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Productivity in social care services: innovating for better jobs, service and resource use

Brendan Martin, 8 April 2014

See also:

Fairly Flexible, redesigning home care services for the 21st Century

The Best Workplace, staff involvement to improve jobs, services and productivity

Home care of older people: the revolution has started

Mrs Thatcher had a level of care local authority workers simply can't provide


The School for Social Care Research was set an important and interesting challenge at its fifth annual conference today when the Westminster government’s social care minister Norman Lamb asked it to focus on how to increase productivity in the sector.

“With the pressure the system is under, nothing else will do,” said the minister, reminding his audience that social care costs are rising at 4% a year while the ratio between working and retired people reduces rapidly.

As the School is funded by the government, which has just renewed a £15m grant for the next five years, no doubt it will give serious consideration to Lamb’s suggestion, along with the two other areas of focus he outlined today, to find “new and better ways to personalise care” and “ways to integrate and join up care systems”.

Indeed, it would surely have done so anyway, since productivity improvements will feature highly in the future social care agenda whoever forms the next government. As ever in the public service context, however, much will depend on how productivity is defined and measured, and how improvements are achieved.

The outlooks and intentions of government ministers will clearly have a significant bearing on those questions, and social care workers and their unions can be forgiven for fearing the worst. But that should prompt them not to reject the challenge of productivity improvement but to contribute positively to framing the debate about how it can be done.

No-one disputes that more resources are needed for social care, although how much more and how it is raised are contested. But whatever the level of funding it will never be enough to meet every conceivable need well, and the political case for sufficient resources is strengthened by showing how budgets can be used more productively.

The good news is that there are big potential synergies between improving working lives and livelihoods for care workers, better and more flexible and personalised services for those they look after, and higher levels of labour productivity.

I have recently returned from a visit to several projects involving Public World’s partner social enterprise in Sweden, Alamanco, where in one municipality — validated by a European Social Fund study — big savings have been produced by reducing — yes, reducing —the use of zero-hours contracts.

Public World is now working to introduce to local government commissioners and service providers in Britain a model of home care inspired by Alamanco’s 20 years of experience in Sweden. We call it Fairly Flexible, and the idea is to redesign services and training so that frontline workers operate in small semi-autonomous local teams able to adapt to changing need in real time and combine more effectively with supports provided by the families and local communities of the older people they care for.

This is incompatible with the ‘command and control’ methodology behind the prevalent ‘time and task’ model of home care services, and with the abuse of zero-hours contracts, because, paradoxically, insecure employment reinforces rigid service delivery while more secure employment supports more flexibility in work organisation.

Similar approaches have been shown to work well in residential settings too, proving that productivity improvement in social care does not necessarily mean more precarious jobs with worse pay and conditions.

On the contrary, it does necessarily involve better and more secure jobs, and that can be achieved if the service opens up to innovation to enable the entirely possible synergies between better resource use, better services and better working lives.

We are actively seeking partners among local government commissioners and service providers for our Fairly Flexible home care project. If you would like to discuss it, please contact me.

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