Greatest Asset and Most Fragile ForceIf I had a pound for every time a social care employer used the phrase that their greatest asset was their workforce then I could probably retire wealthy.

Beneath the sentiment is, at least in my experience, and at one level a real truth. Any care organisation is only as good as the quality of its frontline carers; and its reputation only as valued as the ability and skill of frontline care.

It is a truism that certainly has validity in light of the massive challenges facing employers as they seek to recruit and retain staff.

In research undertaken by Scottish Care this year we are faced with a reality that 9 out of 10 care providers are struggling to fill posts and even once someone is recruited we experience nearly two-thirds of staff leaving within the first six months.

There are very real challenges of recruiting to the work of care wherever you happen to be across the United Kingdom.

There are lots of reasons for this from inadequate terms and conditions, the increasing demands of regulation and registration and the general apathy, if not upon occasion antipathy, to the contribution of social care in general and the care worker in particular.

All of this means that we all must engage in the critical role of reforming social care and re-defining if not re-designing the work of care.

But in the midst of all that I think it important that we pause to reflect on the nature of care and the invaluable and irreplaceable work that the thousands of women and men who work in social care do in season and out.

Care Is Relationship and Encounter

The essence of care is human relationship. It is not a series of tasks and a set of transactions to be calculated by some call monitoring system or in-house assessment. It is an activity which has at its heart human encounter and because of that it is singularly unpredictable, frustrating and immensely rewarding in equal measure.

Meaningful care presupposes an ability to relate to others whom one may not like and with who you may have very little in common. There are few workplaces where the giving of self is such that it costs you at an emotional, physical and spiritual level. Yet that is what being in a relationship by doing the job of care demands.

An encounter with any human being is not a transaction it is an exchange – you give part of yourself in that encounter. The more that I have been around care the more I recognise that care work changes the worker.

When you sit with someone whose life is etched with dementia and listen to their stories or help them to articulate their need and pain, you as a worker are changed by that encounter. When you sit with someone who has been labelled because of their disability as ‘non-communicative’ and learn the gestures of touch and the signals of sound then you are changed by the discovery of a new language of togetherness.

This act of continual giving and exchange is a costly one and all too often we have failed to appreciate and understand the true cost of care for the person doing the care-giving and the care-loving. Care costs because it involves.

Care Is Enabling

True care opens up potential in the person being supported. Care is not about living another person’s life, it is not about doing for or removing choice or capacity.

Care at its best is about opening a door for someone to walk through themselves; giving the chance to a child, an adult or older person to live their days as they would want, to achieve their dreams and reach and fulfil their potential.

That takes tremendous skill, initiative and self-confidence and the best of care-giving is precisely that it gives freedom and power to the other rather than restricts or limits by removing autonomy and decision-making.

Care Is Uncertain

There are many jobs in this world which are mundane and somewhat predictable if not pedestrian. No one day spent in caring for others is ever predictable.

Okay, some of the tasks might be the same, but the relationship, the encounter, the dynamic will always be different and at times frequently contradictory. That is life and that is why in the fullest sense of the word care is one of the most flexible and dynamic roles a person can undertake.

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Care in the Community

Having said all that about care you will have gathered that I am an evangelist for seeing the work of care as something to be more highly valued and recognised as the glue which holds our society together, which knits people into their communities, and which grants cohesion and strength to our society.

But there are risks. We have got to do much more grown-up work in articulating why organisations are struggling to find carers and why society still continues to devalue and dismiss the critical cohesive role which care work contributes.

We have to become much more articulate and convincing in stating the bald truths of a society which seeks to portray itself as modern and contemporary, as caring and compassionate but fails to follow through on that care rhetoric.

So why is it that the closer you are to money the more rewarded you are and the closer you are to people the lower the status given to you in reward and recompense?

Why is it that a sector dominated by women (in Scotland at 85% of the social care workforce) that we see the lowest paid and some of the poorest terms and conditions of any employment sector making life fragile and vulnerable?

Why is it that the care of some of our most vulnerable and talented individuals from children through to older age is worthy of such little political and fiscal attention?

For me, these questions should be resonating throughout our local and national political and cultural discourse and yet around them, there is a strange echoing silence.

The Future of Care

I do not believe it is naïve to dream of a future where the job of care is considered to be so fundamental and cohesive to the well-being of society that it is properly rewarded and resourced.

I do not believe that it is naïve to dream of a future where the places we deliver care, in individual homes or in care homes, in day centres and resource settings, are properly resourced so that they are caring places at the centre, the hub, the heart of our communities.

I do not believe that it is naïve to recognise that care is the job and responsibility of us all, that it is not ‘women’s work’ alone and that the vision of equality, and a challenge to discrimination and an embedding of individual human rights is actually realisable.

But it is naïve to think that having articulated the essence of care and suggested the aspiration behind care that this will all be protected and achieved without energy, struggle and resolve. Because care does not stand still, it continually changes and so I believe the future of care is one which – if properly prioritised and resourced – is both exciting and fulfilling.

It is a future where care workers maximise the best from smart technology to build person led care around the needs of the individual removing the functionalist limits of time and task commissioned care and opening up the fullest potential of the personal relationship which is at the heart of care.

If we allow ourselves to properly resource innovation we have a real potential to use Artificial Intelligence and the Internet of Things to foster care excellence with contact, interaction and communication at its heart.

It is a future where the work of care is truly preventative and responsive rather than reactive and fragmented. Again the use of smart technology should free up more resource for earlier intervention which is truly preventative and enabling of individuals to have more control and choice in their lives.

There are real prospects of greater independence and less reliance into the future and thus less dependency on costly acute and clinical interventions.

It is a future where the frontline care worker needs to be trusted as the skilled, autonomous professional they have the potential to be. Decision making needs to be devolved to the worker, assessments of need and intervention need to be delegated to the person who has the care relationship.

All this demands a renewed and reformed contribution for proportionate scrutiny and realistic regulation, a purchasing of care by the public purse which is trust based and oriented around relationship rather than compliance and suspicion.

Our Greatest Asset

When all is said and done the most important asset is our care worker now and into the future. Any re-design and role-reimagining has to have the frontline care worker at its heart and in its leadership. To do otherwise would be to risk inauthenticity.

Care workers are indeed the greatest asset to social care but they are in a real place of risk and vulnerability.

The future cohesiveness of our communities demands that together we work to build a relationship-based, prevention-focussed, time-flexible approach to building care in our communities.

Author: Dr Donald Macaskill - CEO, Scottish Care (Please note: the views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of The Care Workers Charity).

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