Much of what's happening right now feels dauntingly like last March – we’re back in lockdown and being told to ‘protect the NHS’. We’re seeing similar media coverage of the impact of coronavirus (COVID-19) on the NHS and its hardworking staff but a great deal less attention on protecting adult social care services and staff.
COVID-19 has taken a devastating toll on people being cared for in the community and care homes. Throughout the pandemic, insufficient attention has been paid to the impact on the 1.5 million people working to look after people across residential, nursing and home care in England. We have previously highlighted the challenges facing the care workforce going into the pandemic, including high vacancy and turnover rates and low pay. Here we bring together emerging evidence of the pandemic’s impact so far on a workforce (mostly made up of women) that has for too long been undervalued, underpaid and politically neglected.
The pandemic’s effects on social care staff
Health and wellbeing
Social care workers faced among the highest mortality rates by occupation during the first phase of the pandemic and sickness absence rates more than doubled between February and October 2020. To an extent, care work – which often demands close personal contact – carries increased risk of COVID-19 exposure. Staff are also at higher risk of getting the virus and of dying from it because they are older and more ethnically diverse than the general population – a quarter are aged 55 and older and 21% are from black and minority ethnic backgrounds. And the government was slow to implement policies (for example to ensure staff had access to enough PPE and comprehensive testing) to protect the sector.
Emerging evidence of the impact on staff mental wellbeing is worrying. In a Health Foundation funded ‘pulse’ survey of nearly 300 social care staff in July 2020, a sobering four out of five respondents said that their job had left them feeling ‘tense, uneasy or worried’ more often since the onset of COVID-19. Three out of five also reported feeling ‘depressed, gloomy or miserable’ more often than before the pandemic. In a Queen’s Nursing Institute survey, 56% of care home nurses reported that they felt worse than normal in terms of both their physical and mental wellbeing.
The pandemic has had a negative impact on the earnings of social care staff. Insecure employment and low pay have put care workers and the people they care for at risk.
In a report commissioned by the Health Foundation in September 2020, the Institute for Employment Studies estimated that care workers earning the National Living Wage faced an effective pay cut of up to two-thirds of their earnings if required to self-isolate after testing positive for COVID-19, even after accounting for Statutory Sick Pay. While this does not cover more recent financial support schemes (such as the Test and Trace Support Payment), it raises the bleak prospect of care workers being torn between self-isolating and being able to provide for themselves or their families.
The government’s Infection Control Fund, introduced in May to limit COVID-19 transmission in care homes, has been used by some providers to address this. For example, 80% of Enfield’s allocation went towards paying staff while self-isolating. But this varied by local authority and may not have gone far enough. In the Kent pulse survey in July, one in five workers who reported having to self-isolate had received little or no pay. Additionally, some zero-hours workers may have missed out on pay because of increased childcare responsibilities or having to shield.
A challenging job has been made more difficult by the pandemic. In July, four in five reported that their workload had risen, mainly due to covering for colleagues who had to self-isolate or having to train new volunteers.
In spite of everything, most respondents reported a high level of commitment and pride in their roles. And – though it remains to be seen how long this will last – a silver lining of the pandemic has been an increase in interest in social care roles. COVID-19 has raised the profile of care work and led to increased public awareness of the complexity and skill involved in care provision.
What next for the social care workforce?
In the short term, government must do everything possible to protect social care staff. People working in social care are rightly being prioritised for vaccination, and data are needed to demonstrate how quickly this is actually happening. Regular testing has now been extended to home care workers (in addition to care home workers). But beyond extending the Infection Control Fund, the government’s COVID-19 social care winter plan offered no additional financial support for staff. The taskforce advising on the development of this plan made several recommendations – for example, a loyalty bonus to retain experienced members of the existing workforce. These are yet to be taken up.
Further work is needed to understand the longer term impacts of COVID-19 on the social care workforce. The University of Kent team which led the pulse survey will seek to explore these through a larger longitudinal survey (funded by the Health Foundation).
COVID-19 has also made the deep-rooted workforce problems in social care (of pay, retention, progression, working conditions and recognition in society) more apparent and acute. Resolving these problems requires significant funding and reform of the complex and fragmented social care system. We calculate that the sector needs around £11bn a year in additional funding by 2023/24 to stabilise services, improve pay and conditions for staff and deliver much needed funding reform. But social care again received only the bare minimum in the recent 1-year Spending Review. And long-promised reform is still yet to transpire.
The evidence base on how to tackle these problems is sometimes lacking but this should not be used as an excuse for inaction. The REAL Centre is commissioning a social care modelling project to develop a better understanding of care needs over the next 10–20 years, the workforce needed to meet those needs and the policies that could deliver better results (for example to consider the effect of increasing pay on the number of vacancies in the sector).
The pandemic has exacerbated years of policy neglect in adult social care. By taking a long-term view and providing robust, independent evidence, we hope to inform future government policy that supports our indispensable yet undervalued care workforce.
The invitation to tender for the social care modelling project will launch on our website in the coming weeks. Email REALcentre@health.org.uk if you would like us to get it touch with you when it launches.