England & Wales Health and social care

Lamb and Pickles and the evidence for good care


Photo Credit: EladeManu via Compfight cc heart coin hand

The Resolution Foundation has just published a new report on the living wage for social care workers: As if we cared: The cost and benefits of a living wage for social care workers. This report reinforces the recommendations of Key to Care: report of the Burstow Commission on the Future of the Home Care Workforce and adds some extra grit in the form of workforce and wage analysis from Dr Shereen Hussein of Kings College London.

Unsurprisingly, the shockingly high turnover rates in home care can be correlated with low wages. And while evidence is mixed on the quality of care correlating with better wages – there is a relationship between job satisfaction and quality care.  Care workers say they love the work they do, but it’s hard to have high job satisfaction when training is inadequate and pay can dip below the minimum wage.

At the launch of the report, Social Care Minister Norman Lamb spoke about the importance of these issues and the naming and shaming of companies that fail to pay the minimum wage (although our Key to Care report called for a more proactive approach to enforcing minimum wage legislation).  He also said that councils, too need to take some responsibility. He called for more research on the relationship between the quality of care and the quality of council commissioning.  However, in a tone which well reminded me of the forthcoming general election, Lamb accused Local Government Minister Eric Pickles of blocking an investigation to be led by the CQC into commissioning and the quality of care.

I have some sympathy with Pickles. While of course the CQC’s assessment of care should be part of such a review they may not be best placed to do it with the possible spectre of a regulated approach to commissioning. Councils, though, are desperate for just such information. They want to see impact assessments of programmes like outcomes based commissioning in Wiltshire. They want to bring different approaches to commissioning as evidenced by a recent workshop we ran in Buckinghamshire.  In Key to Care we featured a case study of a Mears care worker who said she got much greater levels of that all important job satisfaction from working in a more flexible, outcome-focused way. But one case study is not enough – we need a real assessment of the difference that innovative commissioning can make and where and how it makes the difference and for whom. David Pearson, president of the Association of Directors of Adult Social Services announced at the launch of Who Cares that the LGA would be supporting peer reviews of commissioning and that’s good news.

But there’s no getting away from the money issue. We think that outcomes based commissioning might make some real difference to the bottom line – that it will help people live more independently or reduce the amount of support they need as progressive conditions progress. We also think there will be fewer hospitalisations and readmissions. It makes sense, but we don’t really know for sure.

W ukhca-min-rate-map hat we do know for sure is that there’s no more room for cutting labour costs when many care workers aren’t receiving the minimum wage. The United Kingdom Home Care Association has calculated a minimum rate of payment to providers that supports care workers receiving the minimum wage and they’ve just published a report showing rates of payment across the UK – and it looks like most aren’t (the purple). You can find much finer detail in their recently published report The Homecare Deficit and a and a bigger copy of the UKHCA map pictured here

So how will we find that money? The reality is that councils are faced with further restrictions on social care budgets and the potential savings from health budgets aren’t being realised.  The LGiU has just published a report with the County Councils Network on health and social care integration: The State of Care in Counties: the integration imperative. It outlines some of the challenges that county councils are facing in particular (though I don’t suppose single-tier councils feel that they’re exactly awash with cash or easy solutions).  Further integration may be the solution, but it needs to look much more like the Manchester deal than further tinkering with the Better Care Fund.