Local challenges in meeting demand for domiciliary care in West Sussex

1. Local challenges in meeting demand for domiciliary care in West Sussex Professor Sue Yeandle Director Gender and Employment in Local Labour Markets Programme Sheffield Hallam University

2. Challenges in tackling demand for domiciliary care: study approach • Analysis of official statistics relating to West Sussex • A new survey and follow-up interviews with providers of domiciliary care in West Sussex • (all sectors) • Interviews with key stakeholders and managers • Documents supplied by respondents to our survey and by West Sussex Social and Caring Services

3. Demand for domiciliary care in West Sussex • 30% of all households contain someone with a LLTI, including over 25,000 where that person is aged 75+ • There is no co-resident carer in 72% of these households • The 85+ population is expected to rise by over 18,000 people by 2028, with a large increase in the number of very aged men • 82% of very aged men, and 70% of very aged women, live in their own homes • 33% of very aged men in the borough, and 51% of very aged women, live alone

4. West Sussex: Population projections 2003-2028 - people aged 65+

5. Employment in the care sector • 7,446 West Sussex residents, 91% of them women, are employed as care workers • 1 in 25 of all employed women in West Sussex is a care worker • 57% of female care workers, and 20% of male care workers, work part-time. • Over a quarter of West Sussex’s care workers had no formal qualifications in 2001 – 51% of women care workers aged 50-59, and about 1 in 8 of men and women care workers aged under 25 years.

6. Ethnicity of care assistants and home carers in West Sussex 2001 Census

7. Organisation of domiciliary care • There has been progress in West Sussex in addressing issues of supply and demand in domiciliary care, including: • Domiciliary Care Review 1998 • Best Value Review of Home Care Services • Care Training Consortium • Domiciliary care providers include small, medium and large organisations, across the public, private and voluntary sectors • About 60% of domiciliary care in the borough is now purchased from the independent sector

8. Employment challenges: providers’ views • All providers had some care workers aged 50+ • Most were achieving NMS targets, but had concerns about: • Covering the workload when staff were released for training • Retaining staff once they had completed their training • Meeting the costs of NVQ training courses • Limited scope to pay staff for time spent on job training • Addressing the basic skills & confidence issues of some staff • Rates of staff turnover varied: some had acute staff shortages – staff turnover was 75% in one case • Most were experimenting with new recruitment arrangements • Most helped their staff with training costs • Pay rates were relatively low for W Sussex

9. Provider/stakeholder perspectives (1) • Supply and demand is a concern • Recruiting is difficult and the image of the job can be a problem • The nature of the job has changed • There is serious competition for staff from other sectors • Some staff in DC are exceptionally committed to their jobs • Flexible working arrangements/hours help attract and retain staff – training and pay are also important

10. Provider comments: supply and demand • ‘Getting good quality carers is becoming quite difficult.’ • ‘The quality of the initial applications – not very good – (although) once we’ve sifted them out, they tend to be good.’ • ‘The supply is very poor – due to the competition, and low rates of pay due to lack of funding.’

11. Provider comments: recruiting staff ‘We make a point of saying we’re an equal opportunities employer, that’s part of our recruitment process – but we don’t have any ethnic minorities, except some White Irish tenants.’ ‘I did a little survey – at that time we had quite a high percentage of South African and Zimbabwean staff. We had a lot of middle aged South African ladies. Because of the conversion rates – the Rand to the £ - they come over here and work for periods of time. The Zimbabwean staff will stay for much longer periods, leaving their families behind, because they are supporting them.’

12. Provider comments: training and development ‘We pay them to do the NVQ and then they have to stay with us for a year afterwards. That’s a fairly new initiative, so I don’t know what is going to happen at the end of the agreed time – I would hazard a guess that they are going to move on.’ ‘(NMS has had) two big impacts - financial, and the actual logistics of it. It’s quite an expense to ensure that all the training is carried out within the timescales. We’ve approached this by becoming self-sufficient - - we have our own in-house trainers – but it’s a bit of a strain at the moment.’

13. Provider and stakeholder perspectives (2) • Regular contact, briefings, supervisions and praise is very important in motivating and keeping staff • Costs of training and workforce development are a concern • West Sussex’s tendering arrangements were seen as difficult by some providers: • Time-consuming and ‘disruptive to clients’ • ‘Very difficult to know what the criteria are’ – ‘an awful tender document’ • Although some were positive about partnership working • Some were concerned about very tight financial arrangements, and felt price was sometimes put before quality

14. Provider comments: supporting staff ‘Supervision is of the utmost importance. We keep our staff through supervision and lots of 1:1 meetings. It’s a very friendly caring atmosphere – a very close-knit team because we are a small company.’ ‘In the early stages it’s difficult for anybody – they’re out there in domiciliary care very much on their own. And that’s when we need to put our arms round them and wrap them in cotton wool – we’ve found that our retention rate, over the first 3-6 months – has improved as a result.’

15. Provider comments: partnerships ‘I would describe it as a partnership. We’ve got very positive relationships. If we’ve got any suggestions, they go with it – it’s quite positive really.’ ‘It would be good if all the districts could adopt a common means of communication, invoicing, commissioning work, contract… All three areas that I work for adopt a different method.’

16. Provider comments: independence ‘We don’t need local authority work. Because it’s only a small percentage of the service that we provide, we don’t need it, and we don’t need to be compromised on how much we are going to pay our staff, or what we charge on our agency fees.’

17. Providers’ retention strategies ‘We offer training and a pension scheme and enhanced holidays. We start on 26 annual leave days a year. We’re a big organisation, so we’ve got things set up – a certain amount of resources.’ ‘The environment you create within your business (is important). People are recognised and rewarded for good work, communication is consistent and regular – giving them incentives to stay, like loyalty bonuses after one year of being with us, increasing their holiday entitlement, increased pay for qualifications. I feel very strongly that it’s the intangible things that make the difference, a big difference.’

18. Policy messages and recommendations (1) Partnerships and dialogue between agencies • Maintain and enhance existing partnerships to create further opportunities for regular dialogue and for sharing good practice • Clarify partnership arrangements with local independent providers • Consider re-assessing the effectiveness of partnership arrangements to: • strengthen the network of agencies with domiciliary care responsibilities • identify any weaknesses in forward planning • contribute to new initiatives designed to draw additional labour supply into domiciliary care work in West Sussex, anticipating the large expected increase the county’s population of older people

19. Policy messages and recommendations (2) Recruiting staff • Put more resource into outreach work and identify new sources of labour supply, from all ethnic groups and both sexes: • attract applicants from the Indian, Pakistani and other Asian groups – especially in Crawley with its diverse population • Streamline the recruitment process • Especially the lengthy process of vetting and checking new workers, which wastes resources when applicants withdraw • Improve job rewards • Providers find it hard to compete for labour supply on pay. Low pay in the sector needs to be addressed, at the national, strategic level and locally. • Some applicants are responding to the new opportunities for training, accreditation and progression, but more may need to be done to reshape the image of the job

20. Policy messages and recommendations (3) Strategic planning and the longer term • It is unclear how far providers in West Sussex have fully understood the implications of the major demographic challenges ahead, or have considered their long-term local ramifications • The impact of greater diversification, through Individual Care Budgets, Direct Payments and private work for affluent older clients, may pose important challenges • The emphasis on strategic planning and review should continue. Further actions to reshape the local social care market and create an effective network of future-oriented organisations are needed • West Sussex should continue to work with national agencies - Skills for Care and the UK Home Care Association – to explore and enhance good practice arrangements

21. Local Challenges in Meeting Demand for Domiciliary Care in West Sussex by Sue Yeandle, Lucy Shipton, & Lisa Buckner (2006) is published by the Centre for Social Inclusion, Sheffield Hallam University. Similar studies are being published in 2006 in co-operation with local authorities in Birmingham, Sandwell, Newcastle, Thurrock and Somerset. Local Challenges in Meeting Demand for Domiciliary Care: synthesis report, bringing together findings from all 6 localities will be available in July 2006. * * * * * The GELLM project, in collaboration with Sandwell MBC, has also published: The Gender Profile of West Sussex’s Local Labour Market(2004) by L Buckner, S Yeandle and N Tang Working Below Potential: Women and Part-time work in West Sussex(2006) by L Grant, S Yeandle and L Buckner Addressing Women’s Poverty in West Sussex: local labour market initiatives (2006) by K Escott, C Price and L Buckner