Foundations for self-directed support in Scotland
Foundations for self-directed support in Scotland

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Foundations for self-directed support in Scotland

5.2 Challenges for the workforce

Health and social care providers are major employers in Scotland. To give you an idea of the scale of the workforce, in September 2011 there were the equivalent of 131,000 (Whole time equivalent (wte)) people working for the NHS in Scotland (Scottish Government, 2011) and in the same year 195,000 social services staff. This means that 8% of the total Scottish workforce was working in the social services sector. Over 80% of the workforce is female (Scottish Social Services Council, 2012a).

There have been considerable changes in the make-up of the social services workforce. In 1994, 60% worked for local authorities; by 2011 this proportion had fallen to a third of the workforce. Significant (and growing) numbers of social service workers work for the voluntary or private sectors, as you can see below:

Figure 5.2: Social services sectors in Scotland in 2011 (Scottish Social Services Council, 2013)

These figures don't tell us everything about the social services workforce. For example, they do not include the increasing numbers of personal assistant s (PAs) - or volunteers, such as ꞌbefriendersꞌ and volunteer drivers. Moves towards integrating health and social care are likely to add considerable complexity to these figures. For example, social workers are increasingly likely to be employed by the NHS or new health and social care partnerships rather than local authorities. This is just one illustration of how what we may regard as familiar boundaries between health and social care, or service provider and service user, are beginning to shift.

Personalisation is, as you have seen, bringing about changes in the way that services are delivered. Public expectations of health and social care are changing, with people increasingly wanting to make their own decisions about their care and support - including the choice to remain at home if they become unwell or disabled. Musselbrook's analysis of workforce change until 2025 suggests that:

If Scotland is to deliver on expectations the future workforce will need to provide more person-centred care that will require relationships with those receiving support to be re - defined .

(Musselbrook, 2013, p. 8)

Emerging challenges and questions are explored by our panel in Dumfries in the next activity.

Activity 5.1 Challenges for the workforce

(30 minutes)

Listen to the panel discussion about the challenges of personalisation and self-directed support for the workforce in Scotland. Use your learning log [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] to make notes on the discussion. Are there any other challenges you can identify?

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Transcript: Challenges for the workforce

Derek Goldman
If we’re serious about embedding self-directed support practises, what does the panel think are the changes that need to take place in the workplace, particularly the most significant change in the workplace?
Willy Roe
John, you’re close to one of the workplaces?
John Alexander
Well, speaking really, I suppose, from social work point of view, I’m going to go back to some of my earlier remarks, my back to the future comments earlier. And I think we need to and reconnect with some of our basic social work values and principles in practise to be supported and led to do that. We don’t have to go and reinvent a lot of things to make the changes that we need to make. But we need to have the courage as a social care workforce to do that. And that needs strong leadership at every level.
Willy Roe
Thank you. Kirstein?
Kirstein Rummery
I think there would need to be a change in culture that is supported by training and development and support, and that involves a workforce that is supported to take risks. And I think that needs to be done within the context of a workforce that isn’t constantly worried about the next level of change and also constantly worried about its own employment and its own role in this. So I think there needs to be a little bit of a decoupling from the role that the workforce plays at the moment in rationing access to resources and managing those tensions at the front line towards a cultural shift that is more about supporting people to make choices and put packages in place. And I’d echo John’s point that it’s back to basics and reinvigorating the values of, particularly, the social care workforce.
Willy Roe
And Etienne, what would your perspective be on this one?
Etienne d’Aboville
Very similar to what people have said already, really. I suppose the think I would point to is about how performance is managed within those structures. And actually, what we need to be measuring and rewarding practitioners for is the extent to which they facilitate the empowerment of the people they’re working with. And that’s about how much power they can give away. Performance-related pay based on how much power you can give away, how about that?
Willy Roe
And finally, Allie?
Allie Cherry
I, again, agree with my colleagues in the panel, certainly around risk enablement. And I think for me, the way for that to be achieved if that staff are supported by their line managers and further up the management structure to make those decisions that will achieve the best outcomes for individuals, and for organisations to trust the professional judgement of the staff that they employ.
Willy Roe
Thank you very much. One of our colleagues couldn’t be here today to pose this question, so I’ll do it on their behalf. And the question essentially asks around do you think that the Scottish health and social care workforce is really ready to take on board, the culture of personalisation, the requirements of this new legislation? And we might just look for brief answers, because if the answer is anything other than yes, emphatically, then there’s a lot of work to be done.
And what is the biggest change, perhaps, that has to be made in that space in order to give the best chance of success? We have bumped into these issues, I think, in the course of the afternoon, but could we hear, perhaps, two voices on workforce issues and the readiness and preparedness of the workforce to respond to this big set of changes. Would you like to go first and then John?
Kirstein Rummery
Can I come in on this relatively briefly? Because my other hat is that I train the future generation of social workers within the university environment. And certainly the values embedded in personalisation and self-directed support are the values that they think they’re going to be implementing when they go out and practise. So there’s absolutely no problem, I think certainly when we show practitioners and when we teach them, about getting them on board with the theory.
I think the challenge, really, really is getting that kind of middle management and senior strategic commitment to the implementation and actually supporting the workforce with the training and skills and equipping them with that so that they can go out as confident advocates and supporters and practitioners rather than this being yet another challenge, change, possible threat to their jobs that would be involved in that.
So I’m quite confident. And I believe in the social work and health practitioner workforce in Scotland. I think its heart’s in the right place. And I think if there was sufficient support and training involved to support practitioners to work with it, then it could work very well.
Willy Roe
John, are you on the same side of the line between positive and pessimistic?
John Alexander
Well, I think I would be on the positive side, the glass half full part of the argument. I think that I agree very much with Kirstein’s cautionary remarks about what needs to be in place to make it happen. I would add one, which we touched on earlier, which I think is leadership.
I think we’ve been very successful in Dunfries and Galloway in recent years in attracting some newly qualified social workers from outwith the area to come and work with us – which is quite a coup because we’re a bit out of the way from where most of the HEI’s are, and our main strategy tends to be about growing our own. So we take our own staff, and we help to support them to achieve professional qualifications. But we’ve had some what I think of as bright eyed and bushy tailed new social workers appearing from over the horizon, and I think what they need when they come here is the space and the support to implement the learning that they’ve done during their professional training.
And I have to say, I know that sometimes middle managers are painted as the bad guys in this. I think that’s a rather and black and white model. I think that many of the operational and tactical managers in the field are very excited about these new developments because they can see better than people like myself, perhaps, sitting at the strategic centre just some of the pressures and the stresses and the strains of continuing to work with old ways of working.
With rising need, reducing resources, there must surely be a more inventive and creative way we can do things. So I don’t see middle managers as an obstacle. I see them as much as an asset as an obstacle going forward. But leadership is the key thing that needs to be right there.
Willy Roe
: Thank you very much. That’s a really powerful way to end this particular question for the moment.
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Discussion

You may have listed a range of different challenges. Some of these challenges may have been for individual members of the workforce, and others about how organisations that provide services will have to change the way they commission, design and deliver services. For example, many care services are provided through ‘block contracts’, whereas a personalised approach to service provision means negotiating contracts for different individuals in different ways to meet their agreed outcomes (Hunter et al., 2012).

Cunningham and Nickson (2011) identified the following challenges from their research about personalisation in the voluntary sector in Scotland:

  • the potential for personalisation to get caught up in public service cuts and being seen – or used – as a cost-cutting mechanism
  • lack of understanding in the workforce of the principles of personalisation and delivery personalised services
  • overcoming cultural barriers to implementing personalisation in local authorities
  • variation in the awareness, readiness, commitment and training of service providers in the principles of personalisation
  • increased complexity in responding to risk
  • concerns about applying personalisation principles to all groups of people, e.g. people who may be vulnerable because they are at risk of harm, or who are not able to make informed decisions about their care and support
  • fears about employment, including job security, changing terms of employment and more unsocial and fragmented working hours.
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