We are in desperate need of substantive care reform. The past few months have sharply highlighted the issues at the heart of our sector. Of course, now that the issues have finally been acknowledged, the notably more challenging task of addressing them begins.
That’s when people like Mark Topps, registered manager at Eastern County Care, step in. He has been working publicly to change the perception and classification of carers through initiatives like #chatforcare and his change.org petition to have carers recognised as skilled workers. He also works privately to shape the culture of social care in his area.
Lorcán Murray, marketing executive of home care software supplier CarePlanner, sat down with Topps (virtually, of course) to discuss the future of care, and how one can start to address its present issues.
Baptism of Fire
Mark Topps got started early in care, and his experiences would shape his career.
“When I was 17 I did witness quite a lot of abuse,” Topps says. “I think that spurred me on to always doing the right thing for somebody. Whether that’s somebody we’re looking after or [somebody] I’m working with. I had managers that used to talk down to you. People who didn’t treat you with any kind of respect at all. When I got into management I always remember those times. I think, ‘well I don’t want to be like that because I know how that makes me feel’.”
It is an experience that, unfortunately, many carers can relate to.
“I think a lot of the times care workers do just sort of ‘get on with it’,” Topps continues. “They don’t really voice their concerns. I don’t think they know the platform to use to speak out. As a manager, I think people that are directors, people who are kind of leaders in the field should speak up and raise awareness. I started a petition on change.org because I saw quite a lot [of posts] on social media were blaming care workers. Just heading into lockdown there was a lot of blame. I thought carers needed to be treated with dignity and respect and be seen as more professional.”
However, the objective of the petition does not lie completely in changing public perception. The government’s refusal to recognise carers as ‘skilled workers’ has repercussions on recruitment and retention as well, most prominently affecting carers who have immigrated to the UK. Many see this as a potentially devastating decision given the current state of social care staffing.
Looking for Alternatives
Social care’s issues are well documented and long proclaimed. Though care reform has been slow it is seeing renewed support from the public during the pandemic. In our search for alternatives, we can draw inspiration from other, more effective, social care systems.
“In Denmark care work is seen as one of the highest professions you can have,” Topps points out. “They go to college and uni to study social care and they go into it as a career choice and probably one of the biggest career choices out there, so they all want to get into it. It’s a completely different model than it is over here. I think if the workforce is seen as more professional then you would equally get more people applying.”
While no system is without its flaws, the need to elevate the stature of carers is evident. And one way to do that would be to elevate the stature of social care careers.
Creating Career Pathways
Both private and public efforts are being made to attract people to the social care sector. While these initiatives are encouraging, and in some cases inventive, they are still offering the same thing. Increasing interest in social care is all well and good – the entire country has been impressed with the work of carers over the past few months – yet considerably fewer of us have been inspired to join the sector. A combination of challenging working conditions and limited opportunities for professional growth stifle the attractiveness of being a carer.
”A lot of it does come down to pay,” Topps admits. “Outside of the sector people think, ‘why would you want to join working for care?’. A lot of people kind of just see it as wiping bums and making cups of tea. I think sometimes, though I don’t know, would pay grades help? When you have tiers to pay for different levels. Maybe having something like that in social care would be beneficial.
“I know for the last nine years I’ve been talking about the qualifications. That’s because they change all the time. They’ve changed four times since I’ve worked in care, so in the past 15 years. I kinda think ‘no wonder nobody sees us as professional because even our qualifications change continuously’. I know they’re going to change [over time] but you don’t see in the NHS all their qualifications changing left right and centre. I do think companies need to have career pathways in place. I’ve always been keen on having somewhere for the carers, even if there’s not a job there [with us]. It’s important to offer upskilling to carers even if they go to another company so they can progress in their career.”
Considering how difficult it is to recruit and retain staff, training them to leave does seem somewhat counterintuitive. However, the opportunity for development is a well-established incentive for employees, so perhaps the conversation needs to be shifted away from viewing staff trajectories as linear (joining to leaving), and more circular, as staff move in flux between different providers whilst building their skills.
A Rising Tide
It can be difficult to lead to change. Frequently those who spearhead reform are amongst the least to benefit from it, and care reform is no different. Such is the nature of trailblazing. Topps draws upon his own experience to inform his position.
“I know when I started my career the company I started with didn’t want to put people through for their NVQ’s,” Topps remembers. “That’s what they said, ‘people will just get the level 3 and they’ll leave’. But I think you get more benefit from encouraging upskilling. I’ve got carers who have worked where I am for seven years because they know if they come to me with whatever training we will look into it and nine times out of 10 put something in place. I think they respect that they know they can continuously develop themselves and look at different avenues.
“My deputy manager is a prime example. She started the company shortly before I did, so three years ago. She was a housekeeper, and after I started I watched the way she interacted with the residents. I thought, ‘you have so much more to offer than just cleaning the toilets and bedrooms’. So I made a role in the home for her, as an activity coordinator, which was pretty outside of the box for a learning disability home. She has progressed the company so much further forward. She won an award for what she was doing and now she’s my deputy manager. I think you’ve got to think outside of the box. Just because someone’s a cleaner that doesn’t mean they can’t go into management.
“I think sometimes we do just see people as their roles.”
Breaking Bad Habits
Whilst the nation’s new-found love of care workers is a recent and welcome phenomenon, no one would pretend that the sector is without its issues. Abuse in social care is a harsh reality and one that can be very difficult for managers to address.
Topps explains: “I think negativity can take hold a lot quicker than positivity. Nobody wants to be taking a staff member through disciplinary and warnings. So sometimes you might let a carer get away with something. But then before you know it, it’s manifested into that happening every time that carer is in. Next somebody else starts thinking; ‘that’s okay, they’re doing it’. Then it spreads and before you know it you just got a whole culture of something going on within a care service that’s way out of hand.
“When I started where I am three years ago we got rid of near enough every member of staff through our changes. I mean, probably half of them resigned because they didn’t like the changes and the other half we had to take through disciplinary. So we’re left with three staff out of the 20 who were originally there. And they had been there for seven years, all of them had been there for so long. But the culture was so negative, you could cut it with a knife. Then the CQC and local authorities were asking us why had we gotten rid of so much of the staff as continuity is great. They even penalised us because we got rid of so many staff. I don’t think that helps.
“It’s not easy taking staff through that, nobody wants to do that, take someone through that and put them out of a job. But you have to look at the home as it is now and compare it to when I started. It’s completely different. At the time even the families didn’t like it. The relatives knew that the staff were disappearing left, right and centre. However, now when they compare it they say; ‘well actually it’s like 100 times better’. But I don’t think a lot of companies want to make that sacrifice. Because they know if you get rid of five staff you have to recruit five more. And then upskill them, train them, teach them your processes and values. There’s a worry about how you’re going to fill the role if you get rid of somebody.”
Stand Up Speak Up
Reform never comes easily. There will always be those who push against it or disagree with its direction. We are currently experiencing a rare consensus from the public that social care must be funded, fixed and valued. However, capitalising on this feeling and actually enacting change will require courage, energy and ambition.
“We definitely need more people in management, leadership, directors to speak out about the issues in social care,” Topps says. “At the beginning of the pandemic when there was no PPE I was one of the few managers that was speaking out saying actually there is no PPE. A lot of my neighbours in the village I live in thought everything was okay. I think to the outside world everything in social care is fine. It’s not until they need to use the system, whether it’s for a loved one or themselves, they actually realise it’s not.”
Topps is quick to acknowledge the importance of unity in this pursuit. He belongs to a local group of care providers who interact through Whatsapp. Sharing pertinent information and providing solutions to each other’s issues. He spoke more about the importance of groups like ‘Care Manager Inner Circle’ on #chatforcare with Jonathan Cunningham MBE. These groups provide an outlet for care managers and prove a great source of information and support. Hopefully, through collective action at the local level, social care can reverse its fortunes and take control of its future.
“Obviously care workers are being seen in a completely different light, which is great news,” Topps acknowledges. “It’s just about if that materialises into anything afterwards.”
You can sign Mark Topps’ petition here: https://www.change.org/p/care-workers-need-to-be-seen-as-skilled-professionals