We think that big policy drivers like Reshaping Care for Older People, Integration and Self Directed Support have created an environment perfect for change. Fit for the Future is about embracing these opportunities and exploring new ways of working. However, we also want to acknowledge some of the challenges facing providers in the independent sector today. It is useful to understand the barriers to progress, and to highlight the ways in which the case studies on this site have managed to circumvent these issues.
Throughout the course of the project, we worked with over 18 providers and openly discussed the key challenges they faced. We then worked with a provider representative on our steering group, to bring them all together.
What is the real cost of care?
Providers are uncomfortable equating care to business, but they need to in order to stay in the market. Low hourly rates don’t just result in poor pay for staff, but mean there is limited investment in robust training and management. The move towards increased regulation, registration (SSSC) and support of the workforce requires more middle management time, development and support which is an unfunded additional expense for the provider at a time of ever-increasing pressures on charge rates. Quality care isn’t just dependent on the carer who comes to your door, but also the people behind the scenes that make them feel safe and supported. We imagine the well trained and developed workforce of the future, but how do we imagine the team that supports and enables them? And how can we get there with such limited investment?
Flexibility vs Regulation
Providers are asked to provide more holistic outcome-focused services at the same time as the increase in strict regulation and technology such as call monitoring means staff are less able to be flexible or make judgement calls on the job. Self Directed Support calls for more person-centred, outcomes-focussed care which can be delivered through choice and flexibility, but the parallel trend of call monitoring is antagonistic. The Care Inspectorate is a key partner in ensuring outcomes for older people, but many providers felt that inspection creates an environment where care providers are discouraged from being creative and innovative. If the systems that regulate and monitor providers are averse to risk, will we be able to meet people’s outcomes when we’re afraid of taking risks?
Finding, engaging and keeping staff
Recruitment and retention of high quality staff is a real challenge for providers, who often find themselves understaffed and spending valuable resources on endless recruitment cycles. We want staff to be confident partners in care; taking responsibility for their own practice as well as helping to develop organisations. We also want them to feel valued and find their work rewarding. Part of this may be about making sure that staff earn a good wage for a good job. Providers in the private sector are often not able to offer the same terms and conditions as statutory or voluntary employers. But there are also wider issues of demographic change, meaning that we should be looking at recruitment more creatively. Who are the workforce of the future? And how do we make a career in care appealing to them?
Perceptions and attitudes
Many private sector providers feel that their sector was seen as based on low cost, low quality care. These perceptions skew relationships with voluntary sector providers, the local authority and, through negative media coverage, the wider public. Private providers may be able to ‘do more with less’, but they do so under extreme pressure and uncertainty. Providers are also concerned about the way the media presents them, particularly in relation to 15 minute visits and zero hour contracts. Some private sector providers want more opportunities to be seen as equal partners and valued resources.
The Challenge of the Future
Almost all of the providers we worked with were worried about the future, and in particular meeting rising demands in the community. Providers’ main challenge is lifting their heads from the day-to-day firefighting to begin to imagine and plan for the future. Reading, research and project work can be seen as a ‘luxury’ in an environment where there is increasing pressure to do more with less.
What can we do about this?
Some providers, managers and staff push for radical change to alter these systems, and some work within these systems and constraints to do what they can. Both of these approaches make a difference for the people who access support, and this project has examples of pioneers who use both approach
The sector is ready to develop. The sector wants to be part of making change happen. But they need someone to believe in them, support them and invest in them to make this happen.