esrc seminar series

Workforce Policy and Care Quality in English Adult Social

Care

Professor Carol Atkinson

Dr Sarah Crozier

Professor Rosemary Lucas

ESRC Seminar Series Regulation of work and employment: Towards a multidisciplinary, multilevel

framework

Adult social care and the workforce: why it matters• Aging population: rapid growth in numbers of

older people with more complex needs requiring care

• Predicted demand for labour of around 2.6 million care workers by 2026

• Highly skilled workforce required• Policy aims: adequate and highly skilled

labour supply; high quality care deliveryESRC Seminar Series Regulation of work and

employment: Towards a multidisciplinary, multilevel framework

And yet…..

Complaints about

adult social care

more than double

Care Quality Commission finds

'appalling' failings

in elderly care

Elderly 'need care

tsar with powers’

Too many care homes

are 'truly awful,' watchdog chief warns


framework

http://www.google.com/url?url=http://www.telegraph.co.uk/health/healthnews/8992593/Allow-assisted-suicide-for-those-with-less-than-a-year-to-live.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=4MVxVLznPIzmarDXgZAL&ved=0CBYQ9QEwAA&usg=AFQjCNHhKVKd5Xy4hcTOPli_8c5wYFe8fQ

The Policy Context: NPM• New Public Management: outsourcing of

statutory provision of services• Over 80% of ASC is now provided by the

independent (private and voluntary) sectors; mainly small firms

• Regulation to ensure control of quality: National Minimum Standards of Care (Care Standards Act, 2000;

Health and Social Care Act, 2008; Care Act, 2014)• Audit by the Care Quality Commission


framework

The Policy Context: SHRM• ‘One way of conceptualizing the ‘whole systems’

approach introduced by the 2000 Act, therefore, is as an attempt to establish in the social care sector a high-skills equilibrium, in which a well-trained workforce is managed by means of a complementary set of HR practices so as to deliver high-quality care.’ (Gospel and Lewis, 2011, p.606)

• A strategic HRM approach (?)


framework

HR practice in ASC

• High-skilled equilibrium: driven by regulation and policy (but at QCF Level 2, HSC diplomas)

• Complementary HR practice: not regulated• Prospects for complementary HR practice?

– Small independent firms– Cost- rather than quality-driven commissioning

practice• Implications for care quality?


framework

Effects of HR practice on care quality• Quantitative study (NMDS-SC and CQC NMS

scores); care workers providing residential and domiciliary care for older people

• Regulated practice had some effect in improving care quality outcomes

• It had less effect than a wider set of HR practices (regulated plus complementary HR practices, where pay was particularly important)

• BUT limited evidence of HR practice generally


framework

Implications of the mixed economy of care provision• Compared effects of HR practice on care quality

outcomes across the statutory, private and voluntary sectors

• Effects substantially larger in the statutory than the voluntary and private sectors

• Suggests more uptake of/more effective HR practice in the statutory sector

• The ‘race to the bottom’ in independent sector


framework

Policy challenges (1)

• Policy framework for development– At too low a level to drive a high skilled workforce?– How to ensure uptake?

• Complementary HR practice: – A role for regulation BUT– Prospects for improving pay given commissioning

processes?• ‘Love versus money’: workforce supply may be

inadequate if relying on those motivated by altruism ESRC Seminar Series Regulation of work and


Policy challenges (2)

• Challenges NPM rhetoric of higher quality care achieved by commissioning/purchaser split, especially where provision is outsourced from the statutory to the private sector

• How then to structure care provision?• How to ensure cost- not quality-driven

commissioning?• Recent Kingsmill/Cavendish reviews: largely

continue emphasis on skill developmentESRC Seminar Series Regulation of work and


esrc seminar series

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