Every week there seems to be yet another report highlighting the crisis state in which the health and social care workforce finds itself. We have had dire warnings about the shortage of doctors and their levels of fatigue. We’ve had the RCN stating the pressures resulting from nursing vacancies in the NHS. Scottish Care in the spring stated that 9 out of 10 care at home organisations are struggling to fill vacancies and two weeks ago we reported again on nurse vacancies running at over 1 in 4 posts lying empty and over 2/3 of care home providers struggling to fill positions. With the added pressure of Brexit, the rising Scottish Living Wage and pressure from retail and hospitality it is an operational nightmare to try to fill posts and establish an adequate workforce.

We need a fundamental review of the workforce in social care and that cannot be undertaken in isolation from a root and branch review of the whole sector. At the moment it feels as if we are lurching from one reaction to another without a coordinated and thorough review.

Policy makers declare that we need to develop a workforce to fit the needs of the future. We keep hearing about ‘new models of care’ as if there is a utopian reality where quality person centred rights based care is just waiting to be discovered offering a cheap alternative to current models. That is a naive wishful thinking that ignores that the basics of care are inherently consistent – the heart remains the same whatever the outward form of delivery. That heart requires people, namely a well-equipped, resourced, valued and skilled workforce.

We have to accept that we will never address workforce shortage by under-resourcing the care sector. How can we build stability, career pathways and a future for staff to commit to when we have organisations with no sense of sustainability due in part to one year contracts and a lack of investment in a sector which is a major player in the Scottish economy?

There are new and innovative approaches to the care workforce with the work of Highland Homecarers and the Local Cornerstone model to name but two.  Whatever the specific model for a workforce fit for the future they have some intrinsic and consistent elements:

  • Autonomous frontline workers able to make decisions and supported to take action
  • Self managed teams where the emphasis is on collegiality and outcomes – a sense of making a contribution that matters
  • Professional respect with colleagues in other teams
  • Being part of a multi-disciplinary team with clear escalation routes and an emphasis on locality and flexibility
  •  Light touch oversight through proportionate regulation and appropriate levels of information recording
  • An emphasis on staff physical and emotional wellbeing as critical to a healthy team
  • Excellent learning and development for staff who are enabled through rota planning to learn and to develop their skills for whatever career pathway they choose
  • Appropriate and rewarding terms and conditions as well as a good level of basic pay.

These are some of the ingredients which we know when they are present staff are made to feel valued and are therefore more likely to remain in their posts. Yet what we have today is light years away. What we have at present are reports which like one from Christie & Co tell us that care homes say they are “increasingly competing with supermarkets like Aldi and Lidl who are actively recruiting and offering attractive pay rates”.

Getting it right for our workforce means getting it right for those who are supported and cared for in our communities and care homes. This should be a set of jobs valued and recognised for their benefit to the whole of Scottish society.

 @DrDMacaskill