Childcare and social care share similar problems - and solutions

High fees, gaps in provision, a low-paid workforce - the problems in the social care system will be familiar to users and practitioners in the early years childcare system. We know that a skilled workforce is crucial for the quality of both social care and childcare provision - but in both sectors we see a vicious cycle of low pay, resulting in high staff churn and expensive recruitment costs. As a result, in social care opportunities for career progression and pathways are limited, meaning staff leave the service or profession altogether. We know this leads to a poorer quality of service, such as a lack of experienced staff due to high turnover, reduced morale of the workforce and a lack of continuity of care that can be disruptive for families.

In a recent forum with care providers and commissioners, we discussed this vicious cycle of workforce issues. One of the positive observations was that if pressure is reduced to any part of the cycle, it can significantly reduce pressures elsewhere in the service. Three areas of opportunity in the social care system - provider alliances, career development opportunities, and more robust outcome-led commissioning - point to practical changes that could have a big impact within the childcare system. 

Bringing providers together can help solve problems

Across social care, providers collaborate informally to support one another and share learning, but approaches are patchy and disjointed. We think there is an opportunity to build on this to help create partnerships that share resources, particularly around recruitment and training. This would help with retention, enhance services, strengthen collaboration, and the development of best practice. Digital platforms like the What Works Centre for Children’s Social Care are also important tools for spreading learning.

We believe that the new Integrated Care Boards and Place partnerships present an opportunity for joining things up locally across health and care. These partnerships exist to solve problems at a much more local level and should be a vehicle for spreading innovation and learning about what works. Social care needs to be at the table, and we would argue, so do those representing the childcare workforce.

We’ve learned that ensuring these forums and alliances aren’t just filled with people from the same sector is essential. Bringing diverse perspectives, multidisciplinary teams and skills around the table helps open solutions to problems that otherwise wouldn't have been considered possible. This must also include service users, and those with lived experience. For example, when we bring new experts, such as representatives from the police force or local authority safeguarding teams into provider forums, it encourages staff to engage more with these services and educated both sides about how they could work more effectively together.

Increasing career development opportunities

Care workers and managers often struggle to see career progression opportunities or pathways. Care City developed an Apprentice Nursing Associate programme in Barking and Dagenham which allowed care workers to continue in their position in a care home that didn’t have a permanent nursing staff member, and receive arms-length nursing supervision and a nursing qualification.

This programme has made the difference for individuals like Ajeesh, who works at Ebury Court nursing home, and who was on the verge of leaving his care role due to the lack of progression opportunities. The apprenticeship nursing programme has allowed him to train and become an Apprentice Nursing Associate without leaving the sector. The Nursing Associate role bridges the gap between support workers and Registered Nurses. Like nursing, it is a role regulated by the Nursing and Midwifery Council. Becoming an Apprentice Nursing Associate – and then a Nursing Associate – is an increasingly important route into nursing. Opening this new career route up to the hundreds of thousands working in care homes could be incredibly powerful.

We must think differently about the skills and opportunities required in care roles and the childcare workforce and consider how to make the most of the new T-Levels and apprenticeships to support learning and build new career pathways, like the Apprentice Nursing Associate programme.

In our experience, we have found that making what seem like small changes to the work environment can greatly impact the perception of work. For example, we found that community nurses are often provided free local authority parking permits, but care workers are not. When this was addressed, it significantly increased the satisfaction of care workers who felt they were treated more equally and were given tools to do their job. Even small things like giving people their birthday off as annual leave can be a powerful motivator of recognition.

Only a handful of Local Authorities have Care Academies, but where these exist they provide care workers access to training to obtain qualifications and improve their skill set. In addition, management and leadership training provided at these academies help staff to be in a position to progress in their career. It makes us think, what might a Childcare Workforce Academy look like?

Outcomes-based commissioning

In social care, packages of support are often commissioned on a per-person basis, without attached outcome measures to demonstrate improvement. Care City believes an outcomes-based care package would lead to more bespoke support. This could involve more community-based approaches to care, different types of caring roles, and new technology to better meet the person’s needs.

There is broad consensus that better formal childcare leads to improved outcomes for children and young people. In the same way as social care packages of support, there is no one-size-fits-all model that works in all childcare circumstances. Thinking upfront about outcome measures could help us think differently about the types of childcare support and models that are needed. For example, if we thought about the needs of a young single mum, we might imagine an outcome of childcare support that included building the families’ social connections. As a result we might encourage more models of parent-led cooperative childcare, like Grasshoppers in Hackney, that encourage parents to participate their skills and time, to get to know each other and support each other with childcare.

Outcomes-based models in adult social care generally educate the participant about how to quantify their own improvement and independence. Using outcomes-based approaches in childcare services could also give families some of the tools and knowledge to do this too.

Conclusion

Whereas policy is often generalised and is designed to serve the needs of a large group of people, implementation needs to be adapted to the local context. It takes time to examine the causes of issues and requires local providers and service users to work together. The issues providers face don’t exist in a vacuum - we need to think of more system-wide solutions. The pressures on funding mean that commissioners feel they are not able to take the time to do engagement well. But we will continue to be trapped in the cycle of services degrading and facing cut after cut until we work together and focus on long-term solutions. We at Care City believe that it is possible to turn the vicious cycle into a virtuous one, but it will require people to have the determination for change to try new approaches and the capacity and openness to work together.