Reflections on frontline social care
A blog entry by PhD Student, Nick Morgan
When I joined social care as a frontline support worker over 10 years ago I naively expected my primary duties would be to accompany kindly care recipients on enjoyable days out, making dinner when we got home and chatting in front of the evening television. There is always more to a job than appears above the surface but this mischaracterisation was pretty spectacular. The definition and practice of care work has become extremely complex with the introduction of ‘personalisation’ which aims to avoid the pitfalls of institutional care by tailoring support to individual needs, being attentive to a care recipient’s likes/dislikes, ambitions, relationships and support for physical and/or neurological conditions in order to live a ‘good’ life. Add to this the government regulations to safeguard ‘vulnerable’ people, organisational policies and the individual service guidelines for day-to-day practice and you can begin to imagine the complicated landscape of frontline social care delivery.
‘A low-pay sector’
Insert into this landscape the ‘unskilled’ social care worker; ‘unskilled’ because this is the definition given in the labour market. Despite working at the point-of-delivery for this complex service, no qualifications are needed to become a care worker. Nonetheless, you quickly acquire a host of essential new skills. In my time as a care worker I learned to support people with autism, schizophrenia, bi-polar disorder, dysphagia, manage epilepsy, administer medication, practise person-centred care, safeguard adults from abuse, complete risk assessments and care plans, de-escalate ‘challenging behaviour’, restorative parenting and suicide prevention. These equip care workers with the skills to practise high quality care which is valued by care recipients, their families, regulators and wider society. There is a rudimentary logic to the labour market that higher skills producing something of value command better pay and conditions. Social care somehow operates outside this logic. It is consistently defined as a ‘low pay sector’ by the Low Pay Commission and rewards workers with 5 years’ experience an average of 6p an hour more than workers with no experience (Skills for Care, 2021). If we accept the conventional wisdom that people secure their welfare primarily by selling their labour for an income then working in social care comes with obvious risks.
For my ESRC White Rose funded PhD research, based at The Centre for Care, I am examining the risks to the wellbeing of care workers. The research is in collaboration with The Care Workers’ Charity who provide financial support grants to care workers in need. Their website shows many are living in such precarity that a single misfortune can plunge them into deprivation. Understanding the financial precarity of care workers means recognising that every misfortune and every increase to the cost-of-living is a possible threat to wellbeing. Care workers are simply not paid enough to afford the luxury of security. Poor employment conditions also threaten wellbeing, particularly for workers on 0-hour contracts which remove rights to sick pay, holiday, pension, and offer no guaranteed hours or steady income. These contracts are the reality for 25% of the social care workforce (Skills for Care, 2021); contrast this with only 3% for the entire UK labour force (Office for National Statistics, 2021). Training and development is often minimal particularly for 0-hour workers and in my experience the quality of care organisations’ training varies widely across the sector. One care worker I spoke to supporting people with a history of self-harm hadn’t completed any first aid training despite lone-working and had received no formal supervision in the 9 months they had been employed. Conversely, I have had the privilege to work for one of the best care organisations in the country by the Care Quality Commission’s standards. The non-profit organisation Partners in Support (click here to visit their website) provided me with formal training to support a range of physical and neurological conditions as well as formal qualifications up to a Level 5 HND in management. Without their focus on staff development I would not have had the opportunity to join higher education and research social care.
The risks posed by poor employment conditions vary by employment type and quality of the organisation but there are so many other challenges in social care work. Some of my family, friends and neighbours would comment that they could never work in care, but I’m still not precisely sure which aspects they were referring to. One which seems fundamental to providing a ‘service’ and caring for people with complex needs is the emotional strain and impact on mental health. There is a day-to-day requirement to perform ‘emotional labour’ and constantly maintain a positive disposition even when care recipients are physically and verbally abusive. Certain abuse is tolerated by remembering that care recipients might have limited comprehension of their conduct. Nevertheless, being aggressively shouted at instinctively produces an acute stress response which needs managing. Some care recipients also require constant attention allowing no respite especially in one-to-one supported living situations where care workers are not guaranteed a lunch break away from work and might be isolated all shift. Conversely, other care recipients can be anxious and withdrawn requiring enormous amounts of empathy and patience to remain supportive and to help overcome the challenges they might face. Burnout is a common complaint in care work and when people’s coping mechanisms fail they take time off with mental exhaustion. I’ve known care workers to despair head-in-hands before a shift because they are struggling to cope with the mental strain of the job.
The shift patterns also require exceptional resilience; even a full-time contract is inconsistent from week to week and demands extremely long, unsociable hours. As a care agency employee, it was common to be offered 8am-11pm shifts and my longest back-to-back shift as a senior care worker started at 2:30pm on Friday and ended at 6pm on Sunday. For senior care workers the extra responsibilities frequently blur the boundaries between paid time and free time and I have known senior care workers to quit because of the strain on their personal relationships. One full-time senior care home worker estimated that they perform 15 extra unpaid hours a week just to catch up with administrative duties. They question how the sector could ever function without relying on the goodwill of care workers to do extra for free. The expectation, they say, is for champagne services on lemonade resources.
The sector is arguably in a recruitment and retention crisis with over 100,000 vacancies and around 30% of care workers quitting every year (Skills for Care, 2021). The response has often been to advertise the intrinsic qualities of care work and so-called ‘warm, fuzzy feelings’ such as relationship building and undertaking socially meaningful work, but this is seemingly not enough to attract and retain workers when weighed against the intrinsic drawbacks. Nobody goes into a job wanting to be assaulted or abused and the majority would rather not work unsociable hours but these are some of the unavoidable realities which care workers tolerate. However, when social care is under-resourced it not only produces unjustifiably low pay and conditions, but it also compels care workers to act selflessly without limitations to cover the deficit. Naturally this is impossible to maintain and inevitably causes burnout and unstable, unsustainable care. The best care work practices reciprocal care, meaning both care giver and receiver are in a relationship that benefits both parties. Therefore, providing high quality care means providing enough resources to guarantee the wellbeing of everyone involved, resources which are now long overdue.
Office for National Statistics (2021) Dataset EMP17: People in employment on zero hours contracts. Accessible at https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/datasets/emp17peopleinemploymentonzerohourscontracts. Accessed 02.02.2022
Skills for Care (2021) State of the Adult Social Care Sector and Workforce 2021. Accessible at https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/State-of-the-adult-social-care-sector/The-State-of-the-Adult-Social-Care-Sector-and-Workforce-2021.pdf. Accessed 02.02.2022
Nick’s PhD research is supervised by Prof. Sue Yeandle and Prof. Majella Kilkey working in collaboration with The Care Workers’ Charity with additional supervision from their CEO Karolina Gerlich. It seeks to understand the risks to wellbeing experienced by care workers before and during the Covid-19 pandemic using a mixed-methods approach to analyse applications to the charity’s financial support grants followed by interviews with care workers and stakeholders. It will explore how longstanding issues within social care manifested during the pandemic alongside wider policy debates regarding the role of the welfare state and social issues concerning intersectional inequalities relating to gender, ethnicity and migration.