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Recruiting for values: key to outstanding quality in social care

Debbie Sorkin National Director of Systems Leadership

Debbie Sorkin shows how you can put leadership and values at the heart of your recruitment practice   

Values-based recruitment is one of the themes of this month’s Care Talk.  I’d like to suggest that it links directly to the other themes of quality and becoming rated as an Outstanding service by the Care Quality Commission (CQC).  Professor Martin Green OBE, in his foreword to Neil Eastwood’s book Saving Social Care[1], makes the point explicitly when he states: “The most important resource in any care service is the staff.  Everything we are trying to achieve hinges on having the right people with the right attitudes and values who are committed to delivering the highest quality care.”

And this quality is the foundation of Outstanding-level service.  CQC writes about this in its latest Annual Report[2], noting the link between strong values and strong leadership: “Strong leaders had a pivotal role in high-performing services.  Registered managers that took an innovative approach, that were known to staff, people using the service, carers and families, and that were open to their feedback had a positive impact.” The Chief Executive of CQC, Sir David Behan, saw having the right staff as the crucial factor – the difference that made the difference – in difficult times, saying “The fact that the quality of care has been maintained in the toughest climate that most can remember is testament to the efforts of frontline staff, managers and leaders.” 

But how do you recruit, never mind retain, social care staff with the right values, when there is already a shortage of workers in the sector? Skills for Care, in its most recent annual survey of the workforce[3], estimated the total number of vacant roles at c.90,000.  This is in the context of a sector that continues to grow, with a workforce now standing at 1.45m, well over the c. 1.3m who work in the NHS.  The number of jobs in the sector has grown by 19% since 2009.  Skills for Care estimate that if the workforce grows proportionally to the projected number of people aged 65 and over in the general population, there will be another 275,000 jobs needed by 2025.

But this in turn makes the sector even more competitive when it comes to recruitment.   And it can lead to real pressures to take on people who might not have the right values, and who therefore might not stay for long.  In its 2017 report[4], the House of Commons Communities and Local Government Committee estimated that 47.8% of care workers left within a year of starting. Historical inequalities around the value ascribed to care work, evidenced in low wages relative to healthcare or other sectors, patchy career progression and the proliferation of zero-hours contracts, particularly in home care, all contributed. In the words of Skills for Care, “The level of turnover and churn indicates that employers are struggling to find, recruit and retain suitable people.”

This has implications for care quality.  Shortfalls in the workforce are an expression of unmet social care need. CQC has highlighted its concern about the continuity and quality of care in these circumstances[5]. If you don’t have genuinely person-centred care for your staff, it makes it much more difficult to provide genuinely person-centred care for your service users.

Aside from this, it (literally) pays to keep good people.  The average cost of recruiting a care worker, allowing for the time of all those involved, has been estimated at £2000 – £3000 per place.  If money is tight, and if net migration continues to fall – especially as Brexit becomes more and more of a reality – so that the pool of potential workers is smaller[6], you don’t need to not recruit many replacement front-line workers to save significant sums.

So what can you do, especially in the face of continuous competition and financial pressures?

There’s no magic wand or easy solution.  But if you’re a manager or an owner of a care organisation, that doesn’t mean you can’t do something.

I’d suggest starting by recruiting the right people, who’ll be more likely to stay with you.

One care worker who gave their views to the CLG Committee commented: “it is more often or not a job of last resort, rather than a job of choice.”  So this is about going for those people for whom care is a job of choice – in other words, recruiting for values.

As another care worker said: “I am often frustrated to hear people conflate low pay with low skill and low value.  Most people working in adult social care are undertaking very skilled roles and they need high skills and personal attributes and high levels of resilience to be able to do what they do.”

High turnover rates, particularly in the first few weeks following appointment, are often an indication that people have come into care and support roles but do not have the right values to sustain them in those roles.  So one way to improve retention rates is to recruit people with the right values – demonstrated through their behaviours ­that are at the heart of social care.

As The Social Care Manager’s Handbook notes: “The values that underpin social care have developed through recognising that the very best practice comes from the highest standards of personal and professional integrity, and the commitment to deliver a service that centres on and responds to the people who use it.”

It’s this integrity that shines through in good leadership.  It’s at the root of how you behave in everyday situations and of what you expect from the behaviours of others.  And so it’s at the heart of the behaviours identified in The Leadership Qualities Framework for Adult Social Care[7], which sets out what good leadership looks like at all levels of a team or an organisation.

And you can use the Framework in recruiting for values, going for people who can show how they’ve expressed those values through what they’ve done in everyday situations.

When we talk about recruiting for values, we mean things like:

Compassion                                                       Courage

 Respect                                                               Responsibility

 Empathy                                                             Imagination

Treating people with dignity                        Adaptability

Integrity                                                               Responsibility   

These values will underpin all the training, skills and competences that people have.  They are the kinds of values that make the difference in the delivery of care and support services. Recruiting people with these values is about having the right people in place from the start, who will not just do the right thing but do it in the right way, so that you can have confidence that your people will deliver truly person-centred services.

There are easy and practical ways of recruiting for values.  There are widely available tools and techniques for looking beyond the standard ways of finding people, for instance[8].  In the words of Neil Eastwood: “A handful of care providers…have found clever ways to seek out, attract, screen, select, mentor and support their workforce….there are actually enough of the right types of people in the communities around us if we know where to look and what to say when we find them.”[9] Employers using screening tools, for instance, have reduced interview no-shows, had higher retention rates, and enhanced the quality and consistency of their care teams[10].

And Skills for Care has a whole section on its website devoted to recruiting for values and behaviours, with suggestions around how you advertise to attract the right people and how you ask questions at interviews that will show how candidates have put their values into action[11].

And once you have people working with you, being a good leader – exhibiting the behaviours in the Leadership Qualities Framework – is intrinsic to being a good employer.  So if you’re an employee, at whatever level you’re at, you should expect your employer to provide the kinds of leadership that would make you want to stay with them.  This means providing guidance and direction, using people’s skills effectively, reviewing performance of team members to ensure that outcomes are met, and providing motivation and development opportunities so that people keep improving.  You should look to your employer to support you to provide good care and better services, encouraging you to speak up and to innovate around improving people’s lives.

In other words, being a good employer is about collectively building a culture of responsibility, trust and commitment to people’s development, so that good people want to stay with you.

And many social care employers must be doing something right.  In its Annual Report, CQC reported that services were performing especially well at caring, with inspectors seeing staff involving people in their care and treating them with compassion, kindness, dignity and respect.  95% of services were rated as good or outstanding for caring[12].  You can only do this if you have continuity of care – in other words, if you’re retaining a good proportion of your workforce.     So let’s make more of this.  In the words of Dame Denise Platt, we can show that social care, when delivered well – by people who are committed to the sector and who are motivated to stay with their employer – has the power to transform people’s lives[13].

 

If you have examples of great leadership in your service, please send them in to www.caretalk.co.uk or contact Debbie.sorkin@leadershipcentre.org.uk.

Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre.  Debbie.sorkin@leadershipcentre.org.uk @DebbieSorkin2

[1] Saving Social Care, Neil Eastwood, Rethink Press 2017

[2] The state of health care and adult social care in England 2016/17, CQC October 2017, http://www.cqc.org.uk/sites/default/files/20171123_stateofcare1617_report.pdf

[3] The State of the Adult Social Care Sector and Workforce in England, Skills for Care September 2017, http://www.skillsforcare.org.uk/Documents/NMDS-SC-and-intelligence/NMDS-SC/Analysis-pages/State-of-17/State-of-the-adult-social-care-sector-and-workforce-2017.pdf

[4] See https://www.publications.parliament.uk/pa/cm201617/cmselect/cmcomloc/1103/1103.pdf

[5] See The state of health care and adult social care in England 2015/16, CQC: http://www.cqc.org.uk/sites/default/files/20161019_stateofcare1516_web.pdf  

[6] See, for instance: http://www.standard.co.uk/news/uk/net-migration-to-uk-plunges-to-below-250000-after-exodus-of-european-workers-in-wake-of-brexit-a3548626.html

[7] See https://www.nsasocialcare.co.uk/about-us/leadership-qualities-framework

[8] See, for example: http://stickypeople.co.uk/#home

[9] Saving Social Care, Neil Eastwood, Rethink Press 2017

[10] http://stickypeople.co.uk/#home

[11] http://www.skillsforcare.org.uk/Recruitment-retention/Values-based-recruitment-and-retention/Recruiting-for-values-and-behaviours-in-social-care.aspx

[12] See p53: http://www.cqc.org.uk/sites/default/files/20171123_stateofcare1617_report.pdf

 

[13] The Status of Adult Social Care: Dame Denise Platt, 2007: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074218.pdf

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