Workforce Supply: The Role of Temporary Staff International Conference on Evidence-based Policy in Long Term Care 8th-10th September 2010, London Michelle Cornes, Jo Moriarty, Saidah Blendi-Mahota, Tim Chittleburgh, Shereen Hussein and Jill Manthorpe

Policy Background ‘By 2020 it is expected that employers will no longer need to rely on temporary staff to cover tasks that would normally be carried out by a permanent social worker and that as a result those receiving care will be able to count on continuity in the person providing their care’ Options for Excellence (DH, 2006)

Study Aims To explore how local councils with adult social services responsibilities are implementing ‘Options for Excellence.’ To assess the impact of ‘Options for Excellence’ on the employment businesses sector and what if any role the sector is likely to play in the social care workforce of the future. To gain a better understanding of the motivations, work histories, and future employment plans of agency workers.

Methods Case studies of progress in three local council areas (rural, metropolitan, urban). Interviews with: social services managers (n=18); recruitment consultants (n=15); and agency workers [both qualified (n=45) and unqualified (n=15)]. A survey of local councils (n=151) in England (36% response rate).

Reasons for using agency workers In our survey 92% of responding authorities had used agency workers in the 2008-2009 financial year. The reasons for using (qualified social workers) (other social care workers) were: Difficulties in recruiting permanent staff (80%) (68%) To fill a post quickly (78%) (82%) Sickness cover (65%) (82%) For a specific task or activity (69%) (63%) Other reason (22%) (16%)

Implementing ‘Options for Excellence’ 80% of respondents in our survey of local authorities reported that their department had implemented strategies to reduce the use of agency workers: ¼ had introduced staff banks or pools ¾ of respondents had introduced managed vendor schemes

Staff Banks “In the NHS it makes sense to have a very strong nurse bank, but for a smaller places or a group of four or five nursing homes – say 200 staff or something – it probably won’t work as you will not have enough vacancies to keep people on the bank happy… I think agencies will always be necessary”

Managed Vendor Schemes There is good evidence that managed vendor schemes are delivering cost savings to councils of between 3 and 10% (IDeA, 2006) In our survey, 60% of respondents reported that their expenditure on agency working in 2008-2009 was less or the same as their expenditure in 2007-2008 Only one respondent thought expenditure would increase in 2110/2011

Impact on quality of service ‘We have to do more safeguarding and as a result our costs are increasing, however [our income] is being reduced and those two don’t really match up…’ Recruitment Consultant

Business as usual ‘[Local councils] tend to go round in cycles They will put a recruitment freeze on locums… It’s really strict and then six months later they realise that people have left or that they haven’t been able to recruit and then go back to using agency staff again. So it is just kind of cyclical. They all take turns in doing it so I won’t take [Options for Excellence] too seriously’. Recruitment Consultant

Blurred boundaries “We’re in a catch 22 situation… we’d like to bring our carers onto permanent contracts, but local authority parameters change so frequently. One minute you’ve got the work, the next you haven’t … We have had 95% of our carers for the last four years” Recruitment Agency Manager Supplying Care Workers to Local Authorities

Volume ‘I would say 70% of our clients are private residential homes… We supply care workers, kitchen staff, cooks, domestics everything to run a care home… We employ two minibus drivers as we are doing the volumes we need to transport people at work… I would say our figures have steadily grown over the period’ Recruitment Agency Manager Supplying Care Workers to Private Care Homes

Retention “All the [residential care homes we supply] on a daily basis are constantly recruiting and it would be cheaper to employ someone full time. The trouble is people don’t stick at jobs so there will always be space for agencies” (Employment Business Manager)

What is under-reliance on agency workers? ‘We are permanently asking our existing staff to do more… I know it is your day off, I know you are on holiday, but can you just do… that’s why people leave. [Covering staff shortages] is big, big problem, I would say it takes up 80% of my time [Researcher: Would you use any agency?] We can’t because of the rate we get paid [by the council], and we have to maintain profit margins.’ Manager of a Domiciliary Care Agency

The experiences of agency care workers ‘I don’t have to be compelled to the rota, I can chose the time I want to work and the time I want to work like time to do my own personal thing so it gives me that flexibility of time. That is why I decided to join the agency – [I could get] full time employment as a support worker but I am not ready to take it up yet.’ Temporary Agency Care Worker

Impact of ‘Options for Excellence’ on Business Confidence ‘Recruitment into the [nursing and social care sector] will continue to be challenging and will demand more innovative strategies as well as models for sourcing and skill development e.g. increased reliance on bank and agency workers’. Recruitment and Employment Confederation, First Sector Profile for the Nursing and Social Care Group (2009)

Safeguarding – Improving the way agency workers are managed in the workplace Expecting agency workers to ‘hit the ground running’ (lack of induction especially for newly qualified social workers) Unequal access to training and supervision Giving agency (social) workers the most complex case load (cases that no one else wants to deal with)

Implementing ‘Options for Excellence’ Progress Update There is evidence that most local councils have introduced measures to tackle over reliance on agency workers. There is evidence of efficiency savings and a trend toward further reducing expenditure on agency working Indications that agency use may increase as challenges in recruitment and retention continue Need to focus on safeguarding and issues around how agency workers managed in the workplace.