Written evidence submitted by The National Care Association (WBR0067)

1. How resilient was the NHS and social care workforce under pre-COVID-19 operating conditions, and how might that resilience be strengthened in the future? 

The social care workforce has been undervalued for decades which has led to a low level of resilience prior to Covid-19 operating conditions. This has led to an under appreciation and low self-esteem for those who work in social care as opposed to those working in the NHS. Our workforce is primarily made up of older carers who have been in the profession for a number of years or new entrants who do not necessarily view social care as a career but more as an alternative or substitute form of employment.

Resilience can only be improved by ensuring an adequate supply of trained, willing and able entrants to the sector who deem social care as an opportunity for a career.

2. What has the impact of the COVID-19 pandemic been on resilience, levels of workforce stress, and burnout across the NHS and social care sectors? 

Responsibility versus recognition/reward has always remained low but the additional pressure of Covid-19 had a severe impact on anxiety levels combined with the additional pressures of having to cover for colleagues who were in self isolation.

Many staff felt the pressure of having to work exceptionally long hours over a prolonged period of time. In order to provide safe care, many staff worked for over weeks without a break in between, often working well in excess of their normal wirking hours a week.

Combined with the anxiety and fears of Covid-19 this level of working has caused considerable fatigue amongst staff, especially the

Many felt begrudged in the early days as the Government campaign was all about the NHS and Social Care was again forgotten until much later on in the pandemic. Furthermore, the Government was more than happy to announce maximum furlough scheme payments which far exceeded the expectations of social care workers who were expected to continue working during the pandemic. This was further heightened by Welsh and Scottish Social Care workers being offered fixed bonus payments by their respective Governments.

Many staff were left feeling tired, anxious, overwhelmed as well as disillusioned by how undervalued they felt and as a result have left Social Care to take up posts with less responsibility and pressure.  This has had a direct effect on workers’ mental as well as physical health and has a direct correlation to those exiting the profession.

There has been so much sudden change in guidance and working practices during the height of the pandemic that many staff were left feeling that they don’t have the knowledge or understanding of the sector. This disillusionment combined with having to work through incredibly difficult challenges has led care staff to look for alternate careers where the challenges versus reward are more commensurate to their expectations.

During the lockdown period, there were many new entrants to the social care employment market which was a temporary easement, however, almost as many left the sector as soon as other sectors began to re-open.   

3. What is the current scale of workforce burnout across NHS and social care? How does it manifest, how is it assessed, and what are its causes and contributing factors? To what extent are NHS and care staff able to balance their working and personal lives? 

Staff were all working far more than their contracted hours just to ensure that safe care was delivered to the residents in their charge. Many felt that they needed a rest and could not continue at the same pace as they had done during the height of the pandemic.

We currently have over 122,000 care vacancies in the UK, so there is already a shortage of able, willing and skilled care workers. Inevitably this puts extreme pressure on the existing workforce to cover the hours that are needed to provide a safe level of quality care. This then will impede on care staff being able to balance their working and personal lives.

Furthermore, professional care staff earn little more that the NMW, so based on a 35 hour week (5 shifts over 5 days), a skilled professional carer can expect a little over £16,200pa. This is clearly insufficient for a professional living wage for an adult, which then forces people to work more simply to survive.

Working in care is physically as well as mentally challenging which carries not just a moral responsibility but also a legal responsibility to provide safe care. As a result, care staff feel highly over worked and undervalued.

4. What are the impacts of workforce burnout on service delivery, staff, patients and service users across the NHS and social care sectors? 

The impact of workforce burnout amongst staff causes additional pressure on remaining staff which in turn means a diminishing quality of care for residents as well as the services that are provided. The increased levels of anxiety only serve to diminish staff morale and absenteeism levels, which further impacts service delivery and the quality of care that residents receive.

As a result of staff shortages, we have experienced that Managers as well as Directors have had to step in to cover shifts to ensure safe delivery of care. Inevitably this has a further impact on essential management and administration services within care operations.

5. What long term projections for the future health and social care workforce are available, and how many more staff are required so that burnout and pressure on the frontline are reduced? To what extent are staff establishments in line with current and future resilience requirements? 

The situation has seen no improvement in so many years and there is no light at the end of the tunnel in terms of recruitment and retention within the social care sector. Recruitment and retention of staff is perhaps the single largest drain on management time and expense. With so many applying, there is such a small conversion rate from application to starting and this diminishes further in terms of a 12-month retention in employment.

There is a dipropionate churn rate in social care that a resilient workforce is simply a pipe dream unless we can attract / recruit able, willing and qualified carers into the profession.

6. To what extent are there sufficient numbers of NHS and social care professionals in training for service and resilience planning? On what basis are decisions made about the supply and demand for professionals in training? 

All care establishments – social care as well as NHS facilities – are suffering from a severe lack of staff. The level of locum and agency employment is perhaps at an all term high. It is therefore virtually impossible to introduce any planning for future resilience if care facilities are unable to firstly have enough permanent staff to carry out basic care.

Many Homes are suffering with low occupancy levels but simultaneously, if the staff burnout levels are at this level, it becomes difficult to fill further beds if safe care cannot be delivered due to a lack of able and willing care givers.

Social care has always been the poor cousin of the NHS due a disparity of esteem between the 2 services. Trained and qualified professionals in social care often use their grounding as a stepping-stone into the NHS. So a movement of staff from social care to the NHS creates a further void in the Social Care sector.

7. Will the measures announced in the People Plan so far be enough to increase resilience, improve working life and productivity, and reduce the risk of workforce burnout across the NHS, both now and in the future? 

There is only a passing comment on the social care sector in the plan which in itself highlights the value of social care and our workforce.

8. What further measures will be required to tackle and mitigate the causes of workforce stress and burnout, and what should be put in place to achieve parity for the social care workforce? 

The ability to be able to pay a living wage so care givers can work reasonable hours and have a work / home life balance. This will require improved LA funding to take into account agreed levels of pay.

An equal parity of esteem between Social Care and the NHS so employees see social care as a career path and not a minimum wage task, if no other employment alternatives are available.

The ability to be able to recruit migrant staff on a sponsorship basis to enable a quality of service to be provided. The long-term benefits of this are that these very same employees will feed into the NHS over a period of time and also help to resolve regional employment voids.

Submitted by: Raj Sehgal on behalf on National Care Association
Suite 4, Beaufort House, Beaufort Court, Rochester ME2 4FB

6625Sept 2020