Residential Care Service

I just love it when the veil of confusion is lifted from my eyes and everything becomes clear.

Over the past year I have become concerned and even frustrated at times, as the residential care service seemed to be slipping back to the bad old days of the 1980s, when it was beset by bad practice, low paid and poorly motivated staff and no identity.

At first I put my confusion down to old age and infirmity, or just not managing change, which seems to be the mantra of the moment, especially from those people who have never experienced working in residential care or understand the care sector. I then decided that maybe it was just a case of working with people who had a vision, but having a safe and professional care team was not part of that vision.

Now, being one of those sad people who enjoys reading through legislation, I have found a common theme, and, as ever in life, it was not as simple as me losing the plot or people not understanding the work.

As we move towards a care service which is joined-up, involving a variety of agencies from education, health and social care, meeting children and young people’s needs in all aspects of life, to a lesser or greater degree we will inevitably change the role and potentially alter the priorities of these differing service providers.

Please don’t get the idea that I am some sort of dinosaur that is clinging on tenaciously to the past. It is my firm belief that the Children’s Workforce Strategy could be the most important and positive step in the development of the care service in many years. I also believe that the Minimum Care Standards have been long overdue and now set a base line standard that all establishments, agencies and carers must meet.

Lack of Professional Identity

However, at this point my bubble of enthusiasm is about to burst or at very least is deflating slowly. Why, you may ask, am I so negative when there has been so much positive legislation in recent months? Well, it’s because there is still no joined-up and professional residential care service with its own identity, and this makes all the difference.

If you work in a profession with a clearly defined identity such as teaching, social work or nursing, then there is no problem in maintaining and identifying standards and establishing a clear working role. Therefore, even if roles and priorities change, basic standards and expectations can be maintained. However, this may not be the case in the residential care sector.

Perhaps I can better explain this by highlighting a section in the Children’s Workforce Strategy. Chapter 1 Section 15 states, “In schools, the national agreement on workforce reform, signed by the Government, employers and school workforce unions, set out a wide ranging re-modelling agenda that would free up the growing numbers of teachers to do what they are best at – teaching. Alongside this, it established the concept of the diverse school team, bringing into the school system a much greater range of adults who can work with children in a wide number of flexible roles, including a bigger classroom involvement with teaching and learning. Re-modeling underpins the development of extended schools – our vision of where the school system needs to go to deliver the five outcomes set out in Every Child Matters. Now we have many more sports coaches, music tutors, language assistants and other support staff who are helping make a reality of this vision in many schools.”

Section 18 goes on to say, “Delivering change for children will rely heavily on the capacity, quality and deployment of workforces locally. Local Authorities and their partners should therefore develop integrated local workforce strategies, rooted in an analysis of local need and supported by local and national action.”

Both of these statements are highly commendable in principle. However they fail to take into account two fundamental issues.

For Flexibility, Read Downgrading

First, although the Minimum Care Standards have gone a long way in setting a base line level of standards for residential care workers to adhere to, as a body the residential care service is fractured, unregistered and unrepresented. I also doubt that the target of having 80% of the work force trained up to NVQ Level 3 is anywhere near being achieved. The result of this is that you have a large body of workers that you can be as flexible as you like with.

On the surface, flexibility in a work force seems like a good idea. However, too much flexibility has inherent dangers. Before you start thinking that I am suffering from an advanced case of paranoia let me give you a scenario.

Just imagine an authority, whether it is education, health or social services, and they are looking at managing their very costly care provision. What you can’t do is change the role or dilute the quality of provision from the qualified staff such as teachers, nurses or social workers. However, with a little bit of imagination, what you can do is remodel your care work force, who do not have any representation and in most cases already support the qualified staff.

So this is what you do. First, you reduce your core number of experienced or qualified care staff. You then introduce a new grade such as care assistant. You can be flexible as to whom you can employ because it says so in the Children’s Workforce Strategy. Because you have created a new grade you can pay them a lower hourly rate, thus increasing your staffing levels (best value) and you can employ them locally (local workforce strategy) on part time hours (flexibility once again). There we are. That was simplicity itself, and it all makes perfect budgetary sense.

However, what you are potentially left with are a core group of experienced or qualified workers who are weighed down with an avalanche of paperwork, whilst you have a number of inexperienced, unqualified, deskilled, demotivated and part-time workers looking after the client group. Of course I realise that I am being unfair to many workers, who, even though they may be low paid and unskilled, will still be motivated and committed to the work, but when I look at the possibilities for the future of the care service, I am afraid that I am not filled with encouragement.

The Consequences in Practice

I suppose that it will be up to the experienced staff to develop these workers (as pointed out in the Children’s Workforce Strategy). However, my guess is that this will be patchy at best, depending on staffing levels and the ability of the staff. Instead, the alternative may well be unsatisfactory levels of caring such as poor administration of drugs in care homes, patients not being cared for in hospitals and children’s rights not being met in the residential setting. (Does this all sound vaguely familiar?)

I was confronted with this spectre when my father-in-law was admitted to hospital. We arrived to visit him, only to find that he was having difficulty walking. My wife, having been a nurse, suggested that he might have broken his hip and insisted that a doctor was called. After an x-ray he was found to have broken his hip some 22 hours earlier, in which time he had been forced to walk to the toilet on more than one occasion. If this wasn’t bad enough, on visiting a few days after the operation to replace his hip, we found his food sitting (now cold) on a tray at the end of his bed out of his reach. Not only that; no one had thought to put his false teeth in, so he would not have been unable to eat his food anyway.

I am not cross at the staff that failed to give the necessary and skilled care to my father-in-law. I am cross with those managers who believe that caring can be done by anyone, that all it takes is a person of good character who is willing to work for a low wage.

As a care manager in a residential school for children and young people with special needs, I need every one of my staff to be knowledgeable, motivated and experienced professionals who know their trade. However, virtually half of my staff are now care assistants, on a lower wages than the care officers, many un-qualified and on temporary hours. Will this be the foundation stone for a service that other professionals will want to cross over into? I think not.

The Role of the Experienced Care Worker

This brings me on nicely to the second issue and that is the understanding of the role of the experienced care worker. I can only speak for the role of the care worker with children and young people.

It seems to me that the role of the care worker and in particular the role that s/he can play as a social educator is largely misunderstood in this country. We keep on making comparisons with European models. However, we seem totally unable to understand that social education or the imparting of practical wisdom is as important for sound development as formal education.

In residential schools and care homes, care staff should be looking at the five outcomes and planning accordingly. Being healthy is not just about more sports coaches but also about good advice, good example and practical wisdom in healthy daily living. Being safe is not just about firm boundaries or a secure environment but also about preparing young people for life. Enjoying and achieving is a lot more than extra music teachers and language assistants; it is also about socialisation and forming relationships. Achieving economic well-being is more than just learning maths and English; it’s about good preparation for life after school and sound advice and finally it is only by developing children and young people into sound and able adults that they will make a positive contribution.

Now, I realise that I am just a simple soul and that professionals and ministers with far greater intellect than mine have put this framework together, but it just seems to me that what a large number of countries in Europe have realised and we seem unable to grasp, is that experienced and professional care workers have been carrying out this role successfully for many years. Childcare can and should be a vital and necessary resource, not only in residential care but also in extended schools and day care.

After all of these years of lobbying and fighting for a professional, registered and regulated residential care service with an identity, I shouldn’t be surprised or disappointed when we are still not getting it right. However, it is disheartening when the Children’s Workforce Strategy recognises the role of the pedagogue (to their credit) but fails to mention residential care workers who have filled this role for years.

As a care manager in a boarding special school this frustration is also compounded when the National Agreement Time for Standards : Transforming the School Workforce fails to recognise the unique role of the care worker in the boarding special school, and the GSCC consultation document on the registration of domiciliary and residential social care workers does not include workers in boarding special school as a setting for registration.

A Challenge, and a Hope

At a time when a joined-up service is the way forward for the future and staff can move around in the different disciplines, it is vital that residential care has an identity, has well trained and qualified staff with a career structure and above all is valued by those staff that work in it, the clients that use the service and the providers. Otherwise it will remain a Cinderella service and joined-up provision will remain a dream.

We have never been better placed to achieve this aim. With the development of the National Centre for Excellence in Residential Child Care (NCERCC), the implementation of the Children’s Workforce Strategy, registration and improved training we could develop a sound, professional, able and cohesive care service. If we do not get this right, it is my belief that we are going to face major problems with recruitment and retention and lose a valuable service.

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