This is a follow up to a report considered by the Health and Wellbeing Board on 12th January 2022. A presentation will give a workforce update on the success of the recruitment drive for additional carers.

The Committee received a presentation from Lynn Bassett, Organisational Development Team Manager and Zoe Mayhew, Strategy and Commissioning Manager within People Strategy and Commissioning. The presentation covered:

• National staffing picture – showing recruitment and retention, vacancies and a comparison between March 2021 and May 2022
• National context, with data on the increase in the number of homecare hours delivered and those it had not been possible to deliver equating to 671%
• Data on commissioned provision - comprising domiciliary care, specialist housing services, residential care, nursing homes, supported living services and extra care housing
• Learning and Development Partnership – showing examples of the support offer
• Staff learning and development – a coordinated approach with health, delivering Warwickshire specific training with a range of training offers, qualification programme, support for managers and sharing good practice
• A data slide on qualifications and training
• Training figures and training. In 2020/21 - 2,150 places attended; in 2021/22 - 3,091 places attended
• Impact of training, delivered in blended approach to increase flexibility. Keeping excellent attendance, with three-month reviews taking place to monitor impact.
• School careers support – the partnership was part of the careers hub program and was notified of career events and parents’ evenings
• College / university careers support – the partnership attended college career days to seek additional employees in either a permanent or bank role
• Promoting job vacancies – examples were provided of the range of methods used
• Recruitment support – the partnership worked with providers and other agencies to raise the profile of social care
• Impact of job vacancies and recruitment support - data for 2020/22 and 2022/23 on the number of jobs advertised, events held and what this work had achieved
• Staff retention and wellbeing – examples of the support and incentives available
• Next steps

Discussion took place on the following areas:

• Councillor Matecki spoke of the need for additional frontline carers, commenting that in Warwick district there were two vacancies for every unemployed person. The report did not mention overseas recruitment to fill vacancies.  Officers replied that a proposal to do this was currently being formulated to attract carers from overseas on behalf of commissioned providers, as an enabler.
• Councillor Marian Humphreys praised home care services. She advocated the benefits of coordinated NHS and social care visits or better still having a hybrid health and care role to reduce duplication. She outlined the many aspects to care visits at home to meet the service users’ needs and the significant training requirements. She reiterated the value of these staff which should be recognised more and be promoted in schools to attract people to this service area.
• Chris Bain said this was a complex problem, both in Warwickshire and nationally. The image of social care and to a lesser extent health was a perception of older people who were in decline. To attract younger people, it was necessary to address this image and there was a role for the media to play. Some media reporting had a negative impact, which could deter people from working in these services. There were recruitment challenges across social care and many parts of the NHS, with alternate employments offering more money. Rates of staff turnover in some organisations were significant which was not helpful. This added to pressures with induction, training and embedding the organisation’s culture. The challenge was multi-layered and there was no quick fix. A need to start by repairing the image of health and social care to make it an attractive career.
• Councillor Mills echoed the points about making the service attractive to students, speaking of the potential for a career path into the NHS. Lynn Bassett responded that this was a challenge. Some of the methods were to emphasise the technology aspects, to use a practical approach whilst delivering information and to demonstrate the career potential.
• Councillor Cooke spoke on the recruitment aspects, commending the combined application form. He asked whether there was a sufficient advertising budget, which was confirmed and there was excellent support from the communications team too.
• Councillor Drew considered there was a service gap between social services and emergency response in the community by first responders. Referring to the meeting documents, there seemed little reference to preventative or community work. In her locality she was aware of an individual who repeatedly and inappropriately called for West Midlands Ambulance Service (WMAS). Filling the referenced gap in service would help to alleviate pressures elsewhere in the NHS. On attracting carers, she noted that people had a range of needs, and ‘one size’ did not fit all.
• Zoe Mayhew spoke of the work within various parts of the NHS to triage and avoid unnecessary admission from A&E into the acute hospitals. Of the local acute trusts, George Eliot Hospital (GEH) had the best results for non-admittance from A&E. The three acute hospitals had recently confirmed that people who were conveyed to hospital by WMAS did need hospital care. The majority of people calling for an ambulance did need medical support. There were ongoing conversations about commissioning a low level, preventative service to help people to remain at home and manage their long-term conditions. Through primary care a lot of education was taking place on correct use of the 999 and 111 services, to reduce reliance on A&E services.
• The Chair asked if there may be other reasons why people were attending the GEH A&E department routinely and whether this indicated a shortage of primary care services. She would pursue this outside the meeting.
• Councillor Rolfe commented on the extremely difficult situation currently. She referred to the data that 2.2 million hours of care service had not been delivered nationally for the first quarter of 2022 and it was likely that this data had doubled over the last three months. She found this frightening and wanted to explore what this meant for Warwickshire service users in real terms.
• Zoe Mayhew advised that there were a number of contributing factors. The data would include some people putting informal alternatives in place with family members bridging the gap. The Council had used its in-house reablement service extensively, particularly for domiciliary care and some interim solutions had been commissioned, including bedded provision to assist discharge from hospital. In Warwickshire, it had not reached the situation where people were in absolute crisis, as various solutions had been found to plug the gap.
• Councillor Rolfe sought more information about career progression opportunities for carers, asking if this may be a barrier to attracting people to the service. She gave anecdotal feedback of a person who had switched careers to become a carer and their enjoyment of this new role.
• Zoe Mayhew spoke about the national workforce strategy. It included clearer career progression aspects for those working in social care. Specific detail was provided about the care certificate undertaken at the commencement of employment, further training and how this could be progressed into an apprenticeship. In Warwickshire the care certificate was now portable, so when employees moved to another employment, they were able to demonstrate the training completed avoiding the need to repeat that training.
• Councillor Holland thanked officers for the presentation. He spoke about recent national articles on the lack of funding, and absence of a national workforce plan. Against this background, he found this a positive report.
• A discussion about the impact of increasing fuel costs, which had contributed to 21 domiciliary care workers leaving their roles recently. Some had transferred to care homes to remove the travel costs. As a solution, a revised commissioning approach was being sought, to make it more localised. This should help providers to schedule services more efficiently and increase capacity. It was hoped that the fair cost of care exercise would assist with the fee structure to support some of the current pressures.
• Councillor O’Donnell referred to young people becoming carers, the challenges they would face and need for resilience. It was important to target the right people when suggesting this career. She spoke about career progression, including a gateway into nursing, for those who wanted to take that route. She asked for an indication of how many current carers may want to transfer to nursing and if the current arrangements were sufficient to allow this. Whilst the specific data sought was not available, there was a pathway into nursing from people completing the care certificate and then an apprenticeship. Further points about the profile of care staff, who may work around other responsibilities and not see their opportunity to progress. People working in care could be used as advocates to show the value and rewards of this role. 
• The Chair was surprised that businesses were not more efficient in their allocation of staff to maximise capacity. Zoe Mayhew confirmed that the Council had given a lot of support to providers to help them manage their businesses efficiently. This was ongoing and there were varying degrees of support required by different providers.
• It was questioned if research took place to identify the causes of people leaving care roles, especially in areas where there was significant turnover. In some cases, the causes would be beyond direct control. In others, it may be the way an organisation was run, and the Council could provide support and advice. Issues linked to travel in rural areas were raised particularly.
• The Chair touched on the current image of care work. There was a need to explain the varying roles and skill sets required, including digital skills, also that it was not just elderly people who needed support.
• Reference was made to delayed hospital discharges. It was questioned if all care roles were filled, how this would assist. Officers replied that this was complex. Hospital discharge in Warwickshire had historically been timely, but pressures had been felt since the previous year. Other contributors were the increasing complexity of care needs, meaning the person could not return to their previous care arrangements, or people perhaps being discharged from hospital too soon with a need for ongoing primary care support. Increasing the amount of domiciliary care staffing would assist, but given the interdependencies, it would not resolve everything.
• Chris Bain added that delayed hospital discharges were a system problem. He then referred to earlier contributions on the challenges of recruiting younger people. In his view, a more granulated approach, recognising the pressures they faced meant these issues did not happen. He made a plea for more care in how these challenges were presented and not to use the characterisations made earlier in the debate.
• A member was concerned about community care arrangements, specifically the short duration of the care visits, the travelling requirements between visits and for staff a lack of satisfaction at the service they were able to deliver in the time available.

The Chair thanked officers for the presentation and for responding to members’ questions.

Resolved

That the Committee notes the presentation.