Examination of Witnesses (Question Numbers
400-419)
MS LIN
HINNIGAN, MR
ALLAN BOWMAN
AND MS
ANDREA ROWE
12 NOVEMBER 2009
Q400 Sandra Gidley: That is probably
a good point at which to tell us about your "New Types of
Worker/New Types of Working" project and any other factors
that are affecting the make-up of the social care workforce.
Ms Rowe: We have talked about
the changing roles of social workers and the changing roles of
care staff and personal assistants particularly. We have had our
New Types of Worker project going for some time. We believe that
role development actually takes place on the ground, it is not
something imposed from above, the innovation and everything else
happens where people are actually providing the services, and
somehow we needed to capture what was going on to find out how
the workforce was moving and how we needed to prepare particularly
for young people to enter that workforce. We did fund a lot of
projects and out of that we have come to about 14 new kinds of
jobs. You might be interested in a couple of these as an illustration.
There is a community support worker which merges some of the roles
and duties of homecare and clinical support workers under supervision
from a relevant clinician. The benefits of that are the delivery
of a holistic service, prevention of hospital admissions, clearer
career pathways and improved retention. Another is assisted technology
support workers, which is a group of staff undertaking the assessment
of people who use services to determine what types of telecare
equipment would suit their needs. Staff skills identified include
having an interest in technology, having research skills and being
able to market the service and train people in the use of the
equipment. There are samples of job descriptions and a list of
identified skills. There is quite a lot of development going on.
We have always done this in partnership with Skills for Health
and occasionally we have done it with Skills for Justice and also
with housing because many of the roles are getting into those
areas. We have got an interactive website where the various projects
can communicate with each other and talk about what they need
to share. We brought out the principles of workforce design out
of the learning from the projects we have funded. There are seven
principles for organisations, so if they want to start trying
to capture the new ways of working and the new roles they have
the checklist of what they need to be aware of. The good news
is there is a lot of change going on and new roles being established
with different skill mixes. We are in the process of setting up
the Qualifications and Credit Framework, which are the new qualifications,
so we are not going to be doing NVQs in social care much longer.
We do not think NVQs are fit for purpose for the social care sector,
as it is going to be, because they are big qualifications. We
used to call them "full fat" NVQs, which was a bit sexy
or something. The NVQs are felt suitable for a static workforce:
they take a long time and are assessment heavy. We are producing
units of knowledge and skills and all the sectors will be doing
this, so it is going to be common across the public and private
sectors. We are going to have a Sector Qualification Framework
that will have these units on it and it will be much simpler for
employers to mix the skills. If they are involved in one of the
new types of worker they will be able to go to the Framework and
pick a set of units. It is a real pick and mix system. We are
going to have lots of common units with health. We are doing this
in partnership with Health and with Children to try and get a
really flexible Qualification Framework that is capable of meeting
that innovation and enabling employers to have the latest information
on the qualifications they need.
Q401 Sandra Gidley: I can see perhaps
the need for flexibility, but there are some significant tensions
in the system which Alan Bowman mentioned. Is there not a danger
that all of these changes are going to make the whole thing messy,
completely incoherent and nobody will have a clue what is going
on?
Mr Bowman: There is always that
possibility with any innovation. The issue is what do you do to
make sure that does not happen. If you take a word like "personalisation",
what does it mean? It means many different things to many different
people. If that is the underlying philosophy then we need to translate
that into something meaningful. Not that we sell anything because
everything we produce is free, but our most popular publication
has been the Rough Guide to Personalisation which tries
to explain in very straightforward terms what this means. We have
produced a number of specific things for housing, for home carers,
"This is what personalisation means for you", and for
advocates as well. We continue to produce information as different
groups of people need it. What we are trying to do is to say that
personalisation is about ensuring that people get the kinds of
services they want and they remain in control over them. Some
things will have to change for us to reach that outcome: "This
is how you can change. This is what you might do differently.
These are the things that work" and sometimes, increasingly,
"Certain things definitely do not work, so do not do them".
It is through that kind of preparation with our colleague organisations
and working through in a way that ensures all the actors in this
have an understanding that is shared because confusion comes when
perceptions are mixed. If someone receiving services does not
have the same perception about what the outcome is intended to
be as the person providing it then you have got problems. That
is very much where we see our role, not just SCIE but collectively,
in trying to ensure that all the bits of the system have a clear
and shared perception about where we are trying to get to and,
through that, avoiding the potential for confusion and disarray.
I always remember with the implementation of community care there
were two agendas at play. One was about privatisation of a lot
of public services and the other was genuinely about trying to
support people to remain in the community, but the confusion between
these two conflicting policy objectives undermined an awful lot
of good work. We are now alive to the potential, so we are trying
to ensure collectively and together with our colleagues in the
Department of Health that people get the outcome they want from
it.
Ms Rowe: There is a lot of simplification
to be done both in the qualification systems, career pathways,
and also the funding. There are huge numbers of streams of funding
and we need to help the different departments in Government. If
I use the example of supply of new entrants, the young people
into the system, there are apprenticeships, CareFirst Careers
and the Society, Health and Development Diploma. If you are a
small employer you are lost, so we need specialist brokers to
help them through the system and that is not right, is it?
Q402 Sandra Gidley: I am glad you
continued because I thought for a moment you were advocating specialist
brokers.
Ms Rowe: No, I am not in favour
of that at all.
Q403 Sandra Gidley: It is simplicity?
Ms Rowe: It is simplicity, absolutely.
Q404 Sandra Gidley: Lin, does this
give you a problem?
Ms Hinnigan: It presents challenges
for regulation certainly. It is right that the workforce should
be flexible, that we should be having new roles emerging, and
we would not want to be ossifying the workforce by setting out
standards saying, "This is what we expect of these roles"
so the roles cannot change. It does present challenges for regulation
and that is a large part of the reason for us looking again at
the models of regulation and thinking what are the right ways.
The sort of professional regulation model that is suitable for
a social worker who invests a long time in long professional training
is different from people in other sorts of roles where they may
be changing, more flexible and need to use the QCF Framework that
Andrea was talking about of pick and mix and change and add a
skill here. That does present different regulatory challenges
and it means we have got to look at the regulatory models that
we use for those sorts of workers.
Q405 Dr Taylor: I am so glad Andrea
mentioned simplification because I am getting more and more bogged
down with this: 14 types of new workers, personal assistants are
undefined, qualifications are undefined, training is undefined.
Lin, in your evidence you said: "Recent research found that
only 7% of direct payment recipients had paid for their personal
assistants to have any form of training". Where are we going?
Is this just back of an envelope stuff? Has nobody thought it
through? Who is going to pay for training? How is it going to
be delivered? Or are these personal assistants just a good friend
who has come off the street and said, "I'll help you with
this, that and the other"? Can somebody make sense of it
for me?
Ms Hinnigan: As Andrea said, on
training there are a lot of people at the moment moving into personal
assistant roles having come from roles in which they were trained,
so there has been a source of people, but as we move forward there
needs to be something particularly in the funding that looks at
how do you make sure you have got the right skills. That research
around the people who have paid for training did show that although
there was overall support by people who employed personal assistants
for them to be registered and regulated, 71% of them said they
wanted to retain the possibility of employing somebody who was
not registered if they made that choice. Predictably, a large
number of those were people who were using friends, relatives
or partners. Do you start to impose upon them, "Your partner
must have this particular sort of training"? The person who
is employing that person may say, "Their knowledge and their
learning has been learning about my needs and me and how best
to meet them". They are very complex questions to try and
set out what are the requirements. We need to unpack this, but
we will need to move to certain standards and have the ability
for people as part of their choice to say, "I don't want
to take those standards". As Alan said, you can tell me I
can get the CRB check, and that is great, but if I choose not
to then that is my decision. The key theme of the personalisation
agenda is balancing risk and choice, and there is always a pay-off.
There is no absolute right place but we have to continue to do
that balancing act.
Q406 Dr Taylor: So a personal assistant
could be an existing carer or it could, in fact, be a partner
or a spouse?
Ms Hinnigan: Yes.
Q407 Dr Taylor: Andrea, I think you
said that Skills for Care are thinking of training and certainly
taking people who have already been trained in other aspects?
Ms Rowe: Yes. We are emphasising
getting young people very much.
Q408 Dr Taylor: Young people?
Ms Rowe: Young people because
we are going to run out of the people we normally recruit from.
We have got to get some young people in. We are taking advantage
of the Government's extra funding for apprenticeships and persuading
employers that apprenticeships are good news. We are working with
the Department of Health and the Department for Work and Pensions
on the CareFirst Careers which are taking NEETs—people not
in employment, education or training—into social care. For
a long time we have felt they are a good source of people to work
in social care. We have put a lot of emphasis on that. We have
put a lot of emphasis on induction. Induction was the first thing
that we did that was not government driven, it came from the employers
who wanted a common induction standard. We have now got common
induction standards across Health and Children. Going round now,
employers tell me that the induction standards are the best thing.
Because there is such a big turnover of staff, many of them just
get through induction. It is based on a 12-week programme and
has the basic skills you need to start with. Together with the
common principles of self-care, which is the personalisation bit,
that will form a good foundation and with the migrant workers
that is what is being used as well. We have had to struggle hard
to get that funded because it is not an NVQ so we could not get
public funding for the induction. We have had to use the money
that the DH has given us, part of the £15 million, to promote
that.
Q409 Dr Taylor: Are you talking about
apprentice personal assistants?
Ms Rowe: Yes, there will be apprenticeships.
Q410 Dr Taylor: Who is going to supervise
them?
Ms Rowe: The provider of the apprenticeship
scheme would do that.
Q411 Dr Taylor: Who would be the
provider?
Ms Rowe: It might be a college
or a consortium of employers and colleges.
Dr Taylor: That is helpful.
Q412 Charlotte Atkins: Lin, should
there be regulation of personal assistants or not?
Ms Hinnigan: This is a really
complex issue and you have heard already from the earlier witnesses
that it is really difficult to balance. On the one hand we certainly
need to provide the right level of public protection so that people
who are being supported in their homes are given that assurance.
The same research that I referred to earlier revealed that one
in ten direct payment employers had experienced some form of abuse
at the hands of their workers. There is a significant protection
and risk issue there. At the same time, certainly I have heard
service users talk very passionately about their independence
and right to make decisions for themselves and not wanting the
state to interfere in what is a very personal relationship and
to regulate personal assistants would interfere with that and
would fetter their choice and independence.
Q413 Charlotte Atkins: You said in
your evidence that if you wanted to extend registration it had
to add value.
Ms Hinnigan: Exactly.
Q414 Charlotte Atkins: What is your
view? Will it add value? Who decides that? Clearly we have a large
number of personal assistants being employed in various ways and
it seems to be fairly chaotic at the moment.
Ms Hinnigan: Our proposal is that
we will contribute to this debate, with Government support and
Government agreement, by launching consultation on this. Last
November our Council agreed some proposals to do some more work,
to build on the research that we have already done to get a better
understanding of these very complex issues and about the different
perspectives and to be able to weigh up the benefits. It must
add benefit. It must be proportionate to the costs, to the burden
and to the impact on employers of personal assistants. What we
propose to do is some more work to develop a better understanding
and then to put those questions out in quite an open way to a
very genuine consultation to seek views from different stakeholders
as to the right way to pick through what is a minefield in terms
of strongly held views on both sides about regulation.
Q415 Charlotte Atkins: Does the GSCC
still have its aspiration to regulate the entire social care workforce?
Ms Hinnigan: That is still Government's
commitment and it is in our primary legislation that we should
extend our regulation to the whole of the workforce. The work
that we did back in 2006 identified that the greatest benefit
was around homecare workers because of the vulnerable nature of
people in their own homes and, therefore, that is where we have
been focusing our effort. As things have changed we need to look
again at the model of regulation. There were 250,000 homecare
workers at the last figure and there were something like 5,000
registered with CSCI in 2008, registered homecare providers. It
is a very fragmented employer base and regulation will have to
have a key link through to employers because they are the people
who capture and have contact with the workers. As we heard earlier,
the 21% turnover rate of homecare workers makes it an incredibly
difficult population to capture and regulate. We need to think
about how we can do it in a way which is streamlined, simple and
deals with those practical issues of the number of workers continually
overturning. Do we do it on a voluntary or compulsory basis, and
on what levels of training? Are we simply defining induction standards
as the basic training or are we seeking to raise standards? Should
we set higher qualification levels and have the regulatory burden
on employers around that when they have got a vast turnover of
workforce? We are back to looking at what is the right model with
the Government. We still believe that the workforce should be
regulated, but the model for doing so needs to be proportionate
and practical.
Q416 Charlotte Atkins: The Council
for Healthcare Regulatory Excellence came up with a recent report
and they were suggesting other sorts of approaches in terms of
statutory licensing schemes, employer-led approaches based on
codes of conduct, and practice and induction standards. Is that
a helpful approach or not?
Ms Hinnigan: Those are some of
the models. As I say, we need to explore alternative models and
those are certainly ones that are worth exploring.
Q417 Charlotte Atkins: You have not
got any preference at the moment?
Ms Hinnigan: At the moment no
because, along with the Department of Health, we need to do much
more to understand what might be the best approach.
Q418 Dr Naysmith: Much of the last
20 minutes or so, maybe longer, has been spent talking about domiciliary
care workers and personal assistants, but your prime task must
be to be responsible for the quality of social work education.
What preparations have you got to make to work in this new era
of personalisation in terms of the statutory training of social
workers?
Ms Hinnigan: As I said at the
beginning, the social work degree is relatively new. The overwhelming
outcome of research into that is that it is fit for purpose and
has had a beneficial effect on the workforce but we need to do
more to develop that. We have put a series of proposals and a
lot of work into the Social Work Task Force about how we take
forward both the initial social work degree and subsequent training.
Some actions we have already taken. A very significant part of
the initial social work degree is 200 days, which is about half
the time, is spent out on placement and we need to make those
placements, which are really key to achieving skilled social workers,
of more consistent quality. There is evidence that the quality
of those placements is inconsistent. Along with colleagues we
developed a tool, the Quality Assurance Practice Learning Tool,
which can be used as a benchmark. That has already been rolled
out and is being used by numbers of higher education institutes
but it will become mandatory for degree courses from September.
Q419 Dr Naysmith: Is it mostly theoretical
or are there some pilot schemes running on the changes you have
just been talking about?
Ms Hinnigan: We are also exploring
how we can make our own inspection of HEIs more robust. At the
moment we work on a model that was agreed with Government when
we were introduced and which fits with the way in which higher
education is regulated. It is largely a self-regulatory model
and we come along and monitor their quality assurance. We think
we need to be much more hands-on and robust in doing inspections,
going out and sampling placements involving both employers, who
are a key part of this, and service users. We do already involve
service users in our inspections, but much more of that, more
intrusive inspection if you like, so that we get a real flavour
of what is going on and whether or not the student social workers
are getting placements that are appropriate that are giving them
experience of personalisation, for instance, that is equipping
them to fulfil these new roles for the future. The other area
I would focus on particularly, as I have mentioned already, is
that of continuing professional development. We have put forward
as the Task Force that we should both require an element of the
current 15 days to be in formal assessed training and the potential
for that to be accredited courses that count towards your days
and we should use that to direct some of the content. For instance,
to direct that all social workers have an element around personalisation
if that is what they wanted to do. Also, the evaluation of that
in terms of its impact on employment should be built in, we should
be able to demonstrate value for that. There is an upping our
game in terms of what we demand both from initial and ongoing
training that will ensure we continue to develop social workers
so they are fitted for the personalisation agenda.
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