October 2020

Written evidence submitted by Oxfam GB (WBR0088)

Health and Social Care Committee – Workforce Burnout Call for Evidence

Written submission on behalf of Oxfam GB

‘[Work has] basically got me in tears every night. Going home, I never switch [off], I couldn’t do this.” Precarious work research[1], social care worker, England

1. Introduction

Oxfam welcomes this opportunity to submit a response to this call for evidence on burnout and resilience in the health and social care workforce. This contribution will focus on the experiences of social care workers during the pandemic and before, on burnout and stresses in the job, and how that is intimately linked with the poverty, low incomes and precarity many face. We believe that social care work is both valuable and at times very challenging, and we should recognise and reward it properly.

Oxfam believes poverty isn’t inevitable. It is an injustice that can be overcome. We are deeply worried about the impact the Covid-19 crisis is having on all those in poverty, or at risk of being dragged into it, and particularly the impact on carers, paid and unpaid. Research conducted by the University of Manchester in partnership with Oxfam demonstrates the difficulties carers face under the current system, both before the pandemic and during it.

Social care workers, in particular, have been at the forefront of the country’s response to the Covid-19 crisis, putting themselves at risk to provide crucial care to those who needed it the most, including the elderly and younger people with disabilities and serious health issues. Yet, for years, funding in the social care sector has been insufficient to cover the growing demand for care. This has resulted in care workers receiving low incomes and faced poor working conditions that not only undervalue care workers, make them invisible, and put them at risk of burnout, but also expose them to a higher risk of experiencing poverty, with all of the additional stress this brings.[i],[ii] 

Covid-19 has made the undervaluing of and underinvestment in social care even more evident, with workers experiencing loss of income and health risks, and the sector being affected by delays in the provision of adequate Personal Protective Equipment (PPE) and testing for staff and volunteers.[iii]

Women are overwhelmingly impacted by these factors as they are over-represented in the care sector (along with Black and Asian Minority Ethnic groups) - 83% of social care workers in England,[iv] 86% of the care home workforce in Scotland,[v] and about 80% of workers in the residential care sector in Wales[vi] are women.

While governments across Britain have taken welcome steps to cushion the impact of Covid-19 on the social care systems, much more support is needed to ensure that (1) the social care sector is adequately funded so the workforce do not experience burnout in short- and medium-term emergencies like Covid-19, but also are able to provide the longer-term caring support that many in our society need; and (2) the crucial and highly skilled role of all social care workers is recognised, valued and rewarded. Ultimately this would be an essential component of responding to the impacts of the ongoing pandemic, and pursuing a more just and fair economic recovery from the pandemic.

2. Before the pandemic

The pandemic has highlighted how little income care workers were receiving and how much they rely on overtime to make ends meet. Even before the Covid-19 crisis:

•         Social care work was underpaid, with half of social care workers in the UK – 500,000 people – being paid less than the Real Living Wage (£9.30 an hour),[vii] and 15% of all social care workers entitled to the National Living Wage (101,000) were underpaid in 2019;[viii]

•         Insecure forms of employment were widespread, with a significant proportion of the adult care workforce in England (24% or 370,000 jobs in 2018), and particularly care workers in domiciliary care services (58%), being employed in zero-hours contracts;[ix] and

•         The competencies and skills required to provide care were not adequately recognised and there was a lack of clear career progression pathways for workers in the sector.[x]

This lack of income and precarity caused significant stress in itself, as shown by evidence from a 12-month study carried out by Oxfam Scotland in partnership with the University of West of Scotland in 2015/16.

‘It’s just not enough, how can I pay all my bills and rents and… buy a bus pass… It means you can’t participate in basic things. I’ve got… my cousin’s 40th birthday coming up at the end of the month, and that’s a real issue for me ‘cause I’m thinking, “How am I gonna manage this financially?”’ Decent Work research[xi], social care worker, Scotland

The stress of the work itself was intense too, even before the pandemic, due to providing care around the clock in an increasingly underfunded and understaffed system, as described by this care worker:

‘[Work has] basically got me in tears every night. Going home, I never switch [off], I couldn’t do this. It was like never, no time for anything really, and I was like rushed off my feet, never get a break. Because it was basically having my break or leave someone in bed for example, obviously incontinent and stuff like that, so I’d rather do this instead of go on my break.’ Precarious work research, social care worker, England

3. Financial and health stressors during the pandemic

This background of being overworked and underpaid is important context for carers’ experiences during the pandemic. Carers interviewed during the pandemic expressed their concerns about losing more income, due the lack of a financial safety net, and how this would have detrimental consequences for their livelihood and families.

“I thought that I was going to be losing money and that was one of my biggest fears, the financial side of it, because me being the only bread winner, that when I did take the time off [for Covid-19]  and I thought well, I am going to be losing a chunk of money. I'm going to struggle and if I struggle financially, I'm going to lose my house and if I lose my house, that's going to lead onto other things.” Precarious work research, social care worker, England

This fear of loss of income meant that some workers reported coming back to work from sickness leave due to Covid-19 before they had fully recovered.

“At the time [while off sick], I was worrying financially. (…) I didn't know how much money I was going to be losing or not losing and I didn't want to lose financially because, like I say, it would have caused difficulties for me… I knew straight away I'd come back too soon. [….] So as soon as I got in and onto my unit, for the whole of the twelve-hour shift I was there, I was literally gasping for breath and I just kept saying to people I can't breathe, I can't breathe.” Precarious work research, social care worker, England

Care workers also reported worries about how going into work would impact on the health of those in their household.

“’Mum, please don't got to work.  Please?’ She [daughter] was petrified. And I said, ‘I can't, because people need me at work.’ ‘Yes, but you've got to think of yourself and dad’, and she was absolutely… I can't sleep, because I'm worried and worried.’“ Precarious work research, social care worker, England

Across Britain, the sector was also affected by a lack of adequate PPE and testing, which left care users and workers even more vulnerable and exposed to the virus.[xii],[xiii],[xiv]  All of this is in addition to the normal stresses of the work itself identified above.

4. Underinvestment in the social care sector

The urgent need to invest more public funding in social care across Britain was highlighted before the Covid-19 crisis. Public investment in adult social care declined by 8.2% from 2011–12 to 2015–16 in England,[xv] with a projected shortage of nearly 350,000 workers by 2028 (without further investment in the sector).[xvi] Evidence was already suggesting that chronic underfunding of the care system was leading to “greater unmet/under-met need, more self-funding, lower quality care, a crisis among care providers, and much greater pressure on staff, families and partner agencies”.[xvii] This lack of funding has also meant that many care providers have either gone out of business or have returned publicly funded care contracts to local authorities. Consequently, in some cases the caring needs of people were not met.[xviii] Research has also found that the sector faces a productivity and employment quality deficit, which cannot be reversed unless more money is provided to the sector.[xix]

As part of the Spending Round 2019, an additional £1 billion was made available by the Government to local councils in 2020/21 in England for adult and children’s social care.[xx] While this was a welcome measure, investment in social care remained insufficient to address the underfunding of social care in recent years – as some suggested, the additional funding was more of a ‘sticking plaster’ than a much needed, long-term and fundamental reform of the sector’s funding system.[xxi]

Based on estimates by The Health Foundation, with regard to the adult care sector only, in order to restore access to 2010/11 levels of service (when funding in the sector peaked) and increase pay among the social care workforce, the total spending in sector would need to be £31.8bn by 2023/24 – this is £12.2bn more than current spending power projections.[xxii] This would go some way to easing some of the pressure staff face, and raising their incomes.

5. Recommendations

Oxfam believe that as part of the first steps to building back better from the Covid-19 crisis, the UK government must provide adequate investment into the social care system by providing at least £12.2bn of extra funding. This investment will enable us to make a significant step towards the proper valuing of social care workers, improving workforce resilience, and , through:

• Paying all social care workers the real Living Wage and ensuring that pay reflects the true value of the work they do;
• Ensuring that all social care workers are offered better working conditions, including Living Hours;
• Formally recognising the high level of skills and competencies required by social care work - this would include giving social care workers the status of a profession on a par with social workers, teachers, and nurses, as well as establishing clear and fair career progression pathways, with training undertaken during paid work hours; and
• Guaranteeing adequate staffing levels, so care workers can do their job, and be less vulnerable to burnout.

If you wish to discuss this paper further, please contact Ieuan Ferrer, Domestic Poverty Policy Advisor, at iferrer1@oxfam.org.uk.