December 2001

South Gate House
Wood Street
Caerdydd/Cardiff
CF10 1EW
Ffôn/Tel: 029 2022 6257
Ffacs/Fax: 029 2038 4764

E-bost/mail: info@ccwales.org.uk
Wefan/Website: www.ccwales.org.uk

Health and Social Care Committee

Inquiry into residential care for older people

RC49 – Care Council for Wales

The Clerk to the Health and Social Care Committee

National Assembly for Wales

Cardiff Bay

CF99 1NA

Dear Sir/Madam

Care Council for Wales’ Response - Inquiry into residential care for older people

Thank you for the opportunity to provide evidence to the inquiry into residential care for older people.

1. Background - Care Council for Wales

The Care Council for Wales (Care Council) is the regulatory body for the workforce in social work and social care. The Care Council has the statutory remit to register and regulate the social workers and social care managers and workers and regulates their education and training. It is also has the remit for workforce development and planning.

The Care Council’s primary responsibilities focus on improving public protection through:

· promoting high standards of conduct and practice in the workforce; and

· promoting high standards of training.

The Care Council is a modern regulatory body, set within the context of devolution and one which tackles public protection in a different way, with accountability to service users and carers. The Care Council membership has already made a reality of the full involvement of lay people, carers and the users of services in its governance and throughout all aspects of its work.

The membership of the Council, its Committees and its regional social care partnerships has provided the Care Council with a mechanism to work in partnership with the sector. This enables us to link with the public, independent and third sector. Our role in delivering the Sector Skills Council (SSC) remit for Wales has required us to have good employer engagement and information which we access at national and regional level. This approach has meant that standards, qualifications and practice guidance have been developed in partnership with the sector.

The Care Council works at a national, regional and local level with partners providing information and ensuring that the sector is aware of our actions and work with us in the initiatives we take forward. The Care Council has a key role to support the delivery of ‘Sustainable Social Services: a framework for Action’[1] in leading and driving the step change for confident competent practitioners, moving beyond minimum standards to a continuing professional education and learning model.

There are raised expectations of practitioners, and raised aspirations for what practitioners need if they are to be confident professional practitioners. One of the key levers for change will be the focus on the leadership role of managers in residential care for ensuring the quality of practice and practitioners.

We welcome the opportunity to contribute to the inquiry to examine the provision of residential care in Wales and the ways in which it can meet the current and future needs of older people. Our response will focus specifically on the workforce, and on areas where we have specific information to provide to the enquiry. We will therefore be responding to specific questions only.

2. The Response

The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.

Providing accessible community based care will be at the heart of taking forward the vision for citizen centred services contained in Sustainable Social Services: a Framework for Action. It is important that strategic work is done to look at the workforce implications of new models of alternative community-based services including domiciliary care and reablement.

New models of community based services have emerged which may increase the range of options available before a person enters residential care. Notable examples of these include the development of telecare, new roles such as Health and Social Care Support Workers and services designed to provide advice, information and support at an early stage.

There has been a particular emphasis on reablement services in recent years and this is now increasingly mainstreamed by Local Authorities, and residential care homes increasingly may provide community based services e.g. rehabilitation, short term care. In order to ensure success of such strategies and innovations the skills of those who commission them are critical, ensuring services that are fit for purpose and value for money.

Joint Health, Social Care and Well-being Strategies have provided a vehicle for social services and health services to work together with other partners to develop community services, and services and support for carers is an essential part of enabling people to remain in their own homes for longer. Advice and information about services is also crucial as some older people (and carers) may not be aware of the alternatives or may not seek help at an early stage (e.g. self funded older people).

The Care Council contributed to work undertaken by the Welsh Government to develop a Community Services Framework in Wales which was an attempt to map the development of community services and share good practice.

All of the above issues have major implications for the social work and social care workforce to assess the need for, plan and deliver community based services. They also have major implications for leadership and management skills in the social care sector, some of which are referred to later in this response.

The workforce within domiciliary care as calculated for those settings regulated by the Care and Social Services Inspectorate Wales (CSSIW) is employed in 408[2] separate agencies registered with CSSIW across the public, independent and third sector. Each agency is unique and trains and manages its own workforce to meet the specific terms of contract commitments they have at any one time. The size of agencies varies from typically 20-50 workers in small private agencies through to over 200 workers in public sector services.

In 2010 – 11 the statistics show that 3,621,515 hours of home care were provided directly by the local authorities in Wales and 7, 555,306 hours were provided by the independent sector under contract to the local authority.

The data for the whole of the workforce numbers are not available, but the local authority total numbers for employed domiciliary care staff as at March 2011 is 5,995, this accounted for 21% of total staff. In view of the number of hours shown previously it is obvious that the total number of workers employed in domiciliary care services is considerably more.

The ’Care at Home’[3] Study published by the Care Council in 2010 aimed to undertake a study on the care at home workforce and the implications for the workforce of moving towards new ways of working. The project was commissioned to answer three key questions:

1. What does the care at home workforce currently look like?

2. What is the future vision for care at home and its workforce?

3. What do we need to do to move the current workforce towards the vision?

The report was clear that further work was needed to promote the value and make sure the workforce delivering care in people’s own homes or in the community had the skills and knowledge, and were properly supported and managed to deliver the changing service.

The report was also clear that further work is needed to equip and support unpaid carers in their roles. Adaptations and equipment continue to play an important part is assisting people to remain in their own homes, and the important role of the Occupational Therapist was highlighted in this context. “There are a hugely complex set of interactions needed to ensure that the 11.7 million hours of care at home delivered by an estimated 15,500 care at home staff to 25,000+ service users in Wales is sustainable and of high quality. This is in addition to the nearly 300 million hours of unpaid care provided by carers”.

One of the key areas is the skill mix necessary to deliver community based services and within that one of the issues is the balance between health and social care aspects of some of the roles.

The Care Council has been undertaking some key actions following the publication of the report, for example, together with the National Leadership and Innovation Agency for Healthcare (NLIAH) we have identified a range of models which have been developed across Wales and are working toward developing a practice governance framework for the workforce working across health and social care boundaries.

This is in recognition that staff play an important role in service delivery and we depend upon their skills and dedication to ensure that health and social care needs are met in a modern and supportive way. It is critical for sound governance arrangements to be in place to support staff to do the job expected of them, and to ensure that organisations use their resources efficiently and effectively.

Drawing on the results of this report, the Care Council is currently taking forward a range of work which include developments to support the workforce working with older people, including older people with dementia, the work focuses on the priorities of the Welsh Government of people remaining independent as long as possible through receiving appropriate care at home, and also on upskilling the workforce generally to deal with the more complex needs of an ageing population.

Actions are also being taken forward to support the workforce working with carers as well as supporting the workforce to develop outcome focused care through guidance, qualification, units and continuing professional learning and development frameworks. This will ensure that the workforce is aware of and responsive to the needs of carers as well as ensuring that carers are aware of their rights, and what they have a right to expect from social care workers as expressed in the Code of Practice for Social Care workers.

A workforce that has the capacity to deliver the citizen-focused, sustainable services as envisaged in Sustainable Social Services is a primary driver in the current work of the Council. This will be a well qualified confident workforce delivering those services both in the community setting, and in residential care. The Care Council’s works therefore is focused on this and also upon the concept of the professionalization of the workforce in social care generally as outlined in the policy document. “We see the quality of professionals and their professionalism as central to responsive and sustainable social services”.

The Care Council through its Sector Skills Council role has been involved in drawing together Labour Market Intelligence. The need for services generally is predicted to grow, and services for older people will also increase, driven by the demographic changes within society in Wales. Employment growth in the social care sector in Wales averaged 4.2% per year from 2002 to 2008[4]. New work is needed on the impact of the economic climate on the growth which was predicted as being necessary to meet future demand and also the implication on delivering different models of services.

In the recently published UKCES report: Strategic Skills Audit for Wales 2011 ‘Skills for Jobs’[5] thecare and related personal services sector was identified as one of the 10 fastest growing occupations in Wales. This growth has been, and is likely to remain, a key driver in the development of the skills of the workforce within the sector.

The report, which does to some extent class ‘health and social care’ together, also specifically notes however that front line caring personal service occupations, including care assistants are amongst the occupational groups with the largest projected volumes of replacement demand up to 2017. The Care Council is working with Welsh Government to improve the data available on the workforce in social care in Wales as at the moment the information is fragmented and collected by different agencies for a variety of purposes, which is a barrier to workforce planning.

The salary levels of social care workers in Wales is on average £10.49[6] per hour, this figure however includes those managers and senior staff included in the data, and the majority of social care workers working in both residential and domiciliary care services earn close to the minimum wage level or slightly above.

The Care Council through its Regional Social Care Partnerships is taking forward several strands of work linked to recruitment and retention. Recruitment initiatives include the development nationally of Care Ambassadors, who work with young people to extend the knowledge of the sector and its opportunities. There are 80+ ambassadors across Wales, and they are reaching out to areas within schools and colleges especially, that have been traditionally hard to reach areas for the sector. The response thus far has been encouraging, with schools beginning to see the sector in a more positive light and the younger people able to learn more from front line workers about the nature of the work. It is too early as yet to have an indication of numbers entering the sector as a result. We are also working with partners such as jobcentre plus and Careers Wales to provide information for their advisers on the qualities needed to work in the sector, as well as engaging with employers to offer training and opportunities for jobseekers. Outcomes as yet are small but several areas report an increase in interest in the sector