Written evidence submitted by Centre for Care, University of Sheffield (RTR0103)
This response is provided by members of the ESRC-funded Sustainable Care: connecting people and systems team, and the ESRC Centre for Care.
University of Sheffield: Tom Hunt, Prof Sue Yeandle, Dr Kelly Davidge
This response focuses on lessons that can be learned from the introduction of mandatory vaccination for care home workers and is based on Hunt, T. (2021) Under-paid and under-valued: assessing mandatory vaccination for care home workers in England (Sustainable Care Paper 4, CIRCLE, Sheffield: University of Sheffield.) The paper is a review of evidence on mandatory vaccination, including the government’s consultation on the policy.
What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?
Factors behind the lack of enthusiasm for mandatory vaccination in social care may also explain why staff turnover in the social care sector is high and why some care home workers have chosen to leave their employment in recent months.
The vast majority of the British public are in favour of compulsory vaccination for all UK adults but most respondents (57%) to the Government’s consultation on Making vaccination a condition of deployment in care homes were opposed to the new policy. One important objection was that “the structure of employment in care creates barriers for care home workers to get vaccinated”.
The employment model for care workers is characterised by:
Our review of the available evidence highlights that pay and conditions of care workers are significant factors in understanding why some remain unvaccinated, and are indicative of wider problems in the social care sector:
These factors mean that workers on low wages who may be uncertain about the availability of future work (due to their ZHC status and unpredictability of shifts) often cannot afford to take time off to attend vaccination appointments. In addition, low-paid workers who have concerns about possible side-effects from vaccines, may feel they cannot risk having to take unpaid time off, if they feel unwell following vaccination, for fear of losing essential income.
We argue that the objections to vaccination by care home workers represent a wider crisis of work in the sector, not just a crisis of recruitment and retention.
To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?
We again take this question through the lens of mandatory vaccinations for care workers.
We argue that there are a number of lessons to learned from the introduction of mandatory vaccination for care workers, and consider the following questions salient:
If planned reforms set out in the Social Care White Paper are to establish the long-term settlement the sector needs, all stakeholders will need to be involved in their design and implementation. Care workers should be fully involved in the reform process to improve the contractual and employment models in social care; these are currently not fit for the purpose of attracting, training, and retaining adequate numbers of staff with the right skills. The introduction of mandatory vaccination for care home workers has exacerbated the recruitment and retention crisis in care. It provides an illustration of the unintended consequences that can occur when the voices of the workforce are not heard, and their concerns are not listened to and acted upon. Central to those concerns is the strong sense amongst the workforce that they are under-paid and under-valued, and that their concerns about the employment arrangements many care workers experience - of low pay, zero-hour contracts and poor terms and conditions, including a widespread lack of decent sick pay - are being ignored.