March 3, 2021

By Ann-Marie Towers (Reader in Social Care, Centre for Health Services Studies, University of Kent)

& Grace Collins (Research Officer, Personal Social Services Research Unit, University of Kent)

What we did

Following an online survey of 296 care workers in July/August 2020, we undertook qualitative interviews with six social care stakeholders, including:  two not-for-profit national provider representatives; a manager from a small independent care home provider for older adults; and the CEOs of three large, multi-client group, provider organisations (live-in care, care home and domiciliary care). The interviews aimed to:

• ‘sense-check’ the findings of our survey,
• gather information on the mood and wellbeing of the workforce going into winter,
• support the development of a longitudinal survey in 2021.

The context

We conducted the interviews in October 2020, at which time the UK was operating a ‘Tier’ system, meaning social distancing measures in the UK varied by country and local authority area. Nonetheless, children were in schools, non-essential shops were open, and the public were able to socialise in groups of six (indoors and outside). However, for social care users, their families and those caring for them, things were still far from normal. The COVID-19 pandemic has had a disproportionate impact on adult social care users, the majority of whom are older and/or have long-term conditions and disabilities.

Our Findings

Looking back

Stakeholders echoed the findings of the pulse survey in reporting understandably high levels of anxiety amongst the social care workforce:

“I would say that those findings around pressure, on work/life balance and sense of just anxiety and tension and feeling how that’s affecting your overall wellbeing, I would say that would be quite mirrored by the conversations that we’ve had over the months.”

Digging deeper, there was a sense that the social care sector felt abandoned in the early months of the pandemic. Speaking about domiciliary care workers, one interviewee said:

“…many of them were very anxious because nobody really knew very much about the virus. And many other professionals like GPs and district nurses and social workers, the national policy was for them to stop doing face-to-face visits, so homecare workers found themselves being the only people out there actually seeing people.”

A fundamental problem was a lack of understanding of the social care sector by central government, with policy guidance focused on the NHS and reducing pressures there:

“In terms of the guidance, I mean it was chaotic at the time and retrospectively it looks like a shambles really.  There was some of that which was avoidable and some of that which probably wasn’t avoidable.  So the bits that were avoidable were assuming that guidance that worked in the NHS would work in social care, not having an understanding of how social care environments actually operate.”

Managers and owners had the additional pressures of sourcing PPE, to ensure the safety of both clients and staff. One care home manager said:

“We’ve had to work hard to get it and been a lot of driving around different parts of the country to pick stuff up.” 

With colleagues self-isolating or getting sick, the increased workload took its toll on the workforce, who reported long working hours, concerns about their own safety and reduced job satisfaction (see summary of survey findings here):

“…in the early days of the pandemic where we were seeing absence rates of between 20% and 30% actually….there were a chunk of people who were off shielding, there were a chunk of people off ill, and therefore the staff that were in work were experiencing increasing pressures…. I guess there was a period of time where there was huge, huge pressure on the workforce that were actually able to come to work.” 

Supporting well-being

How well organisations supported the wellbeing of frontline care workers varied enormously. Stakeholders from small/medium sized enterprises (SMEs) told us their focus had been firefighting – sourcing PPE, interpreting government guidance and keeping clients and staff safe.

“We should probably be having more conversations about how we support staff better.  It’s very hard when you’re facing into a second wave because, again, your focus is on how are we going to get through it?  But… I think, certainly from our point of view, we’re thinking much more about staff wellbeing and welfare than we did in the first wave.  But there’s still work to do. “

Care provider representative organisations, such as the National Care Forum, offered support to owners and managers. Nonetheless, with limited personal and financial resources, SMEs were not able to offer care workers comparable packages of support to those offered by some national organisations.

For example, stakeholders told us that the larger franchises and national organisations were able to use their structure and size to their advantage. Head offices read government policy updates and guidelines and disseminated these to service managers and staff. Some already had ‘wellbeing strategies’ in place and access to staff assistance policies for work-related stress and emotional wellbeing.

“So we split our wellbeing framework into like is it a physical need you’ve got at the moment, is it an emotional need you’ve got at the moment, or actually do you need some training on a skill?”

 One stakeholder told us that their organisation had ‘over-dialled’ the wellbeing to support staff, even commissioning additional resources for their staff, such as wellbeing podcasts for care workers to listen to while driving in between clients’ houses.

Regardless of size and resources, all stakeholders noted the importance of emotional support and simply ‘checking in’ on colleagues to see if they need support:

“let’s split the care givers amongst ourselves and phone up, and we’re not asking about work, we’re just saying, “And how are you, how’s it going at the moment, what can we do to support you?”” 

Looking forwards

The Health Foundation have funded us to undertake a two-wave, panel survey of the social care workforce in 2021, exploring the impact of COVID-19 on frontline staff. This UK-wide survey builds on the pulse survey we conducted in summer 2020 and the interviews with stakeholders. As well as exploring the impact of COVID-19 on care workers’ job satisfaction, well-being and intention to quit, we will be giving staff space to tell us what supported their wellbeing the most during the pandemic, in their own words. Was it training and equipment to keep them safe? Helplines and counselling to support their mental health? Podcasts and apps to aid relaxation? Or was it mostly the emotional support from friends, family and colleagues?

Summary

The true impact of COVID-19 on the wellbeing of the social care workforce will not be known for some time. However, what is clear is that is has taken its toll and highlighted the inequalities in the sector. Unlike the NHS, social care operates in a quasi-market, with a fragmented, low-paid workforce. Our work has shown that providers operating at the upper end of the market have been able to offer frontline staff support throughout the pandemic. Their own workforce surveys indicating higher than ‘average’ levels of wellbeing amongst staff. Others, particularly SMEs and those relying on local authority contracts, have spent the year firefighting to stay on top of ever changing policy guidance. The social care sector is one of the largest employers in the UK, with around 1.6 million staff. Ensuring the sustainability of the sector and the wellbeing of this essential workforce is an urgent policy priority.

About the RESSCW project

This study is part of the Retention and Sustainability of Social Care Workforce (RESSCW) project, funded by the Health Foundation’s Efficiency Research Programme. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The views expressed are entirely those of the authors.

The Retention and Sustainability of Social Care Workforce (RESSCW) project is a collaboration between the University of Kent, University College London, City University, and Skills for Care. The RESSCW study is Co-led by Dr Florin Vadean and Professor Shereen Hussein. A sub-study focusing on the impact of COVID-19 on the wellbeing of care workers was subsequently funded by the Health Foundation and is led by Professor Shereen Hussein.

Contact:

If you would like to find out more about the project, please contact Professor Shereen Hussein (shereen.hussein@LSHTM.ac.uk) or Dr Florin Vadean (f.vadean@kent.ac.uk).