Written evidence submitted by Hft (WBR0109)

Written evidence submitted by Hft to the Health and Social Care Committee Inquiry on workforce burnout and resilience in the NHS and social care

1           About Hft

1.1         Hft is a national charity founded in 1962 by a group of families with a vision for creating a better life for their relatives who had learning disabilities. We pioneered the idea that everyone could have choices about how they live.

1.2         Today, we are trusted to support more than 2,500 people across England and Wales, from living independently in their own home, to day opportunities; from a few hours a week, right up to 24 hours a day.

1.3         We are funded in two ways: through local authorities, who fund vital support services, but also through donors, supporters and volunteers who enable us to find new ways to help more people to thrive rather than just get by.

1.4         For some people we provide round the clock support; for others it may be a question of helping with specific challenges such as building a social life or developing skills for independent living. For every person we support, we are committed to working with them to realise their best life possible.

1.5         The vast majority of references included in this response are from Hft’s Sector Pulse Check reports. These provide an annual snapshot of the financial health of the social care sector, as well as other key challenges it has faced in the preceding year such as staff recruitment and retention. You can find an archive of our research here: https://www.hft.org.uk/about-us/media-centre/research/sector-pulse-check/

2           About the social care workforce

2.1         The social care workforce are highly skilled, providing vital support to people with learning disabilities. Their role is broad and varies from using medical skills to administer medication to supporting someone to get out and about and develop their independence.

2.2         Over the past year, the contributions and dedication of the social care workforce have been bought into sharp relief as staff have continued to provide care throughout the pandemic.

2.3         We hope that the heightened awareness of the social care workforce prompts the government to acknowledge their vital work through increased funding for the sector to permit pay increases and recognition of their role as a professional career.

3           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? 

3.1         Pressure and stress are not new to the social care sector which faced numerous challenges impacting the mental health of the workforce prior to the Covid-19 pandemic.

3.2         This was evidenced in 2019 in Hft’s Sector Pulse Check research when we asked providers what percentage of  absenteeism (i.e. unplanned absences) in their workplace was related to mental health conditions  (e.g. stress, depression, anxiety, etc.). The average figure was 17%, with some reporting shares as high as 60%, illustrating this was a significant issue for the sector even then.[1]

3.3         Challenges leading to stress in the workforce are likely to have included (and continue to include):

3.4         Low pay - Historically, the social care workforce have received low pay in respect to the highly skilled work they do, meaning many individuals feel undervalued. Indeed, Hft’s 2018 Sector Pulse Check report found that 76% of care providers said one of the top three reasons employees gave for leaving their organisation was better pay in other sectors, whilst 43% cited perception of poor pay and working conditions amongst ex-employees.[2]

3.5         The vast majority of care providers recognise the workforce should be paid more for the invaluable work they do, however many are unable to pay it due to the rates to which social care packages are commissioned by the local authority. Whilst increases in the National Living Wage (NLW) as of April this year should go some way to ensure care staff are paid a fair wage, it is imperative that local authority fees and consequentially central government funding is great enough to cover this. As it currently stands, 35% of the adult social care workforce (485,000 workers) are paid below the new NLW rates.[3]

3.6         Financial uncertainty of the sector – More broadly, the social care sector is facing on-going financial pressures, including a lack of fee income and rising wage bills, forcing providers to take drastic action in order to remain sustainable.  Many of these actions are likely to increase feelings of uncertainty and stress among staff.

3.7         According to our research, due to financial pressures providers have been forced to close parts of their organisation or hand back marginal contracts. The amount of care providers taking this action has increased from 45% in 2018, to 62% in 2020. As a result of cost pressures, around 1/3 of providers have made staff redundant each year for the past three years.[4]

3.8         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? 

3.9         The Covid-19 pandemic has exacerbated the long-term existence of stress within the sector and increased incidences of mental-health related absence.

3.10     According to Hft’s 2020 Sector Pulse Check, 62% of social care providers have seen an increase in mental health related absence. On average, mental health related absence has increased by 10% since the beginning of the pandemic. [5]

3.11     This is further supported by research from the Personal Social Services Research Unit, which found that in a survey of social care staff, nearly four out of five respondents said that their job had left them feeling ‘tense, uneasy or worried’ more often since the onset of COVID-19. Three out of five also reported feeling ‘depressed, gloomy or miserable’ more often than before the pandemic.[6]

3.12     As well as the contributing factors listed above, the pandemic has presented unique challenges, both internal and external to the working environment, which have placed additional pressures on the social care workforce.

3.13     These include but are not limited to:

-          Having to adapt and adhere to regularly changing guidance and ways of working in order to prevent the spread of Covid-19.

-          Working in an environment which places the workforce at higher risk of contracting Covid-19. Social care workers faced among the highest mortality rates by occupation during the first phase of the pandemic.[7]

-          Managing staff absences due to colleagues contracting or being in contact with the virus. This may involve extra administration and training for new agency staff, or having to work additional hours to fill shifts where colleagues are self-isolating. Indeed, research shows that four-fifths (80%) of social care staff have increased their workload, while over half increased their working hours since the beginning of the pandemic.[8]

-          Bereavement and grief in instances where individuals that staff support have passed away, some very suddenly and in some instances more than one individual.

-          Personal challenges relating to the pandemic, such as loneliness and isolation, managing childcare (especially in a sector where working from home is not an option) or financial concerns.

4           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?

4.1         Social care providers recognise the vital contribution of their workforce and have acted quickly over the past year to provide a raft of support for staff. Indeed, the latest Sector Pulse Check research demonstrates that all providers took some form of action to support the mental wellbeing of their staff.[9]

         All providers signposted to mental health services, compared to 93% in the previous year

         Almost 90% offered mental health awareness training, an increase from 86%

         67% provided in-house mental health first aiders, an increase of ten percentage points from the previous year

4.2         However, it is vital to remember that an already beleaguered social care sector has dug deep into its own pocket to provide this support. This is at a time when 56% of providers have reported either being in deficit or seeing their surpluses reducing.

4.3         Whilst the government has made some effort to provide support for the social care, including promoting ‘Our Frontline’, it is vital that it steps in to provide support specifically for the social care sector so it achieves parity with the NHS – which in October announced an additional £15m investment in the mental health support for its staff.

4.4         Recommendation:  The government must fund specific mental health support for the social care sector, to ensure all staff are able to access support on a par with the NHS workforce and regardless of individual organisational capacity. The funding should be sufficient so as to provide for:

         The entirety of the social care workforce to receive mental health and resilience training to support their own wellbeing

         Mental health first aid training for one in ten members of the workforce

         Backfill payments to cover for staff while they are receiving training

4.5         Recommendation: The core and mandatory training received by social care staff (as set by Skills for Care) must be updated to include mental health and resilience training to support their own wellbeing

4.6         The significant financial challenges faced by the social care sector have a knock on effect upon the social care workforce, creating an environment of uncertainty and feelings of being undervalued due to low pay.

4.7         Recommendation: the government must bring forward a long term funding solution for social care to place the sector on a sustainable footing. It must include sufficient funding to allow local authorities to commission care at a rate which factors in a fair wage for those employed within the sector that is commensurate with the responsibility and skills required of their job.

March 2021