Last reviewed 6 May 2014
It is a truth universally acknowledged that a care home wishing to provide a good service must attract high-quality staff, as Jef Smith reports.
In attracting high-quality staff, it is appropriate therefore that Skills for Care should concern itself with these matters, but no amount of preaching from the centre can resolve the problems that undoubtedly exist, unless there is local commitment. Attracting high-quality workers and, just as important, holding on to them should be high on every manager’s list of priorities.
A residential home’s building, equipment and operating systems are, of course, very important to the level of service provided, but homes cannot begin to function without staff, their greatest single asset. Care is a personnel-intensive business, which is why there are around a million and a half workers in homes and related areas, such as domiciliary care and extra care housing. That is more people than are employed in the whole of the health service.
Despite their increasing mutual dependence and interlocking systems of working, the NHS and social care are radically different in the status that society accords to their workforces. Social care has no professional group which would attract the public admiration and respect generally given to doctors and, where health and care do employ similar staff, such as nurses and care assistants, those working on the health side of the divide usually enjoy higher status, enhanced recognition and better career prospects.
The result is that social care needs to work very hard, both to establish its image in the public mind and to compete for the categories of worker for whom there are similar openings in health.
While individual managers, particularly those operating on a small scale or as single-establishment businesses, often feel powerless to resolve problems that are of long standing and apply across the nation, they should not give up hope of making improvements in the areas that lie within their own competence.
It is to just such an audience that Skills for Care addressed its recent publication, the title of which, Finders Keepers, wittily encapsulates the twin issue of recruitment and retention.
It opens with a plea for each home to prepare “an overall workforce plan” covering recruitment, selection, training and retention, in the specific context of that particular business. The plan is described as “long term”, but this should be regularly reviewed as the recruitment market can change rapidly.
Who, 10 years ago, would have predicted the massive inflow to Britain of highly motivated, but also rapidly mobile, workers from Eastern Europe, or even five years ago, the current pool of graduates unable to find jobs to match their qualifications? Locally, the closure of a factory or the opening of a supermarket can radically, and at short notice, affect a home’s recruitment. Managing an organisation’s personnel requirements effectively means staying on top of often rapidly changing information, and out-of-date plans can be dangerously misleading.
Some of the questions managers should consider are very well put in Finders Keepers. Is your staff group relatively elderly and, if so, what are the implications? What chances do new workers have for promotion, particularly if advancement seems to be blocked by long-serving senior staff? Most important, the document argues, how does your complement of staff compare with that of similar homes in the area?
On this last point, homes can sign up to Skills for Care’s own National Minimum Data Set for Social Care (NMDS-SC) — membership is free and carries other benefits, such as access to various training funds.
The four main themes suggested for a workforce plan are:
attracting people to your care home
selecting the right candidate for the job
fostering the talents and increasing the skills of established staff
holding on to good people.
For each theme the problems are succinctly stated, possible solutions outlined, case studies of good practice described, and the key messages summarised. Though several of the employers featured in the case studies are large, corporate or not-for-profit organisations, there are enough single-home examples to persuade even the smallest of businesses that diverting effort to more systematic staff planning will pay dividends.
Attracting staff to your home
Attracting staff is about much more than putting out accurate adverts, though getting a personal touch into a home’s advertising is well illustrated in some telling examples. (Simply describing a post as “challenging” is not very original.) It also involves building and maintaining relationships with local job centres and sector-based work academies, and offering visits to the home, and even “taster shifts” to potential applicants.
Some of these initiatives may sound time-consuming, but they are mutually reinforcing and far more creative than the expense and effort that goes into, for example, sending out huge numbers of application forms and getting back only a few. Recruiting via the internet is a must, not just an option these days, opening up literally worldwide possibilities, but paradoxically most recruitment to care assistant posts will be from the home’s immediate neighbourhood, so cultivating positive coverage for the home in local newspapers and on websites is valuable in attracting staff as well as residents.
The section in Finders Keepers that deals with taking on the right people goes back to some basics of good personnel practice: creating standardised interview procedures, using sensible and consistent scoring of candidates, testing for behaviour rather than competence, and scrupulously monitoring recruitment performance.
Much of this is, of course, basic to promoting equal opportunities, but its reiteration demonstrates that sound diversity practice is also the route to making good appointments generally.
For a busy manager time is of the essence, so group selection methods may prove cost-effective as well as providing, for at least some candidates, a more realistic test than an individual grilling by a panel of interviewers. The case study on this point provided by Orchard Care, a private company operating in the north of England, demonstrated that conducting four group interview sessions took 14 hours, compared with the 75 hours that would have been required to appoint the same number of staff if face-to-face interviews had been used.
Disclosure and Barring Service (DBS) checks are also time-consuming, but adopting strategies to train, induct and develop staff in supervised situations before confirming appointments can make good use of such delays.
Another helpful feature of Finders Keepers is the frequent lists of useful sources of further information. The recruitment section, for example, has pointers to the Home Office, the Care Quality Commission, and the Chartered Institute for Personnel and Development, as well as to Skills for Care’s own publications.
Increasing skills and fostering talents
Refreshingly, the third recommended theme for a workforce plan, fostering talent and increasing skills, focuses not just on staff training but also on management processes for building up the capacity of the whole staff group.
A case study here was contributed by Meera House nursing home in north-west London, which employs 64 staff to provide dementia care for 54 residents. The organisation took the decision to introduce structured support and development through supervision in one of the home’s units, specifically to gauge the effect on staff retention, with sessions focused on staff members’ reflections on what was working and what was not working well in their own practice.
The scheme was judged to have increased the confidence of the staff and improved performance generally, but its effect on better retention and teamwork is more precisely measurable. Over the first year, only two staff members left, both departures attributable to changes in their personal circumstances, compared with the previous three years’ average of four vacancies annually.
The sample is statistically small of course, but the story rings true and there was no apparent downside to the experiment.
Retaining good staff
That case study has already introduced the fourth theme: retention. The opening of this section could be read as rather cynical. It frankly acknowledges that “it is difficult to retain care staff in highly responsible and demanding roles with low wages, when similar levels of pay can be earned in less difficult jobs”, but it then draws on research findings that demonstrate that “care staff often take the decision to change career or move from a care setting because of a feeling of not being valued by their employer”. So it seems to be suggesting that an alternative to decent pay is to show respect for staff by, for example, celebrating personal occasions such as birthdays, or organising award ceremonies for employee of the month.
Promoting a satisfying work–life balance through strategies such as flexible working is surely a more realistic route to sustaining motivation. Again, a case study, this time of the Gateshead-based care home company Helen McArdle Care, is more enlightening than mere admonition.
This family-run business boasts that “caring for staff with a personal touch” enables it not only to hold on to staff but even to attract back workers who had left for other employment. A particular feature is the annual family fun day when staff are invited to bring their relatives into work for a bit of enjoyment and celebration. A manager hearing of a staff member suffering hardship or having other personal problems has the discretion to write and offer help, but this is surely a policy any home should adopt.
In another case study, the manager of Woodford Home Care in Bilston near Wolverhampton describes how a staff member who was thinking of handing in his notice was helped by discussion, support and some adjustment to his duties to work through a personal crisis and return to be a fully functioning member of the team.
It is tempting when reading some parts of Finders Keepers, both the official advice and the case studies, to feel that what is proposed is no more than common sense. The record of the care industry, however, is that good sense is often uncommonly uncommon. We could do with much more of it, if we are to overcome the deep-seated problems of our huge and complicated workforce.