collaborative recruitment solutions in social care

-getting and keeping your workforce

DH INFORMATION READER BOX

DEPARTMENT OF HEALTH STAT BOX

collaborative recruitment solutions in social care

-getting and keeping your workforce

Foreword
There is no doubt that the domiciliary care sector is facing new challenges. People are living longer and want to stay in their own homes as long as possible. The government is just as keen to help them retain their independence. But to do this, older people and other vulnerable people with learning or physical disabilities need care and support. This is a very labour intensive sector; if we do not tackle the staffing challenge now, homecare services are going to be seriously affected in the future. This report looks at what individual organisations are doing to address homecare recruitment and retention. It highlights the importance of collaboration across statutory and non-statutory providers in a fragmented sector where many small organisations struggle to compete. Case studies explain how collaboration in various guises can offer a range of benefits and meet specific objectives. The report outlines ways employers have successfully overcome barriers to recruitment, sometimes by taking a fresh approach to existing activities. A traditionally limited labour pool can be expanded by targeting younger people, overseas workers and marginalised groups. But attracting workers is only part of the challenge keeping them can be just as hard. Turnover of domiciliary care staff is 75% in some areas. So the report looks at how to make workers feel valued and stop leakage of new recruits. Ivan Lewis MP,
Minister for Social Care

What many of these examples show is that the simplest actions, like revising application forms, can make a big difference. And because they are drawn from real initiatives, they dont ignore potential obstacles. Instead the report identifies realistic ways around perceived barriers, such as the need for homecare workers to be mobile, or restrictions on employing under-18s. The report also addresses common underlying issues, such as securing funding for sustainable initiatives, and getting the level of buy-in required to make real changes. Its about being flexible and appreciating the potential scale of future problems. Only then can employers begin to invest the necessary time, thought and resources into adopting more innovative approaches now. These initiatives may not suit every homecare provider. Some, particularly efforts to make domiciliary care a more attractive career option, will take time to reap rewards. But this varied range of proactive and positive approaches is well worth sharing, and will save other organisations from starting from scratch. And it is a comforting reminder that you are not alone in facing the challenge.

CONTENTS
1
06 11

Issues facing social care recruitment and retention

Introduction Background About this report

12 17

Working together
Large-scale collaboratives Partnership working

18 23

Approaches to recruitment
Developing a workforce strategy Raising the profile of social care Communication to support recruitment

Increasing the pool

Attracting young people Recruiting from marginalised communities International recruitment

24 31

5
Training

30 37

Promoting retention
Career pathways Increasing job satisfaction Financial incentives

6
Funding

38 43

Factors to consider
Staffing resources Wide-ranging support Communication Obstacles

Conclusion...................................................................................44 Appendix.....................................................................................45

Chapter 1

Introduction Background About this report

08

Issues facing social care recruitment and retention

Introduction
The aim of this report is to help tackle workforce recruitment and retention problems across the whole social care industry by highlighting examples of good practice where a collaborative approach is proving effective. There is a strong focus on domiciliary services, where severe difficulties are making it hard to increase current capacity in line with demand and are likely to impede the development of essential services in the future. Since nearly 70% of domiciliary care is now delivered by independent organisations, there is emphasis within the report on examples of collaborative working across statutory and nonstatutory sectors that have resulted in mutually supportive and effective strategies for workforce recruitment, retention and development. The intention is to disseminate information about the various initiatives and strategies and about effective joint working in a range of different ways to ensure that schemes can be replicated without having to start from scratch and that the learning is available to help others setting up schemes.

1
time, have been required to limit their services on the basis of needs assessments. The number of hours of domiciliary care delivered in a typical week more than doubled between 1992 and 2003, reaching 3.4 million hours per week. Approximately 700,000 people a year now receive a domiciliary service, compared with fewer than half that number in care homes. There is still pressure from the government to increase the proportion of people supported at home. New targets are for social services to focus at least 34% of all older peoples services expenditure on home-based support by 2008. The 2006 White Paper Our health, our care, our say, with its increased emphasis on choice and control for service users, will mean even more demand for home-based care.
1

Staffing demands
Domiciliary care, and all forms of care that support people in their homes and in their communities, are staff intensive. Far more people with mental health problems or learning disabilities now live in the community. Social care support services, expanded since 2003 as a result of the Supporting People programme to help vulnerable people live independently, are likely to be drawing on the same pool of potential staff as domiciliary care providers. The direct payment scheme of cash payments made in lieu of social service provision to individuals who have been assessed as needing services, is predicted to grow and may lead to further demands for staff. At this stage it is uncertain, however, whether the result will be a shift in workforce from formal domiciliary care organisations to working

Background
The growing need for social care
Government policy over the last 12 years has been to support people in their own homes and in the community wherever possible, leading to considerable expansion of some social care services such as domiciliary care. This has been at the cost of losing or reducing capacity in other services such as residential and nursing homes which, for the first

09

1 | Issues facing social care recruitment and retention

individually, or whether the one-to-one employer/employee relationship will draw in new staff resources (including family members). Possibly both of these will result since domiciliary providers already report that they are losing staff to people who have moved over to direct payment arrangements.

Demographics
Government policy has undoubtedly led to increased demand for social care, but demographic shifts also contribute to the need for growth in capacity. Growing numbers of older people, and particularly those in the 80 and over age group, where dependency levels are known to rise sharply, are already having an impact on demand. In the future this trend towards an older population is likely to create huge pressure to provide additional services, though possibly this may be mitigated slightly by the development of alternative forms of support like telecare and assistive technology. Expected increases in the average life expectancy of people with learning disabilities will also add to pressures. While the proportion of older people in the population is increasing, there is both a proportionate and real reduction in people of working age. There are worrying predictions of a growing gap between demand for home care and other community-based services and a dwindling supply of people to provide these services. Particularly alarming is the tentative projection that at current patterns of care and recruitment, by 2014 the supply of homecare workers will have dropped by 4% while demand will have risen by 18%. The UK Home Care Association has reported a reduction in the number of recruits compared with an earlier study, which may indicate that the gap is already opening up.
10 9 8 7 6 5

Funding arrangements
Recent evidence suggests that funding shortfalls may be beginning to impact on demand, demonstrated by a reduction in the number of care packages for older people between 2003/04 and 2004/05. In residential care services, home owners report increasing referrals of more complex cases. It is likely that the real explanation is tightening eligibility and the concentration of available resources on intensive care packages. Nevertheless many authorities are sending out warning signals that settlement levels and the capping of council tax may lead to severe cuts in domiciliary care services and fewer residential placements in the future.
2

Future capacity
There are real questions about future capacity which need addressing urgently. The Department of Health (DH) has taken the lead on this with a number of different initiatives over the last few years. The DH has commissioned research on attitudes to social work and social care and their image as potential careers and funded a 1.5m social care recruitment campaign. Despite a good response to the campaign, anecdotal evidence is that relatively few recruits have chosen to work in domiciliary care, probably because guaranteed full-time work is rarely on offer and because the pressure to work in the early mornings and late evenings, with little work available during the day, has proved unattractive. The national framework to support local workforce strategy development, introduced by the DH in 2005, and other national initiatives are intended to stimulate innovative approaches to the productive use of available workforces in both health and social care.
4 3

The social care environment

Since 1993 social care services have operated within both a market managed by local authorities social services departments and a context of assessment of needs. The imposition of eligibility criteria was intended to reduce markedly the demand for care home places, replacing them with services to support people at home. Effective management of the market was expected to result in increasing availability of home care, lowering or holding down costs, and improvements in quality as organisations competed for business.

10

It was thought that some of the increase in home care availability would result from care homes diversifying into home care and other communitybased services, with their staff transferring relatively effortlessly to the different roles. This proved not to be the case but over the next few years large numbers of new organisations entered the market in response to growing opportunities. With no barriers to entry and the ease with which staff could then be attracted, service provision rapidly became exceptionally fragmented. Despite some consolidation and a reduction in the number of providers with whom local authorities are willing to contract, this remains the case. There are around 4,700 domiciliary care providers now registered with the Commission for Social Care Inspection, many of them very small.

needed for large-scale contracted service supply. Both the pay and terms and conditions of people working in the independent social care sector are markedly poorer than for those working in the statutory sector.
11

The competition for recruits

Relative economic prosperity and almost full employment in many areas mean that social care services are competing with many other opportunities for full and part-time employment for women. In some areas this has meant that employers have had to offer annual pay increases far higher than inflation. Services are still largely staffed by women although male recruits appear to be more readily accepted for support posts. The Commission for Social Care Inspection reports that vacancy rates in social care are higher than for all other employment sectors in England.
12

The role of the independent sector

The independent sector traditionally offered very flexible services and also the opportunity to work flexibly. On the other hand, in domiciliary care, it could not guarantee work and tended to pay only for actual contact time that the care worker spent with the service user. Independent organisations also operated as agents to introduce individual service providers to users who could directly purchase the service themselves or obtain the funding from charitable or other sources. Initially, choice offered by the governments policy for care in the community was widely interpreted as the choice to remain at home and, with little in the way of eligibility criteria and generous budgets, extensive support was available in many authorities. Since there was no charging, the private market for home care was unable to compete and virtually disappeared. Independent organisations became, and have largely remained, over-dependent on single, powerful local authority purchasers. So effective have local authorities proved at managing the market that independent providers have found it difficult to obtain prices reflecting the greater costs associated with building the more professional, reliable and available workforces

Training requirements
Much of social care is now regulated, including both care homes and domiciliary care. Regulation has brought with it the requirement for workforce qualifications such as NVQs, which should, over time, lead to a more competent and professional workforce. Although training is an attraction to many people coming into social care, some 25% of care workers are known to be women aged 50 and over and among this group there is significant resistance to being required to train. Many have already left the industry, even though employers have tended to regard their older workers as less likely to be among the 50% required to have NVQ level 2 by 2008 and taken a more relaxed view about registering them for NVQs. By 2007 all care workers in domiciliary services will be required to register with the General Social Care Council. While in the long term this may help to raise the status and quality of this form of social care work, it will immediately increase pressure for the whole workforce to acquire qualifications and may well be regarded as yet another hurdle.
13

11

1 | Issues facing social care recruitment and retention

About this report

This study was commissioned by the National Older Peoples Programme of the Care Services Improvement Partnership (formerly the Department of Health funded Change Agent Team), in response to a growing awareness that the development and commissioning of diverse, innovative and high quality services was being impeded by the lack of staff to run them. CSIP is indebted to Lucianne Sawyer
CBE*

employers questioned about their experience in developing appropriate workforces and the extent to which they felt that initiatives in their area had helped. Researchers and others working in the field of workforce development also gave their views. Note that the terms domiciliary care, home care and home-based care are used interchangeably. Where services or staff are described as in-house this refers specifically to directly provided statutory social care services.

for her extensive research and for the

first draft of this report; and also to Pauline Spencer who helped gather and check the evidence. In addition, the National Homecare Council, which represents local authority provided and commissioned home care services, contributed to the early scoping of the project. Information about recruitment initiatives and the extent of collaboration was mainly gathered through a survey of all local authorities with social services responsibilities, strategic health authorities, primary care trusts, Skills for Care regional offices and Workforce Confederation regional committees. Additional projects were identified from published reports and articles, through responses to the letter sent to key stakeholders introducing this project and via a variety of other leads and introductions. In total around 90 organisations provided information at this initial stage. Of these, 30 organisations were selected, based on who their project was targeting, how much collaboration was involved and what strategies they had adopted, and asked for more details from a nominated contact. A semi-structured questionnaire was used for these interviews to ensure comparable and complete information was collected from each site. Other people and organisations also involved in the project were contacted for their views on some of the initiatives and independent domiciliary care

Good practice?
It is not easy to say with certainty whether the many initiatives and innovative approaches to recruitment outlined in this report are really contributing to improvements in recruiting and retaining social care staff. For one thing, much of the work, such as raising the profile of social care, is long-term investment rather than offering immediate impact. Many of the projects were relatively new and most had not been formally evaluated at the time the information was gathered for this report. In addition, recruitment success varies geographically depending on a number of external factors, so what is successful in one area may not work elsewhere. Nevertheless, this report covers a variety of proactive, positive and exciting approaches that others may find interesting and helpful in improving workforce recruitment and retention. Contact details are included so you can talk to the people involved about their experiences in more detail, and whether their projects are proving successful. Some organisations are responsible for a number of initiatives referred to in different sections of the report. These are not cross-referenced because although part of an overall recruitment strategy, individually they are approaches that work on their own.

* Lucianne Sawyer, CBE, president of the United Kingdom Home Care Association

12

One problem at present is the turnover of care workers chasing slightly higher wages being offered by another provider. They go round and round
Recruitment and retention project officer

Notes
1 Our health, our care, our say: a new direction for community services Department of Health Stationery Office 2006 2 Referrals, assessments and packages of care Department of Health 2005 3 Perceptions of social work and social care Department of Health/COI 2001 4 National framework to support local workforce strategy development Department of Health 2005 5 National Statistics website http://www.statistics.gov.uk 6 Estimating future needs/demands for support for adults with learning disabilities in England Institute for Health Research 2004 7 The state of social care in England 200405 Commission for Social Care Inspection 2005 8 Philip Mickelborough at Laing and Buissons 2005 Home Care Conference 9 Who cares now? UK Home Care Association 2004 10 Who cares? UK Home Care Association 2001 11 Joseph Rowntree Foundation - various research findings 12 The state of social care in England 200405 Commission for Social Care Inspection 2005 13 Who cares now? UK Home Care Association 2004

13

Chapter 2
14

Large-scale collaboratives Partnership working

2
Working together
Working together can be a worthwhile approach to recruitment, even if the organisations involved could be seen as competing with each other for staff. Collaboration can take many forms. It may be a formal agreement between a number of large organisations within a geographical area or a close partnership between smaller bodies, such as a local authority and an employer. Collaborative approaches are especially helpful in reaching disparate groups of people, for example, to raise the profile of social care careers among potential recruits of all ages. They offer practical benefits such as shared budgets and resources. Different organisations may be able to offer diverse experiences, knowledge and skills. This chapter looks at some specific examples of how large-scale collaboratives and partnership working between authorities and private employers can operate. There appear to be clear advantages from largescale collaboratives in terms of the pooling and costeffective use of resources, the potential for sharing ideas and the opportunities to improve communication and relationships across borders and across sectors.

CASE STUDIES The Black Country Partnership for Care

The Black Country Partnership for Care (BCPC) originated with authorities in Dudley, Walsall and Wolverhampton in response to concerns about the ability of providers to meet NVQ targets within the required timescale. As a result, the partnership worked with the Learning and Skills Council (LSC) to develop a joint training programme, for home care staff in the independent sector to achieve NVQ2 in care. The BCPCs second initiative aimed to tackle the sectors inability to attract care staff. Through Skills for Care an employers group was formed which linked with Jobcentre Plus. A subsequent bid for LSC European Social Fund (ESF) funding led by Sandwell set up a project to recruit people who had been out of the workforce for some time and were new to care. It placed emphasis on recruiting people from deprived backgrounds. Providing support and pre-employment training has successfully attracted recruits to the care sector. The initial training and recruitment initiatives continue and new initiatives have developed as needs have been recognised. BCPC is now the sub-regional employer partnership of Skills for Care in the west midlands region. Independent providers from all four areas are

Large-scale collaboratives
There are large-scale collaboratives working in a number of areas, involving several authorities, independent providers and other organisations. Geographically these collaboratives are frequently based on the sub-regions of the national body Skills for Care, which works on behalf of social care employers to enhance the quality of staff and services in social care. In some cases it is the extent of collaboration across health and social care, rather than across local authority boundaries, which is effectively delivering the range of initiatives that are characteristic of larger groupings.

15

2 | Working together

fully engaged. Members of the BCPC board include: employers training providers the LSC sector skills manager local authority HR departments the COVE (Centre for Vocational Excellence) a health representative This collaborative is seen as very successful by both the statutory sector initiators and by independent employers. It is pulling people together and leading to other projects. One big advantage is the potential for sharing resources one project manager for the whole training project over four local authority areas, and a full-time workforce development coordinator and administrator for the recruitment and other initiatives. Contact: Andrew Packer E-mail: andrew.packer@dudley.gov.uk Phone: 01384 813131

E-mail: trevor.hewitt@barnsley.gov.uk Phone: 01226 772378

East Riding Yorkshire Multi-Agency Workforce Collaborative

The collaborative came about through fears that without a more proactive approach the skills the local authority would need to commission from the independent sector might not be there in the future. The intention was to create opportunities for independent employers to join in open, frank and purposeful discussion of social care staffing problems among all partners. Some of these organisations had previously felt they were in adversarial relationships. The collaborative is chaired by the local authority and brings together a range of interests including employers, the NHS, training providers and the Sector Skills Council. It has led to investment in a number of activities to support recruitment. For example: independent providers are offered some short course training on a par with the statutory sector the Council has been instrumental in coordinating a pilot investment in free distance learning events have been organised to support schools delivering vocational courses Job Centre advisors have been updated on opportunities in social care Contact: Jeff Wheelwright E-mail: jeff.wheelwright@skillsforcare.org.uk Phone: 01482 802415 Contact: Jo Shores E-mail: jo.shores@eastriding.gov.uk Phone: 01482 391164

The Quality Care Partnership

The Quality Care Partnership is made up of four authorities, Rotherham, Sheffield, Doncaster and Barnsley, the local Learning and Skills Council (LSC), Skills for Care and independent employers. Its board is employer-led but includes representatives from the other key organisations. Of the 600 independent providers in South Yorkshire, 400 are members. Initiatives developed through the Quality Care Partnership include: workforce planning the Future Carers training programme Ambition Health a two-year programme for NVQ3 candidates. One of the advantages of the collaborative is that it effectively divorces workforce and training issues from more contentious issues such as fees. Providers value the support they receive with recruitment and workforce development. The collaborative has helped build good relationships among the various organisations and trust between authorities and providers. Contact: Trevor Hewitt

Health and social care in Cheshire

In Cheshire collaboration between health and social care authorities has resulted in a proactive approach to workforce development, with strategic management, primarily between Cheshire County Council social services and NHS trust managers, recognising many shared issues. Strategic planning across health and social care is

16

beginning to happen. The county council has appointed a senior officer to liaise with health colleagues and organisations, while the strategic health authority has funded three posts, one in each locality, to promote joint workforce development. The Cheshire sub-region of the North West Sector Skills and Productivity Alliance is identifying policy drivers and ways to optimise available resources. The range of initiatives which have resulted from this collaboration include: careers development cadet/trainee programmes specialist diploma development supported training programmes supporting employers in provision of entry level NVQs (LSC-funded) an employment charter on employment opportunities for people with mental health problems international partnerships liaison with Jobcentre Plus job fairs, job shops, events and careers promotion changes to recruitment procedures role redesign and enhanced duties to make home care more attractive to potential applicants. A reference group across health and social care meets regularly to share information, developments and workforce issues. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

CASE STUDIES Improving commissioning in Trafford

Twelve local employers are actively involved with Trafford Metropolitan Borough Council through the Trafford Homecare Improvement Partnership. Together they have developed a quality assurance framework against which services can be monitored. Performance-related commissioning has been introduced based on this framework and an enhanced rate for quality providers agreed. The commissioning officer role has been evaluated and contacts made at operational level, formalised by using a standard pro-forma to record issues and solutions for both commissioning officers and home care providers. The authority reports that as a result of these changes: the workforce has been stabilised intensive home care packages have increased by 62% there is a growing trend for independent providers to recruit permanent staff and to appoint senior home care workers communication between commissioners and providers has improved considerably the quality of home care has improved the commissioning process has strengthened the home care market has stabilised. Contact: Linda Harper, Trafford Metropolitan Borough Council E-mail: linda.harper@trafford.gov.uk Phone: 0161 9121890

Partnership working
Some authorities are beginning to work in real partnership with local employers, recognising each others problems and working together to reach solutions. Some partnership work is directly concerned with recruitment and workforce issues. In other cases, although the focus might not be quite so clear-cut, there are obvious benefits in terms of recruitment or retention outcomes. As some of these examples show, supporting independent providers can happen in all sorts of ways.

Cambridgeshire workforce development

Cambridgeshire, along with many other English counties, has experienced problems with recruiting and retaining staff within the social care sector. Some employers had vacancy rates of up to 20-30% and relied upon agencies to provide temporary staff cover. In order to address this issue a partnership has developed between the county council and local employers. Norfolk, Suffolk and Cambridgeshire SHA, the independent sector, Jobcentre Plus and Connexions are also part of the project.

17

2 | Working together

The councils workforce development team, which forms a part of the Disability Service, provides and arranges training for all staff, regardless of who employs them. The staff concerned provide social care services for people with learning difficulties, physical disabilities and/or sensory impairment. The independent sector and the department have also worked together via a training consortium to address training issues and to provide cost-effective and collaborative ways of providing training. A social care careers project was established by the County Council and the SHA, led by a careers adviser, in order to address recruitment and retention issues. As a result, the following projects have been established and are now in the process of development: care ambassadors (staff who visit schools and colleges in order to promote career opportunities in social care and to enhance the work-related curriculum) developing local job role profiles training mainstream careers advisers structured work shadowing for adults a contact for members of the public interested in social care careers the development of a careers matrix. Contact: Adrian Key, Social Care Careers Adviser: E-mail: adrian.key@cambridgeshire.gov.uk Phone: 07765023882 For information about the Training Consortium Contact: Jim Thomas, Workforce Development Manager E-mail: jim.thomas@cambridgeshire.gov.uk Phone: 07766441810 or 01223 718291

a 24/7 helpline for advice on disciplinary, sickness and holiday matters a tribunal service. The authority uses the HR development grant to fund this initiative. It gives providers more confidence, enables them to nip personnel problems in the bud and also makes staff feel more valued. Contact: Gillian Bennett E-mail: gillian.bennett@manchester.gov.uk Phone: 0161 2196787

Capacity building in Gloucestershire

The ethos and operation of Gloucestershires Capacity Building Project, developed following a strategic review of future home care needs, was geared towards partnership working and included many recommendations to address local employers problems. An inter-agency workforce development group focuses on developing the private and voluntary sector. A domiciliary care forum meets every two months and there are more frequent locality meetings. An independent employer sits on the Capacity Building Project board and employers have been involved in discussions about issues like the restructuring of the in-house service and caseload sizes. The project has resulted in: An allocation of part of the HR development grant to pump prime contracted providers workforces through improved pay rates and training Under new contracts, rural areas attract a slightly higher unit price to take account of increased travel and time costs. A system which ensures that providers receive very prompt payments for a percentage of care delivered Joint programmes being developed around particular areas such as medication management A profile raising group using the councils media team to feed human interest stories to the local media, thereby promoting contracted providers Mechanisms to put people interested in social care work in direct contact with providers.

Supporting employers in Manchester

Manchester City Council has recognised that providers may not have the resources to deal with personnel problems. The council offers licensed legal support through a specialist employment law consultancy at a cost per provider of 250 pa. For this they get: policy and practice updates vetting of HR paperwork, such as contracts

18

Recruitment remains very difficult in Gloucestershire but there are real hopes that these measures will pay off over the longer term and in the meantime there is strong commitment to greater openness and improved communication which, it is hoped, will lead to a more efficient work environment. Contact: Julie Walters E-mail: julie.walters@gloucestershire.gov.uk Phone: 01452 425131 or Contact: Bron Williams E-mail: bron.williams@gloucestershire.gov.uk Phone: 01452 425180

going to be needed will depend on taking into account what makes this type of work attractive to people and why they choose to remain in the industry, providing the vital life-blood of the service. Research has shown that what domiciliary staff generally like about the job is: the ability to forge good relationships with service users and being appreciated by them being able to respond flexibly to the needs and preferences of users and to use their own initiative having their views taken into account by those who are making decisions about service users or about how the service is provided working in a team good management support and being valued by managers good training development and career opportunities. What they often dislike is: job insecurity work, or amount of work, not guaranteed pressure to work at non-social times short visits not being paid for time spent travelling between service users split shifts with work often required in the early morning and late evening poor pay and terms and conditions perceived low status of social care work. Many of these attitudes may be shared by people working in other areas of social care. Although some of these factors will depend on individual providers and the way in which they run their organisations, many of them cannot be achieved by providers on their own. The way in which services are commissioned and the contracts under which they are provided will also influence the nature of the job and the terms and conditions on offer to care staff. Examples of this are provided throughout this report.

Involving service users in Somerset

In Somerset partnership working includes service users. As part of a move to make the domiciliary service more user-centred, a group of service users older people and people with physical disabilities were involved in placing new contracts, including taking part in interviews with potential providers. The authority has built on its network of service users and carers, strong relationships with providers and a long history of collaborative working. An industry group started a number of years ago has been revamped and renamed as Care Focus Somerset Partnership; it no longer focuses solely on training but also covers wider workforce issues such as recruitment and retention. All the relevant organisations were involved in the planning and are part of the partnership and, although this made the process slower, it was seen as a worthwhile exercise. Contact: Miriam Maddison E-mail: mmaddison@somerset.gov.uk Phone: 01823 356631

What do care staff want?

All of the foregoing emphasises the challenges that face the purchasing authorities and their providers and the importance of working in partnership. As well as having a clear view of future needs, successfully increasing the volume of care which is

19

Chapter 3
20

Developing a workforce strategy Raising the profile of social care Communication to support recruitment

3
Approaches to recruitment
Overcoming barriers to recruitment may be a matter of taking a more innovative approach to traditional activities rather than introducing something entirely new. This chapter looks at key steps in recruitment, including: developing a workforce strategy raising the profile of social care communication to support recruitment.

CASE STUDIES Worker appointed to help independent sector

Barnsley Metropolitan Borough Council realised that they could not get a complete picture without assessing the present and future workforce across both the in-house and independent sectors. This proved difficult because the range and quality of the data held by the different players were extremely varied. Data were more readily available for the inhouse service. Through the Quality Care Partnership, which extends across four South Yorkshire authorities, they have now appointed a worker to assist the independent sector in collecting and collating workforce data including skill shortages and projected future needs. This information will feed into the regional Skills for Care network and form part of the national census as well as into Barnsleys workforce planning and strategy. Contact: Trevor Hewitt E-mail: trevorhewitt@barnsley.gov.uk Tel: 01226 772378

Developing a workforce strategy

Developing a workforce strategy needs to start with a thorough workforce analysis, looking at the local situation within the context of national data. Some authorities have recognised this critical building block and thought carefully about how to obtain the most complete picture possible of their area. As well as ensuring that workforce projections are as accurate as possible, there were reports that some independent providers reviewed and changed their recruitment strategies in the light of national data. Any strategy should also recognise potential barriers to recruitment. For instance, Criminal Record Bureau (CRB) checks are creating difficulties everywhere. People who apply for jobs in social care are usually in the position of needing to start earning money relatively quickly. Having to wait up to nine weeks for CRB clearance can be a major disincentive. Often potential recruits have moved on to other jobs by the time their clearance comes through, leaving employers to cover the costs of recruitment, the CRB check, and at least part of the induction.

Annual review of data

The Black Country Partnership for Care , supported by the Learning and Skills Council, has commissioned the collection of workforce data from independent sector employers. This review is now repeated annually by the Partnership. There is currently a project to implement the National Minimum Data Set across the Black Country led by BCPC. Contact: Andrew Packer E-mail: : Andrew.packer@dudley.gov.uk Tel: 01384 813131

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3 | Approaches to recruitment

IT support for small providers

Manchester City Council has recognised that if the workforce situation is to be resolved, technology needs to play its part. The council has provided local employers with computers, where necessary, and personnel software, and given them training so that they can collect data in a form most useful to the council. This is also seen as helpful to small providers that may not be IT aware. The approach is expected to greatly improve communication and has also helped take forward another initiative, the setting up of a care vacancy site. Contact: Gillian Bennett E-mail: gillian.bennett@manchester.gov.uk Tel: 0161 219 6787

CASE STUDIES Using multi-media

Oxfordshire County Council has used a multi-media campaign to raise awareness of the potential for working in social care, including: local radio and television the local press advertisements on buses information in community halls, doctors surgeries and libraries details at Jobcentre Plus and job fairs. Numbers of applicants have increased tenfold with this approach. Local radio has proved particularly effective. There is a link from the council website directly to local contracted employers who can provide information on their own employment opportunities. Contact: Joan Chattey E-mail: joanchattey@oxfordshire.gov.uk Tel: 01865 815774

Raising the profile of social care

Attempts to raise the profile of social care careers need to take into account what makes this type of work attractive to people and why they choose to remain in the industry. It helps to keep these factors in mind when planning how to provide services and attract, recruit and develop a suitable workforce. The research into what domiciliary staff generally like about the job was listed on p.XX. There is certainly a need for social care to have a higher profile. But efforts in this direction should be sustained and fairly substantial if there is to be a real impact. Independent employers are very unlikely to be able to engage in effective profile-raising activities on their own since they will probably not have the necessary resources, and a collaborative approach is therefore important. Although in some cases the impact of an initiative can be seen quite quickly through an increase in job applications, the real value of raising the profile of social care may only be apparent over a much longer term as the idea of working in social care gradually becomes part of the normal spectrum of potential job opportunities.

Highlighting real roles

Cambridgeshire County Council has produced locally focused career materials, which feature job roles across the social care sector. Each profile displays photographs of the staff concerned, and features a description of the job written by the member of staff being profiled. This information is now widely available throughout the county to young people and adults, and will hopefully encourage them to consider a career in social care. Contact: Adrian Key, Social Care Careers Adviser Email: adrian.key@cambridgeshire.gov.uk Tel: 07765 023882

Educating job centre staff

Sheffield City Councils locality manager has given talks about the social care sector to job centre staff. The council offers pre-employment training for potential applicants followed by four-week work placements shadowing existing staff, during which CRB checks are carried out. The council also successfully promotes social care jobs through local cinema advertising that runs

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before the main feature. The cost is nominal and the long-running campaign gives a hotline number for further information. All initiatives carry the strap-line What do you do in the mornings? Contact: Helen Rowe, locality manager Care4You Service E-mail: helen.rowe@sheffield.gov.uk Phone: 0114 203 7107

Advertising can be very costly so it is important that expenditure is as cost-effective as possible. Advertisements and any specific recruitment literature must be appealing and relevant to the target audience or could end up a waste of money. The response people get when they enquire about care work whether as a result of advertising or anything else is also critical, and some authorities have taken action to ensure that all calls are dealt with in a positive and helpful way. Sometimes employers feel they have no alternative but to continue advertising even if they dont get a good response. But there are other approaches, such as job fairs. These need to be big and varied to attract people. Local employers may find that their own attempts to put on such events are ineffective, but have reservations about events where they are competing with in-house providers who are in a position to offer much better terms and conditions. And organisations which provide a service within a very local area could find that large centralised events do nothing to assist their recruitment problems. It is worth remembering that every local authority has its own website, which can potentially be used

Communication to support recruitment

Different methods of communication have a part to play both in raising the profile of the sector and recruiting to specific job vacancies. It is important to have well-designed and attractive recruitment literature that can come in many forms, from small eye-catching ideas to more detailed explanatory information. Advertising offers the most direct approach to attract new recruits; the majority of care workers find their job through newspaper or other advertisements.
14

People with qualifications are starting to choose where they want to work but terms and conditions, especially wages and annual leave, are the main factors. Organisations which pay the highest wages get the better choice of applicants.
Workforce development officer

as a recruitment tool, featuring specific vacancies as well as more general careers information.

CASE STUDIES Library link-up

Cambridgeshire County Council has joined with the local library service to produce a bookmark available free from all libraries. One side of the bookmark carries details of library opening times and related information while on the reverse is a message about careers in the care sector. It also gives the phone number for a contact centre so anyone interested can request an information pack or talk to someone about career opportunities. Contact: Adrian Keys E-mail: Adrian.Keys@cambridgeshire.gov.uk Phone: 077650 23882

Advertising may be another area of collaboration for authorities, particularly because it can be relatively cheap when done through the council website. It is possible to provide a direct link from the authoritys website into organisations that provide social care services on a block basis.

Careers guide
East Riding of Yorkshire Council, on behalf of the

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3 | Approaches to recruitment

Multi-Agency Workforce Collaborative, has produced an attractively designed guide to careers in social care, social work and healthcare. It outlines job roles, provides a useful qualification grid and suggests ways into different career routes. The guide features illustrated examples of people currently working in social care and the jobs they do. This has now been complemented by a professionally produced DVD targeted at young people considering a career in social care. Contact: Jeff Wheelwright E-mail: jeff.wheelwright@skillsforcare.gov.uk Phone: 01482 802415 or Contact: Jo Shores E-mail: jo.shores@eastriding.gov.uk Phone: 01482 391164

substantial levels of vacancies. Contact: Gillian Bennett E-mail: gillian.bennett@manchester.gov.uk Phone: 0161 2196787

Jobs and training website

Oxfordshire County Council has a website aimed at employers and trainers that also highlights available job opportunities and offers job seekers direct links to local authority and/or independent sector employers. The site receives hits regularly (more than 2,000 in the first few months) and covers different areas of employment, which means people not previously aware of social care careers may come across care sector information while browsing. The section specifically on social care has external links to further information and career paths. Care sector organisations meet regularly with the consultancy that project manages the website to ensure it provides what is needed. Contact: Joan Chattey E-mail: joan.chattey@oxfordshire.gov.uk Phone 01685 815774

Learning to get the most from ads

In Cheshire, where there is a collaborative approach to workforce development across the strategic health authority, PCTs and local councils, a workforce conference included a workshop on how to get the most from advertising. It featured role play highlighting the approaches most likely to deter potential applicants and those more likely to engage them. The workshop was run by a national advertising agency contracted to Cheshire County Council. While a small independent organisation might not be able to provide training of this sort itself, authorities or employers working in collaboration could organise something similar as part of a joint workforce development event. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

City-wide job fair

Manchester City Council hosted a big job fair, funded by the HR development grant. It was well advertised on the Metrolink public transport system, local radio, newspapers and posters. The event was held in Manchesters Town Hall and was attended by 600 people, 70% of whom were local residents. There are plans for further events in other areas of the city, building on this successful approach, which resulted in one local employer receiving 27 applicants. Contact: Gillian Bennett E-mail: gillian.bennett@manchester.gov.uk Phone: 0161 219 6787

Care vacancy website

The provision of IT hardware to independent providers in Manchester to assist with the collection of workforce data has also supported the setting up of a care vacancy site. This allows employers to advertise their vacancies and applicants to respond online. Use of the webpage should also highlight problems such as providers who have consistent or

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Pay is a major issue there is a conflict of interest in that care workers have to earn a living but providers have to remain competitive
Independent employer

Notes
1 Who cares now? UK Home Care Association 2004

25

Chapter 4
26

Attracting young people Recruiting from marginalised communities International recruitment

4
Increasing the pool
A common concern among social care employers is that the relevant labour market is quite limited and we are all fishing in the same pool. Understanding this may act as a spur to working collaboratively to find solutions, rather than just continuing to compete for a dwindling supply of suitable staff; it may also lead to initiatives aimed at increasing the pool of available recruits targeting: young people people from marginalised communities (see p.27) staff from overseas. The choice of approach needs to be appropriate to the target group. Another effective approach is to develop cadet schemes to attract young people into health or social care work. These usually consist of a combination of work experience placements and a part-time college course, normally leading to an NVQ at either level 2 or 3. Overall there is a lot of interesting work going on with schools in many areas, such as: ensuring that school careers advisers are well briefed on social care opportunities attending school careers events developing material like CDs especially for use in schools supporting teachers delivering the GNVQ in social care providing supported visits for teachers.

Attracting young people

Many authorities and social care organisations are doing their best to make sure that young people are aware of the potential for employment in social care, using a variety of strategies. A popular approach is introducing care ambassador schemes. The thinking is that young and personable staff already working in social care, and who are able to talk enthusiastically and positively about their own jobs, are in the best position to attract other young people into social care work. In most areas where this has been tried, there is great enthusiasm for the scheme. But school visits by care ambassadors require careful planning. Schools often want a session at 9 am and may not understand that this is a difficult time for employers to release any staff. It helps if schools talk directly to employers when planning visits.

Potential barriers
The commonly held belief that the Commission for Social Care Inspection (CSCI) insists that people must be aged 18 and over to engage in direct care duties, specifically personal care tasks, often leads to concern that this creates problems in retaining the interest of the 16+ group until they reach 18. As a result many initiatives aimed at attracting younger people are not delivering any new recruits into home care posts. This mythical age barrier is seemingly the reason there are not many examples of well-developed apprenticeship schemes in the social care sector. For instance, Norfolk County Council first targeted 17 year olds, but raised the age to 18 because of the anticipated CSCI response. There are cases of authorities being unable to attract sufficient young people into care work but able to recruit them as

27

4 | Increasing the pool

apprentices to administrative jobs. CSCI guidance (see Appendix) makes it clear there is no such ban, although there is a need to ensure that younger people have undertaken the essential training required for all recruits. Of course there are other aspects of home care which make it difficult to employ young people, one of which is the need in most cases to be a car driver and have access to a vehicle. Another is the fact that care workers usually work on their own in service users homes. There is apparently a growing need for two-handed visits as increasing numbers of people with very high dependency levels are maintained in the community, so that one option may be to employ younger recruits to travel and work in tandem with an experienced worker providing such visits. Structuring frontline staff so that there is a small team within a given area, together with a senior care worker who has a supervisory role, may also be a way of ensuring that younger workers have adequate support, but this does depend on whether or not commissioning delivers viable caseloads to enable providers to focus on specific localities.

there is an expectation that some of them intend to pursue career opportunities within social care. Contact: Jane Connolly E-mail: janeconnolly@stockport.gov.uk or Contact: Christine Ash E-mail: christine.ash@stockport.gov.uk

Care Ambassador scheme toolkit

Four authorities in the area have implemented Care Ambassador schemes based on a model developed by Skills for Care SW England in partnership with the Dorset Care Association employers group. There is a toolkit available. In tandem with the schemes, handbooks for students, employers and teachers have now been developed as part of a structured work experience programme. There is also a care ambassadors website and plans for a DVD. Contact: Denise Harrison E-mail: denise.harrison@skillsforcaresw.org.uk Phone: 01305 816080

Mix of initiatives for schools

Co-ordinated initiatives are supporting the school curriculum in Cheshire. These include talks in schools, attendance at careers evenings, work experience opportunities, specific localised programmes such as young apprenticeships and junior scholarships and pilots of specialist diplomas. Teachers and careers advisers are offered supported visits. A wide network of partnerships is also developing between the countys local authorities, PCTs, the strategic health authority academy, Connexions services, further education colleges, Education Business Plus and the Aim Higher project. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

CASE STUDIES Integrated approach

In 2003 Stockport Metropolitan Borough Council had no initiatives targeted at young people. Statistics showed 600 young people enrolled on health and social care courses in the area but this pool of potential recruits was being tapped only by the health sector. Since that time a schools and colleges liaison project has been set up in partnership with other stakeholders to develop an integrated approach to attracting more young people into social care. The project has adopted various strategies, including: influencing career choice among 14-16 year olds offering a range of work experience placements for 16-19 year olds a care ambassador scheme a care cadet scheme. There has been positive feedback from students and

Recruiting from marginalised communities

There is a lot of exciting work being done to attract people who may never imagine (even if they knew about it) that they could get a job in social care, for a

28

variety of reasons. For instance, they may have feared exclusion on the grounds of age, lack relevant qualifications or skills, come from a socially excluded community or been unemployed over a long period. A common element of such schemes is providing handholding or other support wherever necessary, an ability to think out of the box and a flexible approach to conventional recruiting procedures. A number of innovative schemes are making a contribution to the numbers in the local social care workforce. Pre-application training can play a major role in getting people job-ready, particularly if they have been unemployed for long periods. Although people often remain on benefits while doing pre-application training, in some places they get paid to train and this is seen as an important element in the success of those schemes. Mentoring schemes to provide ongoing support once someone starts work can be very helpful in stemming leakage of recruits within the early weeks of employment.

likely to be drivers or to have access to a roadworthy vehicle. Authorities recognise the difficulties posed by the need for care workers to be mobile, especially in rural areas, and some have found ways to address this. For instance, recruits may be placed in a residential home or day-care centre until they are able to fund driving lessons and acquire a vehicle, or given home care assignments which involve doubling-up with another worker. Barnsley MBC has teamed up with a scheme called Wheels to Work which provides mopeds so that staff are able to get around the more rural parts of the authority. Some local authorities still pay a bicycle allowance.

CASE STUDIES Future carers scheme

Barnsley MBC launched its Future Carers programme to tackle recruitment problems in an area with a 5% unemployment rate and also to address issues of diversity and exclusion. Many people not in work were regarded as unemployable. The scheme, funded by the European Social Fund, consists of a 16-week programme that trains up to Skills for Care foundation standards and also covers basic skills. During this period CRB checks are completed, there are options to look at various areas of social care and participation in job taster days. Work placements are provided by a growing number of independent contracted providers. Trainees remain on benefits until they are in a job. Participants are given help with job searches and applications. Provision on the Future Carers scheme is for two cohorts each year. Of the first cohort 12 out of 16 were successful in getting through the course, and the majority went into social care jobs. Contact: Trevor Hewitt E-mail: trevorhewitt@barnsley.gov.uk Phone: 01226 772378

We have always celebrated our successes. It never ceases to amaze me how excited people get theyve often had no success at school. Seeing their excitement and satisfaction is a great encouragement to all the rest of us the wow factor!
HR manager, about a successful scheme recruiting and training people from very deprived areas

Overcoming the mobility problem

One of the difficulties in placing people in home care positions is that they need to be able to drive. Although this can be a barrier for all sorts of staff, when people have been unemployed for some time or they are otherwise disadvantaged, they are less

Open day for unemployed

Enfield Council, in partnership with Jobcentre Plus and Focus Training, organised an open day for people who had been unemployed for six months or more. Those who expressed an interest in social care

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4 | Increasing the pool

at the event were given a basic literacy test and a very short interview. Successful candidates were then able to undertake a two or three-week fulltime basic training course in care. Training was provided by a local training agency and included taster days arranged with the in-house service. This project was found to be very successful. Not only did candidates go into social care jobs but also a great deal of time was saved in vetting applications because those who had done the course were able to make a conscious decision to apply for work. Funding for the project has since been withdrawn due to changing priorities within Jobcentre Plus. Contact: Sue Collingridge E-mail: sue.collingridge@enfield.gov.uk Phone: 0208 379 8099

term gains. Typically one event attended by 120 young people resulted in 62 requests for further information about careers in social care. Contact: Shirley Brennan E-mail: shirley.brennan@stoke.gov.uk Phone: 01782 599965

Training support
Cheshire County Councils intermediate labour market programme aims to provide a bridge back into work by improving peoples employability. The scheme is being implemented in localities by groups that include independent employers. The main part of the six-month programme is a supported training contract. It also includes pre-access training, personal development and assistance with job search. The key thing about this programme is that it is a job with training, rather than a training scheme, and participants are paid the going rate for the job. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

Targeting older workers

Warwickshire Quality Partnership Initiative (County Council) aims to recruit older care workers as part of its Careers in Care strategy to encourage more applications from marginalised groups. A key part of the campaign is a leaflet designed as a recruitment tool and available to the independent sector free of charge. Prominently asking Am I too old to care? and showing older care workers on the inside pages. Contact: Elaine Ives E-mail: elaineives@warwickshire.gov.uk Phone: 01926 731034

Applicant friendly recruitment

Conventional recruitment procedures can pose obstacles to applicants who lack basic literacy skills, or who are not confident about filling in forms. Cheshire County Council has piloted shorter application forms and introduced less formal interviewing procedures. Another approach is having lay assessors on recruitment panels. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

Service users join ambassadors

Staffordshire County Council has worked in collaboration with the Staffordshire and Stoke Social Care Workforce Partnership to develop a rapidly growing care ambassador scheme, funded jointly by the county councils social care and health directorate and supported by Stoke-on-Trent City Council. Several ambassadors come from independent employers and some service users. The intention is to extend this scheme to attract older people into social care by using ambassadors from relevant age groups. The scheme is viewed as a longer-term recruitment strategy with some short-

Support for new recruits

Staffordshire County Councils care ambassador scheme aims to attract older workers, especially people who have been carers or who have some form of disability themselves. The council has also obtained funding for a programme of mentoring to support new recruits. The 10 mentors will each mentor five recently appointed care workers over a period of around 12 weeks, giving them up to 25

30

hours each of mentoring time. This should reduce the problems employers often experience of new care workers leaving within the first few weeks in the job and after money has been invested in recruiting, obtaining CRB clearance and providing induction training, so the scheme might well prove cost-effective. Contact: Penny Lawlor E-mail: pennylawlor@aol.com Phone: 07815 827430

visiting countries themselves to select staff obtaining police checks on candidates and evidence of driving tests while in the country, and also ascertaining that candidates can speak English giving candidates a two-week orientation course on living in England when they first arrive in the UK. During this first fortnight recruits also take a driving test and get CRB clearance. They are then given induction training incorporating all the normal requirements but developed especially for international recruits. Agincare has bought properties and converted them into bedsits to offer their overseas workers accommodation at a subsidised rate. The company also provides vehicles. Agincare says overseas recruitment has increased the workforce by 17%. This represents not only an increase in numbers but also a supply of care workers who are able to work full-time and can be extremely flexible. Contact: Derek Luckhurst, Managing Director, Agincare E-mail: derek.luckhurst@agincare.com Phone: 01305 769418

International recruitment
Based on anecdotal evidence there appears to be a great deal of international recruitment going on, and there are some major concerns about the way this is being carried out and about some of the consequences. The Commission for Social Care Inspection (CSCI) has said that the independent sector has become increasingly dependent on a migrant workforce, which does nothing to improve the stability of the sector. Recruiting internationally can have a positive impact on the ability of organisations to maintain and expand their service capacity. It is critical, however, that this is only undertaken in a careful and properly organised manner, with clear protocols and procedures in place, rather than haphazardly attracting would-be migrant workers desperate for employment even at low rates of pay.
1

New providers come into an area and take staff by offering higher rates, and, because they are not a block provider, they can charge more
Independent employer

CASE STUDY Independent provider Agincare

Based in Dorset, the company recruits abroad to increase capacity and tackle problems of patchy recruitment; in some areas the company serves it could not recruit at all. One long-running and successful initiative is to recruit from Poland, Lithuania and the Czech Republic. Agincare has learned through experience that key elements of this approach include:

Notes
1 The state of social care in England 200405 Commission for Social Care Inspection 2005

31

Training Career pathways Increasing job satisfaction Financial incentives

32

Chapter 5

5
Promoting retention
Recent figures suggest turnover rates in home care in particular are very high, around 26% compared to a national labour turnover rate in the UK generally of 15.7%. That means that on average social care employers in all sectors are losing and replacing a quarter of their workforce each year. In areas of very low unemployment where there is competition from less stressful but comparably paid work, turnover can be as high as 75%. High
16

importantly, quality of care is compromised by lack of continuity. Failure to retain staff also means that building up the workforce to respond to the demands for increased capacity becomes increasingly difficult. Once people have obtained NVQ level 2 they are more likely to stay in the industry, although the qualification may put some in a better position to switch employers for better terms and more opportunities elsewhere. Nevertheless, providing support to assist employers in achieving the NVQ targets is likely to be extremely welcome. Whilst seeming self-evident, its worth pointing out that if staff find their work satisfying they are more likely to stay in the social care workforce. Some organisations have made specific efforts to improve job satisfaction among their employees.

'Our turnover used to be almost 100% but since there has been a more structured approach, much better induction and an opportunity to obtain qualifications, retention has improved. This year we have taken on 54 people and only lost 13 in the last nine months. We have already got half our care workers with NVQ2.'
Manager of independent organisation

Training
Being offered good training is generally appreciated by staff and makes them feel valued. Independent employers who invest heavily in training or have access to adequate training resources tend to report fewer retention problems. Training can also be instrumental in creating a shared culture and ensuring that staff are confident in their work which then leads to better retention.

turnover is problematic for various reasons, not least that repeated recruitment, induction and clearance checks represent a very significant cost. Continued turnover of staff makes it more difficult for providers to ensure the necessary 50% of their workforce have NVQ level 2, and, perhaps most

Induction training is critical. There tends to be a leakage of new recruits within the first three months of their employment. There could be many reasons for this but a key one is apparently a lack of confidence among new care workers in dealing with complex needs in a situation where they are

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5 | Promoting retention

probably working on their own. Good and adequate induction could counter this problem. The introduction of Skills for Cares common induction standards which must be implemented from September 2006 will undoubtedly help but will also present employers with some challenges. Training is one of the key areas where collaboration and partnership can be very effective. There is actually a great deal of funding available for training but it is not always easy for independent employers to access and they usually have to make their own contribution. Most funding goes to local authorities in the form of training support grants, both to train their own workforce and to transfer to organisations with which they contract. Employers may be helped with the cost of training to some extent, and this is generally resourced through funding such as the European Social Fund (ESF), from the Learning and Skills Council (LSC) or via industry or regional consortia. Small organisations largely lack either the skills or the resources to undertake the complex application processes to obtain this funding on their own, so this support is extremely valuable. Unfortunately, even where training is provided by councils, employers are not always able to take advantage of it. This is generally because: training takes a whole day and it is not possible to release staff from work for that long, especially where this might mean releasing several people from the same area at one time training is delivered in a central location that is difficult for staff to get to, particularly in rural areas training is in theory open to all sectors, but in practice booking forms go to in-house teams first and independent providers are only offered the remaining places. Experience also shows that where training is held jointly with the in-house service, independent staff are likely to become dissatisfied comparing their terms and conditions with those of the in-house care workers.

CASE STUDIES

Induction workbook
Staffordshire Social Care Workforce Partnership has developed an induction workbook, funded through the enabling fund that is part of the training strategy implementation grant available via Skills for Care. All local employers get a free copy of the workbook, which is being updated to conform to the Skills for Care common induction standards. This approach is more workable than delivering the in-house induction programme to independent employers. Contact: Penny Lawler E-mail: penny.lawler@aol.com Phone: 07815 827430

Training networks
The Tyne and Wear Care Alliance was set up in response to concerns about the ability of the independent sector to train adequately. It is a collaborative of workforce development professionals and employers, who are encouraged to participate in the development and management of individual networks and also provide training placements. The alliance acts as a broker commissioning training that is then supplied at no cost other than the cost of releasing staff while they undertake training to employers. One of the main aims is to ensure that training is equitable across in-house and independent sectors, particularly with regard to NVQs. There have been some problems getting candidates through to completion, partly due to training organisations having too high a ratio of candidates to assessors and partly due to care workers moving from one organisation to another. The Tyne and Wear Care Alliance is also working on Route into Care with Jobcentre Plus and has funding to get 60 people through induction training, Protection of Vulnerable Adults (POVA), CRB checks and into care posts. Within the initiative there is also a drive to ensure that employment organisations such as Jobcentre Plus have a better understanding of care training. Contact: Pauline Wiper E-mail: pauline.wiper@sunderland.gov.uk Phone: 07915 656052

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Commissioning training
Warwickshire Quality Partnership aims to raise standards and enhance quality of care via training. The hope is that this will also improve staff retention, and already turnover has reduced for some providers. The partnership is run by a board consisting of representatives from both independent and statutory sectors who determine the programme, so it is entirely in line with the needs of service providers. There is a project manager who is employed by the local authority but works to the board and takes responsibility for commissioning training. The project manager may also help independent organisations with training needs analysis and other things such as problems with inspections. Providers get funding to pay for training plus advice on how to choose training organisations. Contact: Elaine Ives E-mail: elaineives@warwickshire.gov.uk Phone: 01926 731034

covering general training in both areas of responsibility, such as the aims and values of the extra care scheme, safety and security. Further joint training is planned to cover abuse and some specialist skills. The training initiative has seemingly empowered staff and fostered a better understanding of what the scheme aims to achieve. The staff work more as one team and retention is reported to have improved. Contact: Sue Lewis E-mail: sue.lewis@ph2k.org.uk Phone: 01422 284547

NVQ workpacks
The Cheshire Consortium for Health and Social Care, which has 50 partners, mainly from the independent sector, aims to speed up NVQ attainment. A team analysed all the options for NVQ levels 2 and 3 and has come up with a selection that between them encompasses the whole range of care types. A workpack has been developed for each of the options and for the basic units. Each A4 pack contains questions or examples for the candidates to work through plus some practical tasks. This will help provide evidence in areas that cannot be assessed through observation. The workpacks have been tested on the in-house team and found to be very successful with candidates achieving qualifications in just over three months on average. Contact: Colin Ashcroft E-mail: colin.ashcroft@cheshire.gov.uk Phone: 07957 140384

Opportunities for independent providers

All training offered by Thurrock Council is open to independent sector staff, including core skills training carried out jointly with the health sector, which is also available to care workers from independent agencies. Thurrock uses a number of consultants to deliver its NVQ programme, who have additionally supported several managers in the independent sector in achieving their NVQ level 4, paid for by the council. Independent employers can nominate a certain number of care staff to do their NVQ2 through Thurrock. Contact: Jan Hurn E-mail: jhurn@thurrock.gov.uk Phone: 01375 652856

Using technology for NVQ assessment

The Black Country Partnership for Care has been involved in a project to speed up NVQ attainment through computer-assisted assessment. Training is provided through a programme developed and funded by the Learning and Skills Council (LSC). An e-portfolio system generates and reports evidence for NVQ. This is said to be very successful in getting people through their NVQs much more quickly. There has apparently been a reduction in vacancies and as a result of a significant increase in NVQ2

Joint training
A joint induction programme, set in an extra care housing complex run by Pennine Housing in partnership with Calderdale Council adult services, initially aimed to clear up confusion about the roles and responsibilities of the two sets of staff and give a broad understanding of the interface areas. This has now developed into a joint training programme

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5 | Promoting retention

trained staff there is more chance that qualified staff will apply for vacancies. Contact: Andrew Packer E-mail: andrew.packer@dudley.gov.uk Phone: 01384 813131

should also consider how they can ensure that all providers get opportunities to participate in more interesting and professionally satisfying specialist services. In Norfolk it has been agreed that independent providers will be involved in the early rehabilitation work and discussions are ongoing about the possibility of tendering specialist services in future. Independent service providers find it frustrating to lose staff, especially if they have gained their NVQ2, to the in-house team or to health-related posts. Independent employers, particularly those who are members of any of the large collaboratives, recognise that it is not necessarily a loss when someone moves on to work in another part of the health or social care field, but it is very hard when your organisation is always the entry point and others get the benefit of your investment in training and recruitment. This is particularly difficult in a situation where providers are doing their best to reach 50% with NVQ2 by 2008.

Career pathways
According to research by the Chartered Institute of Personnel Development, the second most common reason for staff turnover is lack of career and development opportunities. In many areas work is already going on to develop social care career pathways. There is also a growing recognition that it is important to provide opportunities for development to keep people engaged in social care work. But when it comes to commissioning services, there is not enough attention paid to making sure that independent providers can offer such opportunities to their workforce. A typical situation is that the in-house team takes on all rehabilitation work for the first six weeks after a user comes into the system, leaving only ongoing maintenance to the independent sector. Independent providers feel it is important, however, for their staff to have development opportunities and not to be marginalised into purely maintenance roles in this way.
16

CASE STUDIES Information sheet

Gloucestershire County Council has developed an information sheet showing the career pathway from home care assistant to manager. It also outlines deviations from the path which could lead to social work or more health-oriented careers. Contact: Julie Walters E-mail: julie.walters@gloucestershire.gov.uk Phone: 01452 425131 or Contact: Bron Williams E-mail: bron.williams@gloucestershire.gov.uk Phone: 01452 425180

Recruitment is now much easier because we are able to pay more as a result of the better price being offered through new contracts.
Independent employer

Career pathway matrix

Cambridgeshire County Council, in partnership with Norfolk, Suffolk and Peterborough learning disability services, has developed a career pathway matrix to address shortfalls in: appropriately trained staff clear progression routes clear links between qualifications and job roles clear links between NHS, local authority and independent sector job roles.

There are advantages to this initial six-week pattern, such as enabling more thorough assessment and getting any necessary aids or adaptations in place. But authorities do need to think through the consequences in terms of helping providers to build up stable and competent home care workforces over the longer term. Authorities

36

Although the model has been developed for learning disability services, it could be applied to older people and general domiciliary care services. It gives examples of all social care posts from management to care workers, and provides information about entry requirements and progression routes. There are two versions of the matrix - one describing the current situation and one outlining what the sector might work towards. An associated paper highlights some of the issues, such as uneven pay rates and the lack of clear progression routes for some staff. Contact: Adrian Key E-mail: Adrian.Key@cambridgeshre.gov.uk Phone: 07765023882

recruitment is easier. This can also make existing staff feel more valued and satisfied with their role. Some authorities have recognised the potential of working more closely with health colleagues to aid recruitment and retention. There is also growing evidence that where authorities have moved to focusing on the achievement of outcomes rather than on specifying tasks and times, staff retention is improved. This is thought to be because service providers, and their employees, are able to respond more flexibly to the needs and wishes of service users on a day-to-day basis. In addition, care staffs views are more likely to be sought on how to achieve outcomes with the service users they visit.

Increasing job satisfaction

Research shows that being able to develop good relationships with service users makes a significant contribution to feelings of satisfaction, both for the service user and the care worker. There is anecdotal evidence that sometimes home care workers prefer to apply for nursing auxiliary posts because the short visits they are required to make in home care give them no time to build any kind of relationship with service users. It is important for home care workers to feel in control of their work rather than being sent from place to place without any apparent rationale. Of course it is not always possible for authorities to provide for longer visits, although there may be the potential for spending more time with younger adults and people with learning disabilities. But any authority which is commissioning for capacity should think about how they can minimise very short visits and create a situation where providers can maximise continuity of care. A recognised barrier to recruitment to the social care workforce is its perceived low status. There is evidence that where a health component to the work is indicated by the job title such as rehabilitation assistant or health care assistant or where the service is somehow specialised,

CASE STUDIES New job title

Staff who work for Maidstones rapid response service are called active care home carers. Using this job title has apparently helped in recruiting and establishing a stable team. The scheme has been jointly developed by social services and the PCT. The remit of active care personal carers is to care in a proactive way towards achieving outcomes. They are able to identify problems or changes in patients condition, are well-supported and receive training and upskilling on the job. Contact: Lesley Geater E-mail: lesley.geater@nhs.net Phone: 01580 755000 or mobile: 07917 211889

Intermediate care
Thurrock Councils Crisis Support and Hospital Discharge teams offer community-based intermediate care. It is a time-limited service, available 24/7, and care staff work closely with Thurrock PCTs Collaborative Care Team, in a multidisciplinary framework with an agreed care plan. Staff are employed directly by Thurrock Council and skills training is provided. The work is seen as more rewarding than ongoing home care support. Contact: Jan Hurn E-mail: jhurn@thurrock.gov.uk Phone: 01375 652856

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5 | Promoting retention

Generic care roles

Norfolk County Council recruitment and retention initiatives include a project in one district where joint appointments spanning health and social care employ home care staff to work across both sectors as generic care staff. Contact: Maggie Hawley E-mail: maggie.hawley@norfolk.gov.uk Phone: 01493 733752

Other financial incentives may be available, such as loans for care workers to take driving lessons or get vehicles roadworthy, but some are only available to care workers from in-house services. Individual independent employers might also be offering a range of incentives.

CASE STUDIES Enhancing rates to provide stability

An enhanced rate of remuneration is offered to staff working on the dementia domiciliary scheme set up by Dartfords capacity planning group. It is important that people with dementia have continuity of care. The scheme, run within the independent sector, provides training so that staff can carry out healthrelated tasks and have an understanding of dementia and working to planned care programmes. The training is delivered through a community mental health nurse. A stable team has been successfully established and maintained and this is said to be due to good training and support and the enhanced remuneration. Contact: Chris Ballard E-mail: christine.ballard@dgspct.nhs.uk Phone: 01322 622388

Outcome-based commissioning
Hartlepool introduced outcome-based commissioning of home care in 2003. Staff retention is said to have improved for both independent service providers and the in-house service. Contact: Phil Hornsby E-mail: phil.hornsby@hartlepool.gov.uk Phone: 01429 523944 Evaluation of a pilot outcome-based home care service in Thurrock found that care workers and care co-ordinators felt it made the job they were doing much more rewarding and that their employing organisation, whether it was the council or an external provider, was acknowledging their skills and abilities. Contact: Colin Slasberg E-mail: c.slasberg@thurrock.gov.uk Phone: 01375 652671

Better rates for quality

The Homecare Service Improvement Partnership, a joint initiative between the statutory and independent sectors, has reported success in stabilising the home care workforce in Trafford. This is partly attributed to an increase in the hourly rate paid to quality providers. Waiting lists of homecare hours needed across the borough had reduced over a 12-month period from 1,200 hours per week to around 200. Contact: Linda Harper E-mail: linda.harper@trafford.gov.uk Phone: 0161 912 1890

Financial incentives
Research suggests that pay is not the major issue determining success in recruiting people into social care posts or in keeping them there. Nevertheless, money is a very important factor in the establishment and development of a viable social care workforce. Experience shows that an enhanced rate of pay is one of the factors that can enable schemes to be fully staffed or make recruitment easier. Some authorities have taken specific steps to ensure that financial issues do not impede local employers ability to recruit and retain staff. Authorities may find it helpful to look at local pay rates, particularly in the retail sector.

Matching local pay rates

Sefton Council was concerned about care workers leaving the industry, and in particular that locally there was a lot of serious competition for staff from light industry, and the leisure and retail sectors. In-

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house care workers were on higher rates than independent care employers could afford to match. There was felt to be a real risk that the authority would not be able to meet its statutory responsibilities in the near future if it did not take action. The decision was therefore made to increase the price paid for domiciliary care to enable providers to pay care workers at a competitive rate at least equal to that paid to equivalent staff in a local authority setting. Providers may also get additional funding so they can match any pay increases received by local authority staff. Support from Seftons chief executive and persuasive lobbying by independent providers ensured that elected members supported this decision, and apparently councillors are now enthusiastic about the change as a result of positive feedback from their constituents. Funding is mainly from the community care budget and efficiency savings. Recruitment problems have greatly eased and morale has improved. Contact: Colin Speight E-mail: colin.speight@sefton.gov.uk Phone: 0151 922 4040

repeated in 2006 and is being applied in areas where there are particular capacity needs, to enable providers to guarantee hours for new staff for a defined trial period. Contact: Julie Walters E-mail: julie.walters@gloucestershire.gov.uk Phone: 01452 425131 or Contact: Bron Williams E-mail: bron.williams@gloucestershire.gov.uk Phone: 01452 425180

Vouchers for apprentices

In Norfolk young people on the care work apprenticeship scheme have been offered 300 in vouchers that can be redeemed at local shops. Alternatively the money may be used to pay back loans for driving lessons. Contact: Maggie Hawley E-mail: maggie.hawley@norfolk.gov.uk Phone: 01493 733752

Additional help for trainees

Barnsley MBC has a fund to cover unexpected needs associated with its Future Carers training programme for people on benefits. In one case this was used to pay for dental work for a young woman who had completed pre-application training but was not applying for jobs due to embarrassment about the way her teeth looked! Contact: Trevor Hewitt E-mail: trevorhewitt@barnsley.gov.uk Phone: 01226 772378

One-off payments
Gloucestershire County Council has made determined efforts to increase capacity, including allocating an additional 145,000 as a one-off payment to the independent home care sector. This is intended to aid staff retention through improving pay and staff training. This has been

Notes
16 Recruitment, retention and turnover 2005 Chartered Institute of Personnel and Development

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Funding Staffing resources Wide-ranging support Communication Obstacles

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Chapter 6

6
Factors to consider
This chapter looks at some of the factors that have generally been found to play a part in the success or failure of attempts to improve social care recruitment and retention. training through their Employer Training Partnership. Strategic health authorities may provide funding, to pump prime large-scale health and social care collaborative work, for example.

Funding
Common sources of funding are the Department of Health grants for recruitment initiatives, the HR development grant, and for training and workforce development initiatives, the National Training Strategy Grant. Skills for Care can supply funding through its training strategy fund with the proviso that the money will only be made available if partnership working with independent sector partners is in place. This proviso has been very effective in ensuring that independent sector providers have been included in and, in many cases have had considerable influence on decisions about how to address staffing shortfalls. Some Skills for Care funding is specifically to support NVQs and is only available in the form of reimbursement for completed units. This can cause problems in areas where there is a shortage of NVQ assessors. Financial support for training is also available from the European Social Fund (ESF) but the administration and quality assurance requirements associated with ESF funding can be onerous. An alternative is the Learning and Skills Council (LSC). LSC funding can support NVQ level 2, paying so much on the candidates registration, a further sum when half-way to completion and a final sum when NVQ2 is achieved. LSC also provides funding so that employers can pay staff while care workers are

Optimising resources helped us get our initiatives off the ground. We have brought in over 1m over the last couple of years for pilot programmes its attractive when you can say that will be funded and senior managers are prepared to take managed risks.
Workforce development manager

It is particularly important to have a source of sustained funding. A great deal of work is being put into recruitment initiatives, some of which are expected to have positive outcomes over a longer term rather than being a quick win solution. It can be extremely frustrating when a scheme starts to deliver improvements in recruitment but then funding is withdrawn.

Staffing resources
It can be difficult to dedicate sufficient time to addressing the recruitment and retention problems recognised across the care sector. A possible solution

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6 | Factors to consider

is to appoint a development worker, an approach adopted in some areas by partnerships involving commissioners, in-house and independent providers and drawing on the expertise of the authoritys HR department. The model used and job role/responsibilities will vary depending on local demographics and choice. Most project workers act as a liaison between the partners to identify problem areas and to develop links with employment organisations such as Jobcentre Plus and Connexions, training agencies including Skills for Care and the Learning and Skills Council, and workforce confederations. Among other functions, development workers are able to standardise data between sectors; this enables accurate and up-to-date workforce information to be produced and can generate a more accurate projection of what skills will be needed. Having a dedicated member of staff who has time to think about the problems and issues and to carry out research can be a key factor in making the right decisions. The majority of development worker posts look at day, home, residential and nursing care services. Line management may take various forms, though a partnership board can help set the agenda for the role and provide additional expertise. Most funding for this sort of post is short-term through the HR development grant. Some posts are now mainstream funded.

Sharing resources
The Black Country Partnership for Care involving Dudley, Wolverhampton, Walsall and Sandwell has appointed a full-time project worker. Funding for the project as a whole comes through various sources including the Regional Development Agency in more deprived areas. One of the benefits is the employers improved understanding of ways to retain staff which has started to reduce competition in the market. Contact: Andrew Packer E-mail: andrew.packer@dudley.gov.uk Phone: 01384 813131

Dedicated helpline
The restructuring of Staffordshire County Council services offered an opportunity to create the new post of service development manager, together with a team of service development officers. This team has a dedicated phone line, so that enquiries are dealt with by someone who knows the business and what social care entails. The personal commitment of the service development manager to be part of making things better and raising the profile of social care has been critically important to the success of Staffordshires initiatives. Contact: Pauline Warrilow E-mail: paula.warrilow@staffordshire.gov.uk Phone: 01785 355841

CASE STUDIES Careers role

The Cambridgeshire social care careers project has a full-time worker whose previous experience was in careers advice. The post is line managed through the learning disability team, and is addressing the problems within that service, although the skills are transferable. A project board has been established that includes the mental health trust and user organisations. Contact: Jim Thomas E-mail: jim.thomas@cambridgeshire.gov.uk Phone: 01223 504118

Wide-ranging support
Recruitment and retention initiatives have more chance of success if they have support from across the local social care sector. It can especially help to have champions offering visible support for various initiatives from high up in an organisation. This might be an elected member from the authority or the director of adult social services, but the champion must understand the problems and issues. In terms of ensuring that the budget is sufficient and that it is sustained, support at this level is critical.

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They are passionate about the importance of the The main thing which helped get our project off the ground was support from the top. The project is part of the integrated service performance plan which feeds into the corporate strategy.
Project manager

sector. Planning started with the local authority, LSC and the employers who had contracts with us.
Head of HR

It is worth trying to engage HR specialists within local authority social services in discussion about recruitment across sectors, although it may not always be profitable. Some HR departments are moving forward and recognising that assisting independent social care providers can represent good value for the authority, and are working enthusiastically with their local employers. Corporate HR is beginning to realise that you do have to consider the independent sector to begin with they just looked at you with blank faces if you mentioned independent employers. But they have important skills and you need to get them on your side.
Workforce development manager

Getting all the key individuals and organisations on board and keeping them there is critical to successful collaboration on recruitment. Ideally all sectors should be involved at a leadership level to get initiatives up and running and enable them to move forward. One of the main things that has helped our projects is the fact that the board is a mixture of statutory and independent service managers from different user groups, the head of policy and the workforce development manager.
Project manager

All key stakeholders should be involved from very early on in the thinking and planning to build support for a particular strategy and to ensure that there is the shared vision to drive the work forward. Understanding the local problems within the context of national data, openness about the challenges and difficulties faced by the different players and a commitment to work together to find solutions can ensure that there is a real community of interest and shared vision about what initiatives are trying to achieve. Its been really difficult getting our independent providers on board. I wish we had got them involved at the beginning. There was a lack of trust they were very suspicious. We had to use an outreach worker to go and talk to them all, but things are much better now.
HR manager

Communication
Good communication is particularly important in situations involving many non-statutory organisations. Communication between partners may include sharing minutes of meetings, or an independent sector representative might sit on the board of the collaborative and be responsible for reporting back to other independent providers. This might be supplemented by open reporting at regular providers forums. Newsletters that can be widely distributed are generally seen as a satisfactory method of ensuring that collaborative members are kept aware of what is going on and offering ready access to useful information.

The main thing that helped us get the project off the ground was that there was a group of people who were willing to share and work together, and willing to do more work than they were paid to do.

CASE STUDIES Employer newsletter

The Stoke and Staffordshire Social Care Employers Group produces a 16-page newsletter. This provides information on different topics, including useful

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6 | Factors to consider

websites, funding for training, working group meetings, care ambassador schemes and workforce data. The newsletter gives contact details for project staff. The newsletter is also sent to the in-house team and in return the in-house publication In Touch, which also discusses joint initiatives, is available to independent employers. Contact: Lindsey Clayton E-mail: lindsey.clayton@staffordshire.gov.uk Phone: 01782 599158

This authority is really trying to make an impact, but it is quite a struggle because of the problems in getting independent employers involved. Everyone is so busy with different government initiatives its very easy for them to get knocked off course. It was difficult to get people involved and its difficult to keep them there. The amount of administration swamped us, filling forms, accounting etc. Anything the ESF funded had to develop policies and procedures in accordance with the standards of the Adult Learning Inspectorate. There are too many providers and not enough work for any to be viable. They (the commissioners) dont understand about the critical mass needed for a viable branch and they are still encouraging new providers into the area and only spot purchasing.

Home care publication

Norfolk County Council produces a quarterly newsletter that goes to all care staff from both independent and in-house home care providers. The Domiciliary Care Steering Group is responsible for the publication, which updates staff on what all the groups and sub-groups are doing. Contact: Maggie Hawley E-mail: maggie.hawley@norfolk.gov.uk Phone: 01493 733752

Obstacles
The converse or lack of the factors listed above could well mean that recruitment and retention initiatives may be less successful, or may fail entirely There are other reasons why an approach may not deliver real improvements in the numbers coming into, and staying in, social care. The following comments from people interviewed for this report give some indication of what obstacles recruitment initiatives may face. Workforce development initiatives are very separate from service commissioning and the fact that providers are not involved in decisions on commissioning undermines much that the working group is trying to achieve. For example, in our area, commented one observer, they are still only spot purchasing so when a service user is admitted to hospital they lose the work and we have nothing to offer them for two or three weeks. We frequently lose staff because they have got to earn a living.

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There are to be major changes in terms and conditions for the in-house staff which is likely to have a big impact on our ability to recruit and retain staff. What they have achieved for their staff is wonderful but it is what all providers want for their staff. Until recently we were almost in line with inhouse terms and conditions, now there will be a big wedge between us again. It is so disheartening.
Independent employer

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Conclusion
Several years ago, when it was still the DH Change Agent Team, the National Older Peoples Programme identified that for many developers and commissioners workforce considerations had become a forgotten factor in service planning. A good many new initiatives, and newly created services, foundered on the inability of service deliverers to adequately staff up those services. It is heartening to discover that many health and social care communities, across both public and independent sectors, have embraced a collaborative and inclusive approach to resolving staffing capacity problems. The role of service commissioning and the nature of relationships between commissioners and providers are central to achieving this. Many case studies and examples quoted in this report demonstrate how the specific barriers to delivering home care and improving capacity can be overcome through working collaboratively and with commitment.

Janet Crampton Care Services Improvement Partnership

September 2006

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Appendix
Further information
These are web addresses for some of the reference material given in the footnotes Our health, our care, our say Department of Health 2006 White Paper http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/ PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4127453&chk=NXIecj Referrals, assessments and packages of care DH 2005 (annually produced statistics) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistics/Publications StatisticsArticle/fs/en?CONTENT_ID=4104361&chk=JzAYv/ Perceptions of social work and social care COI/DH 2001 http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/SocialCareWorkforce/ SocialCareWorkforceArticle/fs/en?CONTENT_ID=4001921&chk=HFS1UB A national framework to support local workforce strategy development: A guide for HR directors in the NHS and social care DH 2005 http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/ PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4124746&chk=iv8Gmm The state of social care in England 2004-05 Commission for Social Care Inspection 2005 http://www.csci.org.uk/default.aspx?page=1270&key= Recruitment, retention and turnover 2005 Chartered Institute of Personnel and Development 2005 http://www.cipd.co.uk/subjects/recruitmen/general/recruitretnt.htm?IsSrchRes=1 Commissioning Domicillary Care http://www.changeagentteam.gov.uk

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