A Workforce for the Future Trends and Challenges in an Age of

A Workforce for the Future Trends and Challenges in an Age of Marketisation: Lessons from the UK and Europe

Dr Shereen Hussein Principal Research Fellow (Chair)King’s College London, UK

Melbourne, Australia, August 2017

Social Services Activities in Europe

A range of services and activities From social work activities (children, families, mental health, older people etc.)To personal care and support for adults and older people in need of careProvided over a range of settings from people’s own homes to residential or institutional carePersonalisation agenda Tendency to extend care into people’s own environment even when complex care is requiredMarketisation of careIncreased role of for-profit providers and competitive markets: issues of productivity,

maximising profitsImplications on the organisation and delivery of services

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Drivers for Further Developments

Demographic changesAgeing populationsGrowing diversity and complexity of needsGlobalisation and MigrationSocial changesFamily structures, labour participation and proximity of livingPerceptions and expectationsEconomic challengesBroad and specific to welfare regime

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European Welfare Models

Most ‘welfare states’ developed post WWIIInitially (and many continued to) targeted the most vulnerable in society particularly Contrast between the provision of health and social care servicesEuropean countries are usually divided into four main welfare models:Corporatist model (e.g. Belgium, Germany, France, the Netherlands and Austria)Family care

model (e.g. Spain, Greece, Italy and Portugal)Residual model (esp. UK)Scandinavian model (more universal and comprehensive

Eastern and Central European countries rely heavily on informal care@DrShereeHussein 30/08/17

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Policy changesDifferences between and within countries

Successive policy reforms Evolving from a ‘social protection’ perspectiveAgenda of personalisation and marketisationIntegration & interdisciplinary workConvergence of welfare regimes towards mixed-economies of care

Regulations, training and qualifications@DrShereeHussein 30/08/17

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Marketisation of Care Services

Promoted by the ‘New Management Approach’ in the 1980sthe approach argues for fewer input controls and a stronger focus on performance and impactThe market is stimulated by the state through commissioning and outsourcing policiesService users are considered as customers and civil servants as service managers@DrShereeHussein 30/08/17

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Some Criticism of Marketisation

Private sector methods such as standardisation may not reflect the individual circumstances The aim to increase productivity can have a negative impact on service quality Potential for increased risk of abuse/safeguarding issuesImpact on the workforce: wages; working conditions; job protection; stress

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Personalisation and Cash for Care

Evolved from concepts of tailored person-centred careDe-institutionalisation of careGreater flexibility, choice and control (personalised purchasing)Two ‘distinct’ approaches: person-centred care and

personalised careEnhance the involvement of families (family policy, e.g. Italy)Neoliberal agenda of reducing public sector expenditure and increasing commercial

transactionsConsumer choice vs. universalism ??Concerns about the use of unregulated, untrained workforcePotential safeguarding complexities

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Impact of Personalisation on the workforce

Ability to provide more tailored services at short noticeDifferences between concepts of person-centredness and personalisationVariations in relation to ‘client’ groupData from the Longitudinal Care Work Study (LoCS) identify four themesAwareness of personalisation and understanding its potential impact;Adapting services;

Contracting (moving away from block-contracts); Impact on business viability

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Adapting services

Care homesConcerns of decommissioning care homes, particularly for people with learning disabilities (deregistering homes to become supported living service- with practical and legal challenges)Non-residential servicesFewer fundamental adaptations are requiredHome care workers are permitted (and encouraged) to exercise more discretion in service delivery depending on users’ preferences@DrShereeHussein 30/08/17

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Stevens, M., Moriarty, J., Manthorpe, J., Harris, J., Hussein, S. and Cornes, M. (Forthcoming) Performing personalisation

in Adult Social Care – the impact on care providers.

Social Policy and Administration

Fiscal ChallengesIncreased demand

Population ageing Choices and expectationsGrowing diversityPressures to do more for lessRefocusing policies to support and facilitate informal careFinancing of social services are organised differently across EuropeSome care reforms have been delayed due to financial pressures@DrShereeHussein 30/08/17

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Social Protection benefits’ expenditures (all functions) in Europe as % of GDP

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Impact of fiscal challenges

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Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017) Investing in the social services’ workforce: A study on how local public social services are planning, managing and training
the social services workforce of the future

. Brighton: European Social Network.

DecentralisationDevolution of resources and competences at the local level

Integration Financial pressuresCould be linked to tailored services (personalisaed) Introducing new laws providing local authorities with more power@DrShereeHussein 30/08/17Public Lecture, Future Social Service Institute

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Integrated Social Services

One-stop-shopsSmart, sustainable and inclusivePotential for: tailor-made, flexible and responsive services; cost effective and efficient; capacity building and innovationAcross Europe these are implemented either vertically or horizontally The importance of the ‘political institution’The implementation is different in systems with ‘central’ governance (e.g. UK) or ‘federal’ structure (e.g. Germany)

One of the best examples is in FinlandProperly designed with clear allocated roles@DrShereeHussein 30/08/17

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Other DevelopmentsTechnologyService delivery

Workforce implicationsIncreased population/workforce diversityTailored servicesEffective communicationsData and researchUse of evidence in decision-makingPrivacy and data sharing@DrShereeHussein 30/08/17

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The Social Services Workforce

A labour intensive and emotionally taxing line of workIncreases in demand are likely to require an almost equal increase in workforce supply (Fujisawa & Colombo 2009)Burnout and stress issues and management strategies Predominantly female Both horizontal and vertical structural differences by genderWages, high turnover and vacancy rates; working conditions and structure & delivery of workFlat hierarchy of work, little room for career development/progressionSupervision; training

opportunities@DrShereeHussein 30/08/17

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Structure of the workforce

Generally two tiers professional groupsHighly skilled – professional qualifications (e.g. social work; occupational therapy etc.)Less skilled – lower threshold of skills requirement at point of recruitmentVariations in regulations, registration, training requirements and qualificationsIncreased attention to the importance of regulating the ‘less skilled’ workforce; however, little progress and inconsistencies across Europe@DrShereeHussein 30/08/17

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The European Social Service Workforce@DrShereeHussein 30/08/17

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Source: Baltruks

, D., Hussein, S., Lara Montero, A. (2017)

Governance & Workforce Planning

Regulatory bodies exist at various levels & might differ depending on the professionPerceived to be responsible for ensuring the competency of the workforce; monitor quality and ensure professional developmentCodes of (good) practice and ethics exist in most countries 60% - employers use workforce planning tools48% never used such tools@DrShereeHussein 30/08/17

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Education & TrainingMost countries have recognised social work training

programmes 50% - social work an undergraduate qualification; 20%, postgraduate; 11% argued it could also be accessed through vocational training Social work studies -

generic or a mixture of specialist and generic modulesFor 85% social care workers are required to have a minimum level of training and qualifications

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Improving social services’ performance @DrShereeHussein 30/08/17

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Source: Baltruks, D., Hussein, S., Lara Montero, A. (2017)

Workforce Shortages: Recruitment and Retention

Offering on-job tailored training and qualifications opportunitiesInitiatives to broaden the pool of recruitsAttracting more men; targeting younger people at school/college fairs; People with disabilities; those from second generation migrants or new communities of refugees)Increase the contribution of migrant workersManaged-migration routes in shortage areas of work)Existing tool kits to improve recruitment to the sector Create opportunities for current workers to act as ‘care ambassadors’ Agency or bank workers

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Impact of Agency Workers16/11/16

shereen.hussein@kcl.ac.uk twitter: @DrShereeHussein24

Source:

Baltruks, D., Hussein, S., Lara Montero, A. (2017)

The Role of Migrant Workers and Workforce Mobility

Large scale mobility within Europe‘Care chains’ and beyondLarge proportion of both the professional and less qualifies workforce are migrants in many European countriesMuch higher prevalence in capitals and large cities (e.g. 40% in London)European and country-specific immigration policies Increased role of Central and Eastern European migrantsSkills, qualifications and language transferability

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Example: Migrant workers entering the English social care sector

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Source: Hussein, S. (In press, 2018)

The English Social Care Workforce: The vexed question of low wages and stress. In Christensen and Billing (eds.) Research Companion to Care Work Around the World

, Rutledge: London.

Example: Migrant workers in the Norwegian care sector

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Source: Christensen, K., Hussein, S. and Ismail, M. (2016) Migrant intelligence shaping work destination choice: the case of long-term care work in the United Kingdom and Norway.

European Journal of Aging. DOI 10.1007/s10433-016-0405-0, 28 November 2016. [Open Access]

Stress & Burnout: Evidence & strategiesSome of the highest burnout rates

Especially with certain client groupsEmotionally taxingCo-relates with motivations to workOrganizational factors are crucial in mitigating burnoutAdequate trainingSupervisory and co-workers supportDevelopment opportunities@DrShereeHussein 30/08/17

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Social workers, job satisfaction and intention to leave

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, S. et al. (2014) Organisational factors, job satisfaction and intention to leave among newly qualified social workers in England, Social Work

Education. 33 (3): 381-396.

Social service staff, Impact of job and personal characteristics on job satisfaction and intention to leave

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Source: Hussein

, S. (Forthcoming) The role of job demand, control and support on job satisfaction and job quitting intention among British long-term care workers. Findings from the Longitudinal Care Work Study (

LoCS)

Factors associated with stress and personal accomplishments: children & families social workers

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Source: Hussein, S. (Submitted) Work

engagement, burnout and personal accomplishments among social workers in England: Does the clients’ group make a difference?

Strategies to reduce burnout and job quitting

Ensure adequate initial and ongoing trainingSet up clear policies Establish in-work support mechanismsQuality and quantity of supervisionOpportunities for co-workers supportFacilitate informal support opportunitiesIT and administrative supportInteractions with own teams and other professionals

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Technology and Workforce ImplicationsIncreasing importance of assistive technology and digital platforms

Advantages and challengesTraining of workers and usersSharing information (changing culture)Changing work structure (remote working, reduced face-to-face working time)Skills’ requirements?15/11/16shereen.hussein@kcl.ac.uk twitter: @DrShereeHussein

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Service Users’ InvolvementAspiration to be achieved

In both care delivery and training process; co-production and ownershipHowever, the reality that only 21 percent of a large European survey indicated that service users in the provision, recruitment or assessment of social work trainingGood examples existMental health peer-support; the Scottish Recovery NetworkHomeless projects in the Netherlands@DrShereeHussein 30/08/17

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Safeguarding Models and Personalisation

Evidence from EnglandThree main modelsDispersed-generic modelLimited or no specialist involvement in operational response to safeguarding concernsDispersed-specialistDispersed-specialist co-ordination for high-risk referralsDispersed-specialist co-ordination for all referrals

Centralised specialist operational safeguarding team- with various variations

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Key factors in safeguarding work

Care settingMulti-agency responsibilities and responsesMultiple concerns (e.g. from the same provider or worker)Local guidance and policiesMulti-agency safeguarding hubDecision-making functions – independent chairing of case referrals@DrShereeHussein 30/08/17

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Source: Graham, K.E., Norrie, C., Stevens, M.,

Manthorpe, J., Moriarty, J. and Hussein, S. (2016) Models of Safeguarding: identifying important models and variables influencing the operation of adult safeguarding. Journal of Social Work. Advanced access

Ways forward

The concepts of personalisation and marketisationParticularly with the NDIS and thinking of transition to ageing servicesInnovative practice Diversifying service structure and deliveryMaximise the use of evidence, data and researchMake best use of technologyIntegration and multi-agency workingEspecially between health and care but also benefits and employment services

Capacity buildingCo-productionInvolving informal cares and broader family policies

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VCOSS CEO & President’s forum 37

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Shereen.hussein@kcl.ac.uk

@

DrShereeHussein 00 44 2078481669

This presentation draws on a number of studies, most are

funded by the Department of Health, Policy Research

Programme

.