In the News
Throughout the pandemic, staff in the social care sector have faced a huge number of challenges. The virus sweeping through homes at the start of the pandemic, a lack of PPE, a huge increase in hours worked and the deaths of many residents in their care have all taken their toll on those who work in care homes and domiciliary care.
On the 18th of February, the Government published its response to the recommendations set out in the Health and Social Care Committee’s report on workforce resilience and burnout (see below). This acknowledgement of the challenges staff in both the health and care sectors have faced, while welcome, is long overdue.
The potential for a wellbeing crisis was voiced early in the pandemic by Nursing Times, who launched their ‘COVID-19: Are you ok?’ campaign to raise awareness of the issue for nursing staff working in both health and social care settings. Despite this, chief executive of Care England Martin Green was blunt in his assessment of the support on offer to care home staff earlier this month, saying that it was not good enough and that staff did not have the same resources as those on offer to NHS staff.
The reasons
Research from the South London and Maudsley NHS Trust identified a number of specific stress points on care home staff. These included working long hours for low pay, not having enough time for self-care, and an expectation to “just get on with it”. Both frontline staff and registered care managers (RCMs) felt that the culture of the sector was not one that invited staff to reflect on the emotional impact of their work.
On top of these, the House of Commons Health and Social Care Committee identified in its report on workplace burnout and resilience in the NHS and social care, published in June last year, that care staff also felt “abandoned”. The feeling was that with the focus on the NHS early in the pandemic, care staff felt less valued in comparison. The recent U-turn on mandatory vaccination for NHS staff has not aided this image.
These pressures, taken together, have taken a severe toll on the wellbeing of care staff. A UNISON survey in September detailed a number of worrying statistics, including:
· 85 per cent who experienced mental health deteriorating since the start of the pandemic said work had been a contributing factor
· 22 per cent were experiencing anxiety
· 35 per cent had difficulty sleeping
Most worrying of all, however, was that 72 per cent said they had not been offered mental health support. One care worker described the pressure of their experience in a report to Sheffield City Council in December as “It’s like four foot of snow, but for 18 months instead of 10 days”.
The solutions?
In the Government’s “People at the Heart of Care” White Paper published in December, the strategy for the social care workforce promised “at least £500 million to transform the way we support… the workforce”. This promises a focus on wellbeing going forward that will include:
· Counselling
· Peer support
· Support helpline
· Mental health first aid training for line managers, supervisors and wellbeing leads
· Coaching
· Workplace wellbeing fund
interview
For February’s edition of Cura Insight, we spoke to Liz Jones, Policy Director of the National Care Forum. She argues that much of the frustration in the sector is down to the feeling of nothing being done to rectify mental wellbeing issues, and that long-term workforce planning is desperately needed.
How long do you feel that staff mental health has been an issue in the adult social care sector?
People have ridden the wave of more positive and less positive mental health for quite a long time. But I think the real challenge for employers in social care is that we don't really have a systematic occupational health offer.
Pre-pandemic, thinking about care homes, staff still had to cope with people's frailty, increasingly complex sets of care and inevitably people passing away - that's always taken its toll.
Also when looking at other services, such as two or three to one support, staff have got to have a set of specific skills and expertise to work with really complicated people, which is a stressful position.
You see the immediate impact of your work, both positive and negative. You see both when people are having a great day and a bad day. If you are out doing your home visits as a home care worker and people are really quite depressed, and you're the only person they've seen every day, that's a big burden?
We need to be honest about that and we need to try and reward people better. Most of the public don’t realise the responsibility social care staff have and the difference they make.
Which factors, specific to the pandemic, do you think have had the most severe impact on staff mental health?
I think it's been different in different waves, but there are some consistent elements that have been incredibly stressful for people.
People working in care feel they've really been left up against it, having to fight for testing and PPE - things we need every day to try and keep people safe. That sense of not having the support of the system is really stressful for people.
Obviously the reality of the pandemic is that people get ill. So, the people who you're caring for might be ill, the people who work with you might be ill. So, absence of staff means you are doing extra work, and at one point it just felt relentless, especially last summer with people starting to leave their roles working in care, creating wider workforce pressures.
In wave one, in 2020, it was really hard to get support from health colleagues. That meant, with hospitals shutting and fewer community health services, that care workers were being asked to take on more clinical type skills without very much support or training. We looked at this kind of pressure in our report Less COVID-19, which we produced with Dunhill Medical and the University of Leeds.
In wave one, there was also the DNAR (Do Not Attempt Resuscitation) issue, particularly affecting people with learning disabilities. So in the early phases, people felt like they were trying to be the champions of the people that they cared for and that it was them against the system.
We then went from no support in wave one to massive guidance, restrictions, controls and inspections that changed from week to week and we couldn’t keep up with.
We needed to try and bolster the resilience of the workforce, give them that recognition, pay them more. That was one of the recommendations of David Pearson’s Social Care Sector COVID-19 Support Taskforce back in August 2020. That in particular frustrates people; it feels like two years on from making those recommendations, not much has changed.
What has been the impact on care provision from the high levels of staff burnout?
Providers have worked incredibly hard to maintain a good service, but when you haven't got enough staff for a prolonged period of time, being able to offer really high quality services is difficult.
For existing residents particularly in care homes, supported living settings, or at home, staff have worked hard to maintain the best service they can. Some may say that they have not always been able to offer the level of really high quality they would've liked, but if you've only got 50 per cent of your staff, you can’t do some of the things you would normally do.
What’s been most alarming has been hearing care providers talk about not being able to meet future requests for care. Whether it's because they've not got enough staff, or whether it's because they're in an outbreak situation in a care home, they can't accept anybody new. So they can't help ease hospital pressures and can’t support people in the community who need to come into care. Care providers are also struggling to accept new requests for care at home, which is really worrying – and in some cases are having to hand back contracts for care at home due to a lack of staff.
That is really challenging, because if you've got a family on the phone to you really desperate for some help or a hospital really desperate for some help, and you haven't got the capacity to offer that extra care, that's very demoralising for somebody trying to run a great service.
You talked earlier about the feeling amongst staff of feeling a bit left behind, or being treated a different way. How much do you think the policy on mandatory vaccinations for care staff has impacted anxiety levels?
It’s important to say that social care providers are absolutely behind vaccination. But I think that the whole VCOD (Vaccination as a condition of deployment) experience has been very destructive for social care - the whole thing didn't seem to be based on really sound policy making .
It will be taught in policy school in future years as how not to do it.
It caused division between colleagues, but it also caused distress for residents as staff they’d known for years in some cases were leaving, and it made them sad. When you looked at the public consultations, certainly for round one of VCOD in care homes, the public were against it, people who used care and support services were against it, and the sector overall was against it. It felt like a political thing. The consultation on VCOD#2 to widen the requirements across health & care, beyond care homes, also showed little support from the public and people who use care and support services.
People have ridden the wave of more positive and less positive mental health for quite a long time
Then everybody was watching to see what happened when it hit the NHS. What do you think is going to happen when you've got headlines about losing 80,000 staff in the NHS, the same NHS we've told you we're raising national insurance for so we can clear a backlog?
There was a sense of inevitability that it would never get applied to the NHS, and I think the revoking of the policy just reinforced the sense that social care is seen as a second class citizen. It has been a hugely damaging policy – ill thought out, badly implemented and not the best way to drive up vaccine uptake. The things that have been shown to work are listening carefully to people’s concerns, addressing them respectfully with expert information and persevering with persuasion.
Do you feel the measures proposed in the ‘People at the Heart of Care’ White Paper on staff wellbeing will make a difference going forward?
I talked earlier about the workforce taskforce recommendations from August 2020. We're nearly two years on and those things haven't manifested themselves yet.
Of course we welcome the wellbeing measures for the social care workforce , but they need to make a tangible difference. So pay, reward and recognition are absolutely critical and not really covered in the WP, but we also need consistent also occupational health. Some larger employers do have occupational health schemes to provide support, but if you're a much smaller outfit it's harder to have such provision. Be good to see concrete OH support across the sector
Also, having been lurching from one workforce crisis to the other and after reading the government’s response to the health and care select committee, I don't understand why they don't want to join up the workforce planning between health and care. We haven't got a social care people plan, we need to think about how we are going to solve the problem longer term, and it has to be joined up with the healthcare workforce.
We’ve got integrated care systems coming. We had the integration White Paper which had warm words about planning your staff but no actual requirements saying, ‘you will have a joined up workforce plan.’ The logical conclusion is that we need systemic planning for the health and social care workforce.
opinion
In February’s edition of Cura Insight, Professor Mike Robling, Director of Population Health Trials, Centre for Trials Research at Cardiff University, argues that domiciliary care workers require just as much attention as those in residential care homes when it comes to reform of health and wellbeing policy.
The COVID-19 pandemic has delivered a shock to all parts of UK society and put substantial strain on health and social care sectors. So much has happened - successive waves, protective measures, people dying, people ill and people afraid. The impact upon carers themselves has received much attention, particularly in the media. However, in social care a stronger emphasis on residential care homes means that relatively little has emerged about those caring for clients living in their own homes.
Whatever pressures may have already existed for those working in domiciliary care, the pandemic will only have made it worse. In many cases, domiciliary care workers will now experience a more isolated pattern of working, with fewer opportunities to gain support from other team members. Throughout the pandemic, they have continued to provide essential and often personal care, but at what cost? A substantial workforce employed across a large number of organisations are spread throughout all sections of the community. A relatively hidden workforce compared to others, but essential and visible to their clients.
A stronger emphasis on residential care homes means that relatively little has emerged about those caring for clients living in their own homes
To better understand the health needs of domiciliary care workers we are using anonymised information drawn from healthcare records. In Wales, the regulator Social Care Wales has shown foresight by enabling professional registration data to be added to this health data. That means we can understand the health of the workforce more precisely than ever before without compromising individual’s confidentiality. We can track health over time and see whether current or future support for domiciliary care workers makes a difference.
Our work in Cardiff has shown that there are important mental health concerns for many domiciliary care workers. This may resonate with many in the sector and our data adds much-needed detail about this. We will explore further why some carers are more affected than others – not just for mental health but for physical health too. Any differences we find may be affected as much by the care worker’s own personal, social and community circumstances as their work environment.
Effective solutions to support care workers are more likely if they draw upon carers’ own experience, including sharing good existing practice. This may include changes to team working and organisation, more appropriate PPE or staff training that reflects the everyday reality of domiciliary care. Working with carers, using locally grown solutions and using existing data offer efficient routes to tackling challenges that are likely to extend beyond the end of current pandemic.