All in a day's work: changes in the content and delivery of social care

Jo Moriarty, Michelle Cornes, Shereen Hussein, Martin Stevens, Jill Manthorpe

Outline

Background What we know about the social care workforce

Methods

Findings Data collection and analysis are ongoing so themes not final

Discussion Links with earlier papers

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Size of workforce

1.85 million adult social care jobs in England

1.63 million people (Buchanan et al, 2012)

About 10% of UK jobs (Moriarty, 2010)

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Image from Learn to become a carer website

Majority are women

Gender

Men WomenSource: Buchanan et al, 2012

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Age

Mean age is 43 Started working in

sector around the age of 35

All ages including those aged 65 and over

Buchanan et al, 2012

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Image from 123RF photos

International recruitment

82%

5%13%

NationalityBritish EEA Other countries

Source: Buchanan et al, 2012)

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Pay

Care worker pay rates range from £6.09 to £12.03 per hour

Buchanan et al, 2012

Most paid at lower end Near National Minimum

Wage

Estimated 9-12% paid below

Hussein, 2011

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Methods (1)

Four locationsMidlands, London, South, North

Simple random sample of social care providers (sampling frame CQC website, mix private/local authority/voluntary)

68 employers interviewed (mixture size and types of service user supported)

Face to face interviews 2008-2010

Re-interviewed 2010-2012

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Methods

Interviews with staff 2011- ongoing

Interviews with service users and carers

Online/postal survey of workers via employers

National online survey via other sources

Approvals Ethical approval from King’s College London

Support of Association of Directors of Adult Social Services

Research governance in four sites

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Data analysis

Interview transcripts read by members of research team

Agreed consensus on codes Data-driven and concept driven coding

Analysed using NVivo

Discussed with members of the Unit Service User and Carer Advisory Group

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Care work as body work

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Because it’s very hard to say... when some people see you naked... at one time…, I was naked with three support workers, because one was being trained, there was a manager, it was all very strange. When people see you naked, you are most vulnerable. And you don’t feel able to give requests… ‘Can you please pass me that, can you please not do this?’ Picture from NHS photo

library

Negotiating

Impact of Mental Capacity Act

‘If they’ve not had a shower for a few days you have to intervene, let’s say, because then it goes to their dignity. Would you want to walk round smelling, wet, [in the] same clothes for two or three days? … It’s not pleasant for everybody involved basically.’

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Working hours

Communal settings have always provided 24 hour support

Now more people living at home with very complex needs Implications for hours that

people need support

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Working hours

Impact of need for flexible working on recruitment

Shifts [might generally be] 3-10s[pm]s, or 7[am]-3[pm]s, or whatever. However, if an individual wants to go out and do something specific then the rota will change to reflect that individual’s needs. I’m very clear with people about that at interview. Yes, you may be doing 3-10 shifts, but I may ask you to work a 6[pm]-12[am] shift because somebody wants to go out for the evening and it might be somewhere further that they need to travel to

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The zero hours contract

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Zero pay

What zero hours really means

You are doing split shifts a lot of the time and they vary as well … because we have a zero hours contract …. [the council] only pay us the work that the carers [care workers] do. If a client goes into hospital, that’s their whole work gone for the week. As a carer [care worker] you need to say yes to absolutely everything, because you are not sure if your clients are going to be in hospital and you’ve not got any work. So we ask an awful lot and we don’t give that much back. But as a private organisation we can’t just pay people guaranteed contracts if we’ve not got the clients

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Pay (1)

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We are paid by the minute that we are at each call and we log in and we log out at each call.… I agree with [this monitoring] to a certain extent … [but] if you are held up in a call for any reason and it goes over the time that they [service users] are allowed, you don’t get paid for that

From workinstyle.com

Pay (2)

Some employers linked pay to possession of vocational qualifications Skills for Care have shown this premium is comparatively small

Small businesses had more flexibility especially if all/most people using services were self funding

Needed to find other ways of creating loyalty and team spirit

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Public scandals

Rising media coverage about standards of care

Also affects NHS Francis Report

Winterbourne View private hospital

Confidence in regulator CQC

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Impact on workers

Distress and concern about public perceptions

‘It pretty devastated a lot of us to hear it. It was quite upsetting, and everybody talked about it … And everybody was fairly upset and said how disgusting and how awful it was, and how could people be like that. And they give the rest of us a bad name as well, and they bring bad publicity, it reflects on us for a little while.’

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Pride

Finding meaning and value in the work

‘On our unit we pride ourselves because when they’ve come down from up on the other units, and it’s no disrespect to them, the families have come down and they’ve said, “What a difference.” We make sure they’re clean and we don’t just chuck any clothes on them. They’re co-ordinated’

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A job others wouldn’t do

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And then obviously from looking after my Nan and granddad to doing nothing, I felt a bit like I wanted to do something for other people to help them as well. That is how I got onto care. My mum used to be a carer as well. I’ve followed her (LAUGHS). She is a lovely person. She is very caring and I think that’s where I get my nature from.... Just helping people in general is what I want to do

Image from Swansea council website

The precariat (Standing, 2011)

Precariousness is the ‘new normality in globalised labour markets’

Members are ‘internally divided’

‘Villainisation of migrants and other vulnerable groups’

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Forms of labour security 1(p10)

Type of security Examples Social careLabour market security

Adequate income earning opportunities

Employment security

Protection against arbitrary dismissal, regulation on hiring and firing

Job security Retain niche in employment, career progression

Work security Protection against accidents/illness at work, unsocial hours

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Forms of labour security 2

Type of security Examples Applies to social care

Skill reproduction security

Opportunities to gain skills through training, apprenticeships etc

generally

Income security Adequate stable income Representation security Collective voice in labour

market

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Disclaimer

The Longitudinal Care Work study is funded by the Department of Health. We acknowledge funding from the Department of Health Policy Research Programme. The views expressed here are those of the authors and not the Department of Health

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