Agenda item

22        ADULT SOCIAL CARE WORKFORCE UPDATE

Adult Social Care and Health (ASCH) Workforce Programme

22.1     The Assistant Director, Operations (ASC) and Head of Training, Workforce and Organisational Development in ASCH introduced a report and presentation updating the Committee on the ASCH Workforce Programme (2022-25). The update was provided in response to a request made by the People Scrutiny ASC Workforce Review Scoping Board, in March 2022, for the Committee to have an update on the Department’s work to address recruitment and retention challenges later in the year. As part of the presentation, the Committee was updated on the latest Skills for Care data on the East Sussex care workforce (all sectors), which showed an increase in the turnover rate (from 27.8% in 2020/21 to 34% in 2021/22) and vacancy rate (from 4.6% in 2020/21 to 8.8% in 2021/22). The turnover rate was slightly higher than the regional (33.4%) and national (30%) average turnover rates. The average number of sick days in the local care workforce (7.2 days for 2021/22) was highlighted as below the national average (8.1 days).

22.2     The Assistant Director and Head of Training, Workforce and Organisational Development outlined a number of projects the Department was undertaking as part of the Programme, within its six workstreams (strategic workforce planning, leadership and management, recruitment, retention, building and enhancing social justice in the workforce, and enhancing the wellbeing of the workforce). The Department had established channels, including a dedicated email address, for all ASCH staff to make suggestions or comments on the Programme and since March 2022 over 700 staff had accessed these channels, demonstrating a good level of staff engagement. The presentation concluded with a look ahead at projects and work planned over the coming years of the Programme. The presentation slides delivered were appended to the report included in the Committee’s agenda pack.

22.3     The Chair thanked the officers for the presentation. The Committee asked questions and made comments on the following areas:

·                     Local social care workforce size – a question was asked on how many posts in total there were in the care sector locally. The Director of ASCH responded that the figure was around 18,500 posts in total but noted that the figure was challenging to calculate accurately as factors such as fluctuating levels of funding in the system impacted overall numbers of posts at any one time. The Director emphasised that regardless of the total number of people employed, both the vacancy and turnover rates were very challenging.

·                     Skills for care data – officers were asked to comment on data covered in the presentation, including the increase in the vacancy and turnover rates. Both the Director and Head of Training, Workforce and Organisational Development responded that both rates were of huge concern. The Head of Training noted that the increase in the vacancy rate may have been impacted by a scheme to enable younger people to try roles before they applied, as a lot of those people had since left. In terms of other work to reduce vacancies, Skills for Care research had found that staff over 60 were more likely to leave their roles so the Department had a project to support staff over 55 to ensure they were able, and felt encouraged, to remain in the workforce, in their existing role or as coaches or mentors to younger staff. A Musculoskeletal (MSK) project was also underway to look at how to support staff with MSK issues to remain in their posts.

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·                     Social Media and targeting younger people – questions were asked on whether work was taking place to target recruitment of younger people to help address the vacancy rate, and whether a range of social media platforms were being used for this. The refresh of the Council’s recruitment branding was also welcomed. It was confirmed a range of platforms were used and the Director confirmed that work to recruit younger people was underway (e.g. with the try before you apply scheme) but that this had to be balanced with efforts to retain older members of the workforce, given a third of the workforce were over 55.

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·                     Exit interviews – in response to a question, it was confirmed that exit interviews were undertaken with outgoing staff and the Department was working to ensure all managers were aware of the need to conduct interviews and to collect feedback on how improvements could support retention and other areas of workforce development.

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·                     Leadership workstream – further information on the Leadership workstream of the programme was requested, specifically what percentage of the workforce was likely to move into leadership roles, what opportunities there were for progression, and to what extent leadership skills, such as mentoring, would be included in this work. The Assistant Director responded that part of the leadership workstream involved reviewing and disseminating ‘top tips for leaders’ to ensure that knowledge and tips on leadership skills, such as mentoring and compassionate leadership, were collated and shared. In terms of Leadership opportunities, the Ladder to Leadership programme had offered opportunities for more junior managers to develop skills and cross-council experience to assist with progression. It was also confirmed that the Department encouraged managers to explore mentoring and coaching opportunities. The Head of Training added that while it was not possible to give a specific percentage of the workforce likely to move into leadership roles, in house personal development opportunities, including management apprenticeships, were highly subscribed to demonstrating that there was a constant flow of staff accessing progression and leadership training opportunities.

·                     Turnover rate for managers – the turnover rate for managerial roles, compared to the rest of the workforce was requested. Officers committed to follow up with this information.

·                     Support for the independent sector workforce – a question was asked on what work was taking place to support recruitment, retention, training and progression in the independent sector workforce. The Head of Training responded that the Department offered the sector access to a wide range of free training courses on mandatory topics, through to more specialist training such as on dementia care. ASCH also offered a leadership programme for registered care managers, senior managers and senior officers in the independent sector, which was well attended and well received. The Department had also been working with Skills for Care and the Registered Care Association on a new project for retaining registered care managers, focussed in part on ways to support their wellbeing, and the next phase of this would be focussed on retaining deputy registered care managers. The Director added that in addition to the training offered, the Department worked to influence the terms and conditions of staff in the independent sector through its commissioning as much as possible, with one example being that new Home Care contract included a range of expectations around peer support, welfare support and supervision for staff. The Department also contributed to the cost of overseas recruitment (e.g. of visas) to support the sector.

·                     Cost of training – with regards to the provision of free training mentioned above, a question was asked on whether the Council recouped the costs of training from those who moved on to other roles and whether consideration had been given to charging for training. The Director responded that in terms of providing training to the independent sector, the Department had made an assessment that it was more effective and efficient to provide the training free of charge, and ensure it aligned with our standards, policies and procedures, than to pay providers to source the training elsewhere. The was no mechanism to recover the money from those who attended training and moved on to other roles and the logistics of tracking that would be challenging and not cost-effective to administer. There was a fee charged for non-attendance at training and within ESCC, if staff were recruited on a training contract and left before that ended there would be a cost to them.  

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·                     Pay – a question was asked on how wages of care workers in the local authority and the independent sector compared with national wages, and to what extent this could be contributing to challenges with recruitment and retention. The Head of Training responded that pay was a challenge, as the sector was competing with higher pay in the private sector. The Department had been working with others in the sector locally to dispel myths around working in social care to support recruitment. The Director added that, without significant national investment, the Council had limited influence over wages in the sector. The Lead Member for ASCH and Director both noted that in recent years the Department had made above inflation increases in contract funding with the ambition of improving the pay of contracted staff.

·                     Costs of overseas recruitment – a question was asked on whether there had been an analysis of the cost of conducting overseas recruitment and how that compared with investment to support recruitment domestically. The Director responded that the Department did have a detailed breakdown of the costs and tended to make a fixed contribution to homecare providers to support the activity. Those providers had also made an assessment that it was cost effective. Fundamentally, the challenge facing providers was that not enough people in the workforce wanted to take up roles in care, despite long-term efforts to increase recruitment, so overseas recruitment was a necessity to fill posts. 

·                     Accommodation for care workers – a question was asked on whether work takes place to support care workers to find accommodation close to the places they worked and to the people they cared for. The Director responded that access to affordable housing was a known challenge in East Sussex and the wider South East. Some providers, such as residential nursing home providers, would offer initial access to accommodation for new recruits but it was acknowledged that it could be more challenging for home care workers to find affordable accommodation close to those they cared for. The Chair of the Committee noted that the time pressures involved in providing care, in terms of travel time, was also significant and may influence people’s willingness to join and remain in the profession.

Personal Assistants and Support with Confidence

22.4     The ASC Service Development Manager and Project Manager (ASC) then presented a briefing report and presentation on the role of Personal Assistants (PAs) and the Support with Confidence (SWC) scheme. The briefing and presentation was also provided in response to a request by the People Scrutiny ASC Workforce Review Scoping Board that the Department re-visit the recommendation of the previous People Scrutiny Review of the ASC Workforce: that the Department should support councillors to promote the role of PAs. The briefing and presentation covered the role of PAs, the support that the Council provided to PAs, figures on PAs in East Sussex, the aims and outputs of the SWC scheme, the role of the Direct Payment Support Service and plans to recommission the service.

22.5     The Chair thanked officers for the presentation. The Lead Member for ASCH commented on the success of the SWC scheme and its positive work. The Committee asked questions and made comments on the following areas:

·                     Personal Assistant Role – in response to a number of questions about the PA role, the Project Manager (ASC) confirmed that PAs are either self-employed or employed directly by the individual receiving care and the majority of PAs worked part-time so annual earnings would vary considerably. In East Sussex, PAs earned on average around £17 per hour but their annual salary would vary depending on how many hours they worked and how many clients they supported. In terms of the requirements to become a PA, the ASC Service Development Manager outlined that the requirements the SWC scheme looked for to accredit a PA were largely values based, with accreditation assessed on the basis of individuals being able to demonstrate qualities such as personalisation, respect and dignity. The broad range of activities PAs could be employed to undertake, from shopping, to administration, to personal care was noted.

·                     Becoming a Personal Assistant – a question was asked on who Councillors should refer residents to that may be interested in taking up a role as a PA. The ASC Service Development Manager responded that anyone interested in becoming a PA could contact the SWC scheme to find out more about what was involved in setting themselves up. Information about SWC was available on the ESCC website. The Project Manager added that ESCC commissioned two Direct Payment Support Service providers which played a role in matching vacancies to PAs, and assisting PAs with any additional training or support they required in taking up the role.

·                     Turnover in SWC – a question was asked on what contributed to the high turnover of people accredited by the SWC scheme. The ASC Service Development Manager responded that alongside ongoing high turnover, the SWC scheme had increased its capacity by 10% every year since 2016 demonstrating the increase in demand for the scheme. However, this was expected to be the first year the scheme would not increase its capacity a similar amount and was thought to be due to a people making changes in, and re-evaluating, their lifestyles post-pandemic and deciding to withdraw from the scheme as a result.

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·                     Resilience and continuity of PA care provision – the Committee noted that while PA roles offered a number of benefits for the PAs and those employing PAs (in terms of flexibility and personalisation of care), there were risks in being able to guarantee continuity of care if a PA became sick or wanted to take leave, as they were a sole provider. The ASC Service Development Manager gave assurance that in order to mitigate this, the SWC scheme required accredited PAs to buddy up early in their employment journey with others to establish cover arrangements; and the scheme worked to ensure conversations between PAs and those receiving care happened at the outset of employing a PA to ensure contingency measures and a robust package of care was in place. The Project Manager (ASC) added that the need for contingency planning had been picked up in responses to a recent survey of Direct Payment Support Service users and work was taking place to ensure this was reflected in the offer from the Direct Payment Support Service providers.

·                     County Council employment of PAs - a question was asked on why the Council did not directly employ PAs. The Director responded that a mixed economy of care was required to meet people’s needs. Around 30% of ASCH’s clients were in receipt of direct payments and it had long been at around this level, reflecting that it was not appropriate, or necessarily desirable given the work involved, for all clients to receive payments and recruit PAs. The Director was therefore confident that the current approach of encouraging a healthy market of accredited PAs, alongside a range of other provision, was the best approach to most effectively, and most cost-effectively, meeting people’s needs.

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·                     Challenges facing direct payment recipients – in response to comments and questions from the Committee about the benefits, risks and practical challenges of direct payment recipients acting as employers of PAs, the Director outlined that the Department was committed to commissioning, and now recommissioning, a robust Direct Payment Support Service that supported people receiving direct payments with their responsibilities as an employer; in recruiting and retaining PAs; and dealing with any employment issues (although these were the expectation rather than the norm). The national Skills for Care website also provided assistance to those employing PAs. The Director confirmed that in terms of safeguards, people’s direct payment accounts were monitored to ensure they were spending the money they received on their care and support needs and anyone in receipt of direct payments would receive a care review to ensure their needs were being met appropriately. The Director also confirmed that there were clear divisions of duty to ensure those in receipt of direct payments were paying PAs, and there was no conflict of interest in PAs paying themselves.

22.6     The Committee RESOLVED to note the presentations and updates.