Do we need a care-force to help us “care differently”?

Fact: there are few places in the country where there is not a significantly short supply of care-workers in both social care and health roles.

The Nursing and Midwifery Council stated in July 2017 that ‘for the first time in recent history the numbers leaving are now outstripping the numbers joining. Between 2016 and 2017, 45 per cent more UK registrants left than joined it for the first time.

And Skills for Care report a turnover rate in adult social care of 27.3% in England alone, meaning there is a requirement to find at least 339,000 new people every year.

In terms of cost, using Chartered Institute of Personnel and Development figures this equates to a recruitment figure of £1.4 billion pounds spent on a stand-still position – no enhanced training; no career development. Just getting existing posts filled but losing the experience of those departing.

Currently the dominant focus is on recruitment to fill the gaps and then retention to then keep people in place.

However, we need to start talking in terms of retention first, and then recruitment – it costs less, with better results. Having engaged people to provide care, we cannot afford to lose them.  This is even more important when we seek to engage with communities.

The Power of People

Michael Young in his 1961 book The Rise of the Meritocracy stated in respect of World War Two, “The war woke people up to the fact that the nation possessed a supply of ability never ordinarily used to the full”.

Admittedly we face a different sort of crisis today, but the crisis that faces our care system will also benefit from the mobilisation of the nation’s under-used resources.

But in asking this of ‘the nation’ and placing on people new demands, they may ask:

‘Engage? – Why?’

‘With What?’

A well-known principle of human behaviour says that when we ask someone to do us a favour we will be more successful if we provide a reason (Cialdini, 2007).

The same is true of course for the wider population. Everyone who could be engaged and willing to provide some help needs to understand why, in the face of rapid population ageing, we need to mobilise a new ‘care-force’. They need to understand the risks for each and every one of us unless full capacity is achieved. And they need to be apprised of the potentially undesirable consequences unless we do take this approach.

In short, we need to be frank with people that on current trends, we will not have enough paid professional workers to provide the help and care that will be needed with millions more of us living longer lives.  And yet there is a solution.

Involving the voluntary sector and community

The level of community goodwill and volunteering in Britain is impressive. 

However, it is not yet sufficiently informed and supported as to the future roles required to build up a competent care-force; one capable of providing the social support, practical help and proportionate community response offers that in future decades many more of us will be looking for.

The Voluntary and Community Sector is cited in nearly, if not all, NHS Sustainability and Transformation Plans. It is also highlighted in the Care Act 2014 with clear obligations on the statutory sector to see it develop.

However there is little clarity as to what is being asked of it at a granular level; especially when it comes to the practical delivery that will be required to bridge gaps in the paid workforce.

Making a care-force a reality

We need to map the activities that are presently being undertaken by professional and paid staff and determine where gaps still remain and what could be moved.

Then we must engage with the public and understand the contribution that citizens can make. There will be risks involved but we need to encourage a new dialogue between formal services and communities.  Collaboration is key, built on trust between the participants: “if you as a community are able to do that, we, the system facilitators, will be doing and providing this.”

What this is not is banking all the savings from activating the citizen. There is the danger of this being seen to be exploiting the community to bridge the deficit in health and social care – an unsustainable proposition.

We should all be aware of the funding challenges ahead and the need to find different ways of delivering care and support. But whatever the funding climate, the fact that our demographic make-up as a country is changing so fast means that in any case we need build up our social infrastructure.

The truth is we need a care-force to complement and build on what paid carers are doing. And we need to hold everyone in the same high esteem, whatever their precise contribution to delivering care and support.

This is not to suggest payment for caring volunteers. But it does mean encouraging well-developed, financially sustainable systems to better coordinate and optimise voluntary effort.

This means moving beyond commercial contracts, beyond a social contract even, to something that is discovered or rekindled within citizenship; a feature of thriving communities.

This could include commitments to:

  • meaningful engagement on a wide range of issues including those around health and care, co-designing solutions with those that are not yet engaged with care challenges
  • the funding of the local voluntary and community sector that enables a resilient and sustainable system to flourish, which prioritises improvements in wellbeing and rewards better outcomes (avoiding short term contracts and grants)

In summary, we need new capacity to support new solutions enabling us to “care differently” in this country.  Solutions in which the community plays a key role. In fact we have little choice. All the projections as to the future demand for care and support describe how the paid workforce is neither available to us in terms of capacity or affordability.

But if we are going to galvanise people to be part of a much wider care-force people will need to both understand and emotionally connect with the cause and why a care-force is so important. Policy in itself will not achieve this.

A starting point will be to offer communities information on care activity and asset mapping, creating a platform for conversations within communities, ones leading to co-produced solutions and ownership.  Valuing that input is key.

“But supporting this to happen will cost won’t it?”

Just a 2% improvement on the retention figures quoted above would provide a development fund of £27 million (money that is being spent already).

Supporting the change

In the South West region there has been a collaboration in support of this agenda. The region’s authorities and Health Education England have delivered the Proud To Care SW campaign1 which increases the profile of, and looks to raise the esteem in which care is held; a starting point to putting society on the front foot so more of us can offer help and support in all its many forms.

The opportunity before us is not unlike that first described by Michael Young. We still have little idea of the creativity, energy, commitment and talent latent within our communities. Public bodies and statutory services need to commit to doing things differently too; to be bold in the honesty and articulation of the challenges of an ageing population and courageous in engaging with our citizens and the value they offer.

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