ESRC Regulation Seminar

1. Workforce Policy and Care
Quality in English Adult Social
Care
Professor Carol Atkinson
Dr Sarah Crozier
Professor Rosemary Lucas
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

2. Adult social care and the workforce:
why it matters
• Aging population: rapid growth in numbers of
older people with more complex needs
requiring care
• Predicted demand for labour of around 2.6
million care workers by 2026
• Highly skilled workforce required
• Policy aims: adequate and highly skilled
labour supply; high quality care delivery
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

3. And yet…..
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

4. The Policy Context: NPM
• New Public Management: outsourcing of
statutory provision of services
• Over 80% of ASC is now provided by the
independent (private and voluntary) sectors;
mainly small firms
• Regulation to ensure control of quality: National
Minimum Standards of Care (Care Standards Act, 2000;
Health and Social Care Act, 2008; Care Act, 2014)
• Audit by the Care Quality Commission
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

5. The Policy Context: SHRM
• ‘One way of conceptualizing the ‘whole systems’
approach introduced by the 2000 Act, therefore,
is as an attempt to establish in the social care
sector a high-skills equilibrium, in which a well-
trained workforce is managed by means of a
complementary set of HR practices so as to
deliver high-quality care.’ (Gospel and Lewis,
2011, p.606)
• A strategic HRM approach (?)
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

6. HR practice in ASC
• High-skilled equilibrium: driven by regulation and
policy (but at QCF Level 2, HSC diplomas)
• Complementary HR practice: not regulated
• Prospects for complementary HR practice?
– Small independent firms
– Cost- rather than quality-driven commissioning
practice
• Implications for care quality?
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

7. Effects of HR practice on care quality
• Quantitative study (NMDS-SC and CQC NMS
scores); care workers providing residential and
domiciliary care for older people
• Regulated practice had some effect in improving
care quality outcomes
• It had less effect than a wider set of HR practices
(regulated plus complementary HR practices,
where pay was particularly important)
• BUT limited evidence of HR practice generally
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

8. Implications of the mixed economy of
care provision
• Compared effects of HR practice on care quality
outcomes across the statutory, private and
voluntary sectors
• Effects substantially larger in the statutory than
the voluntary and private sectors
• Suggests more uptake of/more effective HR
practice in the statutory sector
• The ‘race to the bottom’ in independent sector
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

9. Policy challenges (1)
• Policy framework for development
– At too low a level to drive a high skilled workforce?
– How to ensure uptake?
• Complementary HR practice:
– A role for regulation BUT
– Prospects for improving pay given commissioning
processes?
• ‘Love versus money’: workforce supply may be
inadequate if relying on those motivated by
altruism ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework

10. Policy challenges (2)
• Challenges NPM rhetoric of higher quality care
achieved by commissioning/purchaser split,
especially where provision is outsourced from the
statutory to the private sector
• How then to structure care provision?
• How to ensure cost- not quality-driven
commissioning?
• Recent Kingsmill/Cavendish reviews: largely
continue emphasis on skill development
ESRC Seminar Series Regulation of work and
employment: Towards a multidisciplinary, multilevel
framework