An Undervalued Workforce

There is currently a staffing crisis within Social Care in the UK. According to data from Skills for Care, it is estimated that there are approximately 152,000 vacancies in the sector, exacerbated by high turnover rates and care providers struggling to recruit new talent.

The crisis is being driven by low pay and poor employment conditions, such as the prevalence of zero-hours contracts, as well as the demands of the role.

A root cause of these factors is that the perception of social care work and the vital role that it plays for individuals, communities and wider society, does not reflect reality, and that social care staff are significantly undervalued. 

There are ideas that social care work is low-skilled, and this undervaluation has become entrenched in public perception, commissioning practice and policy-making.  For example, everybody knows what a doctor or a nurse does because everybody visits a GP or goes to a hospital at some point in their life. 

However, most people only really come into direct contact with Social Care when they or someone they are close to requires a service. Similarly, political focus and capital tends to be directed to the NHS over Social Care, as every voter accesses health services more frequently than perhaps they would Social Care. These issues are both the cause and symptoms of the social care workforce being undervalued, and need to be addressed to resolve the staffing crisis.

The True Value of the Workforce

Care and Support Workers are highly trained and regularly assessed on a range of skills. Some of these are essential competencies, such as the administration and management of medication, the safe moving and positioning of people, and specialist techniques and training for specific situations, ranging from challenging behaviour, to stroke, to epilepsy. Increasingly they are also being asked to carry out procedures that were traditionally the preserve of nurses, such as managing PEG feeding.

There is also huge responsibility that comes with the role.  As well as requiring an in-depth knowledge of legal and regulatory frameworks in everything from safeguarding to mental capacity, they also need to have the ability to detect signs of abuse, spot subtle changes in physical and mental health, and make judgements on when medical assistance is required. In such a heavily regulated sector, they also need to create detailed records of their activity and observations.

On a personal level, the role requires a significant level of resilience, and in general there is little emotional or mental health support available, and the staffing crisis only adds to the pressure to “carry on”.  With 82% of the workforce being female, individuals often have external pressures such as childcare and family responsibilities to also contend with.

But care and support workers continue. Most see it as a vocation rather than a job. They are driven by their own desire to help to improve the quality-of-life of people, to make a real difference. What is not trained (or perhaps even trainable) are the relationships they form with the people they support, the human connection and understanding, the things that you can’t list on a task schedule.

They make sure you are – and feel – safe.

They know why you’re sad on a particular day. 

They know what song will cheer you up. 

They make sure you get to go for a walk in the park when the daffodils are out.

They help you build and maintain important relationships.

They allow a relative to get a good night’s sleep. 

They know exactly how you like your tea.

They help you get back to being able to make your own tea.

They celebrate the “little victories” with you every day.

They prevent you from having to go to hospital.

They help you achieve a lifelong goal. 

They support you to connect with your community.

They restore your sense of self-worth.

They support you to access that course you want to do.

They are a shoulder to cry on. 

They make you laugh. 

They are there waiting at the other end when you take your first bus journey independently.

They know when an important religious or cultural event is coming up.

They are the only other person that knows why your neighbour has that rude nickname.

They stop you feeling lonely or isolated.

They re-spark a long-lost passion.

They support you along a journey of recovery. 

They don’t mind that you spilled spaghetti on the carpet, they’re just proud that you made spaghetti.

They know all your life stories. They let you know that you matter and are cared about.

This is the true value of the workforce, but Social Care as a sector has traditionally not been great at celebrating and highlighting it.

Perhaps because these qualities cannot be trained, assessed, or regulated under the traditional approach is the reason that they are not evidenced or valued? The first step in valuing care and support workers is to evidence the value of what they actually do.

The Role of Technology

As social care increasingly embraces technology for everything, from care planning, to falls detection, to monitoring blood pressure, what role can it play in valuing the workforce? 

The first step in valuing the role of a care and support worker is to provide them with the tools to make their working day easier, and technology is increasingly doing this.  Digital care record systems provide instant access to care and support plans, risk management information, and task schedules that are always up-to-date.  eMAR and medication management systems make medication delivery and recording simple. Speech-to-text through a device makes recordkeeping less time-consuming. Managers can monitor service delivery in real-time, with alerts and notifications flagging any issues.

Improvements in operational efficiency and quality monitoring through planning and task-focused data are widely recognised and accepted, and essential tasks such as personal care, meal preparation, and medication need to be completed and recorded. 

However, this represents mainly data traditionally captured in paper records evidencing the basic (but still essential) needs-based tasks, and doesn’t necessarily influence the wider perception of the workforce’s true value.

Technology can capture the data measuring the impacts of care and support workers and not just the inputs to evidence the true value of the workforce.  The impacts are the changes to a person’s quality-of-life, which are often referred to as outcomes.

By incorporating an individual’s wants, wishes, goals, and aspirations in addition to their assessed needs, and positioning these desired outcomes at the forefront of their care planning, we can then record the activity, influence, and contribution that staff have in achieving them. 

Making notes of this activity against specific outcomes means that record-keeping becomes meaningful and tells a story, more akin to a diary than a checklist. Ensuring that the person’s voice is also captured means that it tells a story of a person’s journey, and the impact of their care and support in achieving those outcomes.

Just this one change in approach, facilitated through technology, will allow data to start evidencing the true value of the Social Care workforce.

Linked to quality frameworks, outcome data allows providers to evidence the impact of their services in a quality and regulatory compliance context at a service level, whilst also reinforcing the value of their staff in achieving it.

With this type of data evidencing the impact of care and support workers on people’s lives, we can start highlighting and celebrating the role of Social Care workers to commissioners, regulators, policy makers and the wider public.

The Potential of Data

Considering the further potential of outcome-based data, as we explored in a recent Care England Webinar, (The Role of Data in Adult Social Care Webinar – Care England) the digitisation agenda within Social Care presents significant opportunities for increased and more focused use of data across the sector, including for evaluating and valuing the workforce.

Consider on an individual level, being able to conduct an appraisal, review, or supervision with a care or support worker with data about all of the outcomes that they were involved in helping people achieve, and how that would make the process far more positive and meaningful, enabling impacts to be celebrated and best practices to be shared.

Taking this idea a step further, incorporating the call for a national register of care and support staff in England as promoted by Care England and The Care Workers Charity, an individual care worker’s record could include not only their training record, but details of the outcomes that they helped people to achieve. A record of the real value of their vocation.

This could lead to providers competing for the best staff through improved terms and conditions, and commissioning bodies starting to realise the true value of Social Care staff and reflective rates of pay when awarding contracts. 

With chronic budgetary constraints being felt by most commissioners, there is a reluctance to adopt new models of contracting social care services, but providing more outcome-based data could influence a change in approach. The unmeasured value in someone being supported to become more independent, or to achieve preventative outcomes through an increase in Social Care provision, far outweighs the cost of a period in a hospital bed or repeated access to primary care services.

The financial undervaluing of Social Care is an ongoing false economy. Hopefully the current policy of greater integration of health and care services will start to highlight this, and reliable data will support cultural change.

Acknowledging the value of Social Care staff in this very practical way, as well as celebrating best practice and what the role really involves with relevant data, could inspire future recruits to the sector, knowing that it is valued and rewarded accordingly.

But by embedding technology in to the sector for universal benefit, we can start to collect, collate and present data that evidences the true value of the Social Care workforce, which can lead to meaningful change.