from model ii are equivalent for the total staff turnover measure and

very similar for the measure of staff turnover excluding new recruits. Full details of

coefficients for the independent variables are in appendix table IV.A20.

Table IV.14. The effects of environmental factors, organisational characteristics and HR

practices on indices of HR outcomes for homes

a. Index of recruitment and retention outcomes (XRROUTCOMES)


Size -0.26 * Size -0.26 *

X Pay Levels 0.19 n.s. X Pay Levels 0.19 n.s.

X Pay Strategy -0.19 n.s. X Pay Strategy -0.19 n.s.

X Employee

Development

-0.23 n.s. X Employee Development -0.23 n.s.

X Work Organisation 0.14 n.s. X Work Organisation 0.14 n.s.


b. Index of training outcomes (XTRAINSKILDEV)


Female part-time pay -0.27 ** Female part-time pay -0.27 **

Local chain 0.20 n.s. Local chain 0.20 n.s.

Single establishment 0.34 ** Single establishment 0.34 **

Private for profit -0.19 n.s. Private for profit -0.19 n.s.

XPay Strategy 0.17 n.s. XPay Strategy 0.17 n.s.

XRecruitment&Retention

practices

-0.19 n.s. XRecruitment&Retention

practices

-0.19 n.s.

XWork Organisation 0.35 ** XWork Organisation 0.35 **


A clear finding for IDPs is the significance of association between a range of HR practices and

the two measures of staff turnover (table IV.15). However, good HR practices appear to have

both positive and negative effects. For the measure of total staff turnover (RT3), four good HR

37 Unlike the above regressions, the models testing the staff turnover measures used indicators of HR practices

rather than the summary index measures. As such, many more independent variables were entered as potential

explanatory factors (see appendix table IV.A.20).



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practices are associated with lower staff turnover and three good HR practices are associated

with higher staff turnover. For the measure of staff turnover excluding new recruits (RT9) we

find a significant association between four good HR practices and low turnover and between

five good HR practices and high turnover. We must remember that the regression results only

provide a test of statistical association, not cause and effect. As such, the apparently

contradictory findings may be interpreted as demonstrating, on the one hand, that good HR

practices in many organisations tend to encourage relatively low rates of staff turnover and, on

the other hand, that high staff turnover may induce some organisations to improve their HR

practices (in an effort to improve staff retention).

Those practices associated with higher staff turnover among IDPs include regular uprating of

pay (RT3 only), paying for CRB checks, using formal recruitment methods, fitting work

schedules with employees‟ circumstances (RT9 only) and offering guaranteed hours contracts

(RT9 only). The indicator on formal recruitment methods could feasibly work in the opposite

direction to what we anticipated, if for example recruitment by word of mouth leads to more

committed staff. However, it is very difficult to come up with any explanations why the other

four practices could do anything other than tend to reduce staff turnover. This suggests that the

direction of cause and effect is likely to run from HR outcome to HR practice. In other words,

IDPs in contexts where staff turnover is a particular problem are more likely to implement

better HR practices in an effort to improve staff commitment to the organisation.

The HR practices associated with lower levels of staff turnover among IDPs are opportunities

for pay increases, payment for weekend work (RT9 only), recognising a trade union, selecting

new recruits who have care skills and qualifications (RT3 only) and provision of time off for

training. The first and third of these variables are highly significant (as defined by a 99%

confidence interval), such that those IDPs that offer opportunities for care workers to increase

their pay and those that recognise collective representation by a trade union are strongly

associated with lower rates of staff turnover.

The external environment and organisational characteristics play a lesser role in shaping staff

turnover compared to our other measures of HR outcomes presented above. Both larger size of

provider and the partnership orientation of the local authority only appear as significant in the

regression on the measure of staff turnover excluding new recruits where we find both

measures are associated with high staff turnover. The level of female part-time pay in the local

area is associated with relatively low levels of total staff turnover (RT3 only).

For homes the regression results suggest the relationship between HR practices and staff

turnover measures is more straightforward, albeit revealing a far smaller list of significant

variables (table IV.16). Just two indicators of HR practices are significantly associated with

staff turnover and in both cases the regression results suggest good practice is associated with

lower staff turnover. Just like IDPs, those homes where managers value caring skills and

experience among job applicants are more likely than other homes to enjoy low staff turnover.

For the measure of staff turnover excluding new recruits (RT9) a further indicator of HR



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practice, the share of staff who regularly work weekends, also displays a significant

association. Here, the results suggest that those homes where a smaller proportion of care

workers regularly work weekends enjoy lower staff turnover, excluding new recruits.

Table IV.15. Factors associated with higher and lower measures of staff turnover in IDPs

a. Total staff turnover (RT3)

Factors that reduce staff turnover Factors that increase staff

turnover

LA commissioning environment: -- --

Labour market demand: Higher female part-time pay (**) --

Organisational characteristics: -- --

HR practices: Pay upgrading opportunities (***) Regular uprating of pay (***)

Recognition agreement with trade

unions (***)

Employer pays for CRB checks

(***)

Skills and qualifications desirable

among job applicants (*)

Use of formal recruitment methods

(***)

Time off from care duties to attend

training (*)

b. Staff turnover excluding new recruits (RT9)

Factors that reduce staff turnover Factors that increase staff

turnover

LA commissioning environment: -- Partnership (***)

Labour market demand: -- --

Organisational characteristics: -- Larger Size (*)

HR practices: Pay upgrading opportunities (***) Regular uprating of pay (**)

Extra pay for weekend work (**) Employer pays for CRB checks

(***)

Recognition agreement with trade

unions (***)

Use of formal recruitment methods

(***)

Time off from care duties to attend

training (**)

Work schedules that fit staff

preferences (**)

Offering guaranteed hours contracts

(**)

Note: see Appendix table IV.A20 for details.

As with IDPs, the local labour market appears to have limited association with variation in staff

turnover rates with the exception of female part-time pay which has a negative association with

total staff turnover. A distinctive result for homes is the differentiation between private for

profit organisations and voluntary not for profit organisations. The former are significantly

associated with higher levels of staff turnover on both measures, total staff turnover and

turnover excluding new recruits. For homes, therefore, the private for profit status is negatively



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associated with three of our four HR outcome measures, a result that serves as a cautionary

warning to further advances in the role of private sector providers in delivery of health and

social care. The opposite association is found for the organisational characteristics of single

establishment (compared to national chain homes); single establishment homes are

significantly more likely to register lower staff turnover.

Table IV.16. Factors associated with higher and lower measures of staff turnover in

homes

a. Total staff turnover (RT3)

Factors that reduce staff

turnover

Factors that increase staff

turnover


Labour market demand: Female part-time pay (**) --

Organisational characteristics: Single establishment (*) Private for profit (*)

HR practices: Skills and qualifications desirable

among job applicants (**)

--


Factors that reduce staff

turnover

Factors that increase staff

turnover


Labour market demand: -- --

Organisational characteristics: Single establishment (*) Private for profit (*)

HR practices: Skills and qualifications desirable

among job applicants (*)

--

Lower % of staff regularly

working weekends (*)

--

Note: see Appendix table IV.A21 for details.

In summary, through the method of multivariate analysis this section has demonstrated a

number of statistically significant associations between factors in the internal and external

environment and the likelihood of IDPs and homes implementing good HR practices and

enjoying good HR outcomes. Our guiding framework for analysis was figure 1.1 from part I of

this report, which presents the key factors likely to influence the HR approach of care

providers. Several findings deserve highlighting. In relation to the adoption of HR practices,

the notion that the quality of LA commissioning (specifically higher fees and a partnership

orientation) is associated with better HR practices was confirmed for the summary index of HR

practices among IDPs and for the index of pay levels for homes. However, these positive

influences interact with several other factors that are more difficult to shape through strategic



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policy action. In particular, conditions in the local labour market (especially the median level

of female part-time pay in the locality) display a significant association with the variation in

our measure of pay strategy practices among IDPs and the summary index of HR practices

among homes. Also, two organisational characteristics have a significant impact; smaller

providers and not-for-profit providers are more likely than larger providers and for profit

providers to implement good HR practices.

Our analysis of factors associated with HR outcomes points very strongly to the significant role

of HR practices, especially among IDPs, suggesting a possible linear cause and effect

relationship from internal and external factors through to HR practices and then to HR

outcomes. However, as we have argued, in some cases good HR practices may be induced by

pressure from local labour market conditions, in an attempt to reduce very high levels of staff

turnover. As a consequence not all good HR practices are associated with better HR outcomes.

Nevertheless, the results did highlight a significant association between IDPs‟ use of better

working time practices and better recruitment and retention outcomes, as measured by our

summary index of recruitment and retention conditions. Moreover, a bundle of good HR

practices in IDPs - good pay practices (opportunities for pay upgrading and paying a premium

for weekend work), trade union recognition, appreciation of care skills and care experience

when selecting new recruits and provision of time off for training – is associated with low

turnover among care workers. Those good HR practices what were found to be associated with

higher turnover included some basic employment conditions such as regular uprating of pay,

employer paying for CRB checks, fitting work schedules with employees‟ circumstances and

offering guaranteed hours contracts, suggesting that employers may only provide some of the

basic employment protections when required to do so by high labour demand and associated

turnover levels. Likewise, the association of formal recruitment methods with higher turnover

may reflect either a need to extend recruitment beyond informal networks in areas of high

demand or alternatively that more informal methods yields more stable and committed

employees.

Among homes fewer HR practices are identified as significant. Nevertheless, it is notable that

good work organisation practices, such as encouraging discretion in the job and facilitating

time to undertake caring duties, are associated with high scores on our training outcome

measure for homes. Two other HR practices are associated with lower staff turnover rates in

homes - the identification of care skills when selecting good recruits and the facility for some

staff to avoid regular weekend working.

For both homes and IDPs certain organisational characteristics also matter in explaining

variation in HR outcomes, namely: the smaller the provider the better the summary index of

recruitment and retention outcome; national chain providers appear to have worse training

outcomes than single establishment homes and than local chain IDPs; and not-for-profit homes

enjoy better staff turnover than for profit homes.



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IV.6. Providers’ views on the social care policy and commissioning

environment

IV.6.1. Providers‟ attitudes towards and experiences of local authorities

We asked providers how they would rate their relationships with the LA on a five point scale

from very good to very poor: 81% of care homes and 87% of IDPs regarded their relationship

as either very good or good and only 6% of homes and 6% of IDPs regarded their relationship

as poor or very poor, the rest remaining neutral. Despite this relatively low level of variation in

answers to the question, when we compute average scores by individual LA we do find some

relationship between our classification of LAs and providers‟ responses concerning their

relationships with the LA.

Table IV.16. Measure of providers’ satisfaction with LA relationship

(1-5 scale, very poor to very good)

IDPs

average score

Homes

average score

All

average score

Partnership LAs:

AH 4.6 4.5 4.6

LK 4.3 4.2 4.3

RN 4.5 4.7 4.6

UY 4.7 3.0 4.4

XD 4.2 4.4 4.1

Mixed LAs:

AD 4.5 3.5 4.0

OM 4.3 4.7 4.6

ON 4.2 3.5 3.9

RT 5.0 3.3 4.3

TE 5.0 3.0 4.2

Cost minimising LAs:

AW 4.7 4.5 4.6

HD 3.2 4.0 3.6

IL 3.7 3.8 3.0

RD 3.7 4.5 4.1

Providers in cost minimising LAs tend to display lower satisfaction with their relationship with

the LA for domiciliary care than among providers located in partnership or mixed LAs.38

Table

IV.16 shows that among IDPs, the level of satisfaction was lowest in three cost minimising

LAs – HD, IL and RD. Scores for homes were more varied with three mixed LAs - ON, AD

38 The one exception is the cost minimising local authority AW where relationships with providers were reported

as relatively good.



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and RT – recording the worst scores but two of the cost minimising LAs also receiving below

average satisfaction ratings.

A number of quotes from the providers during the telephone interviews underscore the

complexities of categorising relationships with the LA. Some made a distinction between their

relationship with their immediate points of contact and their relationship with those making

policy decisions. Others pointed to differences in their relationships with different grades or

levels of staff.

The difficulty is it needs to be qualified because they have a contracts officer and we get on

very, very well with her. Her boss, great guy, get on well with him. But when we‟ve got an

issue we have absolutely no way into the council to make any difference. …..when we‟ve got

particular issues they don‟t want to know. ……So that‟s the difficulty of dealing with a public

authority. You just can‟t get there to where the decisions are made. The bureaucracy doesn‟t

allow you to do it. (ON.D.1 DN).

I think its best to speak of the last couple of years because before that it wasn‟t so wonderful, I

think that sometimes its about there are some very capable people there and some team leaders

who aren‟t so good, so probably some problems with communication following things up and

that is often around safeguarding issues. (RD.D.2.CL).

Another distinction made was between the personal relationship and their satisfaction with

funding:

With regard to funding when I said we had a good relationship, well they don‟t meet our

funding requirements. (RD.HN.4.C.N).

Work relationship is fine, but it is the funding issue. We are the lowest paid authority. (IL. H.

4).

Past poor relationships were apparently forgiven if new policies provided more financial

support:

I think it‟s probably a lack of support in the past. But what has improved is training. It‟s had a

huge impact for us because it‟s saved us a fortune off our training budget. (RD.H.3.A.L).

Some providers clearly had a negative view of the role of the LA:

I think the experience we get in nursing homes is it‟s kind of almost like a policing of us rather

than a supportive, or work together. (ON.HN.1 BS).

Yet others attributed problems to the policies of central government rather than the LA itself:

But then again, they‟re on a budget aren‟t they? It‟s the government, it‟s not them. (ON.D.2

AS).



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Specific problems identified ranged from a tendency to impose the latest policy fads or

concerns on providers, regardless of its relevance or priority, to insistence on contract

compliance even when LAs had been informed of recruitment difficulties and staff shortages.

[Its] pressures that senior management put onto you, you know it‟s other people‟s agendas …

So no matter what you‟ve got planned if they say, because of an issue in another unit, every

member of staff has to be refreshed in, oh I don‟t know „Violence at work‟ …then your training

plan just goes out of the window. It means that you‟ve got to get everyone on that training.

(HD.HN.1.C.LV).

[It‟s the] contract – [there‟s] no cap on it. They are aware we have recruitment problems and

we don‟t have enough staff, but they refuse to stop forcing work on us because it is part of our

contract. In other words, it‟s, „You have the contract and it is your problem‟. (HD.D.1).

Recurring themes among the national providers in discussing their relationships with LAs were

first the variation between LAs, with only one national provider saying they did not find much

variation. Others stressed differences in approach to communication; differences in the

administrative details of contracts and commissioning practices (leading to great waste and

duplication); and above all differences in pricing strategies. These include differences in the

fixed fees:

Local authorities will sometimes fix in the contract what the price should be. So I suspect they

haven‟t necessarily market tested whether you can get care workers at some of those rates. So

there are some anomalies there. You‟d like to think that before they came up with the charge

rate they maybe had a view of what they saw in terms of care worker retention and pay. But I

wouldn‟t like to say that always happens…… Managing Director, NATDOM4

And differences in their implementation of policies which affect the overall profitability of the

business:

If you look at some of the requirements, and this is where it gets implicated by local authorities,

the advent of call monitoring, electronic call monitoring. ….Some councils have a greater

rigour to that. Some councils will tell you when they expect the calls to be done. So there‟s

degrees of flexibility, or not, in there. I think the other thing is some local authorities will pay

mileage and visit fees, and some won‟t. Some will fund all sorts of training to support you.

Increasingly that‟s diminishing. You see less and less people willing to fund care worker

training so it‟s down to the providers really. (Managing Director NATDOM4).

Some LAs give us the contract then move the goalposts, for example by introducing call

monitoring. It is a difficult thing to do mid-contract. Some dictate to you what system to use –

it is always a strain on the budget. Because of the different LAs, we find it difficult to

standardise. (National Recruitment Manager, NATDOM3).

Some aggressive pricing strategies were, according to some national providers, jeopardising the

supply of care services. Some national providers stressed that although they would

accommodate to local demands they would not do so at the expense of minimum standards set

by the company.



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So for us it‟s not about flexing completely. It‟s actually about making sure that we have got the

safeguards we want in our business. So we will always enforce the minimum standards that we

see and hopefully they‟re higher or the same as the local authority requires. …We know we can

be efficient and competitive in terms of our price, but for us, we will walk away from contracts

if we think that the local authority is going for cheap and cheerful and basically putting lives at

risk. (Managing Director, NATDOM4).

Some LAs were said to be inconsistent between quality and price, expecting „the highest level

of service but want[ing] to pay per minute‟ (Managing Director, NATDOM5). A further

problem identified was that some LAs wanted to,

…run your business for you. They insist on the structure of the branch. They tell you you have

to have certain people in place, and if you don‟t they reduce the hourly rates that you claim.

Micro-management and minute billing. We can only claim for every minute of care we provide

and we can only pay the carers those minutes. (National Recruitment Manager, NATDOM3).

One specific way in which LAs seek to develop relationships with providers is through

provider forums. Most LAs hold provider forums and this is confirmed by the finding that only

9% of independent providers said their LA did not hold a providers‟ forum. Table IV.17 shows

that of the 88 providers who responded to a question about their own attendance at forums,

65% said they always or mostly attended the forums. There was a notably lower attendance

among the providers located in our „cost minimising‟ LAs than was the case for the

partnerships or the mixed category LAs. Of the 77 who expressed a view on the usefulness of

the forums, around 65% considered them to be very useful or useful. Those located in cost

minimising LAs were most likely to consider them not very useful or a waste of time,

accounting for 18% of all providers in these LAs.

In one LA, LK, the provider forum had apparently broken down and relations between the

independently run homes and the LA had only been restored through formation of an

association of independent care providers to re-establish dialogue with the LA. Members of the

association were now invited to sit on committees and had opportunities to communicate with

councillors:

We have managed to get very good dialogue with them; we communicate a lot better. From

time to time, there might be a few difficulties where they reject things out of hand, but on the

whole, it is innovative, there are not many counties that have this sort of joint partnership. I sit

on the scrutiny committee of the council for special care and that is a voice – it is useful for

informing councillors about what is actually going on. In the past, councillors hadn‟t a clue.

(LK.HN.1 BS).

One national provider commented on the very different approaches to managing forums across

LAs reflecting different degrees of interest in communication with and listening to the concerns

of the care providers:

We deal with some 30 different authorities and I see 30 different examples of local authorities.

What I would call good authorities are the ones who organise regular provider forums. They



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consult all the providers, pretty much in advance, or at least keep them informed as to what

they‟re thinking. Also [they] facilitate meetings between providers, so that they can hear a

consensus view. And [they] are quite happy to accept challenges from providers, and also to

listen. And quite often you find that over a period of time they implement what you have said.

…Then there are the authorities who pay lip service to it. Just try and do the minimum to meet

up with CQC requirements. Say, „Oh yes we are consulting and blah, blah, blah‟ - whatever.

And then there are others who just don‟t do anything. And yet at the same time they impose

things without any commercial awareness as to the impact this would have on the providers. ...

They don‟t seem to connect up the building of the capacity and the building of the service, with

the changes in the rules and the regulations. (Managing Director, NATDOM5).

Table IV.17. Provider views about LA providers’ forums

a. Frequency of provider attendance

Always Mostly Occasionally Never

Partnership LAs 50.0% 26.5% 14.7% 8.8%

Mixed LAs 44.8% 17.2% 20.7% 17.2%

Cost minimising LAs 32.0% 20.0% 24.0% 24.0%

All LAs 43.2% 21.6% 19.3% 15.9%

Note: Total responses 88, missing 17 (excluding LADPs).

b. Usefulness of forums

Very useful Useful Sometimes

useful

Not very

useful

Waste of time

Partnership LAs 23.3% 33.3% 36.7% 3.3% 3.3%

Mixed LAs 32.0% 44.0% 20.0% 0.0% 4.0%

Cost minimising LAs 27.3% 36.4% 18.2% 13.7% 4.6%

All LAs 27.3% 37.7% 26.0% 5.2% 3.9%


The comments confirm the prevalence of very different approaches to building relationships

with providers identified in our own interviews with the selected LAs.

Providers were also asked what, if any, changes in the LA‟s commissioning and contracting

arrangements would do most to assist them in recruiting and retaining a stable and motivated

workforce. A list of options was provided (three items common to both homes and IDPs and a

further two items added for IDPs) and multiple answers were accepted. A rise in LA fee levels

was the most popular option, chosen by 55% of homes and 58% of IDPs. This view was also

forcibly endorsed by at least one manager of an LADP.

For the life of me I do not know how you can offer a service for somebody when all you receive

is ten and a half quid an hour. … A woman set up a cleaning firm in [this area]. She charges

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and she has a number of cleaners that she sends out. For that she charges twelve quid an hour.

We‟re asking people to provide personal care services, with all that that involves, at ten and a

half quid an hour. We have to pay a lot more, frankly, if we want a good quality service that

meets the national minimum standards in a robust way that provides the level of care that

people deserve. We have to pay a lot more for it. (AD.DIH1.DP).

The option of more variation in price by service user or for homes by type of accommodation

was selected by 31% of homes and 34% of IDPs. One home called for „much higher pay rates

for those with mental health problems‟ (RD.H.3.A.L). However, one IDP felt everyone was

underpaid so that the only way forward was better funding all round.

No I think care, whether we‟re going in to give somebody a bath or care to someone being

commoded or providing support to someone through cooking and domestic help, it all places

the same demands on carers, the same training levels and the same conditions that they are

working under, so it needs to be better financed. (RD.D.1.C.S).

There was more variation in the third option – a more integrated approach by the LA to service

delivery- with 37% of IDPs selecting this change compared to only 21% of homes. The

additional items asked of the IDPs were also selected by over a third of IDPs: that is, there was

fairly widespread support among providers for more scope to determine how care is delivered,

higher guaranteed volumes of work and more time for a service user. However, those not

selecting the option on guaranteed volumes may have sided with the provider who said that

block contracts were squeezing out space for those not selected to be block contractors or

preferred providers.

Some more specific issues were raised under the „other changes‟ category. Some of the

comments related to specific policies of their LA: for example, one home (TE.H.2) was

concerned about a five to ten year lock-in written into their contracts. One home asked for

„More clarity, openness and honesty‟ (XD.D.2). Among IDPs, the concerns related to the lack

of attention to people in the tendering process - according to the respondent at one IDP

RN.D.3) the LA commissioner needed to follow the guidelines in this respect - and others

talked about the lack of attention to quality of life of users and the fact many users were lonely.

One provider thought LAs should pay mileage (ON.D.4) and another that they should be

speedier in their response (RT.D.2). Some providers asked for changes that went beyond the

individual LA; for example one home called for registration for care staff to raise their profile

(XD.H.3) and others raised concerns about complexities of the funding arrangements or about

restrictive regulations on admissions to care homes.



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IV.6.2. Providers‟ attitudes towards and experiences of monitoring systems

Through our telephone survey, we asked providers about their experience of monitoring

systems. Questions were designed to cover both the role of the LA in monitoring and of the

role of Care Quality Commission (previously known as the Commission for Social Care

Inspection).

Role of the LA in monitoring providers

The providers were asked what importance they thought the LA placed on provider HR

policies (table IV.18). Around 43% said that it was very important and a further 44% somewhat

important, leaving only 14% of respondents who said their LA attached no importance to it.

This share was highest among the mixed category of LAs and it was the providers in the cost

minimising LAs that had the highest shares saying the LA considered their HR practices to be

very important – at 50%. One provider in a cost minimising LA, however, made the comment

that there may be greater interest in compliance with regulations than in supporting the

providers to improve their HR practices.

Well that‟s it they … love lots and lots of paper work and love giving lots of rules and

regulations but then never support you to obtain them or keep up with them or stuff. We have

tendered for work with them but sometimes its just unrealistic in terms of demands made by

them. (RD.D.1.C.S).

Table IV.18. Provider views about the importance the LA places on providers’ HR

practices

Very important Somewhat important No importance

Partnership LAs 36.0% 56.0% 8.0%

Mixed LAs 44.8% 34.5% 20.7%

Cost minimising LAs 47.4% 42.1% 10.5%

All LAs 42.5% 43.8% 13.7%


The survey also included a question about whether the provider‟s LA was directly involved in

monitoring or whether the LA relied on the Care Quality Commission to monitor its providers.

Table IV.19 shows that around four fifths of providers said their LA was involved directly and

just one fifth said the LA relied completely on the CQC. The involvement in monitoring was

somewhat higher in the partnership LAs at 85% but LA involvement was higher in cost-

minimising than in mixed LAs.

Comments from the providers suggest that the amount and frequency of monitoring varies and

that LA practice may be inconsistent over time:



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[The LA] does do some monitoring. … They come in and check policies and procedures. but

that‟s probably happened just once in the last five years. (RD.H.3.A.L).

[The LA] had stopped active monitoring, but now restarted. (LK.D.3 DS).

Certainly there is a lot of monitoring. [The LA] is very much better than they were I have to

say. (OM.D.2.DN).

They are very strict and visit the branch regularly and take away care workers‟ time sheets for

audits regularly. (HD.D.1).

[The LA] doesn‟t do any [monitoring], but I think that it will do in the future. We have had to

send our policies, procedures, training policies, etc. (TE.H.4 AS).

Table IV.19. The role of the LA and CQC in monitoring providers

LA direct role CQC only role

Partnership LAs 85.4% 14.6%

Mixed LAs 71.4% 28.6%

Cost minimising LAs 81.5% 18.5%

All LAs 79.6% 20.4%


Many provided examples of the types of monitoring that LAs were engaged in. The areas that

were mentioned frequently were recruitment processes and turnover or training. Only one

mentioned equality and diversity policies and some implied that most of the monitoring was

done at the tender and contract stage. One provider said that not only was the LA involved a lot

in monitoring HR, including looking at their HR policies, but they had also provided them with

access to some advice from an employment law firm

For some providers the involvement of the LA as well as CQC was too much:

The day of the cancelled interview [with the research team], they were in all day. I wish they

would talk to each other [CQC and LA], it is exhausting. (IL.H.4).

There is too much inspection. The company come in, the LA, CQC. What I want from the

company is for them to say that I am doing OK, and leave me. CQC is fine, but sometimes it

seems as though there is too much. (IL.H.3).

These views were held by some national providers who saw the active involvement of LAs in

quality monitoring as unnecessary duplication and increasing problems at defining and

adopting a consistent policy.

I think some of them [LAs] decide to have a much greater involvement with inspection of the

services that they‟re commissioning, which we think is duplication because there is the CQC

that is charged with making sure quality is right in everything. (Corporate Services Director,

NATHOME2).



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Where we can have issues is around, from an HR perspective, it is around some of the policy

stuff. Whereby we‟re having to double train people because we have, say, issues around,

someone has a separate medication policy, and we from a CQC perspective have to do it one

way, and then we have to do it again another way from a local authority perspective. So it can

be a little bit of a struggle sometimes, where the local authority will insist on a certain type of

training taking place, which is not necessarily part of the National Minimum Standards or

anything mandatory. (HR Director, NATHOME5)

The results presented in table IV.20 suggest that over 70% of providers were satisfied or very

satisfied with CQC quality standards but that satisfaction rate fell to below 58% when asked

about satisfaction with CQC quality rankings. A very high share of those ranked one star were

unsurprisingly dissatisfied and nearly 27% of those ranked 2 star were also not satisfied. Even

7% of the 3* establishments expressed dissatisfaction.

A repeated theme among the providers was a concern over the consistency of CQC ratings.

Inconsistency was attributed both to variability among inspectors and to false impressions due

to snapshot inspections.

Well I think that the standards are a very good thing but I‟m not altogether sure about the

Commission because I think that they‟re quite sort of inconsistent. I think that some of their

inspectors are inconsistent but the standards are good. (UY.D.2.B.S).

I think it would be better if it was done over a length of time rather than just a snapshot of that

day that they‟ve come in. (HD.HN.1.C.LV).



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Table IV.20. Providers’ attitudes towards the Care Quality Commission

a. Satisfaction with the CQC’s set of quality standards

Very

satisfied

Satisfied Neutral Dissatisfied Very

dissatisfied

Partnership LAs 28.3% 52.2% 13.0% 2.2% 4.4%

Mixed LAs 21.1% 42.1% 26.3% 5.3% 5.3%


All LAs 27.0% 44.4% 19.1% 5.2% 4.4%

Note: Total responses 115.

b. Satisfaction with the CQC’s system of quality ranking

Very

satisfied

Satisfied Neutral Dissatisfied Very

dissatisfied

Partnership LAs 19.6% 37.0% 26.1% 6.5% 10.9%

Mixed LAs 18.4% 34.2% 29.0% 10.5% 7.9%


All LAs 20.9% 36.5% 25.2% 9.6% 7.8%

Note: Total responses 115.

c. Belief that the individual provider star ranking is fair

Yes No

1 star rating 28.6% 71.4%



All providers 72.3% 27.7%

Note: Total responses 112; missing 3.

Similar concerns over consistency were also expressed by national providers (see box IV.22).

A further problem was the focus of the CQC on those rated adequate or poor with less frequent

inspections for those seeking to improve from good to excellent; for some national providers

this made it difficult to apply pressure to raise standards. Some of the national providers were

operating their own audit and monitoring systems both to raise standards and to ensure that

their homes or IDPs were ready for CQC inspections (box IV.22).

Suggestions from the telephone survey respondents as to how to change or improve CQC

monitoring included the following:

Less attention to paperwork and more attention to people - „particularly for people who don‟t

speak [they need to] use more skilful communication with people and their families.‟

(RD.D.2.CL);

More focus on the needs of users through „sight of detailed care plans‟ (AH.D.3.CN);



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More focus on building relationships, „to encourage organisations to meet standards and to

work together with the Care Quality Commission to aim for higher standards right across the

board‟. (OM.D.2.DN);

More „listen[ing] to what we are saying‟ and „less tend[ency] to treat all the homes the same.‟

…. so that „what is deemed necessary in a big home where there might be different staff on

each day‟ might not be in a small home where managers see and talk to their staff every day.

(RD.H.3.A.L);

Change to the ranking system to use the 5* system used by the hospitality industry on the

grounds that „I wouldn‟t stay in a two star hotel‟ (LK.H.3 BL).

Box. IV.22. The views of national providers towards care standards

i) Burden of regulatory compliance

The challenge is to meet the increasing expectations and burdens of regulations, of training, within

a fee rate which is declining, or not increasing at the same rate. (Managing Director, NATDOM5).

ii) Effectiveness of CQC

I think they are in such a state of flux. I think what I‟m not satisfied about is the lack of consistency.

Different inspectors have different approaches, so that‟s one thing. Not satisfied at the rate at

which the inspectors are changing. (Managing Director, NATDOM5).

We actually go quite far beyond CQC standards through quality. So we like to feel that because

we‟re doing that we should be pretty much compliant with anything CQC would do. I think that‟s

been borne out by the results of our audit inspections. I guess the complexity of that is that

sometimes you are dependent upon the inspectors. Good day, bad day, or focus [on a ] particular

area. (Managing Director, NATDOM4).

I think for us, we have our internal audit team as well looking at different things. So for us, the

combination of the two works well. Our internal quality audit is, I think, harder than the CQC was

and I think, in terms of people and motivation, the thing that‟s the most difficult with CQC is that

they‟re not going to be assessing their good and excellent services. They‟re focusing on the poor

and adequates, which means it‟s difficult to get a good service to excellent at the moment. (HR

Director, NATHOME3).

The biggest problem we have is inconsistency. We have what I think is a relationship provider,

which is a senior manager at their headquarters. But that person has no executive power over the

inspectors all over the country. And we will get an inspector in one part of the country saying you

know, you‟ve got to do xyz because regulation say so. And we‟d say, well that‟s not how we read it,

with all due respect, it‟s not like how the CQC read it, and sometimes it will lead to a debate and

others it will lead to, „I‟m inspector here, you do as you‟re told‟, or whatever. (Corporate Services

Director, NATHOME2).



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iii) Activities to improve outcomes

What we‟ve done is we‟ve now got a regulation team which helps managers. Sometimes we don‟t

evidence the good things we do well and I think it‟s taking that turnaround of „you‟re good at this;

lets show it‟ and we sometimes don't have the evidence, because it‟s very evidence led and they‟re

constantly trying to move to an objective type of regulation. But it‟s getting our managers and

supporting them to get the training records. Sometimes it is happening but it‟s how you evidence the

things that are happening. (Recruitment Director, NATHOME1).

Every region now has a head of service quality and they have reporting to them, a team of service

quality inspectors too, who do exactly that; they go into the homes, inspect them and rate them

internally and help them come up with action plans to address any issues, and then there‟s a team of

service quality advisers who actually go into the homes and help them implement plans, coach and

support the home manager. … Rather than waiting for CQC to come and tell us here‟s a problem,

we‟re aiming to identify those kinds of things for ourselves and then we can take action so that by

the time CQC come we can either say, „Yes, we know we‟ve got problems and this is what we‟re

doing about them‟, or we‟ve actually tackled them and in fact CQC are looking at something rather

better. (Group HR Director, NATHOME4).

In addition to asking providers about their satisfaction with care standards, we also asked them

to identify which of the CQC standards they found the most challenging. Table IV.21

aggregates all the answers covering the four most challenging standards for homes and IDPs

separately. This reveals that the care standards that are the most difficult to meet vary between

homes and IDPs, related to the nature of the service. Thus, for IDPs the most challenging

standard was to ensure „service users are protected from abuse, neglect and self-harm‟,

presumably as a consequence of the fact that IDP service users are located in their own homes

and are only seen intermittently and by mainly one member of staff. For homes the most

challenging standards is ensuring that „service users find the lifestyle experienced in the home

matches their expectations and preferences and satisfies their social, cultural, religious, and

recreational interests and needs‟. The difficulty in meeting this standard in part relates to

differences in expectations among service users as one home manager commented:

I don‟t find any of them [care standards] challenging; this is my job, so professionally I should

be able to meet them. Maybe the one … to do with their [users‟] perceptions. They may expect

to be tied to the bed and fed bread and water, or [they may] expect three staff in the room,

chandeliers and champagne for tea (IL.H.4).

The standards that relate to staffing issues - including training, skills or performance appraisal

(asterixed in the table) - were mentioned only by a minority of providers, accounting for 16 out

of 92 responses among homes and for 14 out of 96 among IDPs. But of course many of the

standards are implicitly dependent upon quality care staff, especially in the IDPs.



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Table IV.21. CQC care standards most difficult to meet for homes and IDPs

(aggregate scores for the top four most difficult to meet care standards)

Home care standards Rank

(no. of

homes)

Domiciliary care standards Rank

(no. of

IDPs)

Service users find the lifestyle experienced in the

home matches their expectations and preferences

and satisfies their social, cultural, religious, and

recreational interests and needs.

1 (18) Service users are protected from abuse,

neglect and self-harm

1 (18)

Service users, where appropriate, are responsible

for their own medication and protected by the

home‟s policies and procedures for dealing with

medicines.

2 (10) Policies and procedures on medication

and health related activities protect service

users

2 (16)

Service users‟ health, personal and social care

needs are set out in an individual plan of care.

3 (7) Service users receive a consistent, well-

managed and planned service

3 (13)

Staff are trained and competent to do their jobs* 3 (7) The risk of accidents and harm happening

to service users and staff is minimised

4 (10)

Service users‟ needs are met by the numbers and

skill mix of the staff*

5 (6) Service users know and benefit from

having staff who are supervised and

whose performance is appraised

regularly*

5 (9)

Service users assessed and referred solely for

intermediate care helped to maximise their

independence and return home.

6 (5) Service users treated with respect, valued

and right to privacy upheld

6 (7)

Service users are helped to exercise choice and

control over their lives.

6 (5) Care needs individually assessed 7 (6)

The home is run in the best interests of service

users

6 (5) Health, safety and welfare of service users

is promoted and protected

8 (5)

Service users receive wholesome, appealing,

balanced diet and pleasing surroundings at times

convenient to them

9 (4) The well-being, health and security of

service users is protected by the agency‟s

policies and procedures on the recruitment

and selection of staff

8 (5)

No service user moves into the home without

having his/her needs assessed and assured that

these will be met.

9 (4) Service users know that staff are

appropriately trained to meet their

personal care needs*

8 (5)

The health, safety and welfare of service users and

staff are promoted and protected

9 (4) Service users, relatives and

representatives are confident that their

complaints will be listened to, taken

seriously and acted upon

11 (4)

Service users are in safe hands at all times 12 (3)

Service users‟ financial interests are safeguarded 12 (3)

Service users maintain contact with

family/friends/representatives and the local

community if they wish.

14 (2)

Service users are protected from abuse 14 (2)

Service users feel they are treated with respect and

their right to privacy upheld.

14 (2)

Service users‟ health care needs are fully met 14 (2)

Service users are supported and protected by the

home‟s recruitment policy and practices

18 (1)

Service users live in a safe, well maintained

environment

18 (1)

Service users live in a home run and managed by a

person who is fit to be in charge, of good character

and able to discharge his or her responsibilities

fully

18 (1)

Note: * Care standard relating directly to HR issues such as staffing levels, skills, training and performance

appraisal.



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IV.6.3. Providers‟ attitudes towards, and experiences of, policy developments

likely to affect social care

Providers were asked to comment on two policy developments with potential implications for

the social care market. One was whether the new regulations limiting non EU migrants would

affect their ability to recruit sufficient or sufficiently skilled care staff. Most answering said

either that they had not used migrants or that, while it would have been of concern in the past,

the recession meant it was no longer a key issue. However, one or two providers expressed

rather high levels of concern. For example, one home said it was „our biggest concern‟

(LK.HN.1BS) and another home in the same area had engaged a solicitor to help them obtain

the right certification to enable them to continue to recruit. One home in the HD LA was

concerned that some of their existing staff would fail to get the right number of points required

to stay on.

IDPs were also asked about what problems or opportunities they anticipated as a result of an

increase in direct payments and individual budgets. Some saw this as an opportunity to

improve the quality of care as users might be able to trade volume of care hours against quality:

I think too many LAs focus far too much on price rather than quality, as much as they say that

they do, we know that they don‟t. I think it‟s really sad that the local authorities are in that

situation, they can‟t choose the best care because they can‟t afford the best care so that needs

to change. I think the government needs to recognise that people deserve to choose. Some may

want more hours at a lower price and lower quality of service and if that‟s what they want then

that‟s fine. But equally they should be given the opportunity to choose better quality, maybe less

hours but a more costly service because that‟s what they want for their circumstances, at the

moment people are not getting that choice. (OM.D.2.DN).

Two national providers of domiciliary care also talked about the need to upgrade the quality of

both their staff and services:

Traditionally a lot of domiciliary care provision has been set up around national minimum

standards and that‟s the scope of the ambition. For us, what we need to do is try to look further

forward and to adjust our workforce and the skills of our workforce and the way we reward our

workforce and develop them in accordance with the provisions of personalisation. (HR

Director, NATDOM1).

As a company we are looking at changing the way we recruit - having service user involvement

in recruitment and training - and the services we provide [we are] going to have to extend and

offer more variety. We have a company strategy on this. (National Recruitment Manager,

NATDOM3).

By and large concerns over personalised budgets were prefaced with comments that the

providers - both local and national - supported the idea of personalisation in principle but they

had a range of concerns over practicalities. A first set of concerns related to poaching of staff

and guarantees of payments as some had already experienced difficulties in extracting payment

from individual budget holders.



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Another one we had and we used to provide a serious amount of care for her, two carers four

times a day. Very, very difficult to get payment off her. Direct payments team weren‟t interested

whatsoever. They constantly advertised behind our backs for PAs for her. We lost one of our

staff to her. We‟d CRB‟d her, inducted her, introduced her, we lost her. So that was another

one. (ON.D.1 DN).

I think it‟s just the sheer organisation of getting the money in, [compared to] having a block

contract where we invoice once a quarter, same amount every quarter. (RD.D.2.CL).

These concerns were also echoed by the national providers:

And because if the cash is given to the individual and the individual has to spend the cash and

pay the providers, and then the providers have to take a credit risk on that. Whereas if I‟m

dealing with London Borough XX for example, I can - at least I know that if I‟ve done a proper

bill they will pay me, I don‟t have to worry about the local authority going bust. (Managing

Director, NATDOM5).

Other concerns related to the potential for abuse, if families took the money but didn‟t provide

the care and the problem of an individual personal assistant providing cover. Some were

concerned about personal assistants not being trained or subject to CRB checks, an issue also

taken up by national chains who were concerned about the lack of minimum standards for

personal assistants and the unfairness of holding agencies responsible for meeting a whole set

of standards while allowing individuals to take up work under personalised budgets without

training or CRB checks (see box IV.23). National providers raised another set of concerns over

how the system was being implemented and administered in practice, including the differences

in approach between LAs and the consequent complexities, administrative costs and shifting of

responsibilities onto users or agencies.

Box IV.23. National providers’ views about the implementation of personalised budgets

i) Actions by LAs

As a principle I have no quibbles with [direct payments]. The problems I envisage are the rates of

payments. Some of the local authorities are paying, in terms of direct payment, the rate is lower than

what they would pay an agency. … So if you are paid less than, you have a choice. Either you have to

top up the £11 to buy the service from the agency or you have to employ a personal assistant – a

local, your neighbour or whoever is doing that. (Managing Director, NATDOM5).

The challenge is that every single local authority seems to want to do things differently. If you look at

direct payments. Sometimes people are being paid a lot less than they would if they were getting care

provided through social services. Sometimes they get paid more. And the whole mechanisms by which

that funding is arranged and agreed and how it‟s processed can be quite complicated. So you‟ve

really got to know the local area to know how they process a direct payment. (Managing Director,

NATDOM4).

What I see is authorities seeing individual budgets as a way to effectively cut a substantial amount of

inhouse financial administration because they‟re not laying contracts, they‟re not having to deal with

the invoices coming through, reconciling invoices and timesheets etc., etc. I think they see it as a



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fairly large financial incentive, a large financial incentive to pursue individual budgets. I think the

other aspect is I see the direct payment level is often set substantially below the prevailing contracted

rate. So not only are they saving because they‟re chucking out financial administration. (Commercial

Director, NATDOM2).

ii) Actions by central government

All the registered providers have this problem that personal assistants are not CRB checked. They do

not always pay their National Insurance or tax or whatever. And they cannot provide holiday cover,

and they are not trained. … Having gone round and setting up a registered service, and everybody is

going through the registered process, all the providers, we‟ve got to meet minimum requirements,

you‟ve got all these conditions. To then say, actually we‟re going to have a whole lot of people who

can provide service as a personal assistant. It just doesn‟t work. That‟s one big problem. And I don‟t

know how much the local authorities are spending on administering the direct payment service.

(Managing Director, NATDOM5).



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IV.7. Summary

Building on the mapping of results presented in Part III, this part of the report interrogated the

findings from the telephone survey in more detail using a mix of statistical techniques and also

further explored qualitative interview data from provider managers, including senior HR

managers from the headquarters of ten national chains of providers. The six sections explored

step by step the patterns of effects of organisational characteristics, local authority

commissioning and labour market conditions on HR practices and HR outcomes experienced

by social care providers. Here, we summarise the key findings of each section.

We began by identifying the organisational characteristics of the sample of 115 providers

included in the telephone survey, supplemented by additional details for ten national chains

that also probed the pros and cons of being a national chain. The sample includes a wide range

of organisations characterised by size, ownership type (including nearly half as part of national

chains), public/private/not for profit status and CQC star rating, as well as by business

conditions such as percentage of bed vacancies, role of block contracts and reliance of service

users on LA funding. The extent of management support for HR practices was found to be

stronger in national and local chain providers, with less than one in ten single establishment

providers benefiting from a specialist HR manager. Nevertheless, only a third of all providers

had support available locally or on-site.

Given these different provider characteristics, section IV.2 analysed the statistical relationship

between size, ownership, CQC star rating and public/private/voluntary status and the variety of

HR practices and outcomes, drawing on a specially constructed, „standardised‟ dataset from the

telephone survey. Central to our analysis is the use of carefully defined indices and sub-indices

of HR practices and HR outcomes. These establish a standardised measure of quality for

defined HR practices such as pay levels, employee development, recruitment and retention and

working time, and for defined HR outcomes, including recruitment and retention, training and

staff turnover. Our objective was to identify those characteristics that are associated with good

practice and good outcomes. Key results include the following:

Homes, IDPs and LADPs:

- there is very little overall difference in use of good HR practices between homes

and IDPs, but the public sector LADPs register significantly higher on four out of

six indices, especially pay levels and employee development;

- homes deliver better HR outcomes than IDPs or LADPs despite the better HR

practices in LADPs, suggesting that the nature of domiciliary care work requires a

higher standard for HR practices;

Size differences:

- there are mixed effects of size on HR practices by size of establishment (among

other findings, examples include larger homes making more use of appraisals,



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smaller homes being less likely to require weekend working, and larger IDPs more

likely to offer time off for training);

- large homes and large IDPs tend to have worse recruitment and retention outcomes

than smaller providers as measured by management perceptions, and more training

outcomes but there are no significant differences by size in quantitative measures of

staff turnover;

Ownership differences:

- national chain homes are more likely than other ownership types to have staff

working long hours and long weeks, and least likely to pay premiums for unsocial

hours, but more likely to provide regular pay uprating;

- there is limited evidence of differences among IDPs by type of ownership and this

fits with the qualitative interview data, which highlights local design of HR

practices, such as pay-setting for example, among national chains;

- single establishment homes score better on training outcomes than chains and local

chain IDPs score better training outcomes than national chains;

CQC star rating differences:

- homes with a CQC 3* rating provide significantly better pay and pay-related

conditions than 1* and 2* homes, but worse employee development and voice

opportunities;

- 3* IDPs are more likely to pay for qualifications than 2* IDPs; 3* IDPs are less

likely to have all staff working weekends than 1* IDPs.

Public, private and voluntary sector status

- Public sector LADPs score higher on most indicators of HR practices than both

homes and domiciliary care with working time and work organisation the two

exceptions where homes score higher, suggesting that these are affected by the

nature of domiciliary care work. Voluntary organisations score higher than for

profit independent sector providers, particularly on pay levels, although this may

reflect the higher share of private clients among voluntary sector homes in our

sample (see part III.3).

- The public sector LADPs do not score better on HR outcomes than homes, despite

better HR practices. The low outcome scores for all in domiciliary care suggests that

a higher standard of HR practice is required for similar HR outcomes in domiciliary

compared to the home sector. The voluntary sector has better outcomes than the

private sector and similar to the LADPs but the sample of voluntary sector

organisations is skewed towards homes.

Evidence from the interview data underlined the relatively limited variation in quality of HR

practices among independent sector providers. A willingness to pay more to care workers was

constrained by a perceived inability to raise revenue through charging higher LA fees.

Managers identified several HR practices as possible levers to improve recruitment and



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retention outcomes but tended not to value improving workers‟ discretion at work or their non-

pay benefits.

A second set of results identified the impact of the LA commissioning environment on quality

of HR practices. The interview data suggest LA fees play an important role in determining the

level of care workers‟ pay. However, our analysis shows that while higher fees facilitate the

payment of higher pay they do not guarantee higher pay. For IDPs, for every £1 increase in

hourly fees, the rate of pay increases on average by just 19 pence and for homes by just 14

pence. Reliance on LA funding among homes does appear to dampen pay rates; the greater the

share of LA funded clients the greater the likelihood of them paying care workers very low

rates of pay. As with pay levels, there is positive, albeit relatively weak, support for the idea

that LA fees positively influence the quality of HR practices. The results suggest higher fee

paying LAs support a higher score for the summary index of HR practices for IDPs, as well as

a higher index of pay levels for homes. The quality of other HR practices is higher on average

in high fee areas but differences are not found to be statistically significant. Fee levels offered

limited explanatory value for differential HR outcomes, with the exception of training

outcomes being surprisingly worse in high fee areas than in medium or low fee areas.

Using the categorisation of local authorities as adopting partnership, mixed and cost

minimising approaches to contracting for elderly care services (from part II of the report), we

found that these differences offered some value in explaining differences among homes but not

for IDPs. Among homes contracting with partnership-type LAs, most sub-indices of pay

practices scored higher and weekend working was less likely to be required. At the same time,

however, homes in cost minimising areas were most likely to have adopted good employee

development and voice practices. Like fee levels, this categorisation of LAs offered limited

value in explaining differential HR outcomes, with the exception of training outcomes in

homes (better in mixed LA areas) and recruitment difficulties in homes (worse for those in

partnership areas than in cost minimising areas).

Section IV.4 presented a similar analysis of HR practices and outcomes considering the effects

of local labour market conditions rather than LA commissioning. A first significant finding is

that in their approach to pay setting, just as we found with LA fee levels, not all providers

respond to local labour market pay levels (at least with respect to median pay levels for female

part-time workers in the LA area) in the same way. Around a fifth paid below 75% of the local

median, one in six paid above 90% of the median and the rest in between.

Using the more general categories of strong, medium and weak labour market demand

(developed in part I), the findings point to a tendency for providers to respond to strong labour

market conditions by improving their HR practices. For homes, this is particularly true of the

indices that measure the quality of pay levels and working time, as well as the summary HR

practice index. Other sub-indices support these findings, including greater use of pay practices

that reward unsocial hours and lesser requirement of regular weekend working in homes

located in strong labour demand areas. Two counter-intuitive results, however, are that these

same homes are also less likely than others in less strong labour demand areas to implement



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good work organisation practices (such as encouraging workers to use discretion to manage the

timing and tasks of care duties) and less likely to match working time with employee

preferences. For IDPs, several results follow those for homes, including the measures of good

quality practices towards pay levels, payment for unsocial hours and the requirement for staff

to regularly work weekends - all of which are better in strong labour market areas. The results

for the measure of work organisation are again counter-intuitive, this time suggesting that IDPs

in strong and weak labour demand areas implement better work organisation practices than

IDPs in medium demand areas. The labour market appears to shape HR outcomes also. In

particular, achievement of NVQ targets is negatively related to labour demand, with an

especially strong penalty effect on IDPs in strong labour demand areas. This may be an

indication of poaching of qualified workers in tight labour markets, a problem than is not

confined to the social care sector.

While sections IV.3 and IV.4 usefully illuminated the direction and significance of associations

between organisational characteristics and environmental factors on the one hand and HR

practices and outcomes on the other, section IV.5 applied multivariate statistical methods

(backwards regression models) to interrogate these associations further. The headline findings

for IDPs are as follows:

a partnership, high fee paying LA environment is positively associated with good HR

practices, yet does not display a strong association with measures of HR outcomes

(with the exceptions of two counter-intuitive results that partnership LAs are associated

with high staff turnover on one measure and high fee paying LAs are negatively

associated with training outcomes);

local labour market factors play a role insofar as female part-time pay levels are

positively associated with the quality of pay strategies, the measure of local labour

demand is negatively associated with recruitment and retention outcomes and areas

with high female part-time pay have lower staff turnover;

several organisational characteristics explain some of the variation in HR practices and

outcomes, including:

- IDPs with for-profit status and of a larger size are more likely to have poor quality

HR practices;

- local chain IDPs benefit from a higher index of pay strategies than national chain

IDPs and better recruitment and retention outcomes (subjective measure) and

training outcomes;

and a number of HR practices are associated with good HR outcomes in IDPs,

including:

- good working-time practices (such as not requiring weekend and long hours

working and providing time off for training) are positively associated with

recruitment and retention outcomes (both subjective and quantitative measures);

- a recognition agreement with trade unions is strongly associated with lower staff

turnover;



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- and the practices of providing pay upgrading opportunities, paying a premium for

weekend work and identifying skills and qualifications among job applicants are all

associated with lower staff turnover;

Given the complexity of the organisation of care work it is no surprise to find that some results

point in unanticipated directions. In particular, our regressions on the two quantitative

measures of staff turnover suggest that several good HR practices are associated with worse

outcomes. Examples include regular pay uprating, paying for CRB checks, use of formal

recruitment methods and offering guaranteed hours contracts. In these cases the cause and

effect may run the other way – that is, only in conditions of high staff turnover are managers

persuaded to introduce basic employment conditions and protections such as guaranteed hours

contracts.

The headline results for homes offer a similarly interesting and varied set of findings, as

follows:

the character of the LA commissioning environment has only a limited association with

quality of HR practice, with the important exception of high fee paying LAs being

strongly and positively associated with good pay level practices;

local labour market factors play a strong role through the level of female part-time pay

in the locality registering a strong positive association with quality of HR practices yet

worse training outcomes, and local labour demand is positively associated with quality

of pay level practices;

three organisational characteristics figure in the explanation of differentiated HR

practices and outcomes:

- larger size homes are associated with worse pay level practices and worse staff

turnover (quantitative measure)

- private, for-profit homes are very strongly associated with worse HR practices,

including pay level practices;

- single establishment homes have better training outcomes than national chain

homes;

and, finally, the quality of HR approach towards work organisation practices is strongly

and positively associated with training outcomes.

In the final section we assessed providers‟ views on social care policy and the commissioning

environment in order to provide a more nuanced account of relationships between providers

and LAs and to assess views about planned policy developments. Most providers rated their

relationship with LAs as good or very good. However, providers in cost minimising LAs

generally displayed the lowest levels of satisfaction. The quality of relationships depended on a

variety of factors such as the expertise of LA partners, satisfaction with the funding

arrangements, approach to communication and (unwelcome) involvement in providers‟

business decisions. One important mechanism to strengthen relationships was LA providers‟



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forums. However, providers in cost minimising LAs were least likely to find these useful and

experienced the least frequent attendance.

Providers identified particular changes in commissioning arrangements that might improve

recruitment and retention. The most popular change was a rise in fee levels, followed by

greater variation in price by service user and, especially among IDPs, a more integrated LA

approach to service delivery. Other specific changes identified included a greater role for

providers to determine how care is delivered, higher guaranteed volumes of work and more

time for a service user.

Most providers believed LAs attached importance to their HR practices (especially recruitment

practices and training provision), with around four in ten saying this was very important for

LAs. General monitoring of providers tended to be undertaken directly by the LA, with only a

fifth or so reporting sole monitoring by the CQC; where both were involved in monitoring this

was sometimes perceived as excessive. More than two thirds of providers were satisfied with

CQC quality standards but only slightly more than half the quality rankings; most of those

dissatisfied were providers with a one star rating. Providers‟ suggestions about how to improve

CQC monitoring include greater focus on user needs, strengthening relationships with

providers, better communication and recognition of diverse provider practices.

Finally, providers expressed a number of concerns with respect to the new policy of direct

payments and individual budgets. Most supported the principle of personalisation of care but

voiced doubts about the practicalities, including problems of poaching of staff and managing

the multiple invoices for payments, as well as concerns about the lack of training and CRB

checks for new personal assistants.

Part V. Recruitment and retention in the care sector: a case study

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V. Recruitment and Retention in the Care

Sector: A Case Study Approach

The aim of the case studies was twofold: to explore the HR practices of care sector providers

in more detail, in particular by exploring how these were experienced by care workers; and to

explore and understand some of the personal motivations and expectations of those who enter

the sector. These perspectives, we believe, provide insights into how providers could put in

place HR practices to facilitate smoother entries into the sector and foster longer term

commitments to care work.

Given the impact of LA commissioning and contracting on the HR practices of providers we

selected four local authorities with very different commissioning arrangements. The four LAs

include two from the north of England and two from the south, and include one very low

paying LA (IL), one low paying LA (ON), one medium paying authority (RN) and one high

paying (XD). Two (XD and RN) were classified as having commissioning environments that

typified a partnership arrangement. IL fitted the cost minimisation classification and ON

pursued a mixed approach (indeed it changed approach towards more cost minimisation

during the period of study-see part II above).

Within each LA, we carried out five case studies of providers: two domiciliary care, two care

homes and one local authority provider (in three cases a local authority based domiciliary care

provider and in IL a local authority owned home). We have used a simplified coding system

for the providers included in this case study sample; the relationship between the codes used

here in part V and those used for the same providers in the wider telephone survey are

outlined in appendix table V.A1. We ensured the provider organisations spanned a range of

different types and sizes and included national chains, local chains and not-for-profit

organisations. Qualitative interviews with care staff and senior care staff were used in

conjunction with the survey data already collected and reported in parts III and IV. The case

study data played a central role in the methodology of the project to provide more in-depth

data on range of areas including:

firm level practices and their impact on recruitment and retention in the care

sector;

the characteristics and experiences of care workers including their entry into

the sector, their desire to stay or leave, and the levels of satisfaction with key

aspects of their employment;

the linkages, where they exist, between commissioning practices, employer

practices and job quality issues for care workers;

differences, where they exist, between the views of established staff and those

of new recruits to gauge potential problems in retention in the sector;


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linkages, where they exist, between the provision of good quality care and

good quality care jobs

This part of the report is organised as follows. Section V.1 introduces each LA‟s approach to

commissioning and provides comparisons across the four LAs of key indicators of HR

practices within the five providers per LA included in this part of the study. These

comparisons focus on pay and benefits, working time, work organisation and training and

development. Key HR outcomes relating to recruitment and retention are also compared.

Two detailed comparative case studies of national providers are also presented; in each case

we have included two branches of the same national chain among our 20 case studies and

each branch is located in a different LA with contrasting commissioning strategies and

contracting practices. These case studies provide insights into the relative importance of LA

commissioning practices over company policy in shaping HR practices. In this first section

the analysis draws on data from the telephone survey of managers, building on our analysis in

parts III and IV.

The subsequent sections analyse the issues from the care worker perspective. We identify key

themes that emerge from interviews with care workers across all 20 case study organisations

in the four local authorities. Section V.2 explores care workers‟ perspectives on recruitment

into care work, while section V.3 considers the factors influencing retention among the care

workers. Section V.4 considers care workers‟ perspectives on the key HR practices related to

pay and working time while section V.5 considers their perspectives on the organisation of

care work and how this impacts on the quality of care they can provide. Section V.6

completes this exploration by looking at perspectives on and experiences of training and

development practices. Section V.7 concludes. Although most of the analysis draws on

qualitative data, it has also been possible to quantify some of the responses as nearly 100

interviews were carried out, 88 with care staff. Thus the case studies provide both some in-

depth data and some more general insights into care workers‟ perspectives, an area of research

which has been relatively neglected.


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V.1 Case studies in four local authorities: exploring the impact of

commissioning and contracting arrangements

V.1.1 Introducing the local authorities

The following four boxes give an overview of the LA commissioning environment in the four

local authority case studies, identifying the aspects of each that had led to their subsequent

categorisations as partnership (for XD and RN), mixed (for ON) and cost minimising (for IL).

Box V.1. Partnership local authority XD

The XD local authority is based in the south of England and covered rural as well as urban areas. Its

commissioning approach could be regarded as typifying a partnership approach that put HR issues at

the heart of contracting. It was a high paying LA with fees ranging from £16 per hour to £28 per hour

for domiciliary care and a relatively large inhouse facility covering over 40% of care provision. The

independent sector fees were raised in response to providers asking for a higher fee to remunerate the

staff properly to encourage retention. The LA had also moved to block contracts (for 11 providers

although 24 still provide spot services) in response to provider feedback that recruitment and

retention was being hampered by the lack of guaranteed hours. Overall the LA had adopted an

approach of enabling independent sector domiciliary care providers to offer similar terms and

conditions as those enjoyed by staff in the internal service. For example, they claimed to be only

accepting tenders for organisations that paid workers £7.00 per hour but some of our case study

organisations were paying lower rates. However, to offset some of the costs of paying higher fees

they had introduced electronic monitoring which changed the way of invoicing and was deemed to be

more efficient. According to published data this LA also had the highest average fee of our 14 LAs

for external home providers (note the interview data suggested a somewhat lower fee) and had in fact

moved out of residential care provision by transferring its homes to one voluntary organisation with

the result that more than half the provision is based on block contracts. It did not have any quality

enhancements for higher quality homes but said it would only normally make placements in homes

rated 2* or 3* by CQC and never in zero rated homes. Top up fees were relatively common and most

clients in local homes were not LA funded.

Box V.2. Partnership local authority RN

The RN local authority case study is based in the south of England. Overall it had adopted a

strategic approach to promoting quality by offering quality enhancements to domiciliary care

providers for meeting HR targets (and requiring these to be spent on staff bonuses or incentives,

training or team building) and in adopting a fair commissioning strategy for care homes which

should in principle involve no placements in homes which do not achieve a 2* or 3* CQC ranking.

Fees were also higher in homes meeting higher quality standards. However, this strategic approach

was adopted in conjunction with a policy of only paying a medium-level fee of £13.10 despite

being a relatively high wage area and not paying travel time on the grounds that a district provider

would get 55% of the work in their contracted area. Extra payments were, however, made for


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weekend work. RN contracts with ten preferred providers and the key performance indicators

(KPIs) that IDPs were expected to meet to receive additional payments included keeping turnover

less than the national average, ensuring continuity of care and the take up of work; meeting NVQ

training targets etc. RN had not introduced electronic monitoring and was piloting outcome-based

care with one of the case study providers. RN also commissioned jointly with the NHS. This joint

commissioning was proving more of an obstacle than a support for the fair contracting policy as the

NHS commissioners were said to be still keen to explore ways of keeping prices down while the

LA had come to a view that this would only lead to low quality. However, the fair commissioning

strategy had not been fully implemented due to a shortage of homes with good or excellent ratings

in the area. Fees paid by RN for home placements were rated as high but top up fees were relatively

common but not universal. RN only provided short term residential care in LA owned facilities but

had only a low share of block contract beds in the independent sector. LA funded clients were a

minority in most care homes.

Box V.3. Mixed case study local authority ON

The ON local authority is based in the north of England. The commissioning approach of this LA

contained strong elements of both cost minimisation and partnership. ON espoused a partnership

approach in its discussion of its relationship with providers and up to and including the time of the

interview at the LA, there was substance to the claim that it had taken steps to ensure that IDPs

paid for travel time, by paying a higher fee for short term visits and monitoring IDPs to ensure

travel time was paid for. It also symbolically paid double time for bank holiday working. However,

it combined this approach with a relatively low fee level of £11.17 and during the course of the

project had discontinued the practice of paying more for short visits as a consequence of

introducing electronic monitoring and indeed instead was introducing a system of paying only far

actual minutes spent at the user‟s home. ON had moved to single pricing for domiciliary care some

years ago to try to prevent poaching of care workers between providers. It now had ten preferred

providers and 7 spot contractors. For homes ON only provided a low level of fees and was still

engaged directly in the provision of both long term and short term care but most of the provision

was joint with the NHS around intermediate care. It paid a little more for homes with Investors in

People awards and was considering a wider quality enhancement framework. Top up fees were

found in some but not all homes and the LA was aware sometimes private residents subsidised

those funded by the LA, who are often a minority of residents.

Box V.4. Cost minimising local authority IL

IL is based in the north of England. We have classified this LA as a cost minimising LA in part on

the grounds that it paid very low fees for both domiciliary care (£10.78 per hour) and also for care

homes (the lowest of the 14 LAs) with no quality uplifts. The LA used spot contracts except in one

case where a provider had been awarded a block contract to provide the hospital discharge service.

There was a set price for domiciliary work of £10.78 per hour with few variations and no increases

for bank holidays. There were no enhancements for short visits and the move away from block

contracting had also removed payments for travel time. A premium payment for higher quality care


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had also been removed on the grounds that all providers now met the quality threshold. The LA

contract managers considered that the shift from block to spot contracting had affected recruitment

and retention of staff but commissioning policy was developed independently from contract

management in this LA. With respect to care home placements the LA paid a very low fee and

despite being a low wage area anticipated that most LA-funded residents would still be asked for top

up fees. Although over 40% of placements were under block contracts to the independent sector,

these were said to be political and historical legacies and were being phased out. The LA itself was

only involved in short term care. The LA had a strong quality framework for monitoring IDPs and

care homes but this was not linked to any financial incentives.

V.1.2. Pay practices of providers by local authority.

Comparison of key indicators relating to pay (see table V.1) shows that although there is some

relationship between LA commissioning price and the wages paid by providers, such that pay

rates are marginally higher in the high fee compared to the low fee areas, with pay rates

hovering around the level of the national minimum wage (£5.73) in both IL and ON

providers. However, pay levels were only slightly higher in southern locations despite much

more generous fee levels: for example in one national chain fee levels were £4 to £5 an hour

higher in the southern than in the northern LA but wage levels were only 25 pence per hour

higher (see table V.1 to compare pay levels between XDDom1 and ONDom2). In another

national chain fee levels were around £2 an hour in the higher compared to the lower fee LA

but wage levels were only about 50 pence higher (see table V.1 to compare pay levels

between RNDom1 and ILDom1). This evidence suggests that national chains are not passing

on more favourable commissioning practices by improving employment conditions in the

sector and instead pay wages that are further down the local labour market wage hierarchy.

Table V.1 Pay practices across the case study providers

1Y – Yes; N- No; DK – Don‟t know

2T – Time; M-mileage only; N-none

The case study organisations are typical of the providers surveyed in stage two of the project

in that pay varies according to provider type. The LA inhouse providers all pay higher rates of

Normal pay rates £ Unsocial hours

payment1

Travel Payments 2

Area Case 1 Case 2 LA case Case 1 Case 2 LA case Case 1 Case 2 LA case

XD Home 7.34 6.50 Y Y

Dom 6.50 7.26 8.41 Y DK Y M T T

RN Home 6.60 6.50 N N

Dom 6.51 7.14 11.11 Y Y Y N N T

ON Home 6.21 5.73 N N

Dom 6.05 6.25 9.13 Y Y N N N T

IL Home 5.73 6.08 11.82 N N Y

Dom 6.00 6.00 N Y N N


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pay, all pay for travel time and all but one pay enhancements for unsocial hours and in

contrast the lowest paying providers are care homes, particularly in the cost minimising and

mixed LAs.

The data relating to travel payments and unsocial hours also shows the influence of the LA

commissioning environment. None of the IDPs in RN paid travel time or mileage which is

consistent with RN‟s policy not to pay travel time. In contrast the IDPs in XD paid a mix of

travel time and mileage, although where only mileage was paid the manager reported that in a

rural area the lack of payment for travel time was still a reason for recruitment and retention

problems. Only care homes in XD paid extra to care staff working unsocial hours; all other

care homes offered no enhancement. Significantly, the two providers in IL that paid

enhancements for unsocial hours did so because one was an LA care home and the other

ILDom2 had been awarded the LA hospital discharge contract.

V.1.3. Working time practices of providers by local authority

There is mixed evidence as to the impact of the LA commissioning environment on the case

study providers‟ working time practices. If we firstly look at the type of contracts on offer,

table V. 2 shows only two out of eight IDPs (XDDom2 and ILDom2) offered guaranteed

hours and these had block contracts with the LA. While this shows the LA enabling good

practice in these cases, the data on other dimensions of working time show just as many

variations within LAs as across LAs.

Table V.2 Working time practices across the case study providers

1 Days

2 A-all; M-most; S-some of the time

3Z- zero hours; G- guaranteed hours; ZG- mixed

Three quarters of the 20 case study providers said they matched preferences most of the time.

Four reported that they matched preferences all of the time and three of these were in IL and

ON, the non partnership authorities. One LADP in RN said they only matched hours some of

the time; this is in line with a general finding that those working for LADPs have less

Maximum working

week1

Match staff

preferences2

Contracts3


XD Home 6 6 M M

Dom 6 5 5 M A M Z G G

RN Home 7 6 M M

Dom 7 6 5 M M S Z Z G

ON Home 5 5 M M

Dom 7 6 5 A M M Z Z G

IL Home 5 5 7 A M M

Dom 7 6 A M Z ZG


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flexibility in terms of choosing their hours compared to those working for independent

providers possibly because LADPs have moved from 9 to 5 type work schedules to very

flexible ones, related to their more specialist re-ablement work. This means they pay much

less attention to employee preferences compared to the past.

The type of provider is an important factor in explaining variations in the maximum working

week. LADPs all had a maximum working week of five days although the LA care home had

a maximum working week of seven days. However, some of the lowest paying homes in IL

and ON only had a five day maximum working week. There was thus no obvious bundling

together of poor pay practices with poor working time practices or indeed good with good;

nor indeed any systematic trade-off between good working time and poor pay, for example.

There were also no patterns relating to this and the LA strategy; so although no providers in

XD had a maximum working week of seven days in the partnership, two providers in RN, the

other partnership LA, had a policy of maximum seven day working. In this area company

policy appears to the key factor shaping HR practice.

V.1.4. Work organisation of providers by local authority

We compared the case study providers across three indicators of work organisation. Not only

were these indicators expected to reveal the influence of LA commissioning and provider

practices on how care work is organised but they could also be expected to have an impact on

the quality of care jobs and on the quality of care for service users. The first two indicators tap

into the opportunities to use discretion to prioritise tasks and develop good relationships with

service users (see section I.4 for the links between these aspects of work organisation and the

quality of care). The third indicator relates to the use of electronic monitoring which is linked

directly to LA commissioning practices.

Table V.3 gives a breakdown of this data for each case study provider. Nine out of twenty

managers reported that care workers were free to prioritise tasks, six of the nine being from

care homes. However, no provider in XD said yes to this and our analysis of the manager

telephone survey data from the case study providers suggest that there are conflicting views as

to whether increasing care worker discretion was a good or bad HR practice. These findings

mirror evidence in part IV (section IV.2) that managers did not consider changes to work

organisation as a mechanism to improve recruitment and retention. The quoted responses in

box V.5 from one provider manager in ON sum up the reservations some managers have

about giving care workers the opportunity to prioritise tasks to improve quality care,

especially those working for IDPs where such freedom may have cost implications if

electronic monitoring is in place. However, as we have seen in section I.4, a certain amount of

flexibility is deemed to be an important factor in service users‟ definitions of quality care and

managers appear to have a view that runs counter to such perspectives where the focus instead

is on following contracting requirements and care plans.


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Table V.3 Work organisation across the case study providers

1Y - Yes; N – No; SE - Some extent

2Y - Yes; N – No

Box V.5 Work organisation that encourages discretion: a manager’s views on whether

it is a good or bad practice?

Q. Are staff free to prioritise and carry out tasks in ways that they feel will improve the quality of

care?

A. No. We have to stick to a care plan which is provided by social services, and we have to do the

tasks that are on there.

Q: [So they have to do that in a strict order]?

A: They do, yes. If anything else is required by the service user they have to phone up and let us

know first. (ONDom2, manager)

Providers were more positive about care workers‟ opportunities to develop good relationships

with service users. Sixteen out of twenty providers said care workers were able to do this.

There appeared to be no obvious relationship between this and the LA commissioning

environment although the only provider that said this was not possible, XDdom1, had also

said care staff were not free to prioritise tasks. It would seem in this provider there was

limited discretion and ability to develop good relationships and both could be related to

electronic monitoring. An interview with a care coordinator at the provider suggests this is the

case.

I would say [the job of a care worker is] more difficult [than in the past] and generally that‟s

because of the paperwork involved as well…..Because they‟ve got to write more and more,

that‟s more and more details, spend more time looking at the plan. With the log in, log out,

obviously it‟s not taking into account how long it takes to actually get in the house. Because

they‟re paid by the minute. Plus when they leave, you phone out, and then Miss Bloggs turns

Freedom to prioritise tasks in

ways that improve the quality

of care1

Opportunities to develop

good relationships with

users1

Electronic

monitoring2

Area Case1 Case2 LAcase Case1 Case2 LAcase Case1 Case2 LAcase

XD Home SE SE Y Y

Dom N SE SE N Y Y Y Y Y

RN Home Y Y Y Y

Dom SE SE Y SE Y SE N N N

ON Home Y Y Y Y Y

Dom SE N Y Y Y Y Y Y Y

IL Home Y Y SE SE Y Y

Dom Y SE Y Y N N


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round and says, “Oooh dear, could you just put the bin out?” And then they‟ve got to do that.

And then you‟ve got to say,:”Alright, I‟ll see you again”, and ... get out past the lock up and

obviously none of that‟s taken into account with the log in, log out (XDDom1, Care

Coordinator, age 38, 3 yrs in post)

Table V.3 shows that electronic monitoring was in use in the two LAs - XD and ON- that

specified its use in its commissioning. This use of electronic monitoring did appear linked to

perceived lower levels of discretion for care workers as the only IDPs that said workers had

no freedom to prioritise tasks to improve quality of care were XDDom1 and ONDom2. These

providers were also part of the same national chain so this may either have been a general

company policy to limit care worker discretion or alternatively a company policy in response

to electronic monitoring in those specific LAs that used this practice to ensure care workers

were able to carry out the commissioned tasks in the designated time. However, it is notable

that all providers in ON reported that staff could develop good relationships, even though

electronic monitoring was also in place.

Overall the case-study findings suggest those working in IDPs have less discretion to

prioritise tasks as the majority report this was possible only to some extent. Thus company

policy, the LA commissioning environment and the nature of the work may all play a part in

explaining why work organisation takes the form it does in specific providers.

V.1.5. Training and development of providers by local authority

A comparison of some of the key indicators relating to training reveals the limited influence

of the LA commissioning strategy on this aspect of HR practice.

Table V.4 shows that some of the lowest paying case study providers in local authorities with

the lowest fees perform particularly well on meeting statutory requirements relating to

training. This fits with the overall findings from the telephone survey that training outcomes

were worse in high fee areas ( see part IV, section IV.3). In contrast two of the case study

providers in RN had not met the NVQ level 2 target even though they had been set KPIs by

the LA relating to training targets. The case study care homes were more likely to have NVQ

level 2 qualified staff although this could reflect increased opportunities for care workers to

complete any associated paperwork in the workplace rather than a stronger commitment by

providers to meeting statutory requirements and training.

The payment for time spent in induction training and length of induction are also indicators of

providers‟ commitment to training. The XD partnership authority stands out with induction

training paid by all providers, ranging from a minimum of four days to a maximum of three

months. However, other trends do not relate to the LA commissioning environment. Induction

training was more likely to be both longer and to be paid for in all care homes across all four

local authorities. Company policy may also explain differences in policies towards induction.

For example, XDDom1 and ONDom2 were part of the same national chain and both offered

four days induction training.


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Table V.4 Training and development across the case study providers

11: 4 days or less; 2: 5 days to 2 weeks; 3: More than 2 weeks

2Y – Yes; N – No; L – paid later if staff stayed

31: Up to 45%; 2: 46% to 55%; 3: 56% to 69%; 4: 70% or greater

V.1.6. Comparing national providers in different LA environments

Boxes V.6 and V.7 compare the HR practices in place in provider organisations that were part

of the same national chain but located in different LAs. These two national chain case studies

can illuminate the impact of LA commissioning versus company policy on HR practices as a

whole and on specific elements of HR practices as the case study establishments are located

in LAs that span southern and northern locations and partnership, mixed and cost minimising

commissioning and contracting practices.

Box V.6. A comparison of a national providers’ domiciliary care establishments in a

partnership and cost minimising local authority (RNDom1 and ILDom1).

Background: Both RNDom 1 and ILDom1 were part of the same national chain and were rated

2*by CQC. RNDom1 was based in a partnership authority that paid medium level fees and

ILdom1 was based in a cost-minimising authority that paid very low fees. Both providers found

recruitment easy and had turnover between 10-20%. RNDom1 reported staff shortages in contrast

to ILDom1 that reported no shortages.

Pay: RNDom1 paid £6.51 with enhancements in contrast to its equivalent in IL which paid £6.00

with no enhancements. Thus LA fee levels were higher in RN by around £2 an hour but wages

paid were only 51 pence more in the RN branch than in the IL branch. Not only is there only a

limited increase in line with LA fee levels but also the stronger labour demand in RN compared to

IL has had limited impact in raising wage levels, as is perhaps indicated by the greater staff

shortages in the RN branch. High unemployment in IL may be enabling providers to pay very

close to the NMW without much impact on recruitment and retention. RNDom1 also paid

enhancements for weekend work: this was in line with the RN commissioning policy of paying for

weekend work as well as with perhaps pressure from strong labour demand. Of the nine providers

in RN that were surveyed in the telephone survey, seven out of nine providers paid enhancements

for weekend working and five out of nine paid enhancements for evening work. In contrast, in IL,

only three out of nine of the providers in the telephone survey offered enhancements for weekend

Length of induction1 Paid induction

2 NVQ attainment level

3


XD Home 3 3 Y Y 3 2

Dom 1 2 2 Y Y Y 1 3 1

RN Home 3 3 Y Y 4 4

Dom 1 1 2 L N Y 1 1 4

ON Home 3 3 Y Y 4 4

Dom 1 1 3 N Y Y 1 4 4

IL Home 1 3 2 Y Y Y 4 3 4

Dom 3 2 Y Y 2 3


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working and only one offered enhancements for evening work. In IL there was no commissioning

policy encouraging unsocial hours payments.

Working Time: Both providers had a six day maximum working week. However, there were

differences in relation to efforts to match staff preferences; ILDom1 reported matching staff

preferences all of the time whereas RNDom1 reported to do so only most of the time.

Training: Both providers had short paid inductions, although in RNDom1 this was not paid

initially but only if staff stayed. ILDom1had met the NVQ target but RNDom1 had not done so.

Work Organisation: Electronic monitoring was not in place in either LA but the two providers

differed in terms of whether care staff were able to prioritise tasks and develop good relationships.

ILDom1 reported this was the case whereas RNDom1 where reported only to some extent.

Summary: It would appear that the commissioning environment, combined to some extent with

local labour market factors, has an influence on pay practices, particularly unsocial hours

payments. Other dimensions of HR practice appear to be more influenced by company policy

rather than the commissioning environment. In some cases variations in responses between the

two branches may also be a result of managerial discretion at branch level. For example, even

though electronic monitoring was not in place in either location the two branch managers reported

very different approaches to care workers‟ discretion and to payment for induction.

Box V. 7 A comparison of a national providers’ domiciliary care establishments in a

partnership and mixed local authority (XDDom1 and ONDom2)

Background: Both XDDom 1 and ONDom2 were part of another national chain and were both

rated as 3 * providers by CQC. Both reported staff shortages. XDDom1 found it neither easy nor

difficult to recruit whereas ONDom1 found it quite easy. However, ONDom2 had much higher

staff turnover at over 30% compared to 10-20% in XD.

Pay: XDDom1 paid £6.50 while its northern counterpart ONDom2 paid £6.25 with a weekend

enhancement of 22p. However, fee levels were £4 to £5 an hour higher in the southern LA than in

the northern LA location so this 25 pence extra shows a very marginal impact of LA

commissioning practices on pay levels offered. XDDom1 also paid mileage, possibly a reflection

of its rural location and XD‟s willingness to pay a higher fee in rural areas. ONDom2 was in a

more urban location. However, both paid enhancements for unsocial hours and ONDom2 was

atypical in doing so if we compare this with the other data collected in the telephone survey from

providers in ON. Only three out of nine providers paid an enhancement for weekend work and

only one out of nine paid extra for evening work. In this sense ONDom2 had put in place a pay

practice that was not typical of those on offer by other providers despite limited LA fees and this

may show the influence of company policy. The LA in ON did pay extra for bank holidays but had

discontinued other unsocial hours payments.

Working Time: Both providers had a 6 day maximum working week and matched worker

preferences most of the time.

Work Organisation: Both providers said care staff could not prioritise tasks to improve the


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quality of care and this could be related to the impact of electronic monitoring which was in place

in both LAs.

Training and Development: Both providers had four days paid induction training and neither had

met the NVQ level 2 target. However, the high level of staff turnover at ONDom2 is likely to have

been an obstacle to meeting training targets, but the same did not apply to XDDom1.

Summary: In this case the LA commissioning environment had limited influence on pay

practices. A much higher fee led to only a marginal difference in wage levels, although the

payment of mileage may be related to commissioning practice. Work organisation was also shaped

by commissioning practices since the requirement to use electronic monitoring, as in both these

LAs, limited the freedom of providers in this area. However, in the areas of training and working

time it would appear that it is national firm policy that is primarily shaping HR practices.

The two comparative case studies suggest that the policies of national chains are playing a

significant role in both shaping HR practices and in limiting the actual impact of favourable

commissioning and contracting practices on employment terms and conditions. This

reinforces the picture presented in part IV as well as from the evidence from the case study

providers in these four LAs. A key finding is that the LA commissioning environment may be

an enabler of better practice but there are variations between providers in the extent to which

they respond to more favourable commissioning practices. Furthermore, although there is

variation in practices across providers, this variation is around a very low level of basic

employment conditions and protections. However, we also need to consider the possibility

that national providers are cross subsidising providers in low fee paying LAs where they

may be making losses through retaining higher margins in higher paying LAs. If this were to

be the case, and national providers‟ overall profits are either low or even negative, then the

key driver of low pay can still be said to be LA commissioning

V.1.7. Overview of HR outcomes for providers by local authority

Drawing again on evidence from the telephone survey, we can assess the performance of the

case-study providers with respect to HR outcomes, measured by various indicators of

recruitment and retention. Table V.5 presents the HR outcomes for the 20 providers and

shows that there is no straightforward relationship between practice and outcomes.

The data on HR outcomes show that ten out of 16 independent sector providers considered it

easy or very easy to recruit care workers. Two of the four providers in the low paying IL LA

reported it to be quite difficult or very difficult to recruit but this was not replicated in ON, the

other low pay area where all providers considered it quite easy or very easy. Perhaps

surprisingly the LA providers were the most likely to respond that it was neither easy nor

difficult or quite difficult (all three LA case studies for which we have responses). In contrast

there was a majority view among independent sector providers that they did face specific

labour shortages. This applied to nine out of 16 and seven of these were IDPs out of a total of

eight IDPs. The two LADPs in high wage areas also felt they faced specific labour shortages.


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We have two measures of staff turnover, one the overall rate and one excluding turnover

among new recruits. On both measures the two case study IDPs in ON stand out as

experiencing very high levels of turnover, although the rates are particularly high when new

recruits are included. However, beyond these two providers, turnover rates were more

variable within than between LAs even for the independent sector providers but this was even

more the case if the LA providers are considered where turnover rates were low in the three

LAs for which we have data. If we look in detail at overall turnover rates in these providers

and compare them to the national average turnover rate for care workers of around 22% ( see

part I.5 (Eborall et al. 2010)) we find that only the two IDPs in ON have rates above this

level and of the rest the majority (seven out of thirteen ) are clustered slightly below this level

in the range 18% to 22%. Of the six with rates below 18%, five are homes and only one is an

IDP. However, they are drawn from all four LAs. This suggests that to the extent that

partnership LAs are associated with better HR practices, at most these are tending to alleviate

otherwise very high turnover rates.

Table V.5 HR outcomes across the case study providers

1VD - very difficult, QD - quite difficult N - neutral QE - quite easy VE - very easy

2 Y- Yes N- No

3 for definition see Appendix IV.A1.4 IRT3 MD= missing data

4 for definition see Appendix IV.A1.4 IRT9 MD= missing data 4

The data on HR outcomes show that ten out of 16 independent sector providers considered it

easy or very easy to recruit care workers. Two of the four providers in the low paying IL LA

reported it to be quite difficult or very difficult to recruit but this was not replicated in ON, the

other low pay area where all providers considered it quite easy or very easy. Perhaps

surprisingly the LA providers were the most likely to respond that it was neither easy nor

difficult or quite difficult (all three LA case studies for which we have responses). In contrast

there was a majority view among independent sector providers that they did face specific

labour shortages. This applied to nine out of 16 and seven of these were IDPs out of a total of

eight IDPs. The two LADPs in high wage areas also felt they faced specific labour shortages.

Ease of

recruitment1

Specific staff

shortages2

Level of staff

turnover in the last

12 months3 %

Staff turnover rate

excluding new

recruits 4 %

Area Case1 Case2 LA

case

Case1 Case2 LA

case

Case1 Case2 LA

case

Case1 Case2 LA

case

XD Home QE N N Y 21 17 23 17

Dom N QE N Y Y Y 11 MD 6 14 MD 5

RN Home VE N N Y 19 12 20 13

Dom QE N QD Y Y Y 18 22 7 16 15 7

ON Home QE VE N N 16 5 11 5

Dom QE QE QD Y Y N 101 56 6 48 21 6

IL Home QE VD N N N N 19 6 MD 19 7 MD

Dom VE QD N Y 19 18 MD 4


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We have two measures of staff turnover, one the overall rate and one excluding turnover

among new recruits. On both measures the two case study IDPs in ON stand out as

experiencing very high levels of turnover, although the rates are particularly high when new

recruits are included. However, beyond these two providers, turnover rates were more

variable within than between LAs even for the independent sector providers but this was even

more the case if the LA providers are considered where turnover rates were low in the three

LAs for which we have data. If we look in detail at overall turnover rates in these providers

and compare them to the national average turnover rate for care workers of around 22% (see

part I.5 (Eborall et al. 2010)) we find that only the two IDPs in ON have rates above this level

and of the rest the majority (seven out of thirteen) are clustered slightly below this level in the

range 18% to 22%. Of the six with rates below 18%, five are homes and only one is an IDP.

However, they are drawn from all four LAs. This suggests that to the extent that partnership

LAs are associated with better HR practices, at most these are tending to alleviate otherwise

very high turnover rates.

Moreover, not all „good‟ HR practices may induce lower turnover. For example, some

managers from case study providers suggested that extensive induction and high levels of

training could be a reason for some turnover, particularly of trained staff.

Some do [leave]. Social care is quite popular at the moment. Rehab assistants. Usually NHS offer

better terms and conditions than we do. That‟s my latest one, I‟ve got one of my NVQ 3 girls

going. But often it‟s for advancement. Because we put people through NVQ 2 and then NVQ 3,

which is a springboard to higher positions. (XDHome1, Manager).

I think, to be quite honest, because we train our care assistants up to NVQ3 as much as possible,

and when they‟ve got their [NVQ] three then we encourage them to try to do better. Now, some

come back „cos the grass isn‟t greener, you know, but quite a few have gone to hospital and

whatever and doing their training. (ONHome1, Manager).

This reveals why HR outcomes are not directly related to HR practices; not only will local

labour market factors play a role but also internal policies to train and develop staff may

increase their external opportunities. Furthermore, the personal motivations of care staff and

their experiences will also be a big part of the story of recruitment and retention in the care

sector and while they will be shaped by these organisational and local labour market factors

they will not be determined by them. An analysis of the case study interview data will now

follow and we will look at care worker attitudes and motivations towards the job and areas of

HR practice in more detail.


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V.2. Care workers’ perspectives on recruitment

Drawing now on the interviews with care workers, we explore the attitudes and experiences

of care workers, focusing specifically in this section on the process of recruitment, including

why people entered the care sector and how they heard about care job vacancies. We also

highlight any findings that relate to specific HR practices that may make some providers more

attractive to potential recruits than others. Appendix table V.A2 provides information on the

employment roles of the 98 respondents; 88 were directly involved in care work while a

further 10 had a variety of roles in supporting care work. For much of the analysis the sample

is limited to the 88 care workers but where relevant we use the whole sample. In this section

because all 98 interviewees were recruited as care workers, our analysis draws on data from

the whole case study sample.

V.2.1 Factors that influence entry into the care sector

All interviewees were asked why they had chosen to work in the social care sector as a care

worker. It was possible to identify four dominant factors that shaped entry;

the nature of the job and the search for meaningful work

the influence of family and social networks

the opportunity for a change of direction/career

the search for convenient working time.

The nature of the job and the search for meaningful work

Previous research has shown that „making a difference‟ and doing a job that involves helping

others is important to those working in the care sector and for many of the interviewees it was

simply this that was given as the reason for entering the sector. For many care work was a job

that gave the opportunity to be engaged in satisfying and meaningful work, often in contrast

to previous work they had done (box V.8).

Box V.8. Care work as an opportunity to make a difference and do meaningful work

I think I originally chose it because of the satisfaction it gave me, and to actually see the outcomes

for individuals, which I think was very rewarding for me as an individual. (RNLADP, Service

Manager, age 45, 21 yrs in post)

When I was made redundant [from retail] for the third time, I knew that I didn‟t want to work in

retail any more after all these years, I wanted to do something a bit more meaningful, that give me

more satisfaction from a human point of view (RNDom2, Care Worker 3, age 57, 6 months in post)

I wanted to do something where I actually was making a difference. I had, for example I had one job

where for half a day I worked in tele-sales, cold calling, and I left at lunchtime. It‟s the only job I‟ve


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ever walked out on, because it‟s just a horrendous job and I did not want to do something like that.

(RNDom2, Care Coordinator, age 24, 3 yrs 6 months in post)

I just think it‟s nice to be able to help somebody that can‟t do anything for themselves or can‟t do a

lot for themselves, it‟s just a good feeling to see that you‟ve done something for them, you know, it‟s

an achievement. (ONDom2, Care Coordinator 1, age 54, 2 yrs in post)

Just wanted a career change. It‟s very monotonous [office work], I mean office work is very well

paid, but it‟s not all about money. You know, it‟s job satisfaction. I like the buzz here, it‟s very nice.

It‟s a nice environment and I‟m very much a people‟s person, that‟s why I‟m good at what I do.

(RNHome2, Care Worker 1, age 54, 1 yr 10 months in post)

Some care workers identified the distinctive characteristics of care work in homes compared

to IDPs, or vice versa, and used these distinctions to describe why one type of work was

chosen over the other (Box V.9). For some working for IDPs, the unsupervised nature of

domiciliary care work meant they felt autonomous, an attribute that was very attractive to

them. They also liked the idea of moving around between different places and meeting

different people. In contrast some of those working in care homes had worked for domiciliary

care providers in the past and found it too rushed and had chosen to work in care homes.

Older workers in particular said working in one place was less tiring while younger workers

with no access to transport also chose care homes.

Box V.9. The advantages and disadvantages of working in IDPs

The advantages

Being my own boss, because I‟m obviously out on my own most of the time. I occasionally go out with

other care workers, on double-up runs, but mostly I‟m on my own. So I‟m my own boss as such.

(XDDom1, Care Worker 2, age 37, 2 yrs in post)

You‟re all the time in different places…And I‟m bored when I‟m sitting in one place, so that‟s why.

(RNDom2, Care Worker 1, age 22, 10 months in post)

It‟s something different on your own, you‟re not in one place, somebody watching you while you‟re

working all time, you‟re out and about…..You meet different people. (ONDom1, Care Worker 1, age

48, 3 yrs in post)

The disadvantages

Too much pressure [in domiciliary care providers]. I mean because you didn‟t have the time, like say

if you had to do their dinner for „em[users], it‟s like you‟re rush, rush, rush, don‟t have time to talk to

„em, time to get their dinner, you know, how you want it, and then you‟re off to your next one

then….No, I didn‟t like it, it wasn‟t me. (ONHome2, Care Worker 1, age 47, 8 yrs in post)

I didn‟t fancy home care because of the transport and I don‟t drive. (ILHome2, Care Worker 4, age

29, 3 weeks in post)


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The influence of family and social networks

The case study approach allowed us to contextualise responses about the attractiveness of care

work to this group of workers. This revealed first of all the importance of family and social

networks in influencing these decisions. Thirty-six out of 88 care workers (and 38 out of the

whole sample of 98 interviewees) cited informal experiences of looking after elderly relatives,

neighbours or children as the main motivating factor when deciding to enter care work (box

V.10). This is an important finding because it meant that 40% of our sample of „stayers‟ and

new recruits had some knowledge about what the job involved before they entered the

organisation. Seventeen of these were working for IDPS compared to 15 who were working

for care homes (including four who were working for the LAhome). Four out of 15 care

workers working for LADPs cited this as a motivating factor.

Box V.10. Informal experience of caring for family and the elderly

Why did you choose to work in the social care sector?

Basically because it‟s all I‟ve done, personally, through my life, if you know what I mean….I‟ve

never done it officially but I‟ve done it unofficially with family members...My Nan, my granddad and

my son. (ILDom1, Care Worker 2, age 34, 8 months in post)

It‟s something that I‟ve wanted to do for a long time but I just felt I wasn‟t ready. You know when the

children have grown up and that. And then I was looking after my father in law who has got

dementia and he is in a nursing home. So I helped my mother in law with him a lot. And went round

and was helping her. And when it came to changing him, because he was incontinent, it was me that

actually did it, and I didn‟t think twice about doing it. My mother in law, she couldn‟t do it. And it

was from that and then quite a few people over the years said, you‟re quite good with old people.

Why don't you work with them. (XDHome1, Care Worker 3, age 44, 3 yrs in post)

Because I obviously care for my children, so I‟m already used to caring. And with care work what

we do is very similar to looking after children basically, apart from obviously adults. So I was used

to it. So I thought well it‟s the best job really for me to do. And I enjoy caring. So, it‟s my sort of job.

(XDDom1, Care Worker 2, age 37, 2 yrs in post)

No, it weren‟t just the hours. I mean I looked after an elderly neighbour once, I used to like go in

every day and see to her and I thought I‟d always fancied doing something like that. (ONDom1,

Care Worker 1, age 48, 3 yrs in post)

Related to this was also the influence of family and friends on entry into care (box V.11).

Two thirds of the interviewees (64 out of 98 interviewees) mentioned that family or friends

worked in care and 11 of these stated that this was the main influence on why they entered

care while the majority recognised that this knowledge of the care sector through personal

contacts influenced their entry in some way. Quite a few of the new recruits we interviewed

were younger workers who had family members, often mothers, working in the care home or

the IDP they were working for. Many care workers cited being encouraged by family


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members and friends to do the job and others recognised that being surrounded by care

workers influenced their decision to enter.

Box V.11: The influence of family and social networks on entry into care work

Our [sister-in-law] loves it, she kept saying, „It‟s, just perfect for you, you would just love it.‟ And

she was right. (ONDom1, Care Worker 4, age 43, 5 months in post)

I spent a lot of time with my Nan, like I say, my Nan worked in care for about 30 years. So often

when I was at her house I‟d hear different things from when she was out working. It‟s just kind of,

they didn‟t push me into care, but I think it‟s something that I‟ve wanted to do, hearing stories from

my Nan and my aunty. (ONDom2, Care Coordinator and Care Worker, age 26, 5 yrs in post)

My mum done it, my Nan done it first, obviously, then my mum‟s been doing it for about ten years.

She started off as a cleaner and then become a carer in her home and she‟s been there for ten years.

My cousin was working in my old home which I got a job in and then my sister was like, „Oh, I‟ll

come and join you too.‟ So she come into it…..My mum said, „Give it a go.‟ But I was just like I need

to do something, I just can‟t be bothered to do hairdressing any more. And I couldn‟t hack working

in a shop or things like that, so I just thought, oh. Everything‟s worth a try, ain‟t it, you don‟t know if

you‟re gonna like it or not until you try it. (RNHome2, Care Worker 3, age 21, 3 months in post)

Yes. My mother was a nurse, so yes. And she had a lot of experience in that area…Yeah. I think it

did [influence me] because she introduced me to care and she was quite passionate about what she

did as well, so I think it did have a big influence on my future. (RNLADP, Service Manager, age 45,

21 yrs in post)

Therefore many of the care workers had already had experience of informal care in the home

and knew what the job entailed. In relation to recruitment, this meant that on entry into the

sector many already had a reserve of tacit knowledge and skills that had been built up through

informally caring or having close relationships with those who did the job. How this relates to

the recruitment process will be discussed in the next section.

Care work as a new direction

Many of our interviewees talked about their entry into the care sector as a „career change‟. It

was often a result of a „push‟ factor into the sector; for example a change in personal or work

circumstances such as redundancy and divorce. The case study interviews allowed us to see in

practice how the recessionary effect, as discussed in Section III.1, eased recruitment

difficulties for providers. Of the 50 care workers who had entered the care sector in the last

two years, nine mentioned they had been actively looking for work before they started their


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current post and five of these had been made redundant39

. Others had simply decided they

wanted to leave a job, often higher paid, that they were dissatisfied with and it was the „pull‟

factors of training and opportunities that made the sector attractive. Providers that emphasised

training and careers either in the advert or in interview were more successful at attracting

those who wanted a career in care. For these, working as a care worker was a stepping-stone

to something else or an opportunity to gain training and qualifications.

Box V.12. Care work as a new direction

I‟d been made redundant for nearly seven months. I found the job through a newspaper but a friend

of mine that was working for the same company had got made redundant at the same time, she‟d

applied here as well. And so I follow in the footsteps basically. (XDLADP, Care Worker 2, age 55, 4

months in post)

I was made redundant, sort of. And then approaching 50, I felt this was a good job that I could do

efficiently and well. (XDDom2, Care Worker 1, age 53)

I just wanted a complete career change. I didn‟t want to go in another factory. I just wanted

something totally different. And it is. (XDLADP, Care Worker 3, age 52, 7 yrs in post)

Well, I was obviously looking and came to my interview and like had an interview with Gloria and

she was like very helpful and like 'cos I came with no experience was more willing to give me the

experience I needed. Cos quite a lot of other place I applied for are a bit dubious with no

experience…..More helpful, more willing to sort of teach me and train me, very nice place.

(RNHome1, Care Worker 2, age 19, 6 months in post)

Because I am studying mental health nursing. So it‟s like a way of getting into nursing, so I know

how to care about people. Getting experience first…..I was just walking past. When I came in, I

asked them if they were going to train me, so that I know what I was going to do. (XDDom2, Care

Worker 3, age 28, 4 months in post)

Convenient working hours

The final dominant factor that shaped entry into the sector was the search for work that fitted

family circumstances or other interests. Ten interviewees identified the hours on offer in the

care sector as the main reason why they entered. As box V.13 makes clear, some care workers

were able to negotiate very convenient hours for themselves but often these were not

representative of the hours of work across the sector as they might involve limited weekend

work and hours that fitted around home commitments. Thus those expressing satisfaction

were doing so more with respect to their own specific hours, than those that typified the

sector. It is important to note that the care worker who chose to work for the inhouse service

39 The issue of redundancy and job insecurity prior to the care workers taking up their current position was not

part of our initial investigation and there were no specific questions relating to this. Therefore it may be the case

that at the time of the interviews recent redundancy may have been more common than the data suggests.


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because the hours fitted in with school hours may not have been able to negotiate these hours

if she was a new recruit and the types of hours she mentions are no longer typical. Indeed

others referred to the hours as a reason for deferring entry into the sector. The use of zero

hours contracts was mentioned; a lack of guaranteed work meant that anyone who was reliant

on a wage to bring up their family could not take a risk on the unpredictable hours on offer.

Therefore the case study interviews show that the pattern of working hours in the care sector

are far from being a „pull‟ for everyone.

Box V.13. Care work and working hours: a help and a hindrance in attracting a wider

pool of candidates

Why did you enter the care sector?

Because it is something to do with when you are both full-time and you have to juggle around the

time with looking after your kids and then the time working full-time as well. So it took me three

years to decide I need to get into the kind of job that would suit our time and schedule. Because a

clerical job is normally like office hours. It is not flexible enough. …I laid down my cards to [the

manager] - we have got the schedule ready, my wife and myself. And then I told him already when I

applied for this job, I can only work in the afternoon, …. (XDHome1, Care Worker 2, age 31, 6

months in post)

I'm in a new country and this is the second job I‟ve had, and I‟m really a clothing designer,… I like

how flexible the time is, so I can say that yes, I‟m available to work these days, and also .. I think

that was the main one but I enjoy working with people also but I would have to say being flexible

with my hours was the main reason [I entered the care sector]. (RNDom2, Care Worker 4, age 32, 2

weeks in post)

I left my job [at the hospital] because it was weekends and it was a split shift, so I literally done from

the seven till one and then had to go back and do five till ten, so it was giving up every weekend. And

then this one, when you were home helps you could start at nine and finish at two thirty, so I could

take my children to school and pick my children up from school, which I feel is an important thing to

do. (RNLADP, Care Worker 4, age 46, 20 yrs in post)

But the variability in the hours had been a pull away from the sector in the past for other care

workers

I‟ve wanted to do this forever but because I‟d two kids I couldn‟t, because of the hours (…) and I

was a single parent, so I needed a steady wage and steady hours. Which you don‟t get steady hours

in this job. (ONDom1, Care Worker 4, age 43, 5 months in post)

I‟ve always wanted to work with the elderly but whilst my daughter was younger, you can‟t easily do

the different shift hours. but once she got old enough I just said, well I‟m getting out of this, and

came into caring. (XDLADP, Care Worker 3, age 52, 7 yrs in post)


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V.2.2. Role of employers versus employees in access to information on care job

vacancies

The case studies were designed to investigate the recruitment process from the employee

perspective. In particular we wanted to know how people heard about care jobs and if they

were responding to a formal vacancy (employer-led recruitment) for a care job or whether it

was through informal means (employee-led).

Table V.6 shows that 45% of the interviewees heard about the job via informal means,

referred to here as employee-led recruitment, while 55% entered through formal practices or

employer-led recruitment. This pattern applied to both IDPs and care homes but three quarters

of those entering LAs did so through formal practices. Similarly, around three fifths of those

working for national chains or for single homes or agencies were recruited formally but this

only applied to 13% of the people who worked for a local chain.

Table V.6 Employer-led and employee-led recruitment

Sample

No.

Employee -led

Recruitment (%)

Employer led

Recruitment (%)

a. By type of care provider

Domiciliary 40 43% 58%

Homes 38 58% 42%

LADP/ LA Home 20 25% 75%

b. By Organisation Type

Local authority 20 25% 75%

Local chain 16 88% 13%

National chain 48 40% 60%

Single home 14 43% 57%

Totals 98 45% 55%

Formal recruitment in the case study interviews included press advertising or radio

advertising, placing an advert in a shop window, using the job centre or an employment

agency or advertising on the internet. Only three people mentioned finding out about the job

via the internet. We found that those looking to enter the care sector as a career change were

influenced by particular HR practices rather than informal knowledge and reputation.

Providers who emphasised training in advertisements made themselves attractive to a pool of

recruits that wanted a career in care and LA providers that emphasised secure employment,

quality of care and the adherence to strict procedures were also attractive to the care workers.

Employee-led recruitment took a number of forms; for some it involved ringing around

homes to see if there were vacancies or walking in to the office of the provider and asking if

there were any jobs. The most common way employee-led recruitment took place in practice

was through informal social and family networks; when care workers were asked how they

heard about the job or vacancy it was often friends or family who already worked for the


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agency that passed on knowledge about vacancies and shortages in specific providers and

encouraged them to apply. This informality was found across all four LA areas regardless of

the age profile in each case study local authority. This supports the survey findings that a

significant share of providers (43% of the managers in care homes, 23% of managers of IDPs

but none of the LADPs) found word of mouth recruitment to be the most effective method of

recruitment. The lower share among IDPs may in part reflect the higher share of national

chains in the IDP sample who made more use of formal methods.

Employee-led recruitment in practice

Box V.14 shows the ways employees can take the initiative and enter the care sector without

seeing a formal advertisement about a vacancy. The role of informal networks is central in

this process. Linked to this theme of networks is the localised nature of recruitment in the care

sector. Informal networks were effective because care workers worked in a very localised

area. This meant that chance encounters with friends who worked in the care sector could be

the way knowledge about opportunities was passed on. Fifty-seven out of 88 care workers

reported that they lived in or close to the area they worked40

. It meant that shop window

advertising and simply walking past providers who were visible was an effective way for

providers to recruit.

Box V.14. Employee-led recruitment in practice; informal and local knowledge

Informal networks and word of mouth recruitment

I got divorced and needed a change of direction; I fell into care as I needed a job and a friend

suggested [ILDom2]. I had heard about [ILDom2] and its reputation – there are now 4 providers in

[IL] and this is the leading one. (ILDom2, Senior Care Worker 1, age 39, 8 months in post)

Yes it was through my sister - actually one of our friends told us about the jobs here. And she also

works here. (XDDom2, Care Coordinator and Care Worker, age 23, 1 yr in post)

I heard good things from the person that worked here, and they pay better than some of the other

agencies, and those are the two factors… They‟re more organised than some of the other ones.

(RNDom2, Care Worker 4, age 32, 2 weeks in post)

Well, sort of when I first applied with [the agency] because my friend that works in this section had

put my name forward to them that‟s where I was offered the work. (RNLADP, Care Worker 3, age

43, 2 yrs 6 months in post)

I wanted to do it all the time but I thought it was hard to get into, and then a friend who I worked

with in the shop where I worked, her sister worked here, so it was like by word of mouth. So I just

40 However care workers had very different definitions about what travel-to-work distances constituted being

close to where they worked. For example, some care workers who lived three or four miles away from where

they worked responded that they did not live close to the area where they worked while others defined this

distance as being close to work.


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came along and just asked if there was any jobs going. (ONHome2, Care Worker 3, age 42, 2 yrs in

post

A friend that I‟d worked with in my other job and I saw her when I was out shopping and I said,

„You know, I‟ve had to give it up because of my back.‟ And she said, „Well, this is just a little rest

home that I work in.‟ And I thought, well, yeah, I can manage that. (RNHome1, Senior Care Worker,

age 54, 6 months in post)

So I decided, I thought right, perhaps I‟ll go to a nursing or residential home. So I just randomly just

rang all the nursing homes around like here, I think St Luke‟s. So I just randomly rang….I got an

application form from four of them, and then got an interview for two of them. And then I sort of

liked it here. So…It just seemed more friendly. (XDHome2, Care Worker 4, age 44, 3 yrs in post)

Well, I‟d applied for two, both care companies, and I got jobs at both, but the office for this one was

nearer to me than the office for the other one, so, and I was accepted first by [ONDom1] so I came

here. (ONDom1, Care Worker 3, age 49, 4 yrs in post)

Voucher schemes to encourage the use of existing care workers‟ social networks recognise the

pool of potential recruits that can be tapped into via existing employees. Three of our case

study organisations operated a voucher scheme (XDDom1, ONDom2 and ILDom1) which

involved offering, on average, a £50 bonus payment for employees who introduced a friend to

the sector which was paid once the person who introduced had worked more than 40 hours.

Interestingly these were national chains and the majority of the people we interviewed who

worked for these organisations were recruited formally (table V.6). However, it would appear

that national providers are increasingly recognising that word of mouth recruitment has been

operating quite well for many local providers and they are seeking ways of integrating this

recruitment practice into more formal systems.

In many respects this is unsurprising. It could be argued it is a more reliable method than

others, as the tacit knowledge that is gained from having family members and friends in the

sector manages the expectations of those entering the organisation and this may increase their

propensity to stay. It is also a reliable form of entry from the employee perspective. The

reputation of providers and knowledge about the employer is passed on by existing employees

which is an invaluable source of information when care workers are choosing between

providers. However, an increased focus on informal recruitment methods may have

implications for expanding and diversifying recruitment into care as we discuss in section

V.7.

Suitability of job applicants and the emphasis on informal experience and skills

We also asked all interviewees to describe their experiences of the recruitment process and

what skills and qualities the provider had looked for when they applied for the job. In line

with the general telephone survey findings reported in part III, all the independent case study

organisations identified a positive attitude and friendly nature as the most important factor in

assessing the suitability of a job applicant for a care job. The views of the LA providers were


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more mixed with two LADPs reporting a positive attitude was the most important factor and

one LADP41

(ONLADP) saying skills for care were the most important factor. Interviewees‟

accounts of the recruitment process (box V.15) show how providers value the informal skills

built up through experience of caring in the home. Many of the unqualified interviewees

appreciated being judged on this rather than formal qualifications.

Box V.15. The recruitment process and the stress on informal skills

There wasn‟t nothing on qualifications but it was all, because, like I said, mine‟s all basically down to

personal experience…… And like when they seen what I‟d done with family members and that it was

basically the same, it was the same as the job, if you know what I mean. (ILDom1, Care Worker 2,

age 34, 8 months in post)

My mum had dementia towards the end of her life. So I understood how that affects people as well. So

I had some sort of insight into that as well…..I told them about my dad and I told them about my

mother‟s situation towards the end of her life. And I suppose because I‟d been down that road already

and I knew the insights into what the job could probably be throwing at me, then they seemed to be

more than happy that I could probably cope with it………I don‟t remember them saying that you need

this and this, and they needed ... ….I suppose they took it on face value on my general attitude on

things like that. And I think to a certain extent that is a better way to look at people. Because I applied

for numerous amounts of jobs and I think to a certain extent because of my age as well, people

weren‟t looking at me. (XDLADP, Care Worker 2, age 55, 4 months in post)

No. They just asked what my exam results were. Which I couldn‟t remember. It was a very long time

ago. And apart from that, no. I had the interview and they didn‟t seem to want anything special.

(XDLADP, Care Worker 1, age 50, 3 yrs in post)

41 The ILLADP also said skills for care were most important but this was not included in the cases studies as it

was LAHome that was studied


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V.3. Care workers’ perspectives on turnover and retention

In this section we examine the intentions of the care workers we interviewed to stay with their

current employer and to stay in the sector and the reasons given for these intentions. The

problems of examining turnover from a sample of interviewees that does not include „leavers‟

has been discussed in section I.8. Nevertheless, through our case studies we explored those

aspects of care work that the interviewees did not like and also their perceptions and

experiences of why new entrants to care work may leave. Together these provide us with

some insights into the cause of staff turnover and staff retention.

V.3.1. Care workers‟ intentions to stay or to quit

Table V.7 gives a breakdown of the case study interviewees‟ intentions to quit: 89% of the

sample intended to stay in the social care sector and over half (54%) said they would expect

to be working for their current employer in five years time. Half of those working for care

homes (19 interviewees, all of whom were care workers) said they intended to stay with their

employer compared to only 38% of those working for IDPs (15 interviewees, 13 of whom

were care workers). Among those working for LAs, 90% intended to stay (16 of the 18

stayers being care workers). A further 4% of all interviewees said they probably would stay,

leaving 27% who said they did not expect to stay and 15% who were unsure.

Table V.7. Care staffs’ intentions for employment over the next five years

Sample

No.

Yes

(%)

Probably

(%)

Unsure

(%)

No

(%)

a. With current employer in 5 years?1

Workers in:

domiciliary care 39 38 5 20 35

care homes 38 50 5 16 29

LAs 20 90 0 5 5

all types of providers 97 54 4 15 27

b. In Social Care in 5 years? 2

Workers in:

domiciliary care 38 89 0 5 5

care homes 36 86 0 6 8

LAs 20 90 5 0 5

all types of providers 94 88 1 4 6

1

One missing response- domiciliary care worker 2 missing responses- 2domiciliary care workers, 2 care home

workers

Out of 26 who said they intended to leave, 22 were care workers and they gave a number of

reasons for intentions to quit. Working for the NHS and nurse training were the reasons most

often given for leaving. Low pay was only cited by one care worker as a reason to leave,

although the better pay in the NHS may mean that when care workers stated they intended to


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leave for the NHS, pay could be a factor shaping this choice. Pay is certainly an important

factor cited by managers as reported in part III. A quarter of respondents in the management

survey also identified working in the NHS as a reason why care staff leave (see section III.2)

but in many instances our case study data suggests that care workers were not actively

seeking work in the NHS. Instead it was often presented as an aspiration for the future, often

discussed in quite vague terms. The case study below gives an indication of the ambiguity of

some of the care workers‟ responses when they identified leaving the sector to work for the

NHS (box V. 16).

Table V.8 Reasons for care workers’ intentions to leave

Workers in all

provider types

(%)

Domiciliary

care workers

(%)

Care home

workers

(%)

Workers in LA

care providers

(%)

Nurse training 19.2 21.4 18.2

Work for the NHS 19.2 7.1 36.4

Move to home country 7.7 18.2

To work in a different sector 11.5 14.3 100.0

Lack of support /no promotion 7.7 14.3

More convenient working areas 3.8 7.1

Better Pay 3.8 7.1

Work for another care provider 3.8 7.1

To work for the Local Authority 3.8 7.1

Retirement 3.8 9.1


Box V.16. Case study ONHome2: the ‘pull’ factor of the NHS

Summary

This provider was in an LA classified as „mixed‟ according to its commissioning practice and staff

reported high levels of job satisfaction despite being dissatisfied with staff shortages and low pay.

All care workers felt supported by their manager and one was studying for her NVQ 3. There were

opportunities to progress in the care home; for example, the manager had asked two of the staff if

they wanted to become senior care workers but they were undecided as to whether they would like

to do this because of the extra responsibility for little extra pay. Although they were happy many

aspired to move into working for the NHS in the future although they did not seem to have any

concrete ideas about how they would go about this.

Will you still be working for your current employer in 5 years time?

Possibly be here or I‟ve even considered hospitals and stuff like that, to sort of, well, I‟ve done this

for twenty five years, if I don‟t do it now I won‟t do it, type of thing. But on the whole I‟m content

where I am at the moment so if I was to move it would be …It would be something like the NHS.

(ONHome2, Senior Care Worker, age 43, 5 yrs in post)


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I think I‟ll still be in the caring profession, but I would like to work in the hospital. That‟s what I

want to do. (ONHome2, Care Worker 3, age 42, 2 yrs in post)

No. I don‟t know. Hospital, I hope. (ONHome2, Care Worker 1, age 47, 8 yrs in post)

I‟ll still be in this kind of job, whether it‟ll be in this place or not, I don‟t know. (ONHome2, Care

Worker 2, age 26, 3 yrs in post)

How I feel now I‟d like for to stay here, definitely…..but I say I‟d look at hospitals, that‟s in a

couple of years that I‟d look at the hospital. I‟m not ready for anything like that yet, definitely not.

(ONHome2, Care Worker 4, age 24, 6 months in post)

The patterns with respect to intentions to stay or quit were relatively mixed, with 58% saying

they would stay or probably stay and 42% saying they would definitely leave or were unsure.

Nevertheless the fact that only 27% of those we interviewed definitely intended to quit may

be influenced in a large part to the high level of job satisfaction reported by the care workers.

To explore these issues further, we also asked directly about what the job of a care worker

involved on a daily basis, what they liked and disliked about their job and also the nature of

their relationships with service users. All 88 care workers said they enjoyed their work. All

highlighted the rewarding nature of the job related to helping people, working with the elderly

and building relationships with service users. Care workers spoke with passion and

enthusiasm about their work and were clearly committed and dedicated to providing a good

quality service to users (box V.17). Significantly, they used their discretion in forming their

relationships with users and spoke of the need to adapt the ways they interact with different

users to provide a quality service.

Box V.17. High levels of job satisfaction: making a difference and building

relationships

They‟re elderly, they‟ve had their life and you‟ve got to make their last years or whatever as

comfortable as possible. To me, I would treat them as if they were my family. I mean some have

challenging behaviour but you just deal with it. You don‟t get aggressive with them, you just keep on

a level par with them. I mean some you can have a bit of banter with, some you can‟t, you know

which to step back from. But no, I love the job. Love it. (ONHome2, Senior Care Worker / Deputy

Manager, age 60, 9 yrs in post)

And you have to be understanding, you have to be able to understand your clients and make sure

that they understand you. And you need to be able to - not change so much with different people but

you know how you can talk to one client and how you can‟t talk to another. Everyone‟s different and

you just have to find a way with everybody. (XDDom2, Care Coordinator and Care Worker, age 23,

1 yr in post)

Making a difference to people‟s lives – making an impact – it could be a sociable thing, a wink of the

eye, a joke, any form of communication with them. If I don‟t get the wink from this man I know he‟s

not comfortable – and then I make him comfortable and then he winks. It‟s giving them something


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back for me. (ILDom2, Senior Care Worker 1, age 39, 8 months in post)

You go and someone can be very depressed the first time you meet him or her and then you going on

your days it can cheer them up, so you get job satisfaction. You know, I‟ve had clients that are

bedridden and now they‟re walking with a Zimmer because they‟ve had that encouragement. ..So it‟s

a lot of job satisfaction really, and it‟s very, very rewarding. (ONDom1, Care Worker 2, age 33, 6

months in post)

Levels of satisfaction were shaped by different aspects of the job, depending on the type of

provider they worked for (box V.18). Those working in homes identified the family

atmosphere of working in a care home and working as part of a team as one of the aspects of

the job they enjoyed. In contrast, those working for IDPs identified the autonomy of being

able to work unsupervised and not working in one place as one of the most enjoyable aspects

of their job42

. Those working for LADPs also enjoyed working in different places and spoke

in terms of „working in the community‟ and focused on the challenging and rewarding aspects

of the re-ablement role that many of those working for the inhouse service were now involved

in.

Box V.18. Working in different types of providers brings different sources of job

satisfaction

Care Workers in IDPs

It‟s something different on your own, you‟re not in one place, somebody watching you while you‟re

working all time, you‟re out and about. (ONDom1, Care Worker 1, age 48, 3 yrs in post)

I feel as though I‟m my own boss, sort of like going around, and I feel as though I‟ve like helped

people, you know. (RNDom1, Care Worker 1, age 41, 11 months in post)

you‟re going in and making, you are making a difference to somebody. The only person they might

see that day. I just like chatting with them, socialising with them, just doing anything that I can to

help keep them in their own homes. (RNDom1, Care Worker 2, age 51, 2 yrs in post)

Care workers in care homes

I just think it‟s like loads of grans and granddads, it‟s like really close and family; and it‟s nice to

help people. It‟s just a nice thing to do; it‟s something to give back isn‟t it really. It‟s like having lots

of nans and granddads, and you all have different ways to talk and to interact with them, and you

know how they feel and you can make them happy and vice versa, if I‟m having a down day, they can

bring me up. It‟s just nice. (ILHome1, Care Worker 3, age 23, 3 yrs in post)

It‟s nice when you see a smile on the resident‟s face. It‟s nice helping, it‟s nice when you make a

difference to someone, it‟s like a family atmosphere as well. (ILHome1, Senior Care Worker, age 38)

I like that it‟s a small residential home. So everybody is looked after on a personal level. And the

42 Note two of the quotes are from RNDom1; further details on this case study are given in box V.32


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team that you work with have been here a long time so they know the residents and you get to know

them and you know their abilities. So you can help - if they need help and they can help you. It‟s a

good team. (XDHome2, Care Worker 3, age 26, 2 months in post)

Care workers in LADPs

I like the challenge of, there‟s nothing worse to me than when I‟ve got a client that you can‟t get to …

do what you know is, what is good for them, you know what I mean? I get a real sense of achievement

when I can get them to do something that they‟ve never wanted to do. You know, even if it‟s just like

having a wash, you‟d be amazed how many just won‟t wash, and when you can get a relationship with

them where they trust you, 'cos at the end of the day they don‟t wanna have somebody washing them,

because it‟s perhaps a final admittance that they need help, and when you can finally get them to let

you help them, I enjoy that. I enjoy, you know, the achievement of it. There‟s nothing more frustrating

to me than when I can‟t get somebody to help themselves really. (ONLADP, Care Worker 3, age 43,

14 yrs in post)

I love meeting people, I like the fact that you‟re not stuck in one place, you are actually out and about

in the community with clients that are not, you‟re not just in a care home, for instance, you are out in

the community with clients. (ONLADP, Care Worker 1, age 22, 11 months in post)

It‟s rewarding, it‟s challenging. Yeah. It‟s rewarding and it‟s challenging and I like the colleagues

that I work with. (RNLADP, Care Worker 4, age 46, 20 yrs in post)

I like people. I must admit I do, I like it, especially now if we‟re managing to get them sort of on their

feet more than they were before. I don‟t know, I can‟t imagine doing anything else, to be honest,

although I don‟t particularly wanna say I‟m gonna do it till I‟m 65, I can‟t imagine me doing

anything else. (RNLADP, Care Worker 2, age 45, 15 yrs in post)

This gave us a more complete picture of why, despite the low pay and uncertain hours, it was

only a minority of care workers who intended to leave. As we have seen, motivations to enter

the sector were often related to the nature of care work; being able to help others, to make a

difference, to do meaningful work and to build on rewarding personal experiences of informal

care in the home. Motivations to enter the care sector are important to understand because

these reveal the expectations about the job of those entering the sector. This has a direct

impact on levels of retention. It is often whether the organisation and the job can fulfil

expectations that determine job satisfaction and consequently whether people will stay or

leave. The descriptions above of care workers‟ feelings about their jobs reveal that in many

cases the role did fulfil care workers‟ expectations.


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V.3.2. Factors that may contribute to turnover

Insight into causes of turnover can be gleaned from responses to questions about those aspects

of the job care workers did not like (table V.9). Forty-two percent of the care workers

interviewed said there was nothing they disliked about the job. Of those who did report

aspects of the job they did not like, issues relating to pay (including the lack of compensation

for time spent travelling between users) and working time were most often mentioned. This

suggests that dissatisfaction is often related to the way care work is managed rather than the

job itself.

Table V. 9 Aspects of the job care workers were unhappy with

% of care

workers

Nothing 42.0%

Low pay / Lack of travel pay 19.3%

Working time 10.2%

Difficult clients 9.1%

When clients deteriorate / die 9.1%

Being asked to cover/absent staff 6.8%

Stressful/Chaotic/Exhausting 4.5%

Short staff 3.4%

Lack of autonomy / time 3.4%

Unpleasant parts of the job 2.3%

Travelling between users 1.1%

No promotion opportunities 1.1%

Not working in preferred geographical areas 1.1%

Working with agency carers 1.1%

Language difficulties 1.1%

More paperwork 1.1%

Increased Privatisation 1.1%

Expectations of male carers (to do heavy work) 1.1%

More responsibility and threat of litigation 1.1%

Total respondents =88


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Perceptions of why staff leave

The care workers were also asked why in their experience new recruits into care work may

tend to leave. Two main issues were mentioned: the nature of the job and the unpredictability

of working hours.

With respect to the nature of the job, many of the care workers said that those who enter,

particularly younger people, did not know what the job entailed and it was for this reason

many new recruits left quite quickly (box V.19). This contrasted with the personal

experiences of many of those we interviewed, who, as already mentioned, had experience of

informal caring in the home and/or had contacts working in the care sector before they entered

the sector. This meant they had some prior knowledge of what the job entailed. Their view

was that new recruits often expected it to be more like the traditional „home help‟ role and

those who left often had found the job to be more complex than they had expected.

Box V. 19. The nature of the job as a reason for staff quits.

I don‟t think they[new recruits] come into it with their eyes open. They don‟t think about what

domiciliary care involves, it‟s the old, I think they still think of the old home helps, when it was a bit

of cooking, a bit of cleaning, keeping them company, that‟s what they thought it was. You can tell

them what domiciliary care involves, but until they actually see it themselves then they don‟t actually

realise, and that‟s where we hit the problems. They go through all their theory training in the

classroom, you send them out, and I think that‟s when reality hits (ONDom2, Senior Care Worker 2,

age 36, 1 yr 6 months in post)

I think a lot of them went, especially young girls who are18, I think they come into it thinking it‟s

you‟re just gonna go in and make someone‟s tea and then they realise it‟s not that. You‟re gonna see

some distressing, you know, sights, especially when you go on double-ups, and they can‟t hack it, so

they‟ll go. It‟s not for them. (ILDom2, Care Worker 4, age 37, 7 yrs in post)

Mainly because .. a lot of it comes from the way you‟re paid, doesn‟t it. If you‟re not paid enough for

a job then people don‟t see it as a proper job, it‟s just a little part-time thing that people do. That‟s

how people see it a little bit. And that we just go round making cups of tea for people. (RNDom1,

Care Worker 3, age 50, 1 yr in post)

Another reason put forward by care workers for staff quits was the unpredictability of

working hours and the pressure to do extra hours because providers were often short staffed.

As we have seen in section III.4 a very high share of independent sector providers and LADPs

said it was easy, or very easy to find staff willing to work additional hours at short notice and

by and large providers tend to depend on existing staff to cover shortages. However, what the

survey did not tell us is that this could be a reason for staff turnover. Indeed, pressures to

change working-time arrangements had made one care worker leave her previous provider

(box V. 20).


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Box V. 20. Unpredictable working time as a reason for staff quits.

I mean it‟s not as easy as people think it is. I mean it‟s not a nine to five job, you know, it can be

unsocial hours, you do get mithered a lot from our end, 'cos you know, work has got to be covered. It

doesn‟t matter how many staff we‟ve got off there‟s still the amount of people to look after, and I

think a lot of 'em, you know, they get fed up of being pestered. It‟s not a job you finish, you go home

and you‟re left alone till t‟ next day. You try not to bother people but if work needs covering then you

have to mither 'em. (ONDom2, Senior Care Worker 2, age 36, 1 yr 6 months in post)

I was working from very early in the mornings, never .. they used to pester me night and day to work,

and when you‟ve got children you‟ve gotta have some time to yourself and I was never left alone so I

got alternative employment. (RNLADP, Care Worker 3, age 43, 2 yrs 6 months in post)

But it‟s mostly because of the hours [why people leave]. If you‟ve young families this job wouldn‟t

suit. (ONDom1, Care Worker 4, age 43, 5 months in post)


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V.4. Care workers’ perspective on pay and working time

V.4.1 Pay and travel time

Data was gathered on care workers‟ attitudes towards pay as well other paid benefits such as

enhancements for unsocial hours working and travel pay. We have seen that 19% of care

workers identified dissatisfaction with pay as an aspect of their job they did not like but we

have also shown that it was not cited as a reason to leave the sector, although it could be

argued the attraction of the NHS is linked to the better pay on offer in the health sector.

We asked all care workers whether they thought the pay they received for the job they do was

reasonable. Table V.10 gives a breakdown of care worker perceptions of their pay and shows

that out of a sample of 88 care workers, 35% thought the pay was reasonable, 64% thought it

was not reasonable (1% unsure). Those working in care homes were most likely to perceive

the pay as unreasonable; only four care workers out of 36 (11%) thought their pay was

reasonable.

Table V. 10 Care workers’ perceptions of pay as reasonable

Sample No. % saying pay is

reasonable

% saying pay is

unreasonable

% who don’t

know

Domiciliary care 34 41 59 0

Care homes 36 11 86 3

LAs 18 72 28 0

All types of providers 88 35 64 1

By contrast 72% of care workers employed by LAs perceived their pay to be reasonable

comparing it favourably to the pay on offer in the independent sector. Significantly, it was not

only the basic rate of pay that was discussed by those working for LADPs; all of the LAPDs

in our sample paid for travel time and paid mileage and this was intrinsically linked to care

workers‟ positive perceptions (box V.21).

When IDPs followed similar practices, interviewees were likely to be more positive. For

example, in XDDom2 pay practices mirrored LAPDs; they paid mileage and travel time and

also good enhancements for unsocial hours. Three out of four care workers perceived their

pay to be reasonable in this organisation.

Of those who perceived their pay to be fair, there was often a reference to good weekend

enhancements. This varied by local authority: in XD, every provider paid enhancements for

unsocial hours but in RN and ON, while domiciliary care providers paid enhancements for

weekends, care homes did not. In contrast in IL, the cost minimising LA, three providers did

not pay enhancements including one IDP (see section V.1). Table V.11 shows that there was

a relationship between the LA the care workers worked in and the likelihood they perceived

the pay as reasonable. In the partnership authorities where fees were higher nearly half of the

care workers interviewed perceived pay to be fair (45% in RN and 48% in XD) compared to


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only 23% of care workers in IL. Care workers working for IDPs in the high fee paying

partnership LA of XD were more likely to consider their pay to be reasonable compared to

those working for IDPS in other LAs.

Box V. 21. LADP care workers’ attitudes to pay and non-pay benefits

I would say yes [it is reasonable] I know that they [the council] look after their staff better than the

private company, they pay better, their conditions are better, you know. (ONLADP, Care Worker 3,

age 43, 14 yrs in post)

Our pay is very good for what we do. I‟m not saying it‟s a piece of cake but when you compare our

pay to, especially private sector, we‟re very well paid… There‟s hundreds of agencies out there that

I could work for but their pay is far less than ours, and we have other perks as well, like travel.

(RNLADP, Care Worker 2, age 45, 15 yrs in post)

'Cos you see them advertising and I know people that are working, and on the whole a lot of them

are on like £6.50 an hour, and the main problem with agency and with us as well is they don‟t get

paid their travel time. So in between calls, whereas I know my next call now from here is about eight

miles away, nine miles away. Now, if I didn‟t get paid for that and I‟m in a traffic jam for half an

hour, 45 minutes I‟ve lost 45 minutes pay. So you‟re behind. (RNLADP, Care Worker 2, age 45, 15

yrs in post)

Regardless of which local authority care workers worked in, those working in care homes

thought their pay was unreasonable. Furthermore, the perception of pay as unreasonable in IL

shows that those working in local labour markets characterised by high unemployment were

just as likely to think the pay was unreasonable as those working in higher wage areas as the

quotation below shows;

I think we‟re grossly underpaid. I think we‟re in the firing line for all the mucky jobs and grossly

underpaid….It‟s minimum wage. It is a minimum wage city, isn‟t it. (ILDom1, Senior Care Worker

1, age 50, 1 yr 8 months in post)

Table V.11 Care workers’ perceptions of pay by local authority area

Number of care workers who perceived their pay to be reasonable %

By LA IDPs Homes LA providers All

ON 2 0 4 6 29

RN 3 2 4 9 45

IL 3 1 2 6 23

XD 6 1 3 10 48

All 4 LAs 14 4 13 31 35


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Among the 56 people who said their pay was not reasonable for the work they do, a number

of themes arose in their discussions (box V.22). One of the striking findings was the absence

of any discussion of the employer‟s role in determining low pay. Rather, care workers talked

about the undervalued nature of care work in general and some appeared to accept a trade-off

between rewarding work and well paid work.

Box V.22. Independent sector care workers attitudes to pay and non-pay benefits

I just think it‟s a badly paid profession, it always has been and nobody‟s doing anything about it to

make it any better. I always think if they paid more money they‟d get a higher calibre of people

coming through anyway. (RNDom1, Care Worker 3, age 50, 1 yr in post)

I think it [the pay] should be a little bit more. But, like I say, I love the job, so I mean it‟s not an

issue with me…. (ON.Dom1, Care Worker 3, age 49, 4 yrs in post)

Working as a care assistant is generally not particularly well paid, but … to a certain extent the

reward is the job itself…. Knowing that you‟re able to make a difference to people‟s quality of life by

being there and doing your job properly. (RNHome2, Care Worker 4, age 48, 1 yr in post)

Yeah. I mean my son‟s in [ retail store], stacking shelves and he‟s on like £8 an hour. But it‟s not the

type of job that you can work for money, it‟s a job that you‟ve gotta like and love. (ILHome2, Care

Worker 1, age 50, 2 yrs 6 months in post)

Yes [it is reasonable]. I find that I like the work more, I like getting up of a morning and coming to

work more than I did previously. (ILHome1, Care Worker 1, age 30, 1.15 months in post)

Yeah. I think, I think maybe, I think pay would be a question if you didn‟t like what you were doing. I

think when you enjoy what you‟re doing, it‟s a bonus. (ILDom1, Senior Care Worker 2, age 45, 1 yr

6 months in post)

This data would appear to support the idea that care workers are „prisoners of love‟, accepting

low wages because of altruistic motivations and the intrinsic rewards of the job (see section

1.4). However, while the evidence suggests that some do accept the low wages because of

compensating rewards, these findings also need to be put into the context of care workers‟

previous work histories that have shaped their expectations about wages and job quality. The

majority of the sample had worked in low paid, low skilled jobs in sectors such as retail,

hospitality, administration, and factory work. These jobs were low paid and often described as

monotonous. In contrast care work was found to be more interesting and rewarding than their

previous jobs. It is the limited range of opportunities available to unqualified workers in

general that led the low pay in care work being at least tolerated as the opportunity to have

both higher pay and interesting work did not appear to be an option.

These influences can be illustrated when we look at younger workers‟ perceptions of pay (box

V.23). Half of the total sample of under 30s in the sample felt the pay was reasonable

compared to just over a third of the whole sample. Those who did consider it reasonable

tended to relate their experience in care work to their low expectations, based on their


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earnings in the past rather than to specific organisation policies. It is also notable that pay

tends not to rise with experience in care work, so younger staff may be more likely to

consider the pay reasonable than those with many years of experience in the sector.

Box V.23. Young people and perceptions of pay

Well, for my age it is, yeah. It‟s not too bad. (RN.Home1, Care Worker 2, age 19, 6 months in post)

Yes. I‟m not really bothered about how much I get paid. Because I feel rewarded because of what

I‟ve done. But the pay is fine, yes, it‟s alright. (XDDom1, Care Worker 1, age 18, 8 months in post)

It is more money, yeah .. in a nursery you would think you‟d get paid a bit more money …they‟re

putting their children‟s lives in your hands, you would think that you‟d get paid more, but you don‟t.

So it‟s nice to come here and feel like, you know, 'cos you get paid a little bit more you actually feel

you‟re being a bit more valued. Like they actually appreciate what you‟re doing. (RNDom2, Care

Worker 2, age 24, 1 yr in post)

Some care workers did voice criticisms of their employer‟s policy on pay and a minority

linked the pay to the commissioning practices of the local authority. As discussed above,

when policies about pay were discussed, it was often in relation to enhancements or travel pay

rather than the basic pay. It was the lack of these that was often at the centre of discussions

about pay when people perceived it to be unreasonable (box V.24).

Box V. 24. Lack of travel pay as a source of dissatisfaction

You‟re not getting paid for your distance you walk to, each (…) house, people‟s houses, just for what

you‟re doing….And I think you should get paid for your distance (…), 'cos that‟s all in your job.

….Because we have to go out to various places and pay bus-pass fares and things. And I don‟t see

why we should have to pay to go to work, if you know what I mean. (ILDom1, Care Worker 3, age

25, 1 week in post)

I‟d like to get paid from the time I start to the time I finish, instead of being paid just for the calls I

do. For example, I was out for 5½ hours yesterday in the evening. But I only got 3½ hours pay.

Because of all the travelling here, there and everywhere, by the time I leave home and the time I get

home, I was out for, as I say, 5½ hours. Which is a bit of a shame, because it‟s two hours of my time

that I‟m not getting paid for. And I do think to myself, oooh, that‟s the worst part of the job I

think…Our manager has tried putting it forward but it‟s up to social services, and they say “No,

we‟re not going to give you any more money”. So she can‟t give us any more money. (XDDom1,


The quotations in box V.24 show how some workers made links between the LA

commissioning environment and the lack of travel pay. The impact of commissioning

practices was also becoming increasingly felt through the implementation of electronic

monitoring. This was in place in two of the case study LAs and one care worker raised the


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issue of how this was affecting her pay because she may be told by service users to leave their

homes before she is scheduled to leave (see box V.25). As this practice spreads and becomes

more commonplace care workers may become more directly conscious of the role of the LA‟s

practices on their pay. Although electronic monitoring practices are designed to monitor

providers, the inevitable outcome is increased monitoring of care workers with potentially

negative impacts on their take home pay.

Box V. 25. Electronic monitoring and the impact on pay

So you only get paid for what you clock in for. So if you‟re there ten minutes, you only get paid that

ten minutes. …..Even if they say, “You can go now, I‟ve done everything, there‟s nothing else for you

to do. There‟s no point in you staying. You get on dear and get on with your other jobs”…..So you can

think you‟re getting a five hour shift and you actually end up only doing 3½ hours, because some of

the clients don‟t want you to stay, (XDDom1, Care Worker 2, age 37, 2 yrs in post)

This discussion of pay shows that dissatisfaction with pay alone is only part of the story when

trying to explain recruitment and retention difficulties. Pay may deter people from entering

care work and even among those who have entered, such as our sample of care workers, the

majority consider their pay to be unreasonable. Nevertheless, the majority wanted to stay in

the sector and with their employer. To understand this commitment further, other HR

practices relating to working time, work organisation and training are examined to see what

bundles of practices and trade-offs between particular advantages and disadvantages of the

job help create the group of „stayers‟ that our sample represents.

V.4.2 Working time

We have already discussed the somewhat conflicting findings relating to working time and

recruitment. Although working hours on offer in the care sector can be both a reason to enter

the sector and a reason to defer, in practice only nine care workers identified issues relating to

working time as an aspect of the job they were dissatisfied with.

Table V.A3 in the appendix gives a breakdown of the working hours of our sample of

interviewees. This shows that over half of the sample (54%) worked full-time hours (between

30-45 per week): this applied to 58% of interviewees in IDPs and 63% of those in care homes.

Although there were only 20 interviewees in the sample working for the LAs, these tended to

work fewer hours than those working in the independent sector: only 30% worked full-time

hours and 70% worked long part-time (16-30 hours per week). None of those working for an

LA worked over 45 hours compared to 18% of those in IDPs and 5% of those in care homes.

Although the sample is too small to generalise from, these figures suggest that social care is

far from a short hours, part-time work sector.

To explore the care workers‟ views on working time, we asked whether they were working

the hours they preferred, why they preferred these hours and if their employer was able to


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match their work schedules with their preferences. In the telephone survey five case study

managers said they matched care workers working time preferences all of the time, 14 said

they matched them most of the time and one LADP said they only matched preferences some

of the time. Care workers were in fact more positive about their working time arrangements.

Seventy-two out of 88 care workers said their working hours matched their preferences. Of

those who said they did not work hours that matched their preferences, the majority were new

recruits who wanted more hours, or disliked the fragmented and unsocial nature of the hours.

Eight said they had no preference or reported that they worked contracted hours which

implied limited choice over hours but they did not give any indication whether these were

preferred hours or not. Significantly, out of the eight care workers that reported they did not

work their preferred hours, five of these worked for LAs (out of a sample of 20 LA care

workers). This gives some support to a trend that was discussed in section V.1 where care

workers working for LADPs appear to have less working-time flexibility compared to those

care workers working for other providers. New recruits in particular who were often hired to

provide cover for holidays and sickness could work very varied hours. Many of these care

workers wanted to build up a round of clients and wanted more work. Dissatisfaction over not

being given enough hours could lead to the newly recruited thinking about leaving the

organisation because of the impact on their pay (box V.26).

Box. V. 26. New recruits dealing with the unpredictable and fragmented working time

in the care sector

I asked for 40 hours a week and I‟ve only been getting 21…..Yeah. Because I‟d rather have, do you

know what I mean, set hours like I thought it was, but when they, you know what I mean, when

you‟re starting they‟re not set out like that, they‟re just all different, so that was a problem for me.

I‟m a bit unsure whether to stay here or what. Gonna get back in touch with [employment agency].

(ILDom1, Care Worker 3, age 25, 1 week in post)

I need to work a certain number of hours in a week and I can only go on for like a certain length of

time and if I‟m not getting those hours then there‟s no point in me staying. (RNDom2, Care Worker

4, age 32, 2 weeks in post)

It can fluctuate quite a bit. I find it quite hard sometimes when I‟ve got a gap in the day that‟s over

eight hours. Like this morning I was getting people up. Then I‟m not on until around about 20 past 7

tonight when I‟ve got to go back out again. And I find it very hard. I find it - because you‟re just

winding down. The body‟s winding down and then you‟ve got to - and I‟m looking at the clock from

5 o‟clock on, just keep looking at the clock because you don‟t want to miss that. Because you have to

go out and do double ups and things like that. (XDLADP, Care Worker 2, age 55, 4 months in post)

Oooh, it can vary. I‟ve got 12 permanent hours I do a week and then I cover sort of hours for people

on holiday, things like that, and I can be doing about between about 18 to about 40 hours a week.

Sometimes more. (RNHome1, Care Worker 2, age 19, 6 months in post)

Sometimes I can do 25, sometimes 35, sometimes 40 or 50, depends on how much staff we‟ve got.

(ILDom1, Care Worker 2, age 34, 8 months in post)


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However, for some the fragmented hours were the reason why they entered the sector and

stayed. The split shifts in particular could fit in with school times if family or friends were

available to cover in the evenings and some older workers preferred them. Yet for others, the

hours were seen to be incompatible with a family life and, as we have seen in the recruitment

and retention discussion, they could be the reason for not delaying entry or for leaving the

sector.

Some care workers felt very dissatisfied with the practice of providers using existing staff to

cover shortages and the unpredictability involved in being asked to do hours at short notice.

One care worker was employed in an organisation with a very high turnover rate and there

was a sense that existing staff were constantly being asked to cover. She believed new staff

who did not like saying no to their new employer were doing too many hours and this made

them leave (box V.27). Another one talked about how difficult it was working unpredictable

hours;

Box V.27. Care workers not achieving work-life balance

..they‟re always ringing you up asking you to do extras all the time, can you do this, can you do that,

'cos somebody‟s rang in, you see. They‟ve just asked me now, 'cos it‟s my weekend off. I work every

other weekend and she just said, „Do you want to work this weekend?‟ I said no. ……I mean when

they [new recruits] first start they don‟t like saying no….They think, oh well, they‟ll think I‟m no

good at the job, so they end up doing all these extra hours what they don‟t really wanna do.

(ONDom1, Care Worker 1, age 48, 3 yrs in post)

I feel this is a hard job – you get attached to people, and it‟s a lot of care, and a lot of people can‟t

do it. It‟s like you are not appreciated, it‟s hard working, and its long hours, it‟s not fitting your job

round your life, it‟s fitting your life round your job. You don‟t know what you are doing one day to

the next hours wise. (ILHome1, Care Worker 3, age 23, 3 yrs in post)

However, for others the offer of more hours and the ability to earn more money by working

extra hours was the attraction of the job and the only way they could earn a living wage, thus

enabling them to stay working in the sector. The quotations in box V.28 are from care

workers working long hours, often over 45 hours a week. The opportunity to build up a

weekly wage through additional hours may be a further factor why a third of workers

considered their pay to be reasonable, despite the very low hourly rate of pay.

Box V.28. Long hours working to earn a living wage

It is the hardest profession, it is not reasonable. I wouldn‟t go for a £7 (an hour) job through

because I love this job. It is poor. I have to work an extra 20 hours per week to earn a salary – there

is no recognition as a profession. (ILDom2, Senior Care Worker 1, age 39, 8 months in post, 40-50

hours a week).

It‟s long days. I mean I started at quarter to seven this morning and I won‟t be finished till half

seven, quarter to eight tonight. I‟m off in the afternoon and then I‟m back on at three. If you‟ve got


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kids you just couldn‟t do it. -I work every hour they give me. …This is my first weekend off in about

six, seven weeks, I‟ve always done a bit of overtime for them. I‟m cream-crackered (ONDom1, Care

Worker 4, age 43, 5 months in post, 40-60 hours per week – 6.45 am – 7.45 pm).

But I used to do, that‟s what I‟m used to, you see. In my old home I used to do 72. But the thing is

you get used to earning a certain amount of money and if you cut that down to, say you‟re

contracted to 36, you think, oh God, how can I survive on that? (RN.Home2, Care Worker 3, age 21,

3 months in post, 48-60 hours a week).

'Cos if you want they‟re flexible, if you wanna do more overtime, if you wanna earn more money

there is more money sometimes there to be earnt. (ILDom1, Care Worker 1, age 29, 1 yr 6 months in

post, 30 hours a week)).

Yes. If I didn‟t do weekends, I wouldn‟t make up my money. (XDDom2, Care Worker 1, age 53, time

in post unknown).

For some care workers, therefore, satisfaction with hours may underpin their decision to stay

in the sector. Many talked of a trade off between hours that fit in with their needs and

circumstances and low pay, the former being the most important factor in their job choice at

this point in their lives. Fundamentally, while in many discussions of pay the employer was

not identified as a key agent, in respect of working hours a manager who showed flexibility in

hours scheduling was highly appreciated (box V.29).

Box V. 29. The ‘good employer’ as the one who matches working time preferences

They‟re really, really good. Yeah, we can choose our hours, and they‟re also very good, 'cos I look

after my mum and they‟re really good here if I‟ve got a hospital appointment or something like that

with her, they‟re absolutely brilliant with me. (RNHome2, Care Worker 2, age 56, 2 yrs in post)

And also it‟s like here they‟re very good, I‟ve a got a five year old and because my husband works in

the NHS, they‟re very good about swapping my hours around. I go to the person who does the rotas,

which has all come through Nick as well. It‟s not just me, there‟s other people with children that

need to change their hours and they really accommodate us. They work out who‟s on holiday and

they change your hours, so they are very good like that. (XDHome1, Care Worker 3, age 44, 3 yrs in

post)

We don‟t have guaranteed hours, so we only get what we‟re given. But the co-ordinators are

excellent. They do actually try and give us what they can and help us out. A very good team, very

good office. The ladies are lovely. (XDDom1, Care Worker 2, age 37, 2 yrs in post)


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Care coordinators realised how important this was for care worker satisfaction;

It‟s very important to us[that staff get preferred hours]. We don‟t work people outside their

availability unless they agree to work. If we wanted someone to do any extra, we would always ask

them, we wouldn‟t just give them work… Everyone, when they start, they fill in availabilities and

we do not work people outside these‟. (XDDom2, Care Coordinator and Care Worker, age 23, 1

yr in post)

Hours become important in recruitment and retention if we look at intentions to quit; a cross-

tabulation of the data demonstrates that those who were unhappy with their hours were more

likely to intend to leave their current employer (table V.12). Four of the eight people who said

they were unhappy with hours were likely to quit their employer and three out of five of the

care workers on contracted hours with no choice also said they would not be with their current

employer or were unsure if they would be.

Table V.12 Satisfaction with working hours by intention to stay with current employer

Sample No. Intending to be with current employer in five years

% of care workers

Yes Probably Unsure No

Happy with hours 72 56% 6% 17% 22%

Unhappy with hours 8 50% 0% 0% 50%

No choice offered* 5 40% 0% 40% 20%

No Preference 3 67% 0% 0% 33%

Total 88 55% 5% 16% 25%

*These interviewees did not say whether they were happy or unhappy with their hours

The above discussion has shown the idiosyncratic nature of the hours worked by care

workers. They are a result of a negotiation between the manager or care coordinator and the

care worker and what is a push factor for one care worker (getting asked to do too much

cover, getting split shifts) is a pull factor for others (getting the extra hours they need, getting

some wanted gaps in the day). In general in our case study organisations across all LAs the

providers‟ requirements for flexibility were met by staff and it would appear to be the case

that managers were by and large also meeting staff‟s requirements for flexibility.


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V.5. Care workers’ perspective on work organisation and the

quality of care

Managers‟ perspectives on whether the current system of work organisation was allowing

work to be carried out to a high quality standard were collected in the telephone survey. In

section V.1 we discussed the management perspectives on aspects of work organisation that

we have identified as particularly important in creating both good quality care jobs and

opportunities for care workers to deliver good quality care. This revealed that managers of the

IDP case studies, in particular, perceive there to be some limitations on workers‟ freedom to

prioritise and carry out tasks in ways to improve the quality of care. They also perceive some

restrictions, but not as many, on care workers‟ opportunities to develop good relationships

with service users. Nevertheless, the majority of the care workers we interviewed identified

the relationships with service users as a key source of job satisfaction, and many others

identified the autonomy they had as a reason why they liked the job. These divergent views

suggest there are some contradictions between managers‟ and care workers‟ accounts of how

work was organised. This section will explore these contradictions in more detail.

In the case studies we explored the extent to which care workers felt they were able to deliver

the best quality care. We asked about the concrete ways they could use their discretion to

improve the care they provided and also their ability to develop good relationships with users.

We were also able to explore the impact of the LA commissioning environment by

interviewing care workers who worked in LAs where electronic monitoring was in place. As

section V.1.6 has shown, managers from two IDPs that were part of the same national chain

but located in different LAs (XDDom1 and ONDom2) reported that care workers had low

discretion and that there were also some limitations on care workers being able to develop

good relationships. Both were in LAs where electronic monitoring was in place. We were

particularly interested in care workers‟ perspectives in these cases and if this LA policy and/or

provider policy shaped their experiences of work and their ability to deliver good quality care.

Boxes V.30 and V.31 use some of the qualitative data collected from care workers in

XDDom1 and ONDom2 to illustrate their experiences of discretion and relationships with

users.

Box V.30. Case study of XDDom 1: care worker perspectives in a ‘low discretion’

national provider in a partnership LA

Manager and coordinator perspectives: Staff do not have the freedom to prioritise tasks and do

not have time to spend time talking to service users. There are time constraints on staff delivering

the best quality care because of electronic monitoring and the increased paperwork this brings.

Management reported that although electronic monitoring is a good management tool they were

dissatisfied with the practice of using minute-to-minute invoicing.


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Care worker perspectives:

Time constraints but workers feel they can overcome these

Sometimes I find I haven‟t got enough time. But if that is the case and I find I go in there three or

four times, I found that I‟m taking more than the half hour I‟m given, then I will let the office know

and they‟ll ring social services, and say, this lady‟s going to need extra time, because our care

workers are taking longer. So it gets changed that way. As long as you open your mouth and say,

they‟ll do something about it. If you don‟t say anything, nothing will get done. So you have to speak

out and say. (XDDom1, Care Worker 2, age 37, 2 yrs in post)

There‟s always time. You make the time. And if it means you run over a few minutes then you run

over. But then on some calls you can only be there 10 minutes and it‟s a half an hour call. So you

do make up a bit of time. So you do what you have to do and I always say, is there anything I

should be doing. Even if it‟s not in the care plan. It might be put the washing on the bed, or put the

washing on the line. You do it. I don‟t see why people don‟t do it. I have terrible issues with people

who don‟t even do the basics like wash up and empty bins and things. (XDDom1, Senior Care

Worker, age 42, 3 yrs in post)

Task autonomy: changing the way you do things

Yes. Sometimes [I do change], yes. You‟ve got to remember, a lot of old people are set in their

ways as to how they want it to be. So that‟s how it is. But if you‟ve got an idea that can make their

life easier, they are open to it. But it depends if they like it or not. And you have to go with them.

It‟s freedom of choice. They choose, or their family chooses if they‟re not in the position to choose.

(XDDom1, Senior Care Worker, age 42, 3 yrs in post)

I‟ll just do it [if she finds an easier way to lift a client] And then I‟ll make a note of it in the care

plan, and then next time I speak to them [the office] I‟ll say, oh well I tried this, but everybody has

their own way. And if you‟re on a double up run, you both do it differently. But you work together.

As long as your aim is the same purpose at the end of it, you just do it. (XDDom1, Senior Care

Worker, age 42, 3 yrs in post)

Opportunities to develop relationships

Yes. I think it‟s vital that you go in and you speak about you. I don‟t think you should go in

miserable. And I know we all have bad days. But I think you should go in there upbeat and chat.

And talk about different things. …I‟m always talking about my family. My daughter did a sky dive

and one of the ladies I visit, sponsored her, so I took photos in to show her, even though she[the

user] ended up in hospital. …Because some of those people don‟t see anybody. They don‟t go out.

They sit in that house 24/7. So by talking about something completely different I think it‟s nice for

them. (XDDom1, Senior Care Worker, age 42, 3 yrs in post)

Box V.30 shows that in XDDom1 electronic monitoring does not seem to have affected

opportunities for care workers to develop relationships and „go the extra mile‟ in the way

managers and coordinators believed it had (although it did have an impact on pay, see section

V.1.2). The care coordinators were very aware of the issues that arise with electronic monitor-


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Box V.31. Case study of ONDom2: care worker perspectives in a ‘low discretion’

national provider in a mixed LA

Manager and coordinator perspectives: Staff do not have opportunities to prioritise tasks but are

able to develop relationships with users. There was a reluctance to encourage staff to exchange

ideas and best practice but continuity of care was considered to be very important and the manager

said time was built into care packages for care workers to be able to have time to develop good

relationships.

Are staff encouraged to exchange ideas with other care workers about new ways of working or best

practice?

A: Only at staff meetings, but obviously we have to be made aware of it first because it has to get

authorised, they wouldn‟t be allowed to just change things (ONDom2, Manager)


Lack of task autonomy

I think sometimes what annoys me, it‟s sort of your hands are tied a lot of the time, because we‟re

commissioned by social workers we can only do what they instruct us to do, and sometimes we‟re

the ones who are seeing service users on a daily basis and we‟re seeing what they need, and

sometimes it‟s not always easy to get them what they need, and I think that‟s frustrating. There‟s a

lot of red tape you have to go through. (ONDom2, Senior Care Worker 2, age 36, 1 yr 6 months in

post)

Not really, no [freedom to prioritise tasks]. 'Cos we have a care plan in each house we‟re stuck to

that care plan. But if someone‟s needs have changed we‟re told to ring the office and they get the

authorisation from social services then. (ONDom2, Care Coordinator and Care Worker, age 26, 5

yrs in post)

Time constraints and developing relationships

I don‟t feel we‟ve always enough time for to spend. Sometimes, if you‟ve a lot of service users to see

in a day, you can‟t give them the time they need. And I think that‟s the biggest constraint. You are

on a tight schedule because, you know, …

Q: Is there any way you can get that changed in terms of asking for a longer visit or …?

A: Well, it‟s not always … 'cos sometimes, you see the social workers assess the length of a visit on

what they need doing, but sometimes they don‟t take into consideration that they might just want

somebody to sit and chat to. (ONDom2, Care Coordinator and Care Worker, age 26, 5 yrs in post)

Continuity of care

You do build up, good relationships with some of your clients when you see them on a regular

basis. So you see them, you know, getting better, you can see some getting worse. It is a rewarding

job, that's why I do it. (ONDom2, Care Coordinator and Care Worker, age 26, 5 yrs in post)

'Cos we try and keep the same carer to the same service user. Keep it structured, which is a good

thing. (ONDom2, Care Coordinator 1, age 54, 2 yrs in post)


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ing (see section V.1) and when there are issues related to too little time these seem to resolved

with the LA. This could be the result of the good relationship between the LA and the

provider, rated four out of five in our survey. Although managers expressed the view that

there should be more time to sit with care users, in fact relationships are developing well in

this case often at the discretion of the care worker. Fundamentally it would appear that care

workers have more discretion than managers perceive them to have and the inherent

autonomy in domiciliary care may mean that care workers are able to be more flexible and

develop better relationships than the HR practices in theory would allow. As it is these aspects

that are cited as the source of their job satisfaction, it is unsurprising they are willing to invest

time and energy in building and deepening these relationships with users.

A contrasting picture emerges in ONDom2 as care workers‟ experiences would appear to

support manager perspectives. The lack of autonomy and reluctance to go beyond the care

plan echoed the management perspective. This organisation had a high level of turnover and

this combined with the unsupervised nature of domiciliary care work might be one possible

reason why the provider did not encourage discretion if many of the care workers were new

recruits and inexperienced. There was continuity of care but care workers reported time

constraints on their freedom to spend time with users which was not recognised by managers.

Electronic monitoring was not mentioned as a problem by the care workers specifically, but

the tight schedules that they said did not allow time to talk to users might have been a result

of this.

It is also useful to contrast these care workers‟ experiences with those who worked for

providers who reported different outcomes for care staff in terms of discretion and

relationships with users. Box V.32 gives the perspectives of some care workers working for a

provider in a partnership LA which sets KPIs relating to continuity of care. Box V.33 then

looks at the perspectives of those working for a provider in a cost minimising authority where

levels of discretion were reported to be high. We find that although the opportunities to

develop good relationships were there only to some extent, the manager did encourage care

workers to share ideas.

In box V.32 extracts from interviews with care workers show that the emphasis on continuity

of care at the LA and provider level is implemented in practice and shapes the care workers‟

experience of work. There are some limits on task autonomy but there were high levels of

satisfaction expressed by those working for this provider. It was a low paying provider

compared to other providers in RN but the care workers valued „being their own boss‟, being

unsupervised and caring for regular service users. In terms of delivering good quality care, it

would appear that care workers were able to do so because of the stress on continuity of care

and their ability and confidence to use their discretion and go „beyond the care plan‟.

Research with users shows that this kind of flexibility is valued by users (see section I.4) and

a shift to outcome-based care can have the effect of sanctioning some of the discretionary

behaviours care workers have been carrying out without little recognition in the past.


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Box V.32. Case study of RNDom1: care worker perspectives in a partnership LA that

emphasises continuity of care

Manager perspective: KPIs and incentive payments relating to continuity of care were built into

contracting arrangements. This provider was also piloting outcome-based care for the LA which

would move away from a task and time-oriented approach. The manager identified continuity of

care as very important but reported that workers could only prioritise tasks and develop

relationships to some extent. Outcome-based care was, however, providing more scope for care

workers to exercise discretion over how to provide care .

„Continuity of care is essential…It‟s one of our KPIs to the local authority, is continuity of care‟.

(RNDom1, Manager)


Task discretion

I go straight to the care plan and look at the tasks that are allocated, and then it‟s using a bit,

working round commonsense, what is appropriate and what isn‟t, and just say „Is there anything

else that you need me to do?‟ That‟s not perhaps on the care plan but within reason. (RNDom1,


Not being able to follow things through, if something needs to be done you have to hand back to the

office. I‟d quite like it if I could phone up the social worker and speak to them myself, and that sort

of business. Which I might be able to do soon if they let me be team leader. (RNDom1, Care Worker

3, age 50, 1 yr in post)

Autonomy and relationships

I like it because I‟m on my own and I‟ve got nobody breathing down my neck all the time and I just

feel that, you know, you are, it sounds a bit clichéd, job satisfaction, rewarding (RNDom1, Care

Worker 2, age 51, 2 yrs in post) (see Box V.18 for additional quotes)

Continuity of care

It‟s generally if you build up a relationship. When you‟ve got a regular service user, I do a lady

that I go in to five mornings a week for an hour, and then I do an hour and a half with her doing

her domestic, so it‟s continuity really. (RNDom1, Care Worker 2, age 51, 2 yrs in post)

Outcome-based care

There‟s a bit of both now because they‟re bringing in a different type of care plan where they can

choose a little bit more of what they [the user] have, rather than a set one that we‟ve always

had…..We make sure everything that we‟re supposed to be doing‟s done but there‟s loads of other

jobs that we do and a lot of that‟s in our own time…

Q: What kind of things?

A: Go to post office for them and post letters, pick up shopping, papers, newspapers, fish and chips.

(RNDom1, Care Worker 3, age 50, 1 yr in post)


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Box V. 33. Case study of ILHome1: care worker perspectives in a ‘high discretion’

provider in a cost minimising LA

Manager perspective: The manager reported that staff were free to prioritise tasks and were able

to develop good relationships to some extent, although she recognised this was often when they

worked on other tasks. They were encouraged to share ideas with her and continuity of care was

very important.

„When I asked for ideas/suggestions at a meeting, they didn‟t say anything, but I asked them to

write it down. We got some good suggestions, and when they were less shy, we got more. We try

them out‟ (ILHome1, Manager)


Time constraints on tasks

Sometimes you‟re, you know, obviously rushed off your feet and it can get quite hectic. (ILHome1,

Care Worker 1, age 30, 1.15 months in post)

They do [tasks] get done, just it is rushed a little bit. Like hoisting and things like that, and getting

them all to their meals. (ILHome1, Care Worker 2, age 21, 6 months in post)

Time constraints on developing relationships with users

No, not always, they sometimes think you can spend all day with them, but realistically, you can‟t

and sometimes they want it there and then – you learn to get out of that, you explain we have 42

residents and we can‟t possibly do that, especially if you have only five staff on. If it‟s full, it can be

hard. (ILHome1, Care Worker 4, age 30, 6 yrs in post)

Management support to exercise autonomy

[ Q. (How much) Are you able to introduce new approaches on your own to improve the quality of

care you provide? ]

A. Well, it depends. I‟d ask the supervisor or [the manager] anyway, just to see what their

opinion is. (ILHome1, Care Worker 2, age 21, 6 months in post)

A. I would discuss this first with a supervisor. (ILHome1, Care Worker 4, age 30, 6 yrs in

post)

In the case study of ILHome1 there would appear to be some discrepancy between the

management perspective and that of the care workers. The manager did not mention that staff

shortages were affecting work organisation in contrast to the situation described by her staff

although she did recognise that relationships often had to be developed while care workers

were doing other tasks. However, the care workers identified problems when the service users

wanted them to stop all other tasks and devote time specifically to their relationship needs.

Care workers felt they could use their initiative but only if supported by management.

Fundamentally, it would appear that, despite the manager‟s best intentions, time constraints


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were affecting the quality of care that staff were able to provide. Interestingly, although this

group of workers experienced time constraints as a source of frustration, the care workers

working in this provider cited pay as the aspect of work they were dissatisfied with and they

linked it to the fact that the job was „very hard work‟. This would suggest that dissatisfaction

with low pay can increase when work organisation and staff shortages mean care workers‟

experience their daily job as rushed and hectic.


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V.6. Care workers’ perspectives on training and development

In this section we look specifically at how training and development practices of providers

can affect recruitment and retention. This section will firstly give an overview of the level of

qualifications attained by the sample of interviewees and identify any trends relating to the

commissioning environment and type of provider. We then go on to discuss the care workers‟

views on training and their aspirations for development and promotion. These are discussed

in relation to their effect on intentions to stay with their employer and in the sector.

V.6.1 Experiences of training

Levels of qualifications

Table V.13 gives an overview of the NVQ levels of all of the interviewees across the case

study providers. The share of interviewees with NVQ level 2 qualifications ranged from 53%

in IDPs, 61% in care homes and 85% in LA providers. There were fewer differences in the

shares with NVQ level 3, with 35% of those in IDPs, 34% of those in care homes and only

25% of those in LA providers with this qualification. Those working in LAs pursuing cost

minimisation or mixed strategies were more likely to have NVQ levels 2 and 3, RN had the

lowest number of staff with NVQ level 2. We found only one example of a more obvious

relationship between commissioning strategy and level of training; the high proportion of

NVQ level 3 trained staff in ILDom2 was the result of the block contract they had with the LA

for hospital discharges that stipulated care staff working on this contract should be trained at

this level.

Table V.13 Qualification levels of interviewees

NVQ2 NVQ3 NVQ4 Nursing

qualification

Total Yes

(%)

Due to

start

(%)

Yes

(%)

Due to

start

(%)

Yes

(%)

UK

(%)

Non-UK

(%)

Working in:

Domiciliary 40 53 10 35 3 0 3 0

Care homes 38 61 8 34 5 5 3 8

LA providers 20 85 0 25 0 10 0 0

All provider types 98 62 7 33 3 4 2 3

By LA

ON 25 68 8 56 0 8 4 0

RN 22 55 5 27 0 5 5 5

IL 26 69 0 38 0 0 0 0

XD 25 56 16 8 12 4 0 8


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Experiences of training and links to retention

Our interview data revealed that in general the new recruits and more established care staff

reported positive experiences of training. Induction was perceived as useful by the majority of

the sample, including both new recruits and stayers. Induction can be the first signal to an

employee about the value the employer places on its workforce and can also provide the staff

with a realistic introduction to what the job of a care worker involves, thereby the likelihood

of staff quits where new recruits find the job to be different to expectations. Some of our

case study organisations prided themselves on the training they gave and workers appreciated

the opportunities this brought to help them do their job well (box V.34).

Box V. 34. Positive experiences of training

They do push us to learn more, which is good. And training wise we got all the training that we

need. ...It‟s very helpful, yes they‟re all very helpful, all the training. Made us more confident in

what we are doing. Like manual handling, we become more confident. With dementia training we

become more confident about dealing with people with dementia. We get to understand them and we

become better in the care that we are providing. (XDHome1, Care Worker 2, age 31, 6 months in

post)

Well the training is just absolutely brilliant. The best. It really, really is. It‟s all practical as well

as theory. ….I think [the manager‟s] trying to encourage everybody to do the NVQ. Because it is

interesting, you learn a lot from it. (XDHome1, Care Worker 4, age 32, 2 yrs in post)

Well, I‟ve taken loads of courses. I‟ve taken a lot of courses in dementia. So I‟m really interested in

dementia. Yes. I‟ve been lucky. I‟ve gone on a lot of courses. If I‟ve been interested in something,

they found a course that will cover it. (XDLADP, Care Worker 3, age 52, 7 yrs in post)

While low pay was rarely seen to be the fault of the employer, opportunities for training led

care staff to think of the organisation they worked for as a „good employer‟. Box V.35 gives

examples of care staff working for very low paying providers discussing the reasons why they

value the training opportunities they have been given. These staff often had no or little

opportunity for pay progression when they have completed training, so financial reward was

not the motivator. Significantly, these workers had no or very few formal qualifications and

valued the opportunity given by a sector that offers a rare opportunity for unqualified workers

to gain a qualification.

Box V. 35. Care workers and training: a chance to gain qualifications

I did my NVQ 1. I did that in caring here. And that‟s about it really. I‟m gonna try do my NVQ2. I‟ve

no qualifications with school. Just what knocks me back on that at the minute is like my reading and

writing, so I‟m gonna try and get round, I was at college at one point doing it, it‟s only through me

not going to secondary school through my accident. …And with me having my accident my

confidence went….and I was a bit like behind with my reading and my writing and I didn‟t think that


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I could ever get the chance, and then [the manager] give me the chance and I loved it. (ONHome2,

Care Worker 4, age 24, 6 months in post)

I‟ve got my NVQ2, I‟m in the middle of doing my level three, I‟m also doing a safe medication

course as well. Unfortunately I didn‟t get no GCSEs or anything at school. Well, I‟ve just, I started

off as a carer and I‟ve worked my way up as a senior, and I think up to now that‟ll be like the highest

I can get in this place here, but I wouldn‟t mind like going further up, like management or even

owning my own home or something like that…. If I had the opportunity I would definitely take it,

yeah. (ONHome2, Care Worker 2, age 26, 3 yrs in post)

They do tend to give everybody a chance here, which is nice. They‟re not judgemental and they‟ll

listen, 'cos I‟ve been here and been listened to, you know, so …And they do do a lot NVQ levels with

the skills for life, English and Maths, so they‟re helping people that are perhaps from a

disadvantage, do you know what I mean? (ONDom1, Care Worker 2, age 33, 6 months in post)

Some care staff identified negative aspects of training, relating to the time it took and their

lacked of basic reading and writing skills. However, more often any negative views about

training related to it being too theoretical and class-based which fitted in with the positive

accounts given above where training is valued because it can be put into practice (see box

V.36).

Box V. 36. Preferences for practical induction and training

We did the training downstairs and it was just someone going over basically all the information

about Plan and stuff like that….I found it a little bit useful, but I‟m the sort of person that learns

from actually going out and doing the job and not sitting …. I mean the only time that she showed us

a bit of information and we had to do it for ourselves is when we were learning to do the hoists and

stuff like that. I preferred my shadowing, even though I didn‟t get to do much 'cos I‟m just observing,

I still got to see it from that point of view. (RNDom2, Care Worker 2, age 24, 1 yr in post)

I found the training, because I went straight into training, confusing. Because I‟d never done the

job. It was alright the first day, that was interesting. But by the end of two weeks it was psh, psh, psh

- going over my head. I hadn‟t been out in the field….I think it would have made more sense if you‟d

have done a bit of training, gone out in the field, and shadowed, seen how things worked and

progressed and you could slot what you‟ve just learnt into what you‟re seeing in practice. And then

go back and do a bit more training. (XDLADP, Care Worker 2, age 55, 4 months in post)

There were also many examples of staff who were happy with the training they received but

who wanted more specialist training that was not related to meeting statutory regulations but

related to the needs of specific users they cared for. In particular dementia training was

mentioned by care staff as a form of training many would like the opportunity to have (see

box V.37).

The data across all case studies show that in general care staff valued the training on offer and

this was particularly the case when they were able to train in areas that were relevant to the


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specific needs of users. When employers offered extensive training, care staff often came to

define their employer as a „good employer‟. However, positive perceptions about training did

not necessarily mean that care staff wanted to progress to more senior levels.

Box V. 37. Learning opportunities that are user-led rather than regulation-led

I‟d like to do both the Alzheimer‟s and the dementia, 'cos I have been to a few clients who have got

that. (IL.Dom2, Care Worker 2, age 20, 3 weeks in post)

There are other areas that I‟ve not been trained for that I would be interested in

doing…..Alzheimer‟s and dementia and Parkinson‟s. And now we‟ve someone that‟s got MS and

I‟m interested in that as well. So - and it all helps to understand. (XDLADP, Care Worker 4, age 58,

11 months in post)

Then I‟ve had different individual training at certain houses, depending what the client needs. Some

people you have to be trained to do certain tasks. We have a lady where she had a peg feed, where

you feed her internally with liquid. I was taught how to do that. There‟s a lady who has liquid

medicine. We have to be taught to do that. We‟re not allowed to just go and give liquids. We‟ve got

to be trained. (XDLADP, Care Worker 1, age 50, 3 yrs in post)

I‟d like, well, we do a dementia course but I‟d like to go further into it..More depth, you know, more

understanding about it. (ONHome2, Care Worker 3, age 42, 2 yrs in post)

I‟ve had medication training in the other place I used to work, had it all the time. But I‟d like

dementia training especially, I think, because dementia, it‟s a thing everybody can suffer with, isn‟t

it, quite a scary thing (RNHome1, Senior Care Worker, age 54, 6 months in post)

V.6.2 Development and opportunities training

Restricted career ladders have been identified as a reason why it is difficult to recruit and

retain in the social care sector and the importance of linking training with career ladders has

been identified. Because of the methodology used in the project, we are unable to say whether

the lack of development and career opportunities have been deterring people from entry.

However, in relation to retention we are able to look at whether the care staff we interviewed

had aspirations to progress and if this shaped their intention to stay or quit working for their

provider. We asked all care staff whether they would like to progress in the organisation.

Thirty care workers out of 88 said they wanted to progress, 57 said they did not and one was

unsure. There were no trends relating to type of provider or age, with older workers just as

likely to want to progress as younger workers.

Of those that wanted to progress, some interesting trends can be observed. Firstly, seven out

of nine men wanted to progress; the two men who did not want to progress were in their 50s

and 60s and said they were too old. For the men who wanted to progress, a lack of

opportunities to do this was a reason to leave their employer in the future (see box V.38).


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However, as men made up a very small minority of our sample it is difficult to generalise and

the attitudes of men in care work must be a key area of future research.

Box V. 38. Development opportunities as a retention factor for men

The only way that I can explain it is that I asked - because obviously I‟ve got an NVQ 2, I said to her

[the manager] basically, everybody else is doing their NVQ 2, so I would like to do my NVQ 3. And

[she] turned round and says, we don‟t let you do your NVQ 3 because we cannot promote you.

That‟s not a good excuse really…obviously because of that reason I won‟t stay here. But yeah I

would stay in social care. (XD.Dom2, Care Worker 2, age 32, 1 yr in post)

I wanna do, I‟m thinking about doing my [NVQ] level four after Christmas, or I would really like to

do my RMA [Registered manager‟s award].…I either wanna do like the manager‟s side or I‟d like to

go to university and become a mental health nurse, so sort of like one of the two…..if I got to like a

point within the home where I thought I‟m not gonna get any further, I would have a look around

and if an opportunity come up then I would take it. (RNHome2, Care Worker 3, age 21, 3 months in

post)

Secondly, many who said they wanted to progress did so while anticipating barriers to doing

so. While the lack of part-time positions in professional occupations has been highlighted as a

barrier to women‟s progress, it would appear that in this female-dominated occupational

group there is little room for part-time senior positions, or at least this is the perception of care

workers (box V.39).

Box. V.39. Obstacles to progression

I became a senior, and that was hard work, but with my life the way it is with my young children, I

decided that I couldn‟t keep the devotion up as a senior, so I went back down to being a carer, so

I‟m doing that now….It‟s not a lot more work, it‟s just the company do put a little bit more pressure

on you, because you‟re a senior. They think that you should - well they don‟t think, but they expect

you to take calls on because you‟re a senior, they expect you to take the calls, and it‟s very, very -

it‟s quite hard. And with young kids I just found it too much. (XDDom1, Care Worker 2, age 37, 2

yrs in post)

I think moving up to senior, it‟s just the hours that stop me doing that, because I can‟t work enough

– I‟m not flexible you see. (ILHome1, Care Worker 4, age 30, 6 yrs in post)

The reasons care workers reported for not wanting to progress were threefold; firstly the

limited reward for a senior post that involved a lot more responsibility and stress; secondly

the opinion that a senior role involved taking care workers away from the job of caring; and

thirdly family responsibilities and circumstances that meant they could not work the hours

required to do a senior role. Interestingly, some had been offered senior roles and declined


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them or had had them in the past but returned to a care worker post because they either felt it

was too much work or preferred to be caring for users (box V.40).

Box V.40. Care staff rejecting opportunities for progression

I could. I was offered the job of a senior but I think, it‟s not even a pound extra an hour, so I will not

take on the responsibility of this whole home for that sort of money. (RNHome2, Care Worker 2, age

56, 2 yrs in post)

I was actually a senior carer, I was the first senior carer here, but all the responsibility of all the

phones and all this I didn‟t want, so I chose to go back to be a carer because I enjoy the job, I love

the job, you know, in the field, it‟s a totally different job. (ONDom1, Care Worker 3, age 49, 4 yrs in

post)

I suppose I could be a supervisor, but there‟s not that much, I could go to supervisor and I think that

would be it. Yes, and no, the amount of work load and responsibility they have on them is a lot. I

can see that because that‟s what my mum does. For a minute amount of money for the amount of

responsibility, it‟s just not worth it. (ILHome1, Care Worker 3, age 23, 3 yrs in post)

These comments (box V.40) shows that the increased responsibility associated with a senior

role was difficult for many with families, especially when it was paid poorly and took care

workers away from the direct care of service users. As we have seen, job satisfaction was

largely derived from working with users. As such, the reluctance of some care workers to

progress seems related to the perception that a more senior role would involve more

paperwork and less caring (see Box V.41). It is also worth noting that there was very limited

interest among the care workers we interviewed in taking up roles as personal assistants.

Sixty-three care workers were asked whether they would be interested and of these 44 said

they would not even consider it, while only ten said they were interested and a further four

said possibly (five said they did not know). The majority of care staff expressed the view that

they would not even consider a job as a personal assistant but ten of the 63 who were asked

did say they might be interested. The minority of care workers who would consider it

mentioned that one-on-one work of this kind could potentially be more rewarding and would

also have the benefit of being less rushed than their current role. However, for the majority of

care workers the one-on-one nature of the personal assistant role was not appealing. Many

mentioned how it would be emotionally draining to care for only one user and many felt they

would become too involved and be unable to cope. They identified aspects of their current

jobs they would miss if they were to become a personal assistant, including opportunities to

meet lots of different people, being able to move around autonomously and have the support

of managers and colleagues. Some would not consider it because they wanted the „back-up‟

of management and working in a team and they also anticipated increased job insecurity in

such a role if work was reliant on specific users.


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Box. V.41. Progression as a move away from hands-on caring

It‟s not, it‟s more about paperwork at senior and medication. They do do care and that but I‟d rather

be caring and more hands-on, definitely. (ONHome2, Care Worker 4, age 24, 6 months in post).

I don‟t know if I would [like to progress], because then you don‟t get to do the care. See I like the

care. (XDDom1, Senior Care Worker, age 42, 3 yrs in post).

No. I do .. because the next level up from me would mean giving my care up, you see. The next level

up from me is a coordinator, which is office based. So I do like being out on community, so for to

move up I‟d have to have sort of reached that stage where I don‟t want to actually do hands-on any

more, so to speak. (ONDom2, Senior Care Worker 2, age 36, 1 yr 6 months in post).

I suppose if we went to … be senior carer or whatever, that entails an NVQ3, I don‟t wanna be in an

office. I just don‟t. I don‟t, I wanna be on the floor. (ILLAHOME, Care Worker 2, age 49, 21 yrs in

post).

In summary, positive experiences of training may improve retention in the sense that care

staff felt valued by their organisation. Crucially it was also another means to ensure they were

providing good quality care to users, a key source of job satisfaction. Case-study data also

revealed why a lack of career opportunities may not necessarily be a reason to leave the job or

the sector. Care workers valued hands on caring and opportunities for progression typically

represented a move away from this. Moreover, the more senior roles demanded very high

responsibility with very limited improvements in pay. The examples of care staff that prized

training in the low paying organisations shows the importance of recognising how employees

can feel valued and supported by employers, even if in receipt of a low wage. However, we

have shown this depends on the experiences and expectations of the particular care worker

and we cannot assume this group is typical. For example, in order to expand the potential pool

of applicants, for example to men or to women with more qualifications and career options,

these potential new recruits might be less willing to make the trade off between opportunities

to gain qualifications and low pay. If this is the case, the creation of senior posts that are both

more rewarding financially and that do not involve such a leap away from care work, possibly

involving more specialist care roles rather than only supervisory roles could help to make care

work a more attractive opportunity for those who both wish to enter the sector to care but also

to have opportunities to develop and progress.


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V.7 Summary and conclusions

In section V.1 we compared the HR practices of providers across the case study LAs. This

overview found variations among providers in the same LA as well as across LAs. The LA

commissioning environment appears to have more influence on some aspects of HR practice

more than others: for example pay and the nature of contracts offered to care workers were

related to being in a higher fee paying LA, but the improvements were only marginal. In other

aspects such as training and working time, firm level policies are even more significant with

limited effects from the LA commissioning and contracting. Using case-study data to

compare and contrast the practices put in place by the same national providers located in

different LAs shows we find that the policies of national chains are playing a significant role

in both shaping HR practices and in limiting the actual impact of favourable commissioning

practices on employment terms and conditions. These findings suggest that the LA

commissioning environment may be an enabler of better practice but there are variations

between providers in the extent to which they respond to more favourable commissioning

practices. Furthermore, although there is variation in practices across providers this variation

is around a very low level of basic employment conditions and protections.

Sections V.2 to V.6 explored the experiences and perspectives of care workers and identified

a number of trends. The recruitment process in the social care sector is characterized by a high

degree of informality, particularly in the independent sector. Care workers‟ informal

experiences of caring in the home often lead them to want to do the job and care workers use

family and social contacts and networks who are already working in the care sector to access

information about the nature of jobs and vacancies. Employers are complicit in this

informality and in some ways actively encourage it. Providers identify attitudinal qualities

rather than formal skills as the most important factor when assessing the suitability of

candidates and some national providers are trying to formalise the use of „word of mouth‟

recruitment by using voucher schemes which reward existing care staff with a bonus if they

introduce a friend to the job.

We found that just over half of interviewees anticipated that they would still be working for

their current employer in five years time and 85% intended to stay working in the social care

sector. Only 10% of care workers working for LADPs intended to leave their current

employer. Of those who intended to leave their current employer, going to work for the NHS

and/or undertaking nurse training were the reasons most often given. However, only 27% of

interviewees said they definitely intended to leave. This may be considered unsurprising

because the case study revealed high levels of job satisfaction. All 88 care workers enjoyed

their work, in particular the rewarding nature of the job, helping others and relationships with

service users were given as reasons for high levels of satisfaction. Care workers working for

IDPs also mentioned the autonomy the job brings as a reason for enjoying the job.

However, care workers also reported low satisfaction with pay. Fifty-six care workers out of

88 believed their pay to be unreasonable and there was particular dissatisfaction with the lack

of travel pay and pay for unsocial hours. They also had concerns that the spread of electronic


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monitoring might reduce their total reward still further by restricting paid work time to time

actually spent in people‟s houses rather than at work. In contrast those working for LAs

expressed high levels of satisfaction with their pay, in part because they were aware of the

poor conditions in the independent sector.

Care workers were more satisfied with working time. Many had entered the sector because it

offered convenient working time and 72 out of 88 care workers said their working hours

matched their preferences, although care workers working for LADPs were less likely to work

their preferred hours. Care workers who did not work hours that matched their preferences

were more likely to intend to leave their current employer, although we cannot say whether

this was a direct reason for their intention to leave. Care workers, especially new recruits,

were working variable and unpredictable hours to cover shortages and holidays and the

idiosyncratic nature of the hours worked by care workers was a key finding. Hours were

highly fragmented and did not conform to standard family friendly working time and this had

led some to defer entry into the sector in the past. While the care workers we interviewed

were in general happy with their working hours, the hours suited care workers with very

specific needs and circumstances who often needed to work locally.

In general the new recruits and more established care staff reported positive experiences of

training and the offer of training had attracted some into the sector. Opportunities for training

led care staff to think of the organisation they worked for as a „good employer‟. Significantly,

these workers had no or very few qualifications and they valued the opening for unqualified

workers to gain a qualification. The provision of training and development opportunities

appeared to be an important way in which providers could show care staff that they were

valued. There were some contradictory findings relating to care workers‟ aspirations to

progress. On the one hand the limited opportunities for progression were not perceived as a

problem because many care workers said they did not want to progress, although this was not

true for the small sample of men interviewed. However, one of the reasons the female care

workers gave for not wanting to progress was that senior jobs involved far more extra

responsibility for limited extra reward. Another important factor was that senior roles also

involved taking them away from the hands-on care that was key to their job satisfaction.

The findings on work organisation revealed some contradictory results. We particularly

focused on care workers‟ opportunities to prioritise tasks to improve quality care and their

opportunities to develop good relationships with service users. While some providers reported

care workers had low discretion and also faced constraints in developing relationships, care

workers accounts revealed care workers continue to use discretion despite some constraints

in time and continue to be flexible and go „beyond contract‟. The extent of discretion varied

by context. Thus a national provider operating in LAs that had put in place electronic

monitoring was found not to offer much scope for discretion. However, a case study of a

provider operating in an LA that had established KPIs relating to continuity of care for

providers was found to allow care workers much more scope to go beyond contract. The

opportunity to develop relationships with users allowed room for discretion and in this sense

care work was not found to fit the standard classification of low paid, routine work.


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This finding that care workers do use discretion to improve the quality of care and develop

relationships is important because research on users‟ perspectives shows that the attitudes of

care workers and their relationships with care users are central to users‟ definitions of quality

care. In particular care workers‟ willingness to be flexible and do jobs beyond those stipulated

in the care plan are of particular importance alongside a caring attitude. This definition of

good quality care fits into the definition of a good quality care job as defined by the care

workers themselves. Those care workers who reported high job satisfaction referred to the

importance of the relationships they developed with users.This fits with evidence from other

studies ( see discussion in part I and TNS 2007). The importance of relationships to both

care workers and users thus reveals a complementarity between user and care worker

perspectives and between understandings of good quality jobs and good quality care.

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VI. Research Findings and Conclusions

In this final part of the report we return to our original research questions (see section I.5) and

provide a summary of the findings. We conclude by using the insights gained from our nine

empirical research questions and the three stages of the research project to address our final

policy-related research question. That is, in the light of our findings, we consider the

prospects for the recruitment and retention of an expanded and higher quality social care

workforce in the future under current and emerging conditions and suggest where the key

policy challenges may lie if these workforce objectives are to be realised.

VI.1. The local authority commissioning environment

1. How do those in the local authorities responsible for commissioning and/or

contracting make sense of the multiple, changing and potentially

contradictory pressures on commissioning policy?

Our qualitative interviews with key actors responsible for commissioning and contracting in

the 14 selected local authorities (LAs) revealed the multiple and potentially conflicting

influences on commissioning practices. Social care commissioning takes place within the

wider local authority and is thereby influenced by the specific council‟s organisational and

political environment. At the same time it is shaped by the longer term policy agendas for the

development of social care. Approaches towards commissioning were found to be influenced

by competing agendas, including on the one hand the need to support providers and develop

the supply base and the imperative, on the other hand, to take costs out and control price, even

in a context of pressures to drive up the quality of care delivered. Further competing agendas

stemmed from whether commissioning would in the future continue to be dominated by LAs

or either undertaken jointly with the NHS or devolved to users.

While commissioning in all LAs was being pulled in competing directions, differences could

be identified between LAs in both the preferred strategic approaches taken by their

commissioners and in what they were actually doing to implement these approaches. In

particular there were marked differences in the emphasis placed on developing partnerships

with independent providers and in the emphasis placed on strategies to reduce costs. We

classified LAs on the basis of both actual fee levels paid and on their commissioners‟

espoused views and policies on partnership to distinguish between three types of LAs: those

that are partnership focused; those focused on cost minimisation; and those falling into a

mixed category. This classification was found to have some resonances with the national user

satisfaction scores as recorded by LAs, with the cost minimising LAs assessed by users as

providing less good quality care than the partnership or mixed categories. The cost

minimising category included LAs from different regions and labour market conditions,

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indicating that their classification was a reflection of a particular policy stance by the LA

rather than a reflection of other local conditions. However, the partnership category included

mainly LAs that faced strong local labour market demand while the mixed category was also

more mixed in characteristics. Some of the mixed category LAs topped the user satisfaction

scores and in one case LA directly employed staff in a 3* rated unit provided a high share of

domiciliary care services, suggesting perhaps that it is share of services outsourced as well as

commissioning strategies towards the independent sector providers that may influence user

satisfaction scores.




of these apparent differences in commissioning and contracting stances. Above all there was a

very high rate of change in commissioning policies, some of them implemented during the

course of our project. This rate of change reflected both the changing commissioning

environments and the recognition of potential contradictions between some of the LAs‟

objectives and their current commissioning approach. In some cases the problem was a

perception that their policy was not working (higher prices for rural domiciliary providers

were not being passed on to the workforce) or that their policy might lead to too high costs in

the future (where uprating of fees was guaranteed in the contract as an indicator of

partnership). In one LA the commissioners were planning to use new policy agendas such as

personalisation to push through changes that they had found difficult to legitimize in the past,

such as LA withdrawals from routine domiciliary care. Such double-edged policy initiatives

created problems in developing stable and coherent classifications of the approach taken by

the LA. Among the LA commissioners there was considerable awareness that following short

term and budget driven competitive tendering was undermining the scope for long term

strategic developments but cost pressures and rules on competition policy stood in the way of

a more strategic approach. Furthermore, working with the NHS was identified by some as a

means towards a more strategic approach but for others it had become a source of short term

inconsistencies: for example, where the NHS in the locality created obstacles to policies of

reducing admissions to residential homes or to developing quality rather than simply price-

based commissioning strategies. Past commissioning strategies were also hampering some

LAs in developing current policies and practices. This particularly applied to those LAs that

had effectively ended domiciliary care direct provision in the past. These LAs faced a large

cost legacy in the form of TUPE transferred staff to independent providers but also lacked an

inhouse facility to facilitate the development of re-ablement services and provide training

support to local providers.

Thus, although the LAs did adopt different commissioning strategies and approaches, these

did not necessarily provide sufficiently stable and coherent signals for independent providers

to have the confidence to use them as a basis to develop different approaches to managing the

social care workforce. Even when a policy decision had been taken to provide a higher

quality approach, there were concerns that this might leave them exposed to higher costs than

other LAs which could prove difficult under future funding regimes. That is, the LAs were

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not sufficiently autonomous from central government policy to be able to develop coherent

and stable strategic approaches that would not be easily destabilised by changes in central

government policy, as well as by other local policy decisions.

2. What are the variations and trends in the specific characteristics of LA

commissioning and contracting practices, from price and contract to quality

monitoring and provider relations?

We found significant variation in the specific practices adopted by LAs with respect to

commissioning and contracting, particularly in the case of domiciliary care, but these

differences again were, as already suggested, subject to a high degree of change. The

variations between LAs and the changes within LAs can be best analysed by taking

commissioning of domiciliary care and care home placements separately.

In domiciliary care the majority of service hours had already been outsourced in all LAs and

there were further plans to outsource in six of the eleven where outsourcing was still below

90% of service hours. There were no plans to TUPE transfer LA staff and most LAs felt that

this would not be cost effective. Moreover, most were planning to keep some inhouse

provision and the high levels of outsourcing also coincided with a strong tendency towards

greater specialisation within the remaining LA provision with only four still undertaking

routine domiciliary care work. Nevertheless there were wide variations in the extent of

involvement of the independent sector in specialist work (see table II.1).

One of the major trends identified was a move away from block contracts towards a set of

preferred providers, in part as a cost efficiency measure to reduce risks of paying for unused

hours but also in preparation for the personalisation agenda. One LA described their new

preferred provider systems as a „new block‟ contract, that is involving similar commitments to

block but without minimum guaranteed hours. However, the trends were not uniform as five

still used block contracts and two had recently moved to such contracts. These new preferred

provider arrangements almost always included an increased use of national providers. The

LAs‟ commissioning staff often expressed some concerns about the effect of the increased

role for national providers but nevertheless still included more in their preferred provider list

and in only a few LAs were concerns expressed about the need to maintain local agencies on

the list particularly where they were associated with serving particular communities. All

divided up their preferred providers or block contractors by geographical area but some used a

number of providers per area while others used only one or a main and subsidiary providers.

Many LA commissioners were concerned about the impact of personalisation on the survival

of these arrangements which they saw as essential to reduce costs and keep travel time to a

minimum.

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Pricing strategies did vary between LAs with six setting a fixed fee per hour before the tender

with all providers contracted at that rate while eight LAs fees varied by providers according to

their tender price. The trend appeared to be more towards a fixed fee and in practice the

variations between fees were limited even when they could vary in theory. Not only did the

average fee paid to IDPs (excluding those with TUPE transferred LA staff) only range from

£10.45 to £14.50 for 13 LAs but the range among providers within a locality rarely exceed £2

to £3. One LA was an exception on both counts with a range from £16 to £28. In addition to

a trend towards a fixed fee there was a general trend towards a simple flat rate fee for

whatever hours were worked (several had recently phased out higher fees for shorter visits

and very few paid anything extra for unsocial hours or bank holidays) and also with limited or

no differences by the needs of the user. Likewise fees were paid for service hours and not for

travel time, although some allowed for higher prices from IDPs operating in rural areas. This

simplification of the fee structure was driven by the interests of transaction costs at the LA

level and the implications for wages and for incentives towards taking on more complex or

more unsocial hours work for either the providers or the employed staff did not seem to be

actively considered. Likewise the move towards use of electronic monitoring was primarily

driven by the interest of reducing costs and ensuring clients received their full visits; the

impact on the staff employed appeared not to be a prime consideration. While most LAs

undertook some form of quality monitoring of IDPs, which also included some monitoring of

HR practices, only two provided quality incentives for IDPs to either improve the quality of

their care or the quality of their HR practices.

Commissioning practices with respect to care homes tended to be primarily on a spot contract

basis. Twelve of the 14 LAs still provided some residential home care inhouse and ten had

some block purchase contracts with independent sector homes but most placements were spot

contract with independent sector homes, usually according to the preferences of the user. LA

commissioners were clearly aware that they had less ability to influence the behaviour of care

home providers especially in those areas where a large share of clients were self funded.

Variations in fees for residential care were much wider than for domiciliary care between LAs

and reflected regional variations in housing costs, not just wage costs. However, the level of

fees set also reflected political priorities. In some LAs there was an explicit commissioning

strategy of setting a care home fee at a level where it would not be necessary for an LA

funded client to pay any top-up fees unless they had a special room of some kind. In other

LAs commissioners anticipated that most residents would be asked to pay top-up fees.

Perhaps because of the difficulty of influencing care homes, more LAs had introduced quality

enhancements for homes, with six currently offering quality premia and some others planning

to introduce them. As with domiciliary care, many LAs were actively engaged in monitoring

homes but fewer had developed their own quality frameworks for homes. However, where

they were in place they had potentially more impact because they were linked to a quality-

based fee framework.

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The selected LAs also were, for the most part, engaged in actively supporting independent

sector providers through training partnerships. Nine had current partnerships with the

independent sector and others supported training through opening up LA training to the

independent sector. However, those that had outsourced all their domiciliary services were

less likely to be engaged in training and in some cases LAs discontinued training provision

when sources of central government money for training support dried up, thus providing

another example where changes in central government policy may lead to rapid changes in

LA policy. Although all LAs held forums with providers these were more common with IDPs

than with homes. Moreover there was evidence of variations in activity within the forums in

part linked to the tendency or otherwise for local providers to become organised and engaged

in dialogue with the LA commissioning and contracting staff.

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VI.2. Explaining the variety of HR policies and HR outcomes of

providers

3. What is the current state of HR practices and outcomes in the sector?

The need to map the current state of HR practices and outcomes arises largely out of the

context of radical transformation in the organisation of social care services for the elderly,

characterised by a near complete shift from local authority provision to independent private

sector and voluntary sector provision. As a consequence, there are multiple forms of provider

organisations currently engaged in delivering elderly care, of varying size, diverse ownership

configurations (such as single establishments, local and national chains) and distinctive profit

and not for profit business strategies. Moreover, without a guiding national framework for

employment conditions and HR practices (as provided across much of the public sector

through national framework agreements), there is enormous potential for variety and diversity

in the quality of HR practices. To address the research questions about what factors influence

HR practices and outcomes, therefore, this project constructed an original dataset on the

characteristics, context, practices and outcomes of provider organisations – including

domiciliary care providers, care homes and local authority inhouse providers of domiciliary

care (referred to throughout this report as IDPs, homes and LADPs, respectively). An

important contribution of our dataset is its incorporation of quality measures of a raft of HR

practices and outcomes, encompassing recruitment, working time, pay and work organisation

among others.

The overall mapping of HR practices and HR outcomes presented in part III, and

complemented by the case-study findings in part V, yielded the key finding that the quality of

HR practices across the whole of the independent private sector is clustered at the poor end of

the spectrum of potential HR policies and that there remain notable problems in recruitment

and retention, despite much of the survey having been conducted after the start of the

recession. Some systematic differences were found between homes and IDPs but the major

differences in quality of HR practices were between the independent and the public sector,

although voluntary sector providers offered better conditions than the private sector. However

in our sample a high share of the volunaty providers were residential homes operating

predominately with private clients rather than LA funded clients. The evidence suggests that

there are significant problems of recruitment and retention in the independent sector.

Although most providers judged recruitment to be relatively easy in the recession period,

IDPs in particular faced difficulty meeting their needs with nearly 70% recording shortages

for weekend and unsocial hours work. Much of the recruitment is informal although more so

in homes than IDPs and LADPs ,and all tended to rely on recruiting workers with positive and

friendly attitudes, with only LADPs placing importance on previous skills related to care

work among job applicants. and IDPs were most likely to emphasise availability for early

mornings, evenings and weekend work. Staff turnover averaged 24% for homes and 31% for

IDPs. Homes were better at retaining new recruits but 22% of homes and 32% of IDPs had

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lost more than half of their new recruits in the past year. Even excluding turnover among new

recruits, turnover rates were still 22% for IDPs and 18% for homes.

Responses to these problems by providers have been limited. Overall the independent sector

provided a poor set of employment conditions, whatever the characteristics of the provider.

Thus, the potential for variations in HR practices by type of provider were marginal within

our dataset, although these could still, as we see later, make an impact on recruitment and

retention outcomes. These poor conditions were particularly notable with respect to pay. Pay

levels in the independent sector were clustered within a band for the most part no more than

£1 above the then national minimum wage of £5.73 with limited opportunities for upgrading

even for those who acquire NVQ qualifications at level 2 or even 3. The practice of uprating

pay on a regular basis was not universal and in homes was more influenced by changes in the

statutory national minimum wage while in IDPs the main factor was change in LA fee levels

and profitability.

Not only did we find basic pay levels to be low in the independent sector particularly among

for profit organisations but we also found that other elements of the reward policy resulted in

very low total pay for the length and scheduling of hours spent at work or in work related

activities. Paying a premium for overtime was primarily confined to providers in the public

sector, with most LADPs upholding this convention but only a quarter of homes and IDPs.

Unsocial hours payments were either not made or were more a matter of pence than a

significant proportion of the hourly wage. This lack of compensation for unsocial hours was

particularly significant in a sector where almost all staff were involved in weekend work and

many in early and late hours and night work. A significant share of providers also passed the

upfront costs of entering work (such as CRB checks, uniforms and induction training) on to

new recruits. Overall homes pay lower rates than IDPs and the IDPs in turn pay far lower

rates than the LADPs. Moreover, there is no trade-off between pay and other benefits; LADPs

pay the highest rates of pay and also pay for unsocial hours, travel time and upfront costs of

entering work. The independent sector homes and IDPs pay low rates of pay and do not

conform to good practices in these other areas of reward.

Contractual arrangements were also found to be different between the public and the

independent sector with evidence of a very strong employer-led model of flexibility among

homes and especially among IDPs. The public sector LADPs had followed a standard

approach to employment relationships by providing guaranteed hours to care workers while

the bulk of IDPs offered zero hours contracts only. This seemed to provide IDP managers

with a useful tool of workforce control enabling them to draw on a readily available pool of

employees for the required schedule of hours but the result was that even staff who worked

regularly full-time hours or longer and had been regularly employed for several years were

given no employment or wage guarantees. In homes, care workers were more likely to be

offered guaranteed hours and were also more likely to work full-time than in IDPs. In both

homes and IDPs only a minority of providers claimed to be able to match hours with

employee preferences all of the time.

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With respect to working time the key difference in schedules was between domiciliary and

homes rather than public versus independent sector. Working time schedules were very

fragmented in domiciliary care and managers adopted a wide range of different solutions,

involving either split shifts to allow for continuity of care or more consolidated shifts by

banding together morning and dinner times and teas and evening care periods. In care homes,

managers also struggled with care rotas that respected minimum staffing ratios, which seemed

to vary between homes. Weekend working was extremely widespread in the sector with

nearly three fifths of IDPs, seven in ten homes and nine in ten LADPs reporting that all their

staff were engaged in regular weekend working.

Opportunities to exercise discretion at work so as to improve the quality of care may be

considered an indicator of both job quality and the quality of user care. Managers‟ responses

indicate that there were more obstacles facing workers in IDPs than in homes. This is

confirmed by our index measure of work organisation which is significantly worse for IDPs

than homes (with LADPs in between). However, a similar share of both homes and IDPs

(around a fifth) believed workers did not have sufficient time to develop better relationships

with users.

Two final areas of HR practices investigated concerned opportunities for development (such

as through training and appraisals) and for performance management, including the

expression of individual or collective voice. Although all providers were strongly engaged in

training provision, including induction training and training to NVQ level 2, attainment of

NVQ qualifications was higher in homes than in IDPs. More than half of homes and LADPs

had more than 70% of care workers qualified to level 2 compared to only a third of IDPs.

Nine in ten homes had already met the now abolished national target of having at least half

the staff trained to level 2 compared to just two thirds of IDPs. The two key factors cited by

managers in explaining failure to reach the target were high staff turnover and training related

problems such as funding. Use of appraisals was frequent throughout the sector and most

providers favoured soft over hard methods to improve performance, but poor performance,

including absenteeism, had at times to be tolerated in four out of ten IDPs. While all LADPs

had union recognition agreements, only 8% of IDPs and 15% of homes recognised unions. All

providers held regular staff meetings, although IDPs were least likely to organise these on a

frequent basis.

4. What role do provider characteristics play in shaping HR practices and

outcomes?

In our investigation of the impact of provider characteristics, including size, ownership,

profit/not-for-profit status and CQC star rating, we deployed different descriptive and

statistical methods. The first half of part IV presented the results of what are essentially

multiple correlation tests that compare the differences in mean scores between our quality

indices of HR practices and provider characteristics. Because correlations based on simple

cross-tabulations may produce misleading results, we also applied multivariate regression

analysis and presented these results in the second half of part IV. Thus while the cross-

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tabulations offer a valuable guide to possible associations between variables, in this final part

of the report we attribute greater weight to the evidence from the multivariate statistical

models in pulling together the various results. The short answer to this fourth research

question is that evidence for systematic differences by provider characteristics (other than

between homes, IDPs and LADPs described above) was patchy. Drawing on both our cross

tabulations of HR practices and our multivariate analyses we can summarise the effects as

follows.

Beginning with the size of provider (measured by numbers employed), we might expect larger

homes and larger IDPs to design and implement better HR practices, drawing upon their

better equipped HR teams, and to enjoy better HR outcomes. The findings, while mixed, do

not support this argument. Among homes, it is clear that the larger the size the worse the

quality index of pay levels (including minimum and normal rates of pay, premium payment

for unsocial hours and pay for training) and the worse the overall summary index of HR

practices. And among IDPs, larger organisations have a worse index of pay strategies, which

covers HR practices of providing opportunities for pay improvement, career development and

upfront costs of starting work. With regard to HR outcomes, larger homes and larger IDPs

have worse recruitment and retention outcomes (measured on the basis of managers‟ views)

and larger homes also experience a worse (quantitative) measure of staff turnover excluding

new recruits. These are the main findings supported by the regression results.

Other possible associations with organisational size are highlighted by the multiple

correlation tests (Anovas). These suggest, for example, that smaller homes may have been

more likely to offer better career opportunities, less likely to require regular weekend working

and enjoyed better training outcomes than medium and large homes. Only one result suggests

better practices among larger homes, namely, the greater use of appraisals. Among IDPs, the

results are mixed: for example, larger IDPs had higher shares of staff working long hours and

were less likely to pay for induction training, but on the other hand were more likely to offer

time off for training and less likely to require weekend working (contrary to the result for

homes).

A second important distinguishing characteristic among providers is the form of ownership.

We distinguished between national chain, local chain and single establishment. As with size,

one might anticipate those providers that are members of national chains to be able to invest

in better HR practices and enjoy better HR outcomes than local chain and, especially, single

establishment providers. Again, however, the evidence does not support such an argument.

Among homes the regression results suggest ownership type has no significant effect on HR

practices; local chain homes appear to exert a positive influence on the quality index of pay

levels but the effect is not statistically significant. HR outcomes among homes are influenced

by ownership type, but it is single establishment homes, not chains, that enjoyed better

performance, namely with respect to training outcomes and with respect to both quantitative

measures of staff turnover (with and without new recruits). Among IDPs, local chain

providers have a better index of pay strategies than national chain providers and this combines

with better HR outcomes in the form of recruitment and retention and training; unlike homes

there is no association with the quantitative measures of staff turnover.

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Again, the multiple correlation tests are suggestive (although not fully substantiated) of other

possible associations. The results are mixed. For example, national chain homes were less

likely than single establishment homes to make unsocial hours payments and more likely than

local chain homes to have staff working long hours. On the other hand, national chain homes

were more likely than single homes to provide regular pay uprating and to pay the upfront

costs of starting work, and national chain and single homes were more likely to allow for

workers to exercise discretion than local chains. For IDPs, the correlation tests reveal very

few effects of ownership type: like homes, national chain IDPs were more likely to have staff

working long hours than local chains but on the other hand national and local chain IDPs were

more likely to carry out staff appraisals than single IDPs.

A third organisational characteristic we investigated is the star rating, from 1 to 3, assigned to

the provider by the Care Quality Commission. While the overall variation of practices and

outcomes was small, our analyses nevertheless attributed some broadly positive effects

associated with a provider‟s star rating. Because the star rating may be interpreted as a

performance outcome rather than an exogenous organisational characteristic (such as size of

ownership type) we did not use this variable in our regression results. We did, however,

explore its associations with HR practices and outcomes using the less sophisticated multiple

correlation tests. These reveal the following. Compared with homes rated 1* and 2*, 3*

homes paid significantly higher rates and were more likely to make unsocial hours payments.

However, 3* homes had worse employee voice practices than 1* and 2* homes. Among IDPs,

the net balance of effects was similarly positive with 3* IDPs more likely to pay for

qualifications than 2* IDPs and less likely to have all staff working regular weekends than 1*

IDPs, but less likely to pay for travel time and for paid breaks than 1* IDPs.

A fourth characteristic is the profit status of the provider organisation – either for profit or not

for profit. As might be expected, our regression results show quite clearly that not-for-profit

providers offered significantly better quality HR practices than for-profit providers (both

homes and IDPs) and not-for-profit homes also enjoyed lower levels of staff turnover than

for-profit homes. This result is quite striking. The for-profit status of IDPs also emerges as the

most statistically significant variable in shaping the summary index of HR practices and the

index of pay strategies, and in both cases the effect is negative. Among homes, the for-profit

status is strongly and negatively associated with the summary index of HR practices and the

index of pay levels. Among homes, for-profit status is also significantly and negatively

associated with turnover outcomes, with for-profit homes experiencing higher levels of staff

turnover than not-for-profit homes.

5. What is the impact of the external policy and commissioning environment

and the local labour market demand factors on HR practices?

To explain the patterns of recruitment and retention of the social care workforce and the

associated HR practices that we identified in the telephone survey of providers we

investigated the differential effects of the type of LA commissioning context on the quality of

HR practices in providers, distinguishing the level of fees paid for care services and the

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partnership (or cost minimising) orientation of the LA. In addition, we explored the impact of

varying local labour market conditions, drawing out two dimensions – the median level of

female part-time pay in the local area and a composite index of labour demand, as described

in part I. The results paint a complex picture of inter-related effects, but certain overall

findings are clear:

LA fee levels have a positive, albeit weak, association with good HR practices,

especially pay practices and working time practices;

the partnership orientation of LAs has mixed effects on the quality of pay

practices for homes but significant positive effects on both pay practices and

the overall quality of HR practices for IDPs;

the level of local labour market demand positively influences the quality of pay

levels, pay strategies and HR practices, especially for homes;

In more detail, our results are as follows. With regard to the role of LA fee levels, three

findings deserve highlighting. First, the level of fees paid by an LA positively influenced the

quality of pay practices of providers. With regard to actual pay levels, the relationship was

positive but relatively weak: an additional £1 in fees translated into just 19p (IDPs) and 14p

(homes) extra for a care worker‟s hourly pay. The regression results only identified a

significant effect of LA fees on pay levels for homes, not for IDPs. This is an important result

since it both confirms to some extent managers‟ views that their ability to set pay was

constrained by the level of LA fees but it also clearly shows that there was only limited

willingness among the independent sector homes and IDPs to raise pay. Other pay practices

were also positively associated with high fee paying LAs, including the practice of paying a

premium for unsocial hours working among both homes and IDPs. A further important result

is that both homes and IDPs in high fee paying LAs (compared to those in medium and low

fee LAs) were more likely to reward care workers with additional pay for acquiring

qualifications. Relatedly, the results of multivariate tests show that the level of LA fees was

positively associated with our summary index of pay strategies for IDPs, which includes

practices of pay upgrade opportunities, payment of upfront costs of starting work and internal

career opportunities.

A second set of findings shows that LA fee levels also influenced the quality of working time

practices, although not in a consistently positive direction. For homes, weekend working was

less commonly required of all staff in high fee paying LAs compared to low fee paying LAs.

But long hours working in homes (hours per day and/or days per week) was in fact more

likely in high fee LAs than in medium and low fee areas. For IDPs, high and medium fee LAs

were positively associated with the practice of giving workers time off for training compared

to low fee paying LAs.

Thirdly, LA fee levels appear to have a counter-intuitive association with the quality of

practices that shape work organisation. Homes in low fee paying LAs score higher on

measures of discretion at work than homes in high fee paying LAs; the results specifically

refer to the index measure of work organisation that captures the likelihood that care workers

exercised acquired skills, had the freedom to organise tasks to improve care quality and

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enjoyed opportunities to exchange ideas with other colleagues. It is not clear why such

opportunities would be more prevalent in homes paid low fees by the commissioning LA. For

IDPs the results point to a non-linear association with LA fees; the aggregate index measure

of work organisation is positively associated with both low fee and high fee paying LAs; the

same result applies to the sub-index measure of time discretion. However, the multivariate

regression results do not identify a significant role for LA fee levels in shaping work

organisation. Other factors aside from the LA commissioning context would appear to matter

in determining workers‟ opportunity to exercise discretion at work.

Our categorisation of LAs according to commissioning orientation suggests there is a broadly

positive association between partnership approaches and the quality of pay and HR practices

for IDPs (confirmed by the multivariate regression results) but for homes the statistical

evidence is rather mixed. For homes, the practices of paying a premium for unsocial hours

and providing opportunities for pay improvements were more likely in partnership LAs. Also,

statistical (anova) tests suggest that pay levels in homes were significantly higher in

partnership LAs than in mixed and cost minimising LAs. However, the regression results in

contrast identify a negative association (albeit not strongly statistically significant); it is

therefore difficult to draw a firm conclusion about the impact of partnership LAs on pay

levels in homes. For IDPs, our index measures of pay levels and pay strategies are both

highest in partnership LAs and the significance of this positive association is confirmed by

our regression results. A contrary finding for homes, however, suggests that cost minimising

LAs are more likely to be associated with the practice of paying for training than partnership

and mixed LAs.

In common with the relationship with level of fees, partnership LAs were associated with a

lower tendency for homes to require weekend working among care workers (compared to

mixed LAs). Yet, similar to the fee levels again, the association with long hours working in

homes was contrary to expectations with long hours and/or long days less likely in mixed

LAs. For IDPs, the partnership orientation had one significant association with working time

practices, namely that IDPs in cost minimising LAs were most likely to expect care workers

to tolerate changes in hours or location at short notice. A counter-intuitive result for homes

was that cost minimising LAs were associated with better quality employee development and

voice practices.

With regard to local labour market conditions our findings point to a strong tendency of

providers to respond to strong labour market conditions by improving their HR practices. The

implications for the current period are therefore that all providers may be less likely to

improve the quality of HR practices as labour markets have slackened. For homes, our index

measures of quality of pay levels, working time and the summary of HR practices were all

positively associated with strong demand areas. For IDPs, several results follow those for

homes, including positive associations with quality of pay levels, payment for unsocial hours

and a lesser requirement of staff to work weekends. As with LA commissioning practices, the

association with work organisation measures was counter-intuitive for both homes and IDPs.

The regressions results confirm the general direction of the statistical (anova) tests. In

particular, it is the level of female part-time pay in the locality that drives the quality of pay

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strategies among IDPs (including opportunities for pay improvement and payment of upfront

staff costs) and for homes while the level of female part-time pay is strongly and positively

associated with the summary index of HR practices, it is the summary measure of local labour

demand that drives the quality of pay strategies.

6. The evidence presented in parts III and IV is complemented by the case-study findings

presented in part V. These case studies revealed variations among providers in the same

LA as well as across LAs. The LA commissioning environment appears to have more

influence on some aspects of HR practice more than others: for example pay and the

nature of contracts offered to care workers were related to being in a higher fee paying

LA, but the improvements were only marginal. In other aspects such as training and

working time, firm level policies are even more significant with limited effects from the

LA commissioning. Using case-study data to compare and contrast the practices put in

place by the same national providers located in different LAs shows that the policies of

national chains are playing a significant role in both shaping HR practices and in limiting

the actual impact of favourable commissioning practices on employment terms and

conditions. These findings suggest that the LA commissioning environment may be an

enabler of better practice but there are variations between providers in the extent to which

they respond to more favourable commissioning practices. Furthermore, although there is

variation in practices across providers this variation is around a very low level of basic

employment conditions and protections. However, national providers in keeping pay

levels relatively similar in LAs offering very different fee levels may either be securing a

high profit rate on their investments in high paying areas or may be using these profits to

offset losses in low fee paying areas; that is there may be cross subsidies between the

high and low fee paying LAs. What is the combined impact of HR practices,

environmental conditions and organisational characteristics on the quality of

recruitment and retention outcomes?

Using a combination of statistical techniques we interrogated the multiple internal and

external effects described above on four inter-related measures of recruitment and retention

outcomes that drew on both qualitative and quantitative measures from the telephone survey

dataset. Given the different challenges facing IDPs and homes, we consider the main headline

results for each separately.

We find that retention in IDPs,was more clearly related than in homes to interactions between

the key external influences of commissioning and contracting practices and labour demand

conditions with the internal HR practices of providers, as specified in our analytical

framework. Thus we find evidence of a strong positive association between the quality of pay

strategies pursued by IDPs with both the level of LA fees and the level of female part-time

pay in the local area. While the statistical analyses only demonstrate a significant association,

we believe it is highly likely that these external conditions acted as a trigger for better pay

strategies among IDPs. The regression results demonstrate that these same better pay

strategies not only have value for the care workers (more opportunities for pay uprating and

premium payments for weekend working), but also are effective in reducing staff turnover;

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the result holds for the two quantitative measures of staff turnover (for all care workers and

for all excluding new recruits). These results hold even with the relatively low range of pay

levels provided by the independent sector providers in our study based on a rather low rate of

pay increases in response to higher LA fee levels, and even with the rather high levels of staff

turnover found for the independent sector providers. The implication is that with either more

favourable commissioning and contracting practices or more responsiveness of providers to

fee levels, further improvements in turnover rates could be anticipated.

Better practices in managing working time in IDPs are also positively associated with better

recruitment and retention outcomes, both with regard to our qualitative measure (drawing on

managers‟ perceptions) and with regard to our quantitative measure, at least with respect to

the practice of providing time off for training. Importantly, these positive associations, which

trace the linkages between external conditions, internal HR practices and recruitment and

retention outcomes, are contingent upon certain organisational characteristics. Larger IDPs,

holding all other factors constant, are more likely to experience worse recruitment and

retention outcomes (on two of the three measures) and local chain IDPs experience better

recruitment and retention outcomes than national chains according to our qualitative measure.

For homes, the findings point to a different set of possible causal relationships. There is a

direct association between lower staff turnover on the two quantitative measures of staff

turnover and more emphasis on the HR recruitment practice of recognising the value of skills,

qualifications and care experience in the selection of new recruits. We saw in part III that this

practice is not very common among homes (or IDPs, although it is among LADPs); while

most homes valued the desirability of skills and experience very few believed such attributes

were necessary to do the job. This result therefore illustrates the potential pay-off in terms of

reduced staff turnover for those managers who do attribute greater value to experiences of

informal and formal caring, acquired qualifications and past training among job applicants.

The practice in homes of not requiring care workers to regularly work weekends is also

associated with lower staff turnover (on one measure). This is an important result given the

statistical association between this particular HR practice and the LA commissioning

environment as noted above; namely, that homes in high fee paying, partnership LAs are less

likely to require regular weekend working. One measure of labour demand – the level of

female part-time pay in the locality – is negatively associated with the quantitative measure of

total staff turnover. Again, this is especially significant given the strong positive association

between this indicator of labour demand and the overall summary measure of the quality of

HR practices in homes. The particular organisational characteristics of homes also play a role.

The size of homes has the same association with recruitment and retention as we found for

IDPs – that is, larger homes have worse recruitment and retention outcomes - but the

contingency effect of ownership type is different with single establishment homes faring

better.

A fourth outcome measure reflects the effectiveness of providers in developing a skilled care

workforce, estimated by combining data on the share of workers with NVQ level 2 and

managers‟ ambitions to meet a 50% target. The results for IDPs and homes are similar in the

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cross tabulations of training outcomes by the indicator of strong, medium, weak labour

demand that combines information on local pay and employment/unemployment rates for

women. In areas of strong labour demand both IDPs and homes have worse measures of

training outcomes. However, when in the regression analysis we separate out pay levels from

employment/ unemployment conditions we find it is strong local labour demand that reduces

training outcomes for IDPs but the level of female part-time pay that has this effect for

homes. This last result may be surprising given the association of high female part-time pay in

the area with reduce staff turnover and better overall HR practices although the impact on

staff turnover is only found of the overall measure for homes and for only for turnover

excluding new recruits for IDPs. One interpretation of this result is that higher job mobility in

strong labour demand areas, whether through poaching or staff quits in search of better job

opportunities, may make it difficult for managers to keep up with training new recruits.

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VI.3. Recruitment and retention from a care worker and user

perspective

7. What factors shape the recruitment of care workers?

The case studies identified a number of factors that shape recruitment into the sector. Firstly,

the personal motivations and experiences of care workers reveal the „pull‟ factors into care

jobs. In particular, informal experiences of caring in the home for elderly relatives and/or

children had often led to a commitment and desire to care for others and do meaningful work

and these intrinsic features of the job are an important explanation as to why people enter the

sector. Other features of the job that are shaped by HR practices more directly, such as

training opportunities and convenient working time, were also found to be important

influences on decisions to enter the sector. Secondly, the recruitment process was

characterised by a high degree of informality which was also a trend indicated by the

telephone survey. The informality of the process led to an important role for social networks;

many care workers entered the sector by word-of-mouth recruitment. This informality was

found to provide advantages from both the employer and employee perspective.

From an employee perspective the informality of the recruitment process allowed them to

make use of social networks which not only provided information on job opportunities but

also provided encouragement to enter. This encouragement came not only through factual

information about the work but the care workers in their social networks were often clearly

passionate about their work.

From an employer perspective this form of recruitment was useful in selecting workers who

already had some knowledge of what care work entailed and were therefore less likely

perhaps to quit at an early stage due to misconceptions over the nature of the work. This may

account for employers‟ tendency at the recruitment stage to emphasise informal caring

experiences and attitudes, in contrast to formal skills and qualifications. Moreover, word of

mouth recruitment also provided a useful way of recruiting some younger workers, often

younger family members of existing care workers. These benefits were being increasingly

recognised by employers, including national providers, who were trying to capitalise on the

potential of informal word-of-mouth recruitment methods by using bonus voucher schemes to

encourage existing care workers to introduce friends and family into the sector.

8. What factors influence the retention of care workers?

Our case study research revealed that just over half of the care workers we interviewed

anticipated that they would still be working for their current employer in five years time and

88% intended to be still working in the sector. While we are unable to show whether this

long-term commitment will lead to high levels of retention in practice, what it did reveal is

the relatively high level of job satisfaction experienced by care workers. This satisfaction was

found across the cases studies located in different LAs and representing different types of

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providers. Job satisfaction related to the rewarding nature of the job and the opportunity to

help and care for others. Also, for workers engaged in domiciliary work, job satisfaction also

related to the opportunities provided by the nature of the work for autonomy and discretion.

This high satisfaction with the job was found alongside revealed low satisfaction with key HR

practices, in particular pay practices. Two thirds of care workers reported that they felt their

pay was unreasonable for the work they did and the lack of travel pay and payment for

unsocial hours were key areas of dissatisfaction. A further concern was that the spread of

electronic monitoring might reduce total reward still further by restricting paid work time to

time actually spent in people‟s houses rather than at work. In contrast all those employed by

LAs expressed a high level of satisfaction with pay. Importantly their knowledge that the

independent sector often did not pay for travel and unsocial hours shaped their satisfaction

with their own pay and benefits.

The reported high job satisfaction and commitment to the work, despite dissatisfaction with

pay, could suggest that care workers become what England (2005) has described as „prisoners

of love‟; that is, they become trapped in low paid work due to their engagement with and

concern for their clients. Retention of care staff thus relies to a great extent on altruistic

motivations and the intrinsic rewards of the job. However, while we have presented strong

evidence of such motivations among current care staff, it is notable that most of these staff

had previously worked in low paid, low skilled jobs in sectors such as retail, hospitality,

administration, and factory work. These jobs were low paid and often described as

monotonous. Care workers contrasted the monotony of other jobs with their experiences of

care work which they found to be both more challenging and more rewarding. The limited

opportunities available to unqualified workers mean many will accept low pay in exchange

for interesting work because the opportunity to have both is not considered as an available

option. Thus these findings should be put into the context of care workers‟ educational

backgrounds, work histories and expectations about wages. The negative effects on employee

morale of low wages and other poor employment conditions may be greater if the recruitment

network for social care were to widen to groups with either more positive past experiences of

employment or with a currently wider range of alternative employment options or career

choices.

Certain bundles of HR practices proved to be important in understanding why care workers

seemed to accept low pay and intended to stay. Our case study findings show that satisfaction

with working time and training opportunities meant that some of the high levels of

satisfaction and commitment to the sector were indeed because of the HR practices in place.

The majority of the care workers we interviewed worked hours that matched their preferences

and there is no doubt that care workers valued this aspect of the job and that this is a key

factor in retention. Another way of showing this effect is that those care workers who were

not working the hours that matched their preferences were more likely to express an intention

to leave. However, those satisfied with their hours had often been able to negotiate specific

schedules that fitted their own particular needs and which were not necessarily even typical of

the organisation they worked for. These working time schedules would thus either not be

attractive to the majority of potential recruits, or alternatively represented specific

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arrangements –for example not working weekends- that could not be generalised to all staff

due to the service demands on the organisation. Training opportunities provided another

example of an HR practice that could help with retention. Although many of the training

opportunities on offer in the sector were often a direct result of statutory regulation, they were

also valued by care workers as many had experienced few opportunities to gain qualifications

in the past. Even though the majority did not have aspirations to progress, opportunities for

training made them feel valued by their employer and care workers felt committed to their

employer because of this.

In general, we also found no evidence of the so-called „supermarket effect‟ where care

workers leave the sector for better paying, less demanding jobs in the retail sector. Rather, it

was the „pull‟ of the NHS and nurse training that were the reasons most often given for

intentions to leave. The better terms and conditions of employment in the NHS mean that

when care workers stated they intended to leave for a job in the NHS, pay is likely to be a

factor shaping this choice.

9. Is care workers‟ job commitment influenced by the nature of the job and does

it involve trade-offs between „bad‟ and „good‟ aspects of the job?

The overwhelming reason for high job satisfaction and commitment expressed by the

interviewed care workers related to the nature of the work and in particular the opportunities

to help people, work with the elderly and build relationships with service users. This

represents an example of complementarity between user-centred services and employee-

centred work organisation. Research on older people‟s definition of quality care has shown

the importance that users attach to „process outcomes‟, such as feeling valued and respected,

being treated as an individual, and being cared for by staff that demonstrate a caring

motivation (Francis and Netten 2004, Glendinning et al. 2008). Our case study research has

revealed that the opportunity to focus on these aspects of the job is central to the high levels

of job satisfaction and commitment to care work reported by care workers. The ability to

develop good relationships with service users was a defining aspect of job quality as well as a

defining aspect of service quality. However, evidence about the nature of work organisation

and whether this facilitated good quality care and good quality jobs was at times

contradictory. Care workers‟ accounts reveal higher levels of discretion than reported to us by

management in the telephone survey. In some cases the LA commissioning environment

enabled this, as for example in the local authority RN where key performance indicators

relating to continuity of care were set. In other cases it could prohibit this, for example with

the use of electronic monitoring. However, in many cases it was simply the way care workers

managed the boundaries between commissioned tasks and user expectations that was key to

their high levels of job satisfaction and to good quality service. This was often despite the

formal system of work organisation in place rather than because of it.

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The opportunity to develop relationships with users allowed room for discretion and in this

sense care work does not fit the standard classification of low paid, routine work. As

suggested above, some care workers appear to be making trade-offs between these „good‟

aspects of the job and the „bad‟ aspects of the job, in particular low pay. Yet it may be the

case that low pay is only accepted because other dimensions of HR practice are in place that

accommodate care workers‟ specific needs. For example, care workers in our case studies

were generally satisfied with their working hours and training opportunities. And while

prospects for promotion are usually identified as a „good‟ aspect of a job, the importance

attached to this feature depends on the aspirations of the workforce. Because many of the care

workers did not in fact have aspirations to progress, the limited career opportunities on offer

were not identified as a particularly „bad‟ aspect of the job for many of those interviewed.

However, this lack of aspiration was also shaped by the poor additional rewards for senior

status within social care coupled with a requirement to take more responsibility but reduce

involvement in hands on care. Whether this group is typical in the trade-offs it makes will be

discussed in the next section. It also needs to be recognised that care workers working for

different types of providers may be making different types of trade-offs. For care workers

working for LADPs, pay and benefits were a „good‟ aspect of the job but they faced less

flexibility in terms of hours as this group were less likely to work hours that matched their

personal preferences. For this group working time could be described as the „bad‟ aspect of

the job but was accepted because of the relatively good pay and benefits on offer, especially

when compared to those on offer in the independent sector.

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VI.4. Prospects for recruitment and retention under expanding

demand: the policy issues

The final research question explored relates to the context in which this research was funded,

namely the expectation of increased demand for the social care workforce, in relation to both

quantity and quality. We draw on evidence from each stage of the research and from each of

the above eight questions to ask:

10. What are the prospects of meeting current and future increased demands for

a social care workforce under present conditions - that is, without major

changes in commissioning arrangements, the policies of provider

organisations and the conditions of employment?

The evidence across all stages of this research project suggests that while the current

arrangements are just about delivering the current level of commissioned services, the model

of delivery of social care for the elderly is in a fragile state. There is positive evidence that

providers are achieving adequate levels of recruitment, albeit supplemented by recruitment of

migrants and with clear shortages in some key areas. But providers of all types are

experiencing relatively high levels of staff turnover and significant problems in achieving and

retaining a trained workforce, particularly in domiciliary care. The sector is also very reliant

both on the easing of recruitment conditions in the recession, and on a workforce that for a

variety of reasons has accepted to work under poor employment conditions, primarily

because of the intrinsic rewards associated with the work.

The sustainability of even this quantity and level of service would be even more in doubt in

normal labour market demand conditions but there was little evidence, whatever the

conditions, that the sector was in position to realise aims in relation to expansion in quantity

of service, improvements in quality of service or the delivery of long term strategic change.

This last aim includes both movement towards a more holistic and integrated approach to the

delivery of social care for the elderly and towards a more user-centred service which does not

put in jeopardy the development and stability of an effective supply side of both providers and

social care workers.

It is also clear from all stages of the project, that while LA commissioning and contracting,

provider HR practices and the experiences of care workers all play a part in shaping the

current quality and level of delivery, the impact of each of these elements cannot be looked at

in isolation. Thus, LA commissioning sets the general set of conditions for both providers and

the workforce operating in the independent sector of social care and must bear considerable

responsibility, together with central government, for the current state of the sector and its

ability to deliver on the three aims of expansion, improved quality and strategic change.

Nevertheless, our research also demonstrates that, where LAs do take the initiative to develop

a more favourable commissioning environment for better social care delivery, the

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opportunities offered to providers to enhance their HR practices and improve recruitment and

retention are not necessarily taken up.

Good LA commissioning practice is thus a necessary rather than a sufficient condition for

improvements in HR practices and in HR outcomes in the sector. There is also a need to

consider the strategies and policies of the providers themselves. Providers may not be keen,

unless pushed by commissioning or other regulatory practices, to improve employment

conditions for care staff. This reluctance may be reasonably based upon concerns over the

future, given the rapidly changing and uncertain policy, budgetary and labour market context.

However, they may also be regarded as too ready to take as much advantage as they can of

their committed workforce by, for example failing to offer guaranteed hours even to staff

working regular full-time or even longer hours, in part because the zero hours contracts makes

it easier for them to demand flexibility in the number and timing of hours from their staff.

Particularly significant here are the policies and strategies of the increasingly dominant

national chains whose perspectives extend beyond the immediate LA and may be relatively

unaffected by any specific initiatives in commissioning that are pursued only at a local level.

Finally, we also need to bring in the attitudes and experiences of both current and potential

care workers. Here again some potential contradictions in possible strategies for change

within social care may be identified. The factors that have led the current social care

workforce both to enter and to stay in social care, and to develop a relatively strong

commitment to care work, cannot necessarily be built upon to expand the pool of recruits to

social care or to develop a higher quality workforce, measured in conventional terms of

accredited skills and qualifications and formal career ladders. There appear to be two main

sources of supply into care work as presently organised; those who come into care work as a

result of social networks involved in care, or their own experience of informal care; and those

who have found social care to be an opportunity for more satisfying work compared to other

more routinised and less meaningful jobs to which they have access. Both groups also often

fall into the category of those who have had limited previous opportunities for training and

development.

A further factor in retention has been the recruitment of very local staff with specific needs

for particular hours schedules. Working time arrangements in domiciliary care are far from

employee friendly in any conventional sense; they involve variable hours at unsocial times

and also frequently unpaid breaks and split shifts. However, individual employees, and

primarily those located in the immediate area, may find either that these hours fit their

specific circumstances or that they are able to negotiate specific schedules within the range

available that suit their current needs. All these factors may tend to reinforce commitment of

the existing staff, but operate against the expansion of the pool of recruits as staff may have to

be brought in from wider geographical areas, and to be attracted from groups who have a

wider range of alternative jobs and training and development opportunities. If providers

model their recruitment and retention strategy on what currently makes for the most

committed care workers, they may not realise the need for a strategic change to recruitment,

work organisation, employment conditions and career opportunities if the available pool of

recruits to social care is to be expanded.

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Although the factors that may inhibit recruitment and retention in social care are interlinked,

in order to clarify the policy implications of these findings we will consider these first under

three main and relatively separate headings – commissioning and contracting, HR practices of

providers and the organisation of work and careers - before returning to the need for a more

integrated approach. We focus here primarily on improvements that may be needed within the

current framework for commissioning social care. We address later the significance of our

findings for the move to personal budgets.

Commissioning and contracting practices

If the objective of commissioning is to set the conditions for expansion, quality enhancement

and/or driving long term strategic change then there is a need to address four main problems.

The first is that budgetary constraints appear to be the overwhelming influence on actual LA

commissioning practices. Even though many people in LAs involved in commissioning are

very aware of the need to foster and develop the supply side, they are often unable to put

these concerns into practice, or to do so only in marginal ways, through additional training

support or limited quality uplifts to otherwise very tight fee payments. A second and related

problem is that commissioning practice is variable across both space and time; LAs are

making different compromises between competing agendas and are thus sending out mixed

messages to key national actors such as national chains. However, within a particular LA the

policy and practices are also subject to rapid changes, such that the consistency of the

message even at the local level may not be strong.

Third, short term needs largely take priority over longer term strategic developments, not only

in relation to fostering the local supply structure but also in developing strategic partnerships

with other services such as health and housing or in developing new ways of commissioning

including outcome based commissioning where users have more input into the composition

and quality of services delivered. The priority to the short term reflects both of the first two

problems, that is the immediate imperative of the budget and the changing political balances

across competing agendas. Movements to outcome-based care may also run counter to budget

imperatives to introduce electronic monitoring to take costs out of the service However, the

focus on the short term is also an outcome of practical problems that LAs encounter when

they engage in more strategic developments. In working together with health on elderly care,

problems arise because of the potential dominance of health in the partnership or because of

the difficulties of working across two public bodes with different views, for example, on the

benefits of fair commissioning and with different budget constraints, different regional or

geographical boundaries and different processes of intra-organisational restructuring.

The fourth problem is that LAs are not paying sufficient attention to the employment

consequences of their commissioning practices. In many respects LAs hide behind the notion

of business to business contracting to evade the responsibility that they must share for

employment practices in the sector; as our evidence shows, employment practices are not only

poor, but in some areas may even be on the margin of legality. Nevertheless LAs consider the

issue of payment of travel time between clients to be an issue for the independent providers

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even though they fail to include payments for travel time in their commissioning, except in

the margin above the national minimum wage in their fees for one hour of care. Likewise no

specific provision is made for training time and the decisions to simplify fee structures in the

interests of minimising transaction costs carry with them the implications that wages are

unlikely to be higher for work involving more skill and intensity of care or for work outside

of standard working hours - whether overtime or unsocial hours. LAs are increasing their

monitoring of providers‟ HR practices but are treating the meeting of quality thresholds more

as an additional requirement on providers and not as an indicator of what elements of their

own commissioning and contracting practices may need to change.

HR practices of providers

The evidence presented in the report suggests that by and large providers in social care do not

deliver even the basic guarantees to employees associated with an employment relationship,

rather than a casual employment contract. Thus within the domiciliary care sector, in

particular, staff cannot expect to be given any guarantees of hours or wages, they are not

necessarily paid for all the time they spend at work, receive at most limited compensation for

working unsocial, flexible and long hours and are unlikely to be rewarded more than a few

pence per hour for additional skills and experience. Even those taking positions of

responsibility can expect an uplift of no more than £1 an hour at most. Many of these

conditions appear to follow directly from LA commissioning practices, but even when LAs

offer more favourable commissioning and contracting most of the benefits are not passed to

employees. National providers are developing some company-wide policies but are

continuing to fix pay and other conditions at a local level. However, this approach seems to be

more about ensuring that a national scale does not price them out of work in some low paying

LAs than a means of upward adjustments of wages.

Some of our results suggest that it is only when local labour market conditions push turnover

rates above acceptable levels that providers may be dragged into providing what many would

regard as basic employment conditions and guarantees. One area where providers have

developed HR practices beyond the basics is in training, where most care workers felt they

were offered training beyond what they had experienced in other low paid jobs. One issue for

the future is whether the removal of the training target from CQC care standards will have an

adverse impact on future training provision. The other main area of good HR practice where

providers appear to do more than is required of them statutorily is in relation to efforts to fit

working time schedules to staff preferences. The extent of this accommodation may be

exaggerated as various comments by managers referred to accommodating within the

constraints of their very specific needs to deliver care in short chunks throughout the day and

evening or to provide 24/7 care as in the case of homes. Nevertheless, the efforts made to

accommodate their preferences were valued by the staff in the case studies and this suggests

that this is one way in which the local managers may aim to recruit and retain staff within the

limits of the overall poor employment conditions. It may be worth noting that managers‟

ability to juggle schedules to offer staff hours that fit their needs may be further constrained

under personal budgets as one of the benefits of personal budgets is held to be the opportunity

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to users to have more choice and control over their care. How this may affect the working

time arrangements for care staff has not been widely debated.

Overall we found little evidence of a more strategic approach towards recruitment and

retention; reliance on word-of-mouth recruitment and offering flexibility to match individual

circumstances in working hours may be a means of securing a stable workforce under current

conditions but these approaches set limits to the extent to which providers can develop

ambitions to expand or upskill the workforce.

The overall policy conclusions must be that providers cannot be simply trusted to respond to

more favourable commissioning and contracting and to improve employment conditions or to

develop longer term strategic approaches without some specific incentives or constraints. This

suggests that improvements are likely to require regulatory development – just as, for

example, the improved level of the national minimum wage and the move to 28 days paid

holiday have probably done most to improve conditions in this sector in the 2000s. It also

suggests that improved employment conditions need to be built into LA commissioning and

contracting strategies, but these requirements need to be funded by the LAs rather than simply

added in as an additional requirement without the complications taken into account in the

commissioning and contracting price. Another issue that needs to be considered is the

possibility of developing longer term partnership approaches with local providers; currently

there is a lot of discussion of partnerships but these are contingent on future competitive

tenders. Current partners or preferred providers may be encouraged to improve quality and

invest in their workforce in line with an LA‟s quality framework but they have no guarantee

that at the next tender they will not be rejected on the basis of too high prices. Such risks may

be even greater for providers who may be encouraged to develop a more strategic approach to

the recruitment and development of the workforce by offering not only better employment

conditions but also perhaps more training and development opportunities and more extended

career ladders. Such strategic turns require a long lead in and a stable and favourable

commissioning environment, conditions that are unlikely to prevail under current

arrangements.

The organisation of work and careers

The case studies revealed the current reliance on a workforce with specific characteristics -

that is, a largely female workforce with low qualifications, social and family networks with

links to the sector, very locally based and with very specific working time preferences. This

group was also found to have high levels of job satisfaction linked to their unrewarding work

experiences in the past as well as the nature of their present job. While this group of women

are a reliable workforce, provider practices and employment conditions that can appeal

beyond this group need to be put in place. However, a number of obstacles currently prohibit

this.

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Firstly, if the sector is to expand and appeal to under-represented groups, such as men or

indeed women with higher levels of qualifications, there are limits to how far the sector can

rely on localised recruitment practices that are predicated on informality. This will only

access a certain pool of female recruits, often those with no or low-level educational

attainment who are looking for work where low-level qualifications are not a barrier to entry.

Moreover, this pool of workers is contracting as the educational levels of women rise.

Secondly, it would appear that for too long the sector has relied on workers being „prisoners

of love‟, willing to accept low wages because of the intrinsic rewards of doing meaningful

work. While workers with few qualifications and limited opportunities may be willing to

accept such a trade-off, if the sector is to expand it may not be able to find new pools of

potential recruits willing to do so, quite apart from the social justice question as to whether

committed workers should be rewarded with lower pay. Furthermore, it is a trade-off that

cannot be made until people enter the sector in the first place and we do not know how many

people are deterred from entering because of the low pay levels on offer. This is exacerbated

by the better pay and opportunities on offer in inhouse local authority services and in the

NHS. The „pull‟ of the NHS and nurse training were the reasons most often given by care

workers for intentions to leave.

Thirdly, while workers were generally satisfied with their hours, the case study research

revealed the idiosyncratic nature of the hours worked by care workers. The hours were

unpredictable and variable, fragmented across the day, and did not fit standard notions of

family friendly flexible working. The hours suited care workers with very specific needs and

circumstances who often needed to work locally. This sort of working time would not

constitute flexible working to many and because legislation has ensured that more standard

notions of family friendly flexible time are now available in many organisations, the sector

cannot rely on its image as „flexible‟ as a way to expand the sector in the future.

Thus, to expand the quantity of recruits and provide a more diverse workforce that may also

have the capacity for further quality improvements there are clear needs to:

i) go beyond the informality of recruitment and to recruit across wider segments

both geographically and by gender, age, ethnicity and qualifications;

ii) to stop taking for granted that the nature of the work will compensate for poor

working conditions and provide terms and conditions that are at least

comparable to the main competitors such as the NHS;

iii) provide for more stable and guaranteed hours at work, albeit still with

opportunities to tailor working hours to preferences and circumstances of the

staff.

However, at the same time there could be strategies that build on the positive aspects of the

work, as revealed by our case study research, in developing systems of work organisation on

the one hand and career structures on the other. Four elements in such a strategy can be

identified. First, and above all, there needs to be scope built into the organisation of care work

that enables and encourages staff to develop relationships with users. This is a key factor in

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explaining high levels of satisfaction in the job and is key to both retention of staff and good

quality of care. The intrinsic features of the job, caring for the elderly and doing meaningful

work, bring high levels of job satisfaction and work organisation that supports this should be

part of providers‟ recruitment and retention strategy as well as part of their remit to provide

quality care. Any changes relating to work organisation need to be put in place with the

consultation of care workers and users as this is an area of HR practice where quality service

and quality jobs complement each other. At present this aspect of the work may be developed

more through the discretionary action of care workers than through it being an objective in the

design and organisation of work; if the high levels of satisfaction that we uncovered are to be

the basis for further development of the quantity and quality of the care workforce, we would

suggest that such activities need to be explicitly allowed for and rewarded in the job. The

commissioning environment and provider responses to this must build on the strengths of the

sector by offering interesting and rewarding jobs that are meaningful and allow time for care

workers and service users to develop relationships and be flexible in their approach to care.

This will improve both recruitment and retention and the quality service for users.

The second point follows from the first and that is that the use of electronic monitoring needs

to be carefully assessed and the benefits of improved data and reduced transaction costs and

direct care costs for LAs weighed against the possible loss of opportunities for delivery of

high quality care, with consequences for recruitment and retention as well as for the users of

care.

A third element that provides a positive base for further development is the generally positive

attitude of care workers to opportunities to training and to acquiring qualifications. This

proved particularly appealing to those who had, for example, been made redundant late in life

and wanted to start a new career and to younger workers who had not gained qualifications in

education. This may suggest that social care should develop an eclectic approach to

recruitment, providing opportunities for those who have missed out on earlier chances for

education and training while also raising the overall profile of social care as a career choice

by offering opportunities for training and development.

Finally social care needs to develop more opportunities to progress which do not take the

more senior and experienced care workers away from hands on care. This could involve

combining hands on care work with supervisory and mentoring roles or providing more

opportunities to move into re-ablement work at higher wage levels. Current specialisations of

LAs in the higher skilled work may be restricting those opportunities as LA departments may

not be recruiting as they reduce in size. As this problem eases through natural wastage it may

be important to encourage transfer from the more routine work into more specialised areas as

a means of retaining staff within the sector and providing them with both more rewards for

experience and new challenges. Opportunities to progress may prove to be particularly

important to recruit and retain men, on the basis of the small sample we interviewed.

However, this also means that it is even more necessary to create a range of career

opportunities as otherwise the relatively few men in the sector may be found occupying most

of the higher level positions if they are more active in bargaining for quick progression.

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Summary of key policy recommendations.

The key policy recommendations to achieve better recruitment and retention outcomes

include the following.

Stronger partnership arrangements are needed with providers, either at LA level or

through a national system of care commissioning, involving increased obligations on

both sides. Longer term guarantees of contracts or of preferred provider status need to

offered to enable providers to make a step change in their employment practices ( but

these arrangements should be designed to foster and not reduce the diversity of

supply).

LAs or a national care commission should promote better and reasonable employment

conditions through both better resourcing and more stringent requirements on

providers to meet higher HR standards.

Attention also needs to be paid to maintaining or improving the intrinsic rewards from

the work, potentially calling into question the practice of fragmented commissioning

of care packages, backed up by electronic monitoring.

Likewise there needs to be a more partnership approach to developing working time

arrangements that meet both user and care worker needs, perhaps by moving away

from the fragmentation of care commissioning by task and narrow time periods.

These recommendations should together provide the environment in which providers

can start to extend their recruitment pool and begin to attract and retain staff beyond

the immediate vicinity and to provide both better employment conditions and more

opportunities for advancement within social care work.

Attention should also be paid to how to facilitate the development of high quality re-

ablement and specialist services to ensure that users are not unnecessarily placed in

residential care. The delivery of specialised and short term care could require

consideration of a return to more guaranteed employment conditions and higher paid

employment, possibly within the public sector or under more stable and higher paying

contracts with specialist providers. The further development of specialist services

could also provide the important missing elements of opportunities for care workers to

progress without loss of involvement in hands on care.

Implications of our findings in the context of the move to personalisation

There are several ways in which our findings would support a move towards a more user

centred system of care as a means of recruiting and retaining a larger and more skilled social

care workforce. In particular, to the extent that this offered care workers more opportunities

for developing relationships with users and more opportunities to exercise discretion in the

ways in which they provided care, then this change in direction could promote the intrinsic

value of the work and enhance retention. However, these benefits may not necessarily be

achieved under current proposals for the mode of implementing personalisation. This applies

in particular if the proposals result in the user being the direct employer. In this latter scenario

even the above listed potential benefits of enhanced discretion and more opportunity to form

relationships would not necessarily be realised as the dual role of the user as the person

374

receiving the care and the employer of the care giver could inhibit the formation of a good

relationship. Care workers mentioned concerns about the lack of back up from managers in

their decisions on care provision, about their discomfort at the idea of being paid by the user

and about the potential problems of how they would be able to cope with a user who was

difficult or aggressive.

An important concern is how work would be scheduled and organised without the role of the

intermediary, the employer; this was a critical factor in care workers‟ job satisfaction.

Although opportunities to schedule care to meet their own needs is an important positive

attraction of personalisation for users, it is not clear how the difficult trade-offs between the

ideal time for a care visit and the competing demands from many users would be met. The

scheduling problem in principle could be eased by care workers caring for only one or a

smaller number of users but this would increase the need to expand the available workforce

and reduce the possibility of the job providing for full-time employment for those in need of a

full salary. Care workers we interviewed were concerned that caring for only one user might

prove less fulfilling compared to their current involvement with many users or might lead

them to be too involved, making it difficult to retain some distance from the user. They were

also concerned about job security if a user were to die or to move into residential care. The

ending of the job with the loss of a user could also enhance the risk of loss of skilled workers

to the sector as a whole; when workers are displaced from employment there is no guarantee

that they will confine their job search to the same field of work and having just been made

unemployed they might be unwilling to risk this happening a second time by entering into

another contract with an individual user.

Beyond these concerns over the move to directly employed personal assistants, our research

also pointed to a number of more institutional and budgetary concerns over personalisation as

currently proposed. Those most commonly raised by providers related to the poaching of their

staff and the increased difficulty in securing payment for services. For LAs the most common

concerns were over the impact on costs, the possibility that users would choose not to

purchase the more expensive re-ablement services, even though their long term costs of care

might then increase, and the problems user choice posed for organising care provision by

geographical area to minimise travel time and guarantee supply. The general uncertainty over

the future role of LAs and providers in the provision of services was also inhibiting more

strategic thinking and development, particularly with respect to integration with health.

Finally there was the problem of adding to the existing ambiguity over who had the

responsibility to provide training. Under personalisation three sets of agents might be

involved- the LA, the provider (if the PA were hired through an agency) and the user who

might be asked to pay for the training or the time spent training. In general it seems unlikely

in a sector where public funding inevitably shapes the market that strategic aims will be

achieved, or even the current quality and quantity of care maintained, without some continued

planning of provision at either LA or national level. If policies are not put in place to enable

strategic developments to be maintained and strengthened, the outcome could be moves away

from re-ablement and care in the users‟ homes and back to the more expensive and less

desired outcome of residential care.

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There thus seems to be an urgent need for further consideration of the appropriate modes of

implementing greater user choice in social care. Greater clarity is needed in the future roles of

LAs and existing providers in acting as commissioners, brokers or intermediaries with the

users and detailed consideration needs to be given to appropriate forms of employment

relationships and employment organisation in a caring profession. More clearly needs to be

done to enable users to have more say over how and when their care is delivered but there is

little evidence that the full consequences for the employment relationship of a move towards

directly employed personal assistants or even personal budgets have been considered. A

comprehensive study of the experiences of personal assistants is urgently required, together

with more policy thinking on how care staff are to be provided with adequate training and

some form of employment security under the new budget holding arrangements.

Towards a rebalancing of the care debate

A key premise of this research has been that, in order for the quality of care to be maintained

and enhanced, it is vital to do more to recruit and retain skilled and committed care workers.

What has been missing in current debates over social care is any serious consideration of

employment. While there has rightly been an increased recognition that the voice of the care

user needs to be heard more, the voice of the care worker is still silent when one examines the

main policy debates and documents. The consequence is that the implications of social care

policies, whether towards competitive outsourcing or user-centred care delivery, for the

quality of employment relationships in social care are often ignored or hidden. This is a

surprising feature of public policy in this service area where the quality of care cannot be

divorced from the quality and commitment of the person delivering the care. Thus, whatever

direction social care policy moves in, we would argue for the need to give greater

consideration to the employment arrangements that could be reasonably expected to deliver

the committed and skilled workforce that the care users in turn deserve and need.

376

Appendix

I.A. Appendix part I

I.A1. Social Care Workforce Project -Telephone interview including common

questions and specific questions for domiciliary care providers and for care

homes

Because of the importance of recruitment and retention for care providers we are carrying out this

survey in an effort to find out what is happening in the sector what you think about the current

situation and how it could be improved.

1. General information

1.1 Agency name ………………………………………………

1.2 Interviewee Name ………………………………………………………

1.3 Position ………………………………………………

1.4 (If unable to find out in advance) Number of branches/offices ………

1.5 Which LAs does this branch hold contracts with?

1.6 What proportion of your service users are local authority funded?

1.7 Do you do any work for the NHS?

YES NO

1.8 If yes What kind of work is this? (e.g. intermediate care)

1.9 CARE HOMES ONLY What percentage of your beds are currently vacant?

1.10 Who is responsible for HR issues on a day to day basis?

1.11 Do you have a specialist human resources manager or department

1.12 If yes, where located?

1.13 What support do they provide? (e.g. grievance and disciplinary)

1.14 Do you have a formal recognition agreement with any trade union?

YES NO

1.15 If yes, which?

ADVANCE

1.A How many staff do you employ?

a) This branch b) Total (if applicable)

1.B How many of the staff at this branch are care workers?

1.C How many of your care staff are permanent ……..temporary……… external agency workers

……….?

1.D What proportion of hours are done under a) block b) spot contracts?

1.E Do you collect figures on staff absenteeism? YES / NO

1.F (If yes) How is this measured

What is the rate of absenteeism?

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2. Recruitment and retention of care workers

Now we would like to ask you some questions about recruitment and retention of care workers.

ADVANCE

2.A What proportion of your staff are

under 30 ………………………………..

over 50 ………………………………..

over 60 ………………………………..

Female ………………………………..

White British ………………………………..

White other ………………………………..

Black or Asian ………………………………..

2.B Over the past twelve months

How many new starters have you recruited?...............

How many are still with you?..........................................

How many other staff have left?......................................

What proportion of your staff have been with you over 2 years?..................

And over 5 years? …………………………………………...

NOTE If the agency/branch opened in the last 5 years please state date it opened and the

share of staff who have been with you since that date

Date………………………. Share of staff ………………………….

2.1 Are you happy with the composition of your workforce?

YES NO

2.2 If NO, would you prefer to have

Tick relevant box

more younger employees

more older employees

more men

more women

a more ethnically diverse profile

2.3 Which of the following applies to you?

Tick relevant box

a)We currently have the right number of staff

b) We currently have more staff than we need.

c) We currently have fewer staff than we need

2.4 If c), how many more staff would you be keen to take on?

2.5 How easy or difficult is it to recruit care staff?

Tick relevant box

1. Very difficult

2. Quite difficult

3. Neither difficult nor easy

4. Quite easy

5. Very easy

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2.6 Has this changed since the summer of 2008?

2.7 If it is difficult to recruit, what are the main reasons? (No prompt).

Tick relevant boxes

Local competitors (e.g. new supermarkets)

Higher (or lower) wages elsewhere

Changing nature of care work

Working time schedules

Transport costs

High (low) local unemployment

Other – please specify

2.8 Are there any specific shortages (for night work, weekend work etc. or other specific

shortages)?

Tick relevant box

Night

Weekend

Other specific shortages

ADVANCE

2.C What methods do you normally use to fill vacancies?

Tick relevant boxes Use

Tick all that

apply

Most effective

Pick one only

Word-of-mouth recommendations from existing staff or others

List of interested applicants

Schools, colleges

Jobcentre Plus

Other agencies

Press advertising (local, regional or professional press)

Notice in office or shop window

Internal advertisement

Fee charging, private employment agency,

Any other way? (Please specify)

………………………………………………

2.D Which of the following do you normally use as part of the recruitment process?

Tick if

normally

used

Extra info

Formal job descriptions and person specifications

Application form If yes -

Requires full

work history?

CV

Initial telephone screening

References If yes -

Before or after

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interview?

Formal interview If yes -

With whom?

Informal interview IF yes -

With whom?

Aptitude testing IF yes –

At interview

At induction?

2.E Which of the following factors do you consider a) necessary b) desirable c) most important when

recruiting care workers?

Tick relevant boxes Necessary

(Tick all

that apply)

Desirable

(Tick all

that

apply)

Most

important

(tick one

only)

Availability for early starts or evening work

Availability for weekend work

Recommended by another employee

Skills related to care work

Experience of caring for family member or friend

Formal experience of care work (e.g.care home, other

home/agency)

Qualifications - NVQ2 or above in care

Positive attitude/ friendly nature

Ability to drive

Own transport

Lives locally

Other (please specify)

2.9 Is it easy for you to meet your recruitment criteria?

YES NO

If no, what are the main reasons? (prompt using questions below):

Appropriate availability to match our service needs

Appropriate skills

Appropriate age range

Who already have appropriate experience/qualifications

Who are willing to gain appropriate qualifications

With appropriate attitude (friendly nature, motivated, positive attitude)

Who live locally.

2.10 What is the most frequent reason you find an applicant unsuitable for a care job?

……………………………………………………………………………………

2.11 Do you turn down staff who would, in your view, be acceptable care workers?

VERY OFTEN OFTEN OCCASIONALLY ALMOST NEVER NEVER

2.12 Do you find that you are taking on staff who do not have as many of the desirable qualities as

you would like?

380

VERY OFTEN OFTEN OCCASIONALLY ALMOST NEVER NEVER

2.13 If unable to recruit staff locally do you

Tick relevant boxes

extend recruitment efforts to surrounding areas

attempt a more national recruitment drive

use other agencies

contact agencies/intermediaries who are seeking work for migrant workers

recruit abroad directly yourself?

2.14 Approximately how many migrant workers (defined as living in the UK for less than two

years) do you have working for you?

…………………………………………………………………………………………

2.15 What are the two most common nationalities?

…………………………………………………………………………………………

2.16 In the past two years approximately how many staff have you failed to recruit due to

a) delays with CRB checks

b) failure to pass CRB checks?

2.17 Do you consider staff turnover to be

VERY HIGH? QUITE HIGH ABOUT RIGHT/ACCEPTABLE

QUITE LOW VERY LOW

2.18 What are the main reasons for staff care workers leaving? (No prompt)

Tick relevant boxes

Work for another care provider

Work for the NHS

Work for the Local Authority

Work in a different sector

More convenient working time

Better pay

Full-time education

Nurse training

Not suitable, dismissal

Family responsibilities

Other

2.19 Do you normally recruit senior care workers/team leaders/supervisors/managers from within

your existing staff or externally?

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3. Pay

3.1 What is the range of hourly rates of pay for care staff (minimum/average/maximum)?

3.2 DOMCARE ONLY Are there different rates of pay for personal care and domestic work? (If

yes, what?)

3.3 DOMCARE ONLY (If applicable) Are there different rates of pay for those providing

intermediate care?

3.4 How do these rates compare with other domiciliary care providers in the area?

LOWER ABOUT THE SAME HIGHER

3.5 If there is more than one pay rate used, what are the main reasons for differences in pay rates

(give details of pay rates): (PROMPT FOR THOSE NOT MENTIONED - CAN I JUST CHECK

ARE THERE ANY DIFFERENCES IN PAY RELATED TO AGE, EXPERIENCE , ….

Age

Experience (including special probation rate)

Qualification

Weekend work

Night work

Length of Service/increments


3.6 Is there a regular upgrading of pay?

3.7 What are the main factors influencing pay upgrading? (PROMPT FOR THOSE NOT

MENTIONED)

Change in NMW

Performance Related

Completion of qualifications

Incremental salary scales

Commissioning price

Employee‟s request

Profitability

Other

3.8 DOMCARE ONLY How do you compensate for travel costs/travel time? (NO PROMPT)

Included in hourly rate

Supplement – flat rate

Supplement - percentage

Higher rate for call lasting under an hour

Mileage allowance

Reimbursement of petrol costs

Re-imbursement of public transport costs

Other

3.9 Do you provide uniforms?

YES NO

3.10 (If yes) are staff required to pay for them?

3.11 Do you pay for CRB checks?

YES NO

3.12 (If no) does that cause a significant drop out among those applying for vacancies (apart from

any other pay issues)?

3.13 CARE HOMES ONLY Do any service users make extra financial payments?

382

4. Organisation of Work

Work Scheduling

4.1 DOMCARE ONLY What are the hours of care provision?

4.2 DOMCARE ONLY How important is it to organise working hours to provide continuity of

care (1-5 scale)?

4.3 DOMCARE ONLY How important is it to organise working hours to fit employees‟

circumstances (scale 1-5)?

4.4 DOMCARE ONLY What kind of contracts do you offer for care staff?

Zero hours only – percentage of staff

Guaranteed hours - percentage of staff

4.5 In practice, what percentage of staff work:

under 16 hours

16-30 hours

over 30 hours

over 45 hours?

4.6 What is the maximum number of days a week that care staff work?

4.7 How many care staff occasionally/regularly work weekends?

4.8 DOMCARE ONLY Do care workers work alone or in pairs?

4.9 DOMCARE ONLY What is the minimum/average length of visit?

Are visit lengths tightly defined?

4.10 How is working time organised?

4.11 DOMCARE ONLY Is there a minimum length of a work period?

4.12 Do staff work:

continuous shifts

split shifts (morning shift and evening shift on same day)

Permanent early shift

Permanent late shift

4.13 DOMCARE ONLY Excluding travel time, what happens if there is a gap between service

users? Prompt: Unpaid break (only paid for contact hours)

Paid break

4.14 DOMCARE ONLY (If applicable) Are there different working time arrangements for care

workers providing intermediate care?

4.15 CARE HOMES ONLY Do all staff work some weekends? Or are there weekend/weekday

only schedules?

4.16 If there is a need for additional hours do you:

Ask existing staff to work extra hours

Use external agencies

Subcontract to other care providers?

4.17 DOMCARE ONLY How easy is it to find staff willing to work additional hours?

What about at short notice (2-3 days notice) or very short notice (the same day)?

4.18 Are care workers ever paid overtime premia?

YES NO

4.19 If yes, does this apply to all staff or only those contracted to work a certain number of hours

per week. If so, how many hours?

383

4.20 Are your care staff able to get work schedules that match their preferences for particular

hours?

Tick relevant box

All of the time (1)

Most of the time (2)

Some of the time (3)

Occasionally (4)

Rarely (5).

4.21 CARE HOMES ONLY Do you have minimum staffing levels

YES NO

4.22 CARE HOMES ONLY If yes, what are they?

Communication

4.23 Do you hold staff meetings?

YES NO

4.24 {If yes) How frequently?

4.25 Do you carry out attitude/ staff satisfaction surveys? (If yes) Can we have a copy?

Performance

4.26 How is performance (of staff) monitored?

User surveys by care provider

User surveys by LA

Visits by supervisors

Observation

Electronic monitoring


4.27 What are the most common problems of poor performance that you encounter?

Absenteeism

Timekeeping

Skimping on time or services provided to

service users

Complaints from service users (over

attitude, competence, completion of tasks

etc.


4.28 What has been the most effective way you have found of dealing with problems of poor

performance?

Disciplinary action

Loss of wages

Training

Electronic monitoring

Other (specify)

384

4.29 Do you carry out staff appraisals?

YES NO

4.30 (If yes) How often? Who carries these out?

4.31 Do recruitment difficulties mean that you are sometimes forced to put up with some problems

of poor performance?

4.32 Do your staff have opportunities to improve their performance in any of the following ways:

Tick relevant boxes Yes To some

extent

No Don‟t know

Having enough time to carry out the work

to a high standard

Having the opportunity to put into practice

the training/qualifications they have gained

Being free to prioritise and carry out tasks

in ways that they feel will improve the

quality of care?

Having the opportunity to spend time

talking to service users

Being encouraged to exchange ideas with

other carers of new ways of working/best

practice

4.33 Would you expect workers to tolerate any of the following as part of their job (tick all that

apply)?

Regularly Occasionally Never

Working longer than scheduled due to

unanticipated needs of service users

Variations in hours or location at short notice

Working in very unsanitary conditions

Working with aggressive service users (due to

dementia etc.)

Working alone late at night (after 10 pm)

4.34 Do you consider rates of staff absenteeism to be:

VERY HIGH QUITE HIGH ACCEPTABLE QUITE LOW VERY LOW

5. Training and Development

5.1 Describe the induction training offered to new recruits:

How long is induction?

Is it offered by yourselves, LA, other external body?

Who pays for the induction?

Are staff paid for attending induction training?

5.2 For new staff who already have experience of care work, approximately how long does it

normally take before they are able to do their job as well as employees already working here? :

1) One week or less,

2) More than one week, up to one month,

3) More than one month, up to six months,

4) More than six months, up to one year,

5) More than one year

385

5.3 How do you identify training needs? (prompt if necessary)

Appraisal

Employee request

ADVANCE

5.A What training courses are offered to staff?

Compulsory Optional

Health and Safety

Food hygiene

Service user handling

Use of equipment

Infection control

First aid

Medication management

Dementia care

Diabetes care

Loss and depression in elders

Parkinson‟s care

NVQ 2

Others (please specify)

5.4 Refer to grid on advance information sheet - Who organises the training? (e.g. employer, LA,

other external body).

Where the LA organises the training: Where other….

Who delivers the training? Who delivers the training?

Is training devised specifically for providers? Is training devised specifically for providers?

Is it provided free of charge? Is it provided free of charge?

If it is not free, who pays the course fee? If it is not free, who pays the course fee?

5.5 Are staff paid for time spent training?

5.6 Do they get time off from care duties to attend or do they attend outside their normal working

hours?

5.7 Does this apply to all courses? (Prompt – optional courses).

5.8 Does the local authority provide help with access to funding for training?

5.9 How many care staff have the following formal qualifications?

NVQ2

NVQ3/4

nursing qualifications

other relevant qualifications?

(Check – if any staff have NVQ3/4 or nursing qualifications are they employed as care

workers or in more professional/management jobs?

5.10 DOMCARE ONLY If agency provides intermediate care (Q1.6) Do staff providing

intermediate care need extra qualifications?

5.11 If yes, what qualifications?

5.12 How likely are you to meet the 50% NVQ2 target?

Already met/ will meet soon/ experiencing difficulties. (Check with CSCI)

386

5.13 If not yet met, what factors make it difficult to meet this target: NO prompt.

staff turnover

staff motivation

pressure of work (e.g. scheduling, fatigue)

other

5.14 Do any staff need to have NVQ3?

YES NO

5.15 (If yes) Are they recruited externally or internally trained?

6. Relationship with NAMED LA (Prompt – remind interviewee that their answers will be

treated confidentially)

6.1 How would you describe your relationship with NAMED LA (1-5 scale)

6.2 What is the main problem, if any, you have you experienced in your dealings with the LA?

Obtain from the LA interview/questionnaire whether LA organises a providers’ forum and how

often it meets.

If it does:

6.3 How frequently do you attend? (always, mostly, occasionally, never).

6.4 How useful is the forum on a five point scale? (1-5)

6.5 How much importance does the NAMED LA place on providers‟ HR practices in the

tendering process?

6.6 What monitoring if any does the LA undertake itself or does it rely on CSCI?

7. Policy and regulatory environment

7.1 How satisfied are you with the CSCI‟s a) set of quality standards b) system of quality ranking?

(1-5 scale)

7.2

Star rating:

Do you consider your own ranking to be fair?

ADVANCE –DOM ONLY

7.A Which of the following quality care standards do you find most challenging? (Tick up to 4)

Care needs individually assessed

Service users treated with respect, valued and right to privacy upheld

Policies and procedures on medication and health related activities protect service

users

Health, safety and welfare of service users is promoted and protected

The risk of accidents and harm happening to service users and staff is minimised

Service users are protected from abuse, neglect and self harm

The well-being, health and security of service users is protected by the agency‟s

policies and procedures on the recruitment and selection of staff

Service users know that staff are appropriately trained to meet their personal care

needs

Service users know and benefit from having staff who are supervised and whose

performance is appraised regularly

Service users receive a consistent, well-managed and planned service

Service users, relatives and representatives are confident that their complaints will be

listened to, taken seriously and acted upon

387

ADVANCE: CARE HOMES ONLY

7.A Which of the following quality care standards do you find most challenging? (Tick up to 4)

No service user moves into the home without having his/her needs assessed and

assured that these will be met

Service users assessed and referred solely for intermediate care are helped to

maximise their independence and return home

Service users‟ health, personal and social care needs are set out in an individual

plan of care

Service users‟ health care needs are fully met

Service users, where appropriate, are responsible for their own medication and

protected by the home‟s policies and procedures for dealing with medicines

Service users feel they are treated with respect and their right to privacy upheld

Service users find the lifestyle experienced in the home matches their

expectations and preferences and satisfies their social, cultural, religious and

recreational interests and needs

Service users maintain contact with family/friends/representatives and the local

community as they wish

Service users are helped to exercise choice and control over their lives

Service users receive a wholesome, appealing balanced diet and pleasing

surroundings at times convenient to them

Service users and their relatives and friends are confident that their complaints

will be listened to, taken seriously and acted upon

Service users are protected from abuse

Service users live in a safe, well maintained environment

The home is clean, pleasant and hygienic

Service users‟ needs are met by the numbers and skill mix of staff

Service users are in safe hands at all times

Service users are supported and protected by the home‟s recruitment policy and

practices

Staff are trained and competent to do their jobs

Service users live in a home run and managed by a person who is fit to be in

charge, of good character and able to discharge his or her responsibilities fully

The home is run in the best interests of service users

Service users‟ financial interests are safeguarded

The health, safety and welfare of service users and staff are promoted and

protected

7.3 What change, if any, would you most like to see in the inspection/regulatory system?

7.4 What, if any changes in the LA‟s commissioning/contracting arrangements would do most to

assist you in recruiting and retaining a stable and motivated social care workforce? Prompts:

388

Improvements in commissioning price

Variations in price by type of service and time of delivery

Higher guaranteed volume of work

More scope to determine how care is delivered (e.g.

commissioning in hours not minutes)

More integrated approach by LA to care provision

More time per service user

Other?

7.5 What changes to HR policies/practices would do most to improve recruitment and retention,

and have you implemented any of these changes in your organisation in order to improve recruitment

and retention?

Tick relevant boxes (prompt) HR policies that

would do most to

improve R and R

Have implemented

Improved opportunities for training

Pay increases

Recognition of variations in service -

time of day/weekends/ type of care

/skill etc

Improved opportunities for internal

promotion

Flexible hours/hours to suit

Improved Non-pay benefits

More scope for care workers to

exercise discretion over how to

provide care

Any other?

7.6 DOMCARE ONLY What problems/opportunities do you anticipate as a result of an increase

in direct payments and individual budgets?

7.7 Do you have any concerns that proposed new regulations limiting non EU migrants will affect

your ability to recruit sufficient or sufficiently skilled care staff?

8. Further information

(If interviewee unable to answer any of the questions) Could we get back to you for the answer to this

question?

We will be selecting a small number of providers interviewed for more in-depth case study research.

This will involve researchers visiting the organisation to interview a sample of care workers. If you

are chosen would you be willing to take part in this? Would it be possible for some of your staff to

attend a focus group to discuss issues for the case studies?

389

Appendix Table I.A1. Classifying female demand conditions in the selected LAs

Female

employment rate

in relation to

average for

Great Britain

69.4a

Female

unemployment rate

in relation to Great

Britain average

female

unemployment rate

of 6.1b

Share of women

who are inactive

but wanting a

job compared to

Great Britain

average of 6.6c

Classification

of female

employment

conditions

based on

columns 1-3d

Female part-

time hourly

earnings

relative to

Great Britain

average f

AH M L M 5 M

ON L M M 3 L

RT L M M 3 M

RN H M M 5 H

UY M M L 4 L

AD M H M 3 L

AW L H L 3 H

IL L H H 2 L

OM L H M 2 L

XD H L M 6 H

HD M M L 5 M

TE L H H 2 L

LK H L L 6 M

RD M M M 4 M

aH=2.2 to 7.9 %points above GB average, M=0.6 to 1.3 % points below GB average L= 3.4 to 10.3 % points

below GB average 2008 bH=1.4 to 3.2 %points above GB average, M=0.7 below to 0.9 %points above GB average L= 1.6 to 7.9 %

points below GB average 2008 cH=2.6 %points above GB average, M=0.3 below to 1 %point above GB average L= 1.2 to 3.4 % points below

GB average 2008 dScores computed as 3,2,1 H, M, L column 1 plus average of scores on columns 2 and 3 where 1,2,3 correspond

to H,M,L. fH=£1.13 to £2.97 above GB average, M=-1p below to 43p above GB average L= -78p below to £-1.91 below

GB average (2009)

Source: LFS on NOMIS for 2008, Ashe table 2009 8.6a for part-time earnings

390

Figure I.A1. Strong, medium and weak labour demand conditions

Female employment

conditions – low to high

High pay Medium pay Low pay

2 IL, OM, TE

3 AW RT ON, AD

4 RD UY

5 RN AH,HD

6 XD LK

Note: Weak demand: white

Medium demand: light grey

Strong demand: dark grey

391

IV.A. Appendix part IV

IV.A1. Technical notes explaining the standardised dataset - Indicators, sub-

indices and indices

The analysis in part IV of the report draws on a standardised dataset that we constructed from

the telephone survey general data set. Four principles guided the construction of the

standardised dataset, as follows.

i) Selection of providers: inclusion of providers on the basis of no less than 10% missing

values from the list of standardised indicators

- resulted in the selection of 102 out of 105 providers from the full sample

of independent sector providers.

ii) Selection of indicators: inclusion of indicators for use with the standardised data set on

the basis of a) their potential for explaining variations in HR practices and outcomes

and b) having less than 10% missing values (after elimination of providers with more

than 10% missing as in i) above)

iii) Construction of sub-indices: designed in order to group together indicators that

measure similar dimensions to HR practices

iv) Construction of indices: designed to provide overall summary measures of HR

practices in a particular HR domain.

The following tables provide details of the various indicators, sub-indices and indices, along

with a note referencing the table or figure in the report that provides descriptive statistics.

392

392

Appendix Table IV.A1. HR practice indicators, sub-indices and Xindices: standardised data set.

HR practice

indicators

Description and range of scores For data

distributions see

tables in part III

Sub-indices (unweighted

average of the component

indicators)

X indices (unweighted

average of the

component sub-indices)

IP1 Pay level (minimum)

Very low = 0; Low = 0.25; Medium = 0.50; High = 0.75;

Very high= 1

Table III.14 and Fig.

III.11

SIPAYLEVEL INDEX OF PAY

LEVELS

XPAYLEVELS

IP2 Pay level (normal)

Very low = 0; Low = 0.25; Medium= 0.50;High = 0.75;Very high =

1

Table III.15, Table

III.41and Fig. III.12

IP3 Regular uprating of pay

No, or not regular = 0; Yes = 1

Table III.19 SIPAYUPGRADE

IP8 Extra pay for weekend work

No= 0; Yes= 1

Table III.16

Fig.III.16

SIPAYUNSOCIAL

IP9 Extra pay for night work

No = 0; Yes = 1

IP10 overtime premia for extra hours

No = 0; Yes = 1

IP14 Payment of staff for time spent training

No = 0; Some courses=0.5; all = 1

Table III.20 SIPAYTRAIN

IP13 Payment of staff for attending induction training

No =0; Partly/ Reimbursed after specified time in post = 0.5; Yes = 1

Table III.22 SIPAYTR

AIN

SIPAYUPFRONT

IP11 Pay for CRB checks

No (+staff pay but reimbursed if stay) = 0; 50/50 = 0.5; Yes (+but

staff reimburse if leave within specified time) = 1

Table III.21 SIPAYUPFRONT INDEX OF PAY

STRATEGIES

XPAYSTRAT

IP12 Pay for uniforms Yes = 0; No (or only for extra uniforms) = 1 Table III.21

IP4 Pay upgrade opportunities

(normal pay minus minimum pay) zero= 0; 1p-20p = 0.25; 21p-40p

= 0.50; 41p-99p = 0.75; £1 or over =1

Table III.14 and

III.15

SIPAYIMP

IP5 Differences in pay rates by reason of experience or incremental

scales?

No = 0; Yes = 1

Table III.16

393

393

IP6 Differences in pay rates by reason of qualification?

No = 0; Yes = 1

Table III.16

IP15 Opportunities to become senior care workers

No seniors = 0; Externally only = 0.33; Both internally and

externally = 0.67;

Internally only = 1

Table III.5 SIPAYOPPCAR

IHR1 Recognition agreement with trade unions (Q109)

No = 0; Yes = 1

Fig III.35 SIEMPVOICE

EMPLOYEE

DEVELOPMENT

INDEX

XEMPDEV

IHR2 Frequency of staff meetings

Less frequently than once a year = 0; Between once every three

months and once a year = 0.33; Between once every month and

every three months = 0.67; Every month or more frequently = 1

Table III.46

IHR3 Staff attitude/staff satisfaction surveys

No = 0; Yes = 1

Fig.III.35

IHR4 Frequently of appraisals?

No appraisal =0; Less frequently than annual= 0.2; once a year =0.4;

every six months to once a year =0.6; every 3 to 6 months= 0.8;

More frequently than 3 months=1

Table III.41 SIEMPAPP

IHR5 Identification of training needs

No system = 0; Employee request = 0.5; appraisal alone or appraisal

plus employee request = 1

Table III.41

IRC1 Formality of recruitment

Word of mouth recommendations=0; Other agencies/ internet/ open

days/any other way or notice in shop window=0.5;

Press advertising or job centre plus=1

Table III.4 SIRECRUITPR INDEX OF

RECRUITMENT AND

RETENTION

PRACTICES

XRRPRACT

IRC3 Importance placed on skills, qualifications or experience in

recruitment: score of 0=0; a score of 1-4=0.5; a score of 5-8=1

Table III.7 and fig.

III.5

SIRECRSELEC

IRT5 Role of push factors in staff quits

one or more push factors=0; no push factors=1

Table III.15 SIRECRETEN

IWT3 Work schedules that fit staff preferences for particular hours?

Occasionally/some of the time = 0; Most of the time =0.5; All of the

time = 1

Fig. III.21 SIWTSTFFPREF WORKING TIME

INDEX

XWT

IWT4 Percentage of staff regularly working weekends?

100 percent = 0; Less than 100 percent = 1

Fig. III.20 SIWTWEND

IWT5 Availability for weekend work as recruitment requirement Fig.III.4

394

394

Note: index of all HR practices is called-XHRPRACT and is the result of the average of XPAYLEVELS, XPAYSTRAT, XEMPDEV, XRRPRACT, XWT, and XWO

Yes = 0; No = 1

IWT6 Maximum number of days that care staff work

7 = 0; 6 = 0.5; 5 or less = 1

Table III.24 SIWTLHOURS

IWT8 Share of staff working over 45 hours

Over 6 percent = 0; 1-5 percent = 0.5; Less than 1 percent = 1

Table III.23, and fig.

III.19 and fig. III.27

IWT9 Time off from care duties to attend training?

No = 0 Sometimes = 0.5 Yes = 1

Table III.20 SIWTTOFFTRAIN

IWO1 Time to carry out the work to a high standard

No = 0 To some extent = 0.5; Yes = 1

Table III.45 SIWOTIME WORK

ORGANIZATION

INDEX XWO IWO2 Opportunities to develop good relationships with service users

No = 0; To some extent = 0.5 Yes = 1

Table III.45

IWO3 Opportunity to put into practice their training/ qualifications

No = 0; To some extent = 0.5;Yes = 1

Table III.45 SIWODISCRET

IWO4 Freedom to prioritise and carry out tasks in ways to improve the

quality of care

No = 0; To some extent = 0.5; Yes = 1

Table III.45

IWO5 Encouragement to exchange ideas with other carers of new ways

of working/best practice

No = 0; To some extent = 0.5

Yes = 1

Table III.45

395

395

Appendix Table IV.A2. HR outcome indicators, sub-indices and Xindices: standardised data set

HR outcome indicators Description and range of scores For data

distributions see

tables in part III

Sub-indices

(unweighted average of

the component

indicators)

X indices (unweighted

average of the

component sub-indices)

IOUT1 Percentage with NVQ2 (Q194)

<46 %= 0 46–55 %= 0.33 56-69% = 0.67

>69%= 1

Table III.36 and

fig.III.28

SITRAINSKILDEV TRAINING/SKILL

DEVELOPMENT

OUTCOME INDEX

XTRAINSKILDEV

IOUT2 Likelihood of meeting the 50 percent NVQ2 target

Experiencing difficulties = 0

Will meet soon = 0.5 Already met = 1

Fig. III.29

IRC5 Difficulty in recruiting care workers

very difficult=0 quite difficult =0.25

neutral=0.5 quite easy=0.75 very easy=1

Fig. III.1 SIRECDIFF INDEX OF R&R

OUTCOMES

XRROUTCOMES

IRC7 Staff shortages in particular areas Yes=0

No=1

Table III.3

IRT1 Staff turnover considered to be: very high=0 quite

high=0.25 about right=0.5

quite low=0.75 very low=1

Fig. III.7 SITO

IRT6 Absenteeism among care staff considered to be:

very high=0 quite high=0.25 acceptable =0.5 quite

low=0.75 very low=1

Fig. III.34 SIABSENT

396

396

Appendix Table IV.A3. HR practice indicators: non standardised data set.

HR practice -

Indicators

(excluded from

standardised data

set due to too high

missing variables)


distributions see

tables in part III

IP7 Pay levels compared to other agencies/homes

Lower = 0; About the same = 0.5; Higher = 1

Not addressed

IHR7 Most effective method of dealing with poor performance?

Disciplinary only = 0; „Soft‟ measures plus disciplinary = 0.5;

Training and „soft‟ measures only =1;

Table III.42,

IOUT3 Do you have the Investors in People Award?

No = 0 Yes = 1

Fig. III.31

HR practice

indicators specific

to domiciliary care


distributions see

tables in part III

IPDOM1 Compensate for travel costs/travel time

No extra pay = 0; Mileage or reimbursement = 0.5;

Supplement or higher rate for short call = 1

Fig. III.15

IHRDOM1 Performance monitored by electronic monitoring

Yes = 0; No = 1

Fig. III.32

IWTDOM1 Domiciliary care workers expected to tolerate variation in

hours or location at short notice

Yes = 0; Occasionally = 0.5; Never = 1

Fig. III.22

IWTDOM2 Paid break between service users

No = 0; Yes = 1

Fig. III.24

IWTDOM3 Minimum length of a work period (QDO149a)?

No minimum = 0; One hour or less = 0.5; More than one hour = 1

Fig. III.23

IWTDOM4 Important attached to organising working hours to fit

employees’ circumstances

very unimportant/ unimportant/neutral = 0; important = 0.5; very

important = 1

Table III.26

IWTDOM5 Minimum length of a visit

No min/15-29 minutes = 0; 30 minutes = 0.5; More than 30

minutes = 1

Fig. III.23

IWTDOM6 Staff required to work alone late at night

Yes = 0 Occasionally = 0.5 Never = 1

Table III.32

IWTDOM7 Contracts offered to care staff

All zero hours = 0

mix zero and guaranteed hours = 0.5 all guaranteed hours = 1

Fig. III.18

397

397

Appendix Table IV.A4. HR outcome indicators: non standardised data set

HR outcome

Indicators

(excluded from

standardised data

set due to too high

missing variables)


distributions see

tables in part III

IRT2 Share of new starters in the last 12 months that have been

retained

less than 70%=0; 70-99%=0.5; 100%=1

Fig. III.8

IRT3 Overall level of staff turnover in the last 12 months

30%+=0; 10-29%=0.33; 1-9% =0.67; 0%=1

Fig. III.10

IRT9 Staff turnover excluding new recruits (as a percentage of staff

12 months previously)

>30%=0; 20-29%=0.33; 10– 19%= 0.67; 0-10%=1

Fig III.9

398

398

IV.A.2. Descriptive statistics for indicators, sub-indices and indices from the standardised dataset

Table IV.A5. HR practices by size

Homes IDPs

All Very

small

Small Medium

& Large

All Very Small&

Small

Medium Large

SIPAYLEVEL Pay levels 0.33 0.31 0.33 0.35 0.50 0.49 0.50 0.53

SIPAYUPGRADE Regular upgrading of pay 0.91 0.91 0.91 0.93 0.78 0.79 0.79 0.75

SIPAYUNSOCIAL Pay for unsocial hours 0.28 0.31 0.30 0.19 0.44 0.40 0.46 0.45

SIPAYTRAIN Pay for training 0.91 0.91 0.90 0.95 0.79 0.93**

(L)

0.77 0.65**

(VSS)

XPAYLEVELS Index of pay levels 0.61 0.61 0.61 0.60 0.63 0.65 0.63 0.59

SIPAYIMP Opportunities for pay improvement 0.44 0.44 0.38 0.52 0.46 0.43 0.51 0.40

SIPAYOPPCAR Opportunities for career 0.78 0.92**

(ML)

0.77 0.64**

(VS)

0.81 0.88 0.82 0.72

SIPAYUPFRONT Payment of upfront costs 0.83 0.76 0.86 0.85 0.67 0.77 0.67 0.58

XPAYSTRAT Index of pay strategies 0.68 0.71 0.67 0.67 0.65 0.69 0.67 0.57

SIEMPVOICE Employee voice practices 0.50 0.49 0.47 0.57 0.54 0.50 0.56 0.54

SIEMPAPP Employee appraisal 0.65 0.66 0.57**

(ML)

0.75**

(S)

0.64 0.60 0.68 0.61

XEMPDEV Index of employee development

practices

0.58 0.57 0.52**

(ML)

0.66**

(S)

0.59 0.55 0.62 0.57

SIRECRUITPR Formality of recruitment process 0.58 0.63 0.55 0.55 0.72 0.77 0.71 0.69

SIRECRSELEC Selection by skills, qualifications or

experience

0.58 0.54 0.64 0.55 0.62 0.50**

(L)

0.63 0.75**

(VSS)

SIRECRETEN Role of push factors in staff quits 0.67 0.69 0.68 0.64 0.54 0.57 0.63 0.33

XRRPRACT Recruitment and retention practices

index.

0.61 0.62 0.62 0.58 0.63 0.61 0.65 0.59

SIWTSTFFPREF Work schedules that fit staff preferences 0.64 0.59 0.71 0.57 0.61 0.65 0.63 0.55

399

399

SIWTWEND Weekend working 0.29 0.35 0.17**

(ML)

0.41**

(S)

0.32 0.31 0.58 0.30

SIWTLHOURS Long hours/long weeks 0.80 0.77 0.84 0.77 0.73 0.59 0.62 0.70

SIWTTOFFTRAIN Time off for training 0.87 0.94 0.84 0.82 0.86 0.96 0.83 0.85

XWT Index of working time practices 0.65 0.66 0.64 0.64 0.63 0.63 0.66 0.60

SIWOTIME Time discretion at work 0.96 0.97 0.95 0.96 0.83 0.79 0.88 0.79

SIWODISCRET Task discretion at work 0.93 0.96 0.94 0.88 0.84 0.85 0.83 0.86

XWO Index of work organisation practices 0.95 0.96 0.95 0.92 0.84 0.82 0.85 0.83

XHRPRACT Overall index of HR practices 0.68 0.69 0.67 0.68 0.66 0.66 0.67 0.64

Table IV.A6. HR outcomes by size

Homes IDPs

All Very

small

Small Medium

& Large

All Very

small

& small

Medium Large

SIRECDIFF Recruitment difficulties 0.69 0.56 0.76 0.72 0.38 0.37 0.45 0.24

SITO Perceptions of staff turnover 0.72 0.72 0.82 0.55 0.52 0.45 0.61 0.40

SIABSENT Perceptions of absenteeism 0.63 0.66 0.70 0.48 0.46 0.52 0.47 0.40

XRROUTCOMES Index of recruitment and retention

outcomes

0.68 0.64**

(ML)

0.76**

(ML)

0.58**

(VS &S)

0.45 0.44 0.51 0.34

XTRAINSKILDEV Index of training outcome 0.81 0.87 0.84 0.70 0.63 0.67 0.69 0.44

400

400

Homes IDPs

All Local

chain

National

chain

Single

home

All Local

chain

National

chain

Single

home

SIPAYLEVEL Pay levels 0.33 0.36 0.37 0.27 0.50 0.49 0.49 0.55

SIPAYUPGRADE Regular upgrading of pay 0.91 0.93 1.00*

(S)

0.83*

(N)

0.78 0.80 0.76 0.82

SIPAYUNSOCIAL Pay for unsocial hours 0.28 0.31 0.17**

(S)

0.35**

(N)

0.44 0.37 0.45 0.48

SIPAYTRAIN Pay for training 0.91 0.95 0.92 0.89 0.79 0.93 0.76 0.73

XPAYLEVELS Index of pay levels 0.61 0.64 0.61 0.58 0.63 0.64 0.62 0.64


SIPAYOPPCAR Opportunities for career 0.78 0.76 0.70 0.87 0.81 0.87 0.82 0.76

SIPAYUPFRONT Payment of upfront costs 0.83 0.80*

(N)

0.93**,*

(S, L)

0.76**

(N)

0.67 0.72 0.65 0.69



SIEMPAPP Employee appraisal 0.65 0.64 0.66 0.64 0.64 0.59 0.65 0.65

XEMPDEV Index of employee development practices 0.58 0.59 0.58 0.57 0.59 0.57 0.61 0.55



experience

0.58 0.54 0.62 0.58 0.62 0.55 0.62 0.68


XRRPRACT Recruitment and retention practices index 0.61 0.60 0.64 0.60 0.63 0.57 0.62 0.70


SIWTWEND Weekend working 0.29 0.44 0.24 0.23 0.32 0.37 0.45 0.12

SIWTLHOURS Long hours/long weeks 0.80 0.89*

(N)

0.71*

(L)

0.81 0.73 0.59 0.70 0.58



SIWOTIME Time discretion at work 0.96 0.91**,*

(S,N)

0.99*

(N)

0.98 0.83 0.85 0.85 0.75


XWO Index of work organisation practices 0.95 0.90**,*

(S,N)

0.96*

(L)

0.97**

(L)

0.84 0.84 0.84 0.83


Table IV.A7. HR practices by ownership

401

401

Table IV.A8. HR outcomes by ownership

Homes IDPs

All Local

chain

National

chain

Single

home

All Local

chain

National

chain

Single

home




XRROUTCOMES Index of recruitment and retention outcomes 0.68 0.67 0.67 0.69 0.45 0.52 0.43 0.45

XTRAINSKILDEV Index of training outcome 0.81 0.77*

(S)

0.71**

(S)

0.93**,*

(N,L)

0.63 0.86*

(N)

0.56*

(L)

0.60

402

402

Table IV.A9. HR practices by star ratings

Homes IDPs

All 1* 2* 3* All 1* 2* 3*

SIPAYLEVEL Pay levels 0.33 0.19*

(3*)

0.34 0.39*

(1*)

0.50 0.44 0.51 0.50


SIPAYUNSOCIAL Pay for unsocial hours 0.28 0.13**

(3*)

0.24**

(3*)

0.46**

(1*,2*)

0.44 0.39 0.44 0.47


XPAYLEVELS Index of pay levels 0.61 0.52**

(3*)

0.60*

(3*)

0.68**,*

(1*,2*)

0.63 0.55 0.64 0.63




XPAYSTRAT Index of pay strategies 0.68 0.62**

(3*)

0.66**

(3*)

0.77**

(1*,2*)

0.65 0.67 0.62 0.73

SIEMPVOICE Employee voice practices 0.50 0.58**

(3*)

0.55**

(3*)

0.35**

(1*,2*)

0.54 0.57 0.55 0.49





experience

0.58 0.58 0.60 0.54 0.62 0.50 0.65 0.60


XRRPRACT Recruitment and retention practices index 0.61 0.49**

(2*)

0.66**

(1*)

0.57 0.63 0.57 0.65 0.59


SIWTWEND Weekend working 0.29 0.21 0.28 0.37 0.32 0.38 0.50 0.50

SIWTLHOURS Long hours/long weeks 0.80 0.78 0.82 0.74 0.73 0.64 0.65 0.65



403

403



XWO Index of work organisation practices 0.95 0.97 0.94 0.95 0.84 0.90 0.81 0.88


Table IV.A10. HR outcomes by star ratings

Homes IDPs

All 1* 2* 3* All 1* 2* 3*




XRROUTCOMES Index of recruitment and retention outcomes 0.68 0.67 0.67 0.69 0.45 0.47 0.47 0.38

XTRAINSKILDEV Index of training outcome 0.81 0.83 0.79 0.85 0.63 0.65 0.65 0.55

404

404

Table IV.A11. HR practices by LA commissioning practice

Homes IDPs

All Partnership

LAs

Mixed LAs Cost

Minimising

LAs

All Partnership

LAs

Mixed

LAs

Cost

Minimising

LAs

SIPAYLEVEL Pay levels 0.33 0.44**

(M C)

0.27**

(P)

0.24**

(P)

0.50 0.55 0.48 0.45



(M)

0.15**

(P)

0.31 0.44 0.52 0.40 0.37

SIPAYTRAIN Pay for training 0.91 0.89**

(C)

0.89**

(C)

0.98**

(M P)

0.79 0.74 0.83 0.81


(M)

0.54**

(P)

0.61 0.63 0.66 0.64 0.55


improvement

0.44 0.54**

(C)

0.41 0.33**

(P)

0.46 0.55 0.43 0.36







development practices

0.58 0.55*

(c)

0.55*

(c)

0.66*

(M P)

0.59 0.61 0.60 0.55

SIRECRUITPR Formality of recruitment

process

0.58 0.51 0.62 0.51 0.72 0.70 0.83 0.60


qualifications or experience

0.58 0.58 0.53 0.68 0.62 0.62 0.59 0.67

SIRECRETEN Role of push factors in staff

quits

0.67 0.57 0.78 0.57 0.54 0.64 0.50 0.42

XRRPRACT Recruitment and retention

practices index.

0.61 0.55 0.64 0.59 0.63 0.65 0.64 0.56

SIWTSTFFPREF Work schedules that fit staff

preferences

0.64 0.58 0.67 0.69 0.63 0.59 0.66 0.67

SIWTWEND Weekend working 0.29 0.46** 0.12** 0.27 0.38 0.37 0.31 0.48

405

405

(M) (P)

SIWTLHOURS Long hours/long weeks 0.80 0.71**

(M)

0.93**

(P C)

0.74**

(M)

0.64 0.63 0.63 0.67

SIWTTOFFTRAIN Time off for training 0.87 0.93**

(M)

0.75**,*

(P,C)

0.93*

(M)

0.90 0.98 0.81 0.88

XWT Index of working time

practices

0.65 0.67 0.62 0.66 0.64 0.64 0.60 0.67



XWO Index of work organisation

practices

0.95 0.94 0.96 0.93 0.84 0.86 0.84 0.78

XHRPRACT Overall index of HR practices 0.68 0.69 0.66 0.68 0.66 0.68**

(C )

0.66 0.62**

(P)

P, M, C used to indicate difference from partnership, mixed and cost minimising LAs respectively

Table IV.A12. HR outcomes by LA commissioning practice

Homes IDPs

All Partnership

LAs

Mixed

LAs

Cost

Minimising

LAs

All Partnership

LAs

Mixed

LAs

Cost

Minimising

LAs

SIRECDIFF Recruitment difficulties 0.69 0.60*

(C)

0.70 0.80*

(P)

0.38 0.36 0.38 0.39



XRROUTCOMES Index of recruitment and

retention outcomes

0.68 0.68 0.67 0.68 0.45 0.46 0.45 0.44

XTRAINSKILDEV Index of training outcome 0.81 0.75**

(M)

0.94**

(P C)

0.73**

(M)

0.63 0.55 0.73 0.63

H, M, L used to indicate difference from high, medium and low fee paying LAs respectively

406

406

Table IV.A13. HR practices by LA fee level

Homes IDPs

All Low fees Medium

fees

High

fees

All fees Low fees Medium

fees

High fees

SIPAYLEVEL Pay levels 0.33 0.20**

(H)

0.34 0.47**

(L)

0.38 0.54 0.57 0.50


SIPAYUNSOCIAL Pay for unsocial hours 0.28 0.25 0.13**

(H)

0.39**

(M)

0.36 0.40 0.58 0.44



(H)

0.59 0.69**

(L)

0.60 0.61 0.68 0.63

SIPAYIMP Opportunities for pay improvement 0.44 0.37**

(H)

0.38 0.55**

(L)

0.26 0.57 0.52 0.46








SIRECRSELEC Selection by skills, qualifications or experience 0.58 0.57 0.51 0.64 0.57 0.63 0.67 0.62


XRRPRACT Recruitment and retention practices index. 0.61 0.56 0.61 0.67 0.56 0.65 0.66 0.63


SIWTWEND Weekend working 0.29 0.17*

(H)

0.23 0.46*

(L)

0.29 0.49 0.31 0.38


(H)

0.95**

(H)

0.66**

(M L)

0.63 0.66 0.62 0.64




407

407

SIWODISCRET Task discretion at work 0.93 0.96**

(H)

0.93 0.89**

(L)

0.82 0.81 0.91 0.84

XWO Index of work organisation practices 0.95 0.95 0.95 0.93 0.87 0.75*

(M)

0.91**,*

(L,H)

0.84**

(M)

XHRPRACT Overall index of HR practices 0.68 0.66 0.67 0.70 0.66 0.62**

(H)

0.70 0.66**

(L)


Table IV.A14. HR outcomes by LA fee level

Homes IDPs

All

fee level

Low fees Medium

fees

High fees All fees Low fees Medium

fees

High fees


SITO Perceptions of staff turnover 0.72 0.69 0.65 0.78 0.52 0.37**

(M)

0.60**

(L)

0.55



retention outcomes

0.68 0.69 0.61 0.70 0.45 0.39 0.51 0.43


(P)

0.95**

(P)

0.68**

(M L)

0.63 0.71 0.67 0.49


408

408

Table IV.A15. HR practices by labour demand level

Homes IDPs

All Strong

demand

Medium

demand

Weak

demand

All Strong

demand

Medium

demand

Weak

demand

SIPAYLEVEL Pay levels 0.33 0.46**,*

(W,M)

0.31*

(S)

0.20**

(S)

0.50 0.56**

(W)

0.56**

(W)

0.38**

(S M)

SIPAYUPGRADE Regular upgrading of

pay

0.91 0.98**

(W)

1.00**

(W)

0.79**

(S M)

0.78 0.82 0.75 0.75


(W)

0.31 0.12**

(S)

0.44 0.56**

(M W)

0.31**

(S)

0.38

(S)



(W)

0.64**

(W)

0.50**

(S,M)

0.63 0.67 0.61 0.59


improvement

0.44 0.52 0.39 0.38 0.46 0.48 0.56 0.36

SIPAYOPPCAR Opportunities for

career

0.78 0.75 0.83 0.79 0.81 0.80 0.72 0.90

SIPAYUPFRONT Payment of upfront

costs

0.83 0.85 0.85 0.79 0.67 0.69 0.59 0.72


SIEMPVOICE Employee voice

practices

0.50 0.51 0.54 0.47 0.54 0.53 0.53 0.56



development practices

0.58 0.57 0.64 0.54 0.59 0.57 0.56 0.63

SIRECRUITPR Formality of

recruitment process

0.58 0.62 0.52 0.56 0.72 0.70 0.77 0.70

409

409


qualifications or

experience

0.58 0.62 0.51 0.58 0.62 0.62 0.63 0.63

SIRECRETEN Role of push factors in

staff quits

0.67 0.71 0.67 0.63 0.54 0.64 0.58 0.38

XRRPRACT Recruitment and

retention practices

index

0.61 0.65 0.57 0.59 0.63 0.65 0.66 0.57

SIWTSTFFPREF Work schedules that fit

staff preferences

0.64 0.57**

(W)

0.63 0.72**

(S)

0.63 0.59 0.63 0.69

SIWTWEND Weekend working 0.29 0.48**

(W)

0.33**

(W)

0.06**

(S M)

0.38 0.45 0.48 0.20


(W)

0.80 0.87**

(S)

0.64 0.64 0.66 0.63

SIWTTOFFTRAIN Time off for training 0.87 0.93**

(W)

0.92 0.76**

(S)

0.90 0.95 0.96 0.78

XWT Index of working time

practices

0.65 0.68*

(W)

0.67 0.60*

(S)

0.64 0.66 0.68 0.57

SIWOTIME Time discretion at

work

0.96 0.95 0.98 0.96 0.83 0.88**

(M)

0.63**

(S W)

0.92**

(M)

SIWODISCRET Task discretion at

work

0.93 0.87**

(M W)

0.96**

(S)

0.97**

(S)

0.84 0.86 0.82 0.83

XWO Index of work

organisation practices

0.95 0.91**,*

(W,M)

0.97*

(S)

0.97**

(S)

0.84 0.87**

(M)

0.72**

(S W)

0.88**

(M)

XHRPRACT Overall index of HR

practices

0.68 0.70**

(M W)

0.69**

(S)

0.64**

(S)

0.66 0.68 0.64 0.65

S, M, W used to indicate difference from strong, medium and weak labour market demand areas respectively

410

410

Table IV.A16. HR outcomes by labour market conditions

Homes IDPs

All Strong

demand

Medium

demand

Weak

demand

All Strong

demand

Medium

demand

Weak

demand



SIABSENT Perceptions of absenteeism 0.63 0.67 0.54 0.64 0.46 0.43*

(M)

0.63**,*

(W,S)

0.39**

(M)


retention outcomes

0.68 0.71 0.62 0.68 0.45 0.44 0.50 0.43


(W)

0.76*

(W)

0.94**,*

(S,M)

0.63 0.46**.*

(W, M)

0.73*

(S)

0.78**

(S)

411

411

IV.A3. Technical notes on our presentation of results from the multivariate

statistical analysis

For all our regression analyses we used the backwards method. This method works by

beginning with an examination of the combined effect of all independent variables on the

dependent variable. Then in a series of steps, the independent variables that offer the weakest

explanatory value are removed and a new analysis is performed. As with other regression

methods, the final results provide coefficients for each independent variable that signify the

degree to which each one, when combined with the others, contributes to predicting the

dependent variable.

We have considerably simplified the results generated from our regression analysis and

therefore wish to provide a brief explanation of the format of tables used in the report. Each

table of results adopts the following general form43

:

Effects of environmental factors and organisational characteristics on different indices

of HR practices for homes

b. X HRPRACT


LA fee levels 0.24 * Female part-time pay 0.17 n.s.

Single establishment 0.17 n.s. Single establishment 0.12 n.s.

Private for profit -0.46 *** Private for profit -0.47 ***

Etc. Etc.

Note: OLS regression, sample 52 (homes) and 50 (IDPs). Adjusted R2 of 0.32 (model i), 0.31 (model ii).

Since the backwards regression method removes those independent variables that are weakest

in terms of their predictive power, the tables do not list all the independent variables that

were included in the first step but rather those that remain in the nth

step, selected because it

has best predictive power as estimated by the adjusted R2.

For each table, the title clarifies the nature of the relationship being tested and identifies the

independent variables and the dependent variable, in this case the summary X index HR

practices. The independent, explanatory variables are listed in the left-hand column. The

column „coefficients‟ presents the estimated effects of each variable on the outcome or

dependent variable. In all tables we use the standardised (beta) coefficients. Because the

dependent variables used are measured on a continuous 0-1 scale the interpretation of

coefficients is relatively straight forward. In the above example using the first model that

includes the LA fee variable (and excludes the labour demand variable) the results suggest

43 We borrow here from the style and explanation of statistical results presented in Gallie et al. (1998).

412

412

that for every unit increase in standard deviation of LA fees, holding all other factors

constant, the X index HRpractices increases by 0.24 times a standard deviation. For

dichotomous variables, such as Single establishment and Private for profit, the coefficient

refers to the effect on the dependent variable compared to the reference variable; in this case,

National chain and Voluntary not for profit, respectively. For example, the results generate a

negative standardised coefficient for the variable Private for profit, which means that

compared to Voluntary for profit homes there is negative impact on the dependent variable X

HRPRACT, again holding all other factors constant.

The importance of each variable is estimated by applying a t-statistic to measure the

statistical significance. To simplify the presentation the tables only present the result that is

derived from the t-statistics following a „starring‟ convention. A single * indicates a

minimum 90% confidence level (p < 0.1), ** indicates a 95% confidence level (p < 0.05) and

*** a 99% confidence level (p < 0.01). The abbreviation n.s. means the result is not

statistically significant.

Estimates of the adjusted R2 (the coefficient of determination) and sample size are provided

in the notes to each table. The R2 shows the proportion of variability explained by the

variables included in the model and for our regression method varies from 0 to 1. In the

above example, the first model had an adjusted R2

of 0.32, which means that the predictors

account for 32% of the variation of the index X HRpractices. The results presented in part IV

are confined to those where the independent variables in a particular model offer relatively

strong explanatory value. We therefore exclude from the text all results where neither the R2

nor the adjusted R2 exceeds 0.2. The one exception is for the model that explores the effects

on the index X Paylevels for IDPs, which has an adjusted R2 of 0.11 (with LA fees) and 0.12

(with labour demand), since we wished to compare the results with those for homes where the

models produce a higher value R2.

413

413

IV.A4. Description of variables for regression analyses

The following tables list the independent and dependent variables used in the regressions

presented in section IV.5.1 and IV.5.2.

Table IV.A17. Variables in regressions investigating indices of HR practices

Dependent variables Independent variables Notes

XHRPRACT LA Partnership Partnership = 3, Mixed = 2, Cost minimisers = 1

XPAYLEVELS LA fees levels

XPAYSTRAT % dependency on LA For homes only

XRRPRACT Local labour demand Range of 2-6

XEMPDEV Female part-time pay Median level of earnings (£) in local area

XWT Size

XWO Ownership (3 categories):

national chain

local chain

single establishment

Converted into 2 dummies:

Dummy1 (Local chain= 1; others= 0)

Dummy2 (Single establishment= 1;

others=0)

Private sector/ Voluntary sector Dummy (Private = 1; Voluntary= 0)

Table IV.A18. Variables in regressions investigating the HR outcomes

XRROUTCOMES and XTRAINSKILDEV


XRROUTCOMES XHRPRACT

XTRAINSKILDEV XPAYLEVELS

XPAYSTRAT

XRRPRACT

XEMPDEV

XWT

XWO

LA Partnership Partnership = 3, Mixed = 2, Cost minimisers = 1

LA fees levels

% dependency on LA For homes only

Local labour demand Range of 2-6

Female part-time pay Median level of earnings (£) in local area

Size

Ownership (3 categories):

national chain

local chain





others=0)


414

414

Table IV.A19. Variables in regressions investigating the HR outcomes RT3 and RT9


RT3 P2

RT9 P3

P4

P8

P11

HR1

HR4

HR5

HR7

IRC1

RC3

WT3

WT4

WT9

PDOM1 Only for IDPs

WTDOM2 Only for IDPs



LA Partnership Partnership = 3

Mixed = 2

Cost minimisers = 1

LA fees levels

% dependency on LA For homes only

Local labour demand Range of 2-6

Female part-time pay Median level of earnings (£) in local area

Size

Ownership (3 categories):

national chain

local chain





others=0)


415

415

IV.A5. Detailed results of selected regression models

The following results serve to accompany summary tables presented in Part IV section 5.3.

For the staff turnover measures, RT3 and RT9, we have used the logarithm of the actual

turnover rate, which means that the higher the measure the higher the level of staff turnover

and the worse the HR outcome.

Table IV.A20. The effects of environmental factors, organisational characteristics and

HR practices on measures of staff turnover for IDPs

a. Overall staff turnover (RT3)

Model i: With LA fees Model ii: With labour demand

Code Coefficient Significance Coefficient Significance

Female part-time pay -0.26 ** -0.26 **

IP3 Regular uprating of pay 0.47 *** 0.47 ***

IP4 Pay uprating opportunities -0.42 *** -0.42 ***

IP11 Pay for CRB checks 0.39 *** 0.39 ***

IHR1 Recognition agreement with

trade unions

-0.40 *** -0.40 ***

IRC1 Use of formal recruitment

methods

0.40 *** 0.40 ***

IRC3 Skills and qualifications

desirable among job applicants

-0.23 * -0.23 *

IWT9 Time off from care duties to

attend training

-0.20 * -0.20 *





Partnership 0.46 *** 0.59 ***

Size 0.24 * 0.33 **

IP3 Regular uprating of pay 0.28 ** -- --

IP4 Pay uprating opportunities -0.58 *** -0.61 ***

IP8 Payment for weekend work -0.35 ** -0.43 ***

IP11 Pay for CRB checks 0.43 *** 0.39 ***

IHR1 Recognition agreement with

trade unions

-0.72 *** -0.75 ***

IRC1 Use of formal recruitment

methods

0.63 *** 0.70 ***

IWT9 Time off from care duties to

attend training

-0.30 ** -0.27 **

IWTDOM4 Work schedules that fit staff

preferences

0.26 ** 0.34 **

IWTDOM7 Offering guaranteed hours

contracts

0.34 ** 0.43 **


416

416

Table IV.A21. The effects of environmental factors, organisational characteristics and

HR practices on measures of staff turnover for homes

a. Overall staff turnover (RT3)



Female part-time pay -0.34 ** -0.34 **

Single establishment -0.26 * -0.26 *

Private for profit 0.23 * 0.23 *



-0.33 ** -0.33 **





Single establishment -0.28 * -0.28 *

Private for profit 0.24 * 0.24 *



-0.26 * -0.26 *

IWT4 % of staff who regularly work

weekends

-0.28 * -0.28 *


417

417

V.A. Appendix part V

Table V.A1. Simplified identifier codes for case study organisations

Code in

telephone survey

Case study code

for Part V

XD XD

XD.HN.4 XDHome1

XD.H.5 XDHome2

XD.D.1 XDDom1

XD.D.3 XDDom2

XD.DIH.1 XDLADP

RN RN

RN.H.3 RNHome1

RN.H.1 RNHome2

RN.D.1 RNDom1

RN.D.2 RNDom2

RN.DIH.1 RNLADP

ON ON

ON.HN.1 ONHome1

ON.H.2 ONHome2

ON.D.1 ONDom1

ON.D.3 ONDom2

ON.DIH.1 ONLADP

IL IL

IL.H.4 ILHome1

IL.H.3 ILHome2

IL.HIH.1 ILLAHome

IL.D.1 ILDom1

IL.D.2 ILDom2

Table V.A2. Job positions of case study interviewees

Position of interviewees All Female Male Migrant

Workers

Roles involving direct care work

Care Worker 69 62 7 6

Care Worker with Supervisory Role 14 13 1

Care Coordinator and Care Worker 3 2 1

Line Manager / Senior Car Worker 2 2

Roles involving organising/supporting care

work

Care Coordinator 5 5

Nurse with supervisory role 2 2 1

Service Manager 2 2

Line Manager/Coordinator 1 1

418

418

Table V.A3. Working Hours of Case Study Interviewees by LA

Domiciliary

workers per

LA

Care homes

workers per

LA

LA providers

workers per

LA

All providers

workers per

LA

XD Under 16 hrs 10.0 0.0 0.0 4.0

16-30 hours 20.0 40.0 40.0 32.0

30-45 hours 60.0 60.0 60.0 60.0

Over 45 hours 10.0 0.0 0.0 4.0

No. of respondents 10 10 5 25

RN Under 16 hrs 11.1 0.0 0.0 4.5

16-30 hours 22.2 37.5 60.0 36.4

30-45 hours 44.4 50.0 40.0 45.5

Over 45 hours 22.2 12.5 0.0 13.6


ON Under 16 hrs 0.0 10.0 0.0 4.0

16-30 hours 20.0 20.0 100.0 36.0

30-45 hours 60.0 70.0 0.0 52.0

Over 45 hours 20.0 0.0 0.0 8.0


IL Under 16 hrs 0.0 0.0 0.0 0.0

16-30 hours 18.2 20.0 80.0 30.8

30-45 hours 63.6 70.0 20.0 57.7

Over 45 hours 18.2 10.0 0.0 11.5


All LAs Under 16 hrs 5.0 2.6 0.0 3.1

16-30 hours 20.0 28.9 70.0 33.7

30-45 hours 57.5 63.2 30.0 54.1

Over 45 hours 17.5 5.3 0.0 9.2

Total respondents 40 38 20 98

419

419

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