The Future of Care Work?
The shortage of workers in the care sector is a key concern to care providers and people who draw on care and support. It results in care needs going unmet, unpaid carers filling this gap and care workers themselves being under huge pressure to work more hours and take on extra responsibilities. Bringing together care providers, care home managers, care workers and researchers, the Future of Care North conference explored the challenges facing the sector both now and in the future. Of particular concern was this shortage of available care workers. In this commentary Rachael Black draws together the discussions centring on the care workforce, including the changing nature of the role and the potential opportunities this could bring when encouraging people to join and remain in the sector.
Alongside a range of issues facing social care, including funding, the ageing population and the increased time people spend living in ill health, a recurring issue covered by speakers and attendees at the conference was the shortage of workers in the sector. There are currently 165,000 vacant adult social care sector jobs which is an increase of 52% from last year. The rate of people joining the sector has fallen, while the high staff turnover rate in the sector has not changed. This means that the same proportion of people are leaving roles, but fewer people are replacing them.
Within a wider context of rising energy and food costs, uncertainty over reforms to charging for social care and broader pressures on the UK labour market across all sectors, care providers continue to grapple with issues relating to recruitment, retention and turnover of care sector staff; how to not only attract, but to maintain their workforce. Staff retention in the care sector is vital for continuity of care and building positive relations between the people in receipt of care and support and care workers. This has positive impacts on the quality of life and wellbeing of people receiving care and the satisfaction of staff. Navigating staffing shortages leaves care staff burnt out and considering leaving the sector.
The future of care work is clinical?
These urgent workforce issues come at a time when care work is undergoing significant change. There is ongoing debate about what it means to professionalise the role, and the training and support staff require to develop the skills needed. One example of this is that care workers are supporting people with increasingly complex physical needs. This is particularly the case for care home providers. The increase in virtual wards and virtual health care means that many people are choosing, and are able, to remain at home for longer. Research shows that over the last two decades the needs of people in care homes have become increasingly complex in terms of levels of disabilities and multimorbidity. Before the Covid pandemic district nurses would have undertaken some of the clinical care required to support residents, including pressure sore management, ventilators and PEG feeding. However, during Covid medical professionals were unable to visit care homes and supported living environments; they therefore trained care workers, virtually, to undertake these tasks. At the Centre for Care we have held discussion events with care workers and care sector managers to inform our evidence submissions to government inquiries. Supported living managers told us that receiving training in clinical care was actually a positive experience for their staff as it enabled them to learn new skills and expertise and provide some variety in their roles. Learning these specific new skills was more appealing to staff than moving up the career pathway into a senior ‘lead’ role or locality manager:
The lead role is very difficult to recruit and we tend to recruit for this internally. It is hard; it goes back to pay every time. The difference between support worker and lead support is more responsibility with supervisions, the on-call process, rotas (Recruitment Manager of a supported living organisation).
This issue of care workers delivering clinical care was raised again at the Future of Care Conference. On the one hand it provides opportunities for care workers to develop expertise in a particular area, but on the other, if the pay does not match the skills required then many will be reluctant to take on the additional responsibilities. Currently the role of a support worker has been assessed to be the equivalent of an NHS Pay Band 3 role in terms of the skill required. NHS Pay Band 3 roles are paid on average £25,142 compared to £17,696 per annum for the average care worker. One national care home provider at the Future of Care Conference explained that they were implementing a band payment system to bring their pay in line with the NHS. Care workers would be offered the chance to specialise in clinical care tasks, as well as supporting and advising others. This would enable them to progress through the bands while maintaining their frontline care role and avoiding taking on management responsibilities. However, care workers in attendance at the Conference highlighted that although there was an appetite to undertake this training, courses were not offered regularly and were therefore difficult to access. In response to this increasing delegation of health care tasks to care homes, Skills for Care has launched a steering group to develop a Delegated Healthcare National Framework to be published in Spring 2023.
The future of care work is digital?
Digital and technology enabled care, including its impact on both people in receipt of care and the care workforce, was a theme that ran through the Conference. Technology has the potential to support people to stay in their own home for longer and to enable care home providers to monitor outcomes more efficiently and accurately, for example by being able to report on efforts to reduce falls and hospital admissions. This access to real time data from sensors could be used as evidence for the Care Quality Commission (CQC) to demonstrate the quality of support being offered, outside of the physical inspection. For care workers, technology can enhance their experience at work – for example they can use the data collected to directly see the impact of their support on that person. Using digital platforms to keep notes and record visits was also described as being appealing to care staff.
However, in our conversations with care workers and supported living managers, the increased digitisation of the work has been off-putting to some:
One difficulty is that technology comes up as a barrier. We’ve started using i-planet software which is supposed to enhance support by including individuals and families more in their care. In terms of best practice it’s a great way to go but despite relatively limited requirements we lost someone who just didn’t want to engage in the process.
Reasons care workers may not want to engage with digital technology include staff feeling they lack the skills to use technology, and a suspicion that the technology on offer will not enhance their caring, but take them away from the face to face nature of their role. In addition to staff willingness to use the technology, there are issues with the connectivity of care homes. Without the necessary infrastructure in place, residents in care homes, their families and the care workers, cannot make the most of the potential of digital.
As with undertaking clinical support care workers require training to develop their digital skills. This is a key area that employers identify as a ‘skills gap’. Without the training and development, care workers may feel unable to undertake the work required of them and leave the sector.
It will continue to be vital for the care sector to offer stimulating roles that provide opportunities for skill and career development. Although pay remains at the heart of any discussion about the care workforce, speakers at the Future of Care conference covered some other factors that can enhance a person’s experience of delivering care work and their satisfaction in the role. These include:
- Seeing the impact of their work – this could be making use of sensors and data that show improved outcomes for the people they support
- Celebrating good outcomes and practice
- Opportunities to build expertise
- A career pathway that was not necessarily into management
- Opportunities to undertake training to develop new skills, including in digital and clinical care.
Raising the esteem of social care is a means of making the sector a more exciting and appealing one to join and stay in. This requires recognising and valuing the huge and increasing range of skills needed to undertake the role, and ensuring staff have the support and training necessary to deliver it.
Rachael is the Impact Specialist in the Centre for Care, working with academics and external partners including charities and policy makers to mobilise research findings to have the greatest impact beyond academia. Her role is to work with our researchers to plan for impact, explore the ways research findings can be widely shared and identify partnerships and possible collaborations.
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