WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC

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WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
Who cares?
Building the
care workforce
of the future
WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
Contents

Foreword                      01
The challenge in statistics   02
Summary of our findings       04
The state of play             05
The burning platform          08
Carers love caring            13
Squaring the circle           16
What does ‘good’ look like?   24
How we can help               26
Methodology                   27
WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
Foreword
Every day, across the country, hundreds of thousands of
hardworking and committed health and social care professionals
go to work to care for people at their most vulnerable. They are
strongly motivated by their desire to work in a sector that directly
helps so many people. Many find their work hugely rewarding
but working in the care sector is becoming more challenging.
Funding pressures, red tape and low wages contribute to high                                      Rt Hon Alan Milburn
levels of staff turnover. How do you successfully attract, develop                                Health Industries
                                                                                                  Oversight Board Chair
and inspire a care workforce in this environment?
Society needs a well functioning, high           We have carried out research amongst
quality social care sector. A growing elderly    people working in care to better understand
population makes it a necessity. Demand          what can be done to help. This report
is rising and is set to do so for decades to     contains a diagnostic of the workforce
come. Yet the challenge of delivering safety     issue and it proposes positive and practical
and quality to those people needing care         steps that organisations can take to
is exacerbated by the impact of financial        navigate workforce challenges. The health
pressures. Social care is on the frontline       and social care landscape is changing
of under-funding across the whole of the         quickly, not least due to the introduction
health and care system. For example, the         of new and innovative technologies that
Health Foundation estimates the funding          are transforming how care is delivered.
gap for adult social care will be over £4bn by   The key to sustainability and success
2020/21.                                         for organisations in the care sector is a
                                                 workforce that is motivated, equipped and
Behind the gloom, it’s worth noting that the     galvanised to embrace the challenge of
vast majority of care homes, overwhelmingly      change. We very much hope this report will
provided by the private sector, are now          help you put that into action.
rated ‘Good’ or ‘Outstanding’ by the Care
Quality Commission. This is testament to
those providers who have persevered in this
challenging setting, but above all else to
the commitment of their workers. Their job
is getting more difficult not easier. Brexit
uncertainty is not helping. It has become
harder and harder to carry out effective
workforce planning as shortages severely
impact the ability of organisations to recruit
and retain staff.

Authors

Andrew McKechnie                     Reena Virdee                     Ollie Cohen
Partner                              Senior Manager                   Manager
M: +44 (0)7799 602 349               M: +44 (0)7712 596 068           M: +44 (0)7816 588 757
E: andrew.mckechnie@pwc.com          E: reena.virdee@pwc.com          E: oliver.j.cohen@pwc.com

                                                                                                            Who cares?    1
WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
The challenge in statistics

    Over 1 million adults                                     1.6m people
                                                              are employed
                                                              in social care
                                                              (more than
                                                              the NHS)

                                                              Representing
          used formal social care last year                   5% of the UK workforce

           This vacancy rate has risen
           consistently for the
           last 5 years                                                          The
                                                                                                   vacancy
                                                                                                   rate amongst
                                      …partly due to rising
                                      staff turnover,                           8%                 care workers
                                                                                                   is high

           now at 31%
           37% for care
           workers under 30

          Carers want
            to care                                                   An       majority of
                                                                 87%           carers have an overall
                                                                                  positive
                 61%                                                              experience
                                                                                       of social care

      said the primary reason for
     joining the sector was for the
     opportunity to
      help people
2   PwC
WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
A further
                                                The elderly
      8%               of the UK
                       population
                                               population is
                                                growing at
                       are informal
                       carers                  c.3%
                                              per year

                    By comparison,
                 we have only managed
                    to recruit a net
            20,000 carers                                       If demand continues
                                                                to grow at this rate,
            per year                                            we will need an
            since                                               additional
            2013
                                                                          440,000
                                                                          carers by 2030

  And over 90% of                         Operators need to capture
 carers plan to stay                     this positivity to recruit and
within the sector beyond the next year     retain enough carers to

                              2019
                                         Meet demand      Deliver high     Drive positive
                                                          quality care       outcomes

                                                                                   Who cares?   3
WHO CARES? BUILDING THE CARE WORKFORCE OF THE FUTURE - PWC
Summary of our findings
Social care is a critical part of our health economy, but it is
facing a number of challenges. Of these obstacles, staffing is
becoming ever more critical.
Developing and maintaining a sustainable             We have spoken to over 2,000 carers and
workforce is key in delivering high quality          care home managers to better understand
care with positive outcomes, but recruitment         what is driving this staffing crisis and
and retention of staff is becoming                   more importantly, how a good operator
increasingly difficult. Vacancy rates are            can distinguish itself in the eyes of the
high and agency spend is rising, impacting           workforce. Through our research, we have
the viability and growth of health and care          identified 5 key actions for operators to put
operators across the market.                         in place.

1. E
    nsure care is always at                                  2. B
                                                                  uild the right                              3. F
                                                                                                                   acilitate a smooth
   the core                                                      organisational structure                         day-to-day
• Create a care-centric culture                               • Invest in managers                             •   Streamline paperwork
• Get the right KPIs                                          • Redefine management roles                      •   Ensure sufficient resources
• Champion carers                                                                                              •   Consult on rostering
                                                                                                               •   Embrace technology

                                  4. Commit to                                     5. D
                                                                                        rive career
                                     personal development                              development
                                  •   Understand needs                              •   Develop career plans
                                  •   Build resilience                              •   Codify ‘good, better, best’
                                  •   Promote collaboration                         •   Track progress
                                  •   Celebrate success                             •   Endorse role models
                                                                                    •   Focus on training

Focus, commitment and investment in                  But unpicking the issue isn’t simple. At a
addressing these issues is an immediate              headline level, carers love their job and find
priority as staffing supply is increasingly          the work hugely rewarding. However, there
unable to meet growing demand. This is               are specific areas of dissatisfaction that
likely to get worse over the coming years.           span the breadth of their role, ultimately
                                                     driving them to leave. Our research assesses
                                                     these areas in detail and helps navigate this
                                                     increasingly complex issue.

4        PwC
The state of play
Social care is fundamental to our health, care and wellness system                              “Government must act
and is becoming increasingly important. A functioning, high-                                    to halt crisis in social
quality social care system is key to the wellbeing of the individuals                           care recruitment…
who require care, and the wider health and social care ecosystem.                               Undervalued and poorly
                                                                                                rewarded care workers
The move towards therapy, based in              The rapid development in the size, quality      are leaving the sector
and around the community rather than            and efficiency of the social care system is     and they are not being
institutions, requires a well-developed         challenging on multiple fronts. Demand is       replaced quickly enough
and sustainable social care system. This        rising and becoming more complex, whilst
in turn can release pressure on the NHS.        funding has been under pressure for a
                                                                                                to meet demand”
Between 2007 and 2018, two million NHS          number of years. As a result, the thresholds
                                                                                                Guardian, Feb 2018
bed days were lost due to delayed transfers     at which you’re eligible for care have been
(‘bed-blocking’), caused by a lack of social    tightened, placing further pressure on the
care support.                                   social care system but also the NHS.

Key challenges facing social care:

                                 Integrating health and social care

                                       Balancing public and private provision

                                      Managing rising volume and complexity of demand

                               Regulating and delivering quality care

                   Maintaining a sustainable workforce

Of all these challenges, creating and           The adult social care sector employs 1.6m
maintaining a sustainable workforce sits        people, spread across elderly, nursing and
across the entire health and social care        specialist care. This workforce is made up
system and is integral to its functioning.      of frontline workers (carers in care homes,
Care is one of three sectors with the highest   personal assistants and nurses) as well
concentration of low-paid workers, alongside    as managers and senior managers who
retail and hospitality. It is a challenge       coordinate care delivery, and are integral to
that faces government, public and private       the working of the social care system.
providers. Government and the Department
of Health realise the importance and
extent of this challenge, and spend £23m
per year on the monitoring of the state
and development of the adult social care
workforce through its associated charity and
thinktank, Skills for Care.                                                                              Who cares?    5
Adult social care jobs by type of employer

                                    6%
                                                Independent
                                     9%         (private sector)
                                           7%
                                                Local authority

78%                                             Direct pay
                                                NHS

Adult social care jobs by setting

                                    2%
                                                Residential
                                     13%
                                        42%     Domiciliary
                                                Community
42%
                                                Day

Adult social care jobs by type of role

                                    11%         Direct care
                                      5%
                                           7%   Managerial
                                                Regulated professional
76%
                                                Other

Source: Skills for Care (2018)

6         PwC
The social care workforce is diverse, with        The formal care sector now faces the             “Brexit and Social Care
83% of staff being UK nationals, 8% EU            additional challenge of the decline in           crisis threaten NHS,
and 9% from the rest of the world. And            informal carers, driven by an increasing
                                                                                                   hospital boss says on
there are geographical nuances – London           retirement age, decrease in co-residence
is particularly reliant on non-UK workers         with parents, the increase in single person      70th Anniversary…
as 39% of the current workforce are from          households, and a decline in community           We are going to need
outside of the UK. With Brexit looming and        networks. The increasing demand placed on        more and more people,
immigration rules coming into question, this      the formal care system, and the associated       not fewer”
is a further potential challenge to the sector.   increase in required carers further highlights
                                                  the importance of the workforce to the           Huff Post, July 2018
Alongside these formally employed workers,        whole system.
there is a parallel economy of informal,
unregulated care workers who have                 But what is the scale of the issue? What’s
historically relieved much of the pressure        its impact? What’s causing it? And more
on the system. This informal sector is made       importantly, what can be done about it?
up of relatives, friends, and simply those        We’ve done extensive primary research,
employed directly as carers or personal           involving over 2,000 UK carers and home
assistants without official records, employed     managers to better understand how they feel
via word of mouth or local advertising.           about their roles, what they like, whether
                                                  they’ve considered leaving, what drives staff
                                                  turnover and what can be done to make
                                                  them stay.

                                                  From this we have distilled a set of
                                                  meaningful and practical steps that the
                                                  sector can take to create a more content,
                                                  cohesive and loyal workforce.

                                                                                                            Who cares?    7
The burning platform
Addressing the issue now is critical. There is no doubt that
our current cohort of care workers is already under strain,
and our need for more carers, with more specialised skills,
is only increasing.

Drivers of increased carer requirements

    Growing elderly    Increase in      Increase in       Increase in
      population      single person   acuity of needs    complexity of
                       households        amongst        needs of people
                                        the elderly      with physical
                                        population       and learning
                                                          disabilities

8        PwC
290,000 –
                                                                                                               estimated deficit in
                                                                                                               the number of carers
                                                                                                               required to meet
                                                                                                               demand in 2030 vs.
                                                                                                               the forecast number
                                                                                                               of carers employed
                                                                                                               in 2030

                                                                                                               Source: PwC analysis

According to estimates from Skills for Care,                  The need could be greater. If the workforce
the adult social care workforce will need                     demand grows at the same rate as the 75+
to grow to over 2.0m employees by 2030 to                     year old population, without any workforce
maintain the same level of service we have                    efficiency savings, we’re going to need closer
currently, up from 1.6m today. And that’s                     to 2.5m employees by 2030.
just a conservative estimate.

Projected demand for adult social care workers (England) 2013-2030

                         2.5
                                                  Projected

                         2.0
 Number of workers (m)

                         1.5

                         1.0

                         0.5
                               1.61       1.65

                          0
                            13

                            14

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                          20

                          20

                          20

                          20

                          20

                          20

                          20

                          20

                                      Baseline case            Medium case                 High case

Note: High case: assumes the workforce demand grows at the 75+ population growth rate. Medium
case: assumes the workforce demand grows at the 65+ population growth rate. Baseline case: assumes
the workforce demand grows at the current workforce growth rate.
Source: Skills for Care (2018) and PwC analysis

                                                                                                                        Who cares?    9
This analysis only takes growing demand
   into account. In other words, how many
                                                         The pool is emptying faster than it can be
                                                         filled. As operators scale, their recruitment        2,800 –
   carers do we need if demand continues to              functions don’t typically grow at the same           the average number
   grow? But we know that recruiting and                 pace. And so the deficit continues to grow.          of unfilled care home
   retaining carers is becoming increasingly                                                                  manager jobs at any
   challenging and there is already a gap                                                                     one time
   emerging between the number of carers
                                                         Staff vacancy rate by Local Authority
   we need and the number we have. We can                (England) 2018
   see this in the number of vacancies across
                                                                                                              Source: Skills for
   the sector.                                                                                                Care (2018)

   Vacancies can’t be filled and agency spend
   is rising, impacting operating margins.
   Staff turnover across the sector, already
   high, is increasing and this is seen across
   all care settings, whether provided by
   Local Authorities or private operators.
   Recruitment and retention of care staff is
   fast becoming the greatest challenge for
   operators across the UK. Operators are
   spending time, money and resources on
   innovative recruitment techniques to target
   and attract carers.

   They are using cutting edge digital
   marketing initiatives to identify potential
   carers, grow the addressable pool of
   potential care staff and target them in the
   most impactful way. But this can’t keep up.

                                                       Source: Skills for Care (2018)

     Staff turnover rate for adult social care workers by type of employer (England) 2013-2018                Staff turnover rates
                                                                                                              (2018):
                    35

                                                                   28.9%
                                                                                  32.1% Independent
                                                                                           (private sector)   30.7%
                    30                                28.7%                                                   all job roles
                                              27.2%                               30.7% All
                    25
                           24.6%
                                      25.7%
                                                      27.4%        27.7%                                      34.8%
                                              25.8%                                                           direct carers
                                      24.1%
                           23.1%
                                                                                                              26.1%
Turnover rate (%)

                    20
                                                                                                              regulated professionals
                    15                                13.7%        14.1%          14.1% Local authority       (e.g. nurses and
                                              12.5%                                                           occupational
                           11.7%      11.3%
                                                                                                              therapists)
                    10
                                                                                                              14.9%
                    5                                                                                         managerial staff

                                                                                                              20.6%
                    0                                                                                         other staff
                               2013    2014   2015    2016           2017           2018
  Source: Skills for Care (2018)                                                                              Source: Skills for
                                                                                                              Care (2018)

  10                     PwC
These market-wide staffing challenges       Estimated number of adult social care workers required vs. forecast
are having a significant impact on all      (England) 2013-2030
stakeholders: service users, families,
carers, managers, social services and                               2.2
                                                                                          Projected
operators. Ensuring it doesn’t negatively                           2.0
impact front-line service delivery and
                                                                    1.8
quality is a priority.
                                            Number of workers (m)

                                                                    1.6
So operators are having to tackle a                                 1.4
growing demand for carers whilst the                                1.2
staffing environment is becoming even
                                                                    1.0
tougher. Today, it is estimated that the
number of staff employed falls 120,000                              0.8
short of the number required within the                             0.6
adult social care system. Conservative
                                                                    0.4
estimates suggest that this could rise to                                 1.61     1.65
140,000 by 2030, assuming the vacancy                               0.2
rate doesn’t increase further. If the                                0
vacancy rate increases as it has been
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over the past three years, the gap in
the industry’s workforce could be over                                    Number of workers           Forecast number
                                                                          required to meet demand     of workers
290,000 by 2030.
                                                   Note: Number of workers required uses the baseline case, where we estimated
                                                   demand to increase at the current workforce growth rate. The forecast number
                                                   of workers is estimated by assuming the vacancy rate continues to grow at its
                                                   current rate.
                                                   Source: Skills for Care (2018) and PwC analysis

                                                                                                             Who cares?      11
Whilst trying to fulfil this growth, the
system will have to battle with an ageing
                                                           are unavoidable. Many younger workers
                                                           choose carer roles as temporary jobs before    27%
workforce. The average age of care workers                 settling on longer-term careers outside of     of carers under 35
has increased consistently over the last                   care. The problem being that these transient   chose the sector to
five years, a trend seen across the country.               workers continue to perform a vital role in    gain recognised
There’s a real need to reduce staff turnover               the workforce, but care is not seen as an      qualifications,
in younger cohorts to be able to sustain                   attractive long-term career.
carer tenures. There are some reasons that
                                                                                                          versus only
                                                                                                          5%
Average adult social care worker age 2013 – 2018                                                          of carers over 55

                                                                                                          Source: PwC research
                                                                                                          (2018)
                                                      2018

                                                      43.3
                    2013

                  40.6

Source: Skills for Care (2018)

Staff turnover rate for adult social care workers by age (England) 2018

         42%
                           37%
                                             30%
                                                            25%             22%         22%

         < 20             20 – 29           30 – 39        40 – 49         50 – 59       60+

                                    Care worker turnover rate by age bands (%)

Source: Skills for Care (2018)

12        PwC
Carers love caring
Carers are driven by a desire to help people and support                                          “One problem with
individuals in need. They don’t do the job for the money or with                                  care work specifically
an agenda, it’s to make individuals feel happy and ‘normal’.                                      is its reputation as a
Seeing positive development, progression and outcomes, and                                        ‘last resort’ career...
the impact this has on families, is hugely rewarding.                                             people say, ‘If I can’t find
                                                                                                  anything else, there’s
                                                                                                  always care work’.
What most attracted you to working in the care sector?
                                                                                                  Although the people
                                                                                                  who work in care say
                                                                                                  it’s very rewarding, the
                                                                                                  external view is that
                       4%          2%                      The opportunity to                     it’s not rewarding, but
                                                           help people
                                                                                                  demanding.”
                                                15%        The chance to gain
                                                           recognised qualifications               Carolyn Downs, the
      61%                                       17%        It suited my skills
                                                                                                  Helpcare Project in The
                                                                                                  Guardian, 2017
                                                           The pay

                                                           Other

Source: PwC research (2018)

A key underlying driver of satisfaction          the development of individuals and often
amongst carers is the ability to create and      moderates challenging or disruptive
maintain meaningful relationships with           behaviour. The carer becomes trusted,
the people they care for. This develops a        and the importance of this extends to service
reciprocal appreciation that extends beyond      users across the sector but particularly those
the daily tasks and duties that carers will      with dementia, learning disabilities, mental
fulfil. These strong personal relationships      health issues and special educational needs.
are critical in delivering care that supports

                                                                                                             Who cares?      13
The role is clearly challenging, both          What are the key reasons why your experience is positive?
physically and emotionally. It is              (Top 3 reasons shown)
also varied with no two days the
same. This creates a vast learning
opportunity for carers who are exposed
to a multitude of situations and the key
decisions are usually in their hands.
They make the judgements that often
shape the operation of a home and                                               63%
                                                                                I like the nature of the work
the delivery of care to an individual.
They see the impact first-hand, and can
see improvements in their knowledge
and ability to make these decisions,
creating an intellectually fulfilling
experience.

Further to ‘on the job’ learning,
carers also have the opportunity to
gain qualifications, and are often
encouraged and funded to do so.
Having a formalised and recognised
qualification can create a platform for
them to develop and build a career
within social care.                                                             53%
                                                                                I have had opportunities for
Taking these factors together,                                                  training and learning
sentiment towards the sector is
positive. As a result, the majority
of carers are not planning on
changing careers.

                                                                                50%
                                                                                My shifts are regular / predictable

                                  Source: PwC research (2018)

14      PwC
How would you describe your experience of working in the social care sector, with your            “There is a real value
current employer?                                                                                 to making a resident
                                                                                                  smile. Such small things
                                  2%                                                              we do can make a real
                                         11%                                                      difference and make
                                                                                                  them happy. Many of
                                                                      Very positive
                                                                                                  them don’t often feel
                                                                      Somewhat positive
    39%                                                               Somewhat negative
                                                                                                  happy, so making that
                                                                      Very negative
                                                                                                  difference is a great part
                                            48%                                                   of the job”

                                                                                                  Carer, elderly
                                                                                                  residential care home,
Source: PwC research (2018)
                                                                                                  PwC research (2018)

How would you say your experience has changed over the past year or so?

                               12%

                                                                    Got better
                                                                    Stayed the same
 30%                                                                Got worse

                                          59%

Source: PwC research (2018)

What are your expectations for how long you will be working for your current employer?

                              10%

                                                            Leave current employer in
Squaring the circle
 So if carers love caring, why are they leaving?
 The issue isn’t as simple as the pay, or the role,    Loyalty is limited and resignations can be
 or the job, or the individuals. It often lies with    triggered easily, so a carer can leave and
 employers not always creating and nurturing           have little trouble finding another job at
 the most effective working environment.               short notice.
 And, as we’ve seen, vacancy rates are high
 so alternative jobs are available.

 Reasons for leaving social care employment 2018

                                        15% 15%

                                             4%   4%
                                                                          Personal
                                                                     Personal       reasons
                                                                              reasons        / resignation
                                                                                      / resignation
                                                                     Competition / transfer
                                                                           Competition      to
                                                                                        / transfer to
36% 36%                                                              another provider
                                                                           another provider
                                             11% 11%
                                                                     Development
                                                                           Development
                                                                                  / nature
                                                                                         / nature
                                                                                           of employer
                                                                                                  of employer
                                                                     Fired /Fired / contract
                                                                             contract        terminated
                                                                                      terminated

                                        17% 17%                      Conditions
                                                                           Conditions
                                                                                / pay / pay
        17% 17%                                                      Other Other

                                                       Potentially preventable

 Source: Skills for Care (2018)

 Destinations of leavers from adult social care employment 2018

                                                                           Adult care
                                                                     Adult care
                                         36% 36%                     HealthHealth
                                                                     Unemployment
                                                                         Unemployment
                                                                     Same Same
                                                                          organisation
                                                                                organisation
                                         23% 23%                     Retail Retail
36% 36%                                   2% 2%                      AbroadAbroad
                                             3% 3%
                                                                     Children's care care
                                                                           Children's
                                             5%   5%
                                                                     Other Other
       14% 14%                         14% 14%

                                                       Potentially preventable

 Source: Skills for Care (2018)

 16        PwC
Who cares?   17
But the issue can only be addressed if the underlying drivers                                                         “Strong leadership
behind staff turnover, and dissatisfaction more broadly, are                                                          has a pivotal role in
understood in more detail. Our research has highlighted a number                                                      both high-performing
of these key drivers.                                                                                                 services and bringing
                                                                                                                      about improvement
Home managers                                                                                                         in adult social care. At
The quality, experience and capabilities of home managers is critical in retaining direct care                        registered manager level
staff. Our research and analysis shows a correlation between home manager experience and                              … strong managers were
carer turnover.
                                                                                                                      visible in the service,
                                                                                                                      and known to staff,
Average care home manager tenure (to nearest year) vs. direct carer turnover
                                                                                                                      people using the service,
                                                                                                                      carers and families, for
                            35                                                                                        example by sharing an
                                                                                                                      office with all levels of
                            30                                                                                        staff and working closely
                                                                                                                      with them.”
                            25
Direct carer turnover (%)

                                                                                                                      Care Quality Commission

                            20

                            15

                            10

                            5

                            0
                                     2         4       6       8     10       12       14        16       18     20
                                              Average care home manager tenure in the sector (to nearest year)

                                 Source: Skills for Care (2018) and PwC analysis

18                               PwC
Recruiting home managers from within the sector is important. Often home managers
are from outside the sector or haven’t previously been carers, this presents an immediate
tension between them and the front-line carers. This can lead to poor relationships
between managers and carers that can create a negative and sometimes detrimental
environment in the home.

  “
        ”
                      They don’t get it.

                      They have no idea what or how much we do.

                      They don’t understand our needs or those of the
                      individuals we care for.

                      They ask me to do things without understanding what
                      it entails or how long it’s going to take. And then I get
                      in trouble because it obviously takes longer.
                      Source: PwC research (2018)

Understanding and appreciating the demands of front-line carers, and demonstrating
a willingness to muck-in and help out where needed, is critical. Further to that, internal
promotions to manager are important in creating role models for junior carers and helping
them develop career aspirations.

                             Profit-only culture
                             Costs across the sector are rising, often faster than fees. Operators are having to drive
                             efficiencies to maintain margins. Whilst carers understand this and appreciate that
                             this needs to be done, it shouldn’t become an overwhelming aspect to the culture of the
                             places they work. Care should be at the core and carers shouldn’t be faced with messages
                             about maximising revenue and minimising cost as opposed to delivering great care with
                             positive outcomes.

                                                                                                    “
                                                                                                          ”
                                 I don’t want to hear how much money you’re making,
                                 I want to know how the clients are developing.

                                 Every team meeting starts with a telling off about the
                                 empty beds. It’s not my fault.

                                 Communications are all about targets and metrics, not
                                 about how I or my service users might be getting on.

                                 We’re not motivated by these kind of targets. That’s how
                                 you incentivise people in suits, not us.
                                 Source: PwC research (2018)

                             Clearly, maintaining and driving financial and operational performance is critical for
                             all businesses. And this is ever more important in the sector as margins are often under
                             pressure. But the KPIs that front-line carers see and hear about should focus on great
                             teamwork, quality and outcomes to motivate them in the most effective way.

                                                                                                           Who cares?    19
Resources
Clearly local authority funding has been under pressure, and as a result operators have
had to drive cost efficiencies across their businesses. Whilst the impact of cost efficiency
initiatives is widespread, it shouldn’t affect the availability of resources and the investment
in equipment and refurbishments. In many cases, cut-backs are inevitable but it is vitally
important that this doesn’t impact the quality of care that is being delivered or have a knock-
on effect on the development of service users.

                                                                         “
                                                                               ”
     Our clients don’t have activities anymore. There’s no
     money for it. They suffer as a result.

     We used to do day trips to the seaside, which was great for
     the older people. It used to make such a difference.

     We really need a Hydropool. We’ve asked so many times
     but the answer is always no. There’s no money.

     The washing machine has been broken for days. I’m
     having to take the washing home and do it myself.

     We’re always running out of gloves, paper towels, wipes,
     pads, etc. How can I do my job without these basics?
     Source: PwC research (2018)

There’s a feeling that cost cutting is going too far and there is a perception that
front-line services are being reduced whilst head office costs are remaining high.
This must be addressed.

20       PwC
Training
Classroom training with face-to-face engagement is important in creating a forum in which
carers can learn skills from those more senior and with more experience, but can also ask
questions, seek help or get advice. Whilst e-learning has a place, it’s often becoming the
dominant (and sometimes only) type of training that carers are receiving. Carers learn
and thrive in a collaborative culture where they can draw on other people’s experiences to
help them tackle the challenges of their role. Having an open discussion amongst peers and
superiors is critical in the development of practical skills as well as physical, mental and
emotional resilience.

  “
         ”
                        We used to get face-to-face training but they
                        cut that and put in e-learning. It’s no-where near
                        as useful.

                        E-learning is just a box ticking exercise so the
                        managers can say that everyone’s passed it.

                        Someone completes it and then does it for
                        everyone else. How is that useful?

                        You can’t learn in that way. How can I ask
                        questions if I don’t understand something?

                        They should get older, more experienced carers
                        to do proper practical training. You can learn so
                        much more that way and make sure you’re doing
                        the right thing.
                        Source: PwC research (2018)

Carers are driven to develop and progress and the training they receive is
important in helping them shape a viable career. What’s more, it drives retention
and loyalty. If they feel like they’re being invested in, they’ll stay, and they’ll
aspire to be a senior carer or a manager. They want to feel like they’re being
supported and that management wants them to be there.

                                                                                      Who cares?   21
Career development
Carers often feel that their job is simply a means to an end. Carers coming into the sector
are typically young, school or college leavers and often don’t have a clearly defined career
plan. They’re not sure what they want to do or where they want to be in two / five /10 years
time. And that’s before they’ve worked out how to get there, the hoops to jump through or
the skills they need. And so caring becomes a stop-gap before they move onto other things.
In order for care to be considered as a career, they need to see examples of it or speak to
someone that’s done it.

                                                                              ”
     I don’t see any opportunities to progress where I’m
     working so I may as well go and do something else.                 “
     There are no examples of a great career story. There’s no
     one to aspire to.

     I’ve never had a conversation about where I want to get to.

     I don’t really know what I’m expected to do or if I’m any
     good or what I need to do to be promoted. Or if that’s even
     an option.

     I’m just a carer. I’m not really proud of it. I’m a bit
     embarrassed actually.
     Source: PwC research (2018)

Despite their level and the role they fulfil in an organisation, focus and attention on
developing a career should be seen as priority. There are a numerous examples in
organisations across the sector of people that have worked their way up from carer to senior
management. There are CEOs who were carers. But if these stories aren’t told then it’s very
difficult for carers to see a long-term future within their business. And more immediately,
they need clarity on what skills they need to become a senior carer and then a manager and
then a senior manager, etc. for progression to feel tangible.

22       PwC
Paperwork
There’s a feeling that the admin and paperwork burden is increasing and the time carers can
spend caring is diminishing. There’s a growing culture of ‘if it isn’t written down, it didn’t
happen’ and this is creating a fear amongst carers that they’re exposed to disciplinary or
legal action. Carers love their work and so the time they spend with service users should be
maximised. It is critical that their job doesn’t lose its essence.

  “
        ”
                       I spend more time doing paperwork than I do
                       caring for my service users.

                       I didn’t take this job to fill in forms, if that’s what
                       I wanted to do I’d go and work in an office and get
                       paid double.

                       I look around the home and everyone is writing
                       notes but should be caring and doing their jobs.

                       I can’t spend enough time with clients. It makes
                       me feel so bad. It wears me down. I’m constantly
                       disappointing people.
                       Source: PwC research (2018)

New ways of working need to be developed. There are a range of cost-effective
digital solutions that can be used to help alleviate the admin pressure and there are
simple apps that can be used to better log notes, file reports and manage care plans.
These are now the norm in many other sectors and social care must keep up.

                                                                                        Who cares?   23
What does ‘good’
look like?
                                                  1. Ensure care is always at
What can operators actually do to                    the core
                                                  • Create a care-centric culture:
mitigate and improve the staffing                   Mandate that care and outcomes are
issue? How can you attract the                      central to the business’ vision and values
right people and retain your best                   and this is articulated at the forefront
                                                    of communications
staff? Through our research, we                   • Get the right KPIs: Ensure home KPIs are
have distilled a number of actions,                 a mix of quality, financial, operational,
spanning multiple parts of the                      engagement, happiness, outcomes, etc.
business, that can help build a                   • Champion carers: Recognise and
                                                    advocate carers as the powerhouse of
more united, productive and                         the business
fulfilled workforce.

Whilst these are a range of short-term
solutions, they must be considered in
the context of a wider set of longer-term
solutions that the sector will have to
consider in order to drive transformational
change – e.g. reforming funding structures,
driving investment, increasing pay,
improving qualification levels, etc.

Importantly, the sector must be aligned.
Carers may be the lowest paid part of the
workforce, but failure to recruit and retain
can make a business unviable. Carers are
the cogs that keep the business moving.
They care for the service users, fulfilling the
fundamental premise of the business, and
so they need to be engaged and appreciate         4. C
                                                      ommit to personal
the value they deliver. Attracting talent            development
                                                  • Understand needs: Carve out time
and empowering carers has to be top of the          for managers to have meaningful
agenda for everyone.                                conversations with staff around their
                                                    needs, constraints, preferences, etc.
                                                  • Build resilience: Support carers and
                                                    provide guidance and training in mental
                                                    and emotional resilience
                                                  • Promote collaboration: Create a peer-
                                                    to-peer forum where carers can meet and
                                                    share best practice, without feeling like
                                                    they’re competing or being tested
                                                  • Celebrate success: Recognise
                                                    and highlight great work and
                                                    positive outcomes

24    PwC
2. Build the right                                      3. Facilitate a smooth day-to-day
   organisational structure                              • Streamline paperwork: Rethink internal
• Invest in managers: Recruit and promote                  processes and explore automated and digital
  experienced managers who have done                       options for simple admin tasks
  the job                                                • Ensure sufficient resources: Respond
• Redefine management roles:                               promptly when resources need replenishing and
  Increase the time managers can                           replacing and keep staff informed of progress
  spend with staff and make sure they                    • Consult on rostering: Plan rotas well in
  aren’t overloaded by revising their                      advance and share these with staff whilst being
  responsibilities vs. regional managers and               open and flexible to changes
  other central functions                                • Embrace technology: Roll-out digital solutions
                                                           to carers and managers to better organise rotas,
                                                           manage care plans, measure progress and
                                                           outcomes, fulfil admin, etc.

  5. Drive career development
  • Develop career plans: Ensure managers work
    closely with carers to discuss and outline career
    aspirations, then create a plan and timeline to
    get there
  • Codify ‘good, better, best’: Define a set of
    objectives and behaviours that carers should adhere
    to, clearly outlining skills to be developed
  • Track progress: Ensure managers feedback and
    appraise performance of carers vs. their objectives
  • Endorse role models: Identify examples of carers
    who have worked their way up and communicate
    their story across the business
  • Focus on training: Invest in meaningful face-to-face
    training that upskills carers to fulfil their role and
    develop skills for progression

                                                                                          Who cares?     25
How we can help

Through this report we’ve touched on some           We can cut our analysis by local authority, type of provider,
                                                    type of carer, etc. There are a multitude of lenses that we
of the key insights from our research. We’ve        can use to create a picture that’s most relevant to you. And
seen the critical role that social care plays,      we can help you take these insights and synthesise them into
                                                    meaningful actions to implement across your business. If
the challenges it faces, how staffing fits into
                                                    you’d like to hear more about our research and analysis, or
that puzzle, what can be done to fix it and         you would like to discuss how our work can help you or your
why we have to act now.                             business, get in touch.

Some examples of areas in which we can help:

        Understanding your carer workforce,
                                                              Developing leadership and
        what drives them and how to develop a
                                                              governance structures
        compelling employee proposition

        Sizing the addressable pool of potential
        carers and / or care home managers in                 Building robust and engaging
        your locations and developing strategies              performance management processes
        to target them
                                                              Assessing the potential uses of
        Reviewing your quality and regulatory                 technology in managing your
        infrastructure and performance                        workforce and understanding the best
                                                              options for you

Authors – who to contact if you want to know more

             Andrew McKechnie
             Partner
             M: +44 (0)7799 602 349
             E: andrew.mckechnie@pwc.com

             Reena Virdee
             Senior Manager
             M: +44 (0)7712 596 068
             E: reena.virdee@pwc.com

             Ollie Cohen
             Manager
             M: +44 (0)7816 588 757
             E: oliver.j.cohen@pwc.com

26    PwC
Methodology

Our work has been underpinned by extensive primary
research. We conducted an online survey with a
nationally representative sample of over 2,000 UK carers
to understand how they think, feel and behave and how
they expect this to change in the future. To support these
quantitative insights, we also carried out a number of focus
groups with carers to probe specific areas of interest in
more detail and capture more qualitative insights on their
experiences, needs, demands and drivers of sentiment.

We have also used and analysed data published by
Skills for Care on the profile and state of the adult social
care workforce.

                                                               Who cares?   27
Notes

28   PwC
Who cares?   29
www.pwc.co.uk/healthcare
© 2018 PricewaterhouseCoopers LLP. All rights reserved. In this document, “PwC” refers to the UK member firm, and may sometimes refer to the PwC network. Each member firm is a
separate legal entity. Please see www.pwc.com/structure for further details.

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