Many care staff have a negative view of their work, research shows, but the chance to gain skills and qualifications would make the job more attractive
Funding problems, and an increasing number of older people needing care, mean the care crisis is rarely out of the headlines. Some 41% of community based care services were found to be inadequate or requiring improvement by the Care Quality Commission in 2015. Predictions are that England alone will need 718,000 more care workers by 2025, but the turnover rate in adult social care of 25.4% means that around 300,000 workers leave the sector each year.
Lancaster University has been exploring these problems of recruitment and retention through the Helpcare project. The project is a three-year research partnership, spanning the UK, Italy, Poland, Bulgaria and Greece, funded by Erasmus+. So far we have interviewed more than 700 care sector employees, employers, commissioners and informal carers. The aim is to compare practices between the countries and explore barriers to care work, issues of career progression, training and the role of informal carers in supporting ageing populations.
We hope to develop innovative education practices for the qualification and professionalisation of health and social care workers. We have completed the first stage of the project and the initial findings are eye-opening.
Care workers are often not able to access training and it seems there are significant training gaps – more than 400 training needs were identified by the people we spoke to.
Care workers suffer from low self esteem and high burnout, particularly when working full time. Despite the new care certificate, significant numbers of UK care workers are interviewed one day and start jobs the next, with limited induction or training.
Some examples of excellent practice were identified, but they were not often shared widely or were the result of short-term interventions or pilot projects.
Sadly, for many care work is seen as an unattractive career option – a “last resort” – and people often do not have the soft skills or empathy needed for this demanding and important role.
Most care workers said they felt valued, but a quarter felt their role was not appreciated or understood by society. Around the same proportion believed they were treated as “second-class workers” (according to one Polish care worker), and one UK care worker said: “When people ask what I do, I feel ashamed to say.”
One reason for this feeling of inadequacy was that few care workers saw any potential for career development. Most were pessimistic about the opportunity for personal or career development unless they moved into training for nursing, social work or occupational health. But doing this was seen as impossible by many, who cited their need for an income, a lack of qualifications, or personal circumstances as preventing them from making such a move.
Many care workers were keen to develop their skills within care but found opportunities were limited, stating that even if they took on training this did not result in increased recognition – either through pay or promotion.
In particular, those working in domiciliary care were unhappy and stressed by the lack of time to do their work to the standard they wanted. They reported being unable to take breaks because of the need to get to the next call, and having to leave patients before they had completed tasks that needed doing.
The level of training needs identified by care workers was striking. One area they felt needed attention was nursing and medical-related skills, such as dispensing medication, manual handling and managing conditions such as strokes, dementia, diabetes and pressure sores. Other training requirements were psychological such as communication, counselling, emotional regulation and team working.
Care workers mentioned some positives about their roles, such as the opportunity to make a difference to the lives of others, and the social aspects of the role. These benefits kept them working in the sector.
However, the negative perceptions of care point to why there is such a high turnover of staff. In response, we have developed a series of recommendations.
- Training needs to be formalised, with national or EU-wide validation of qualifications and a range of qualifications from level 1 (entry level) to level 6 (degree level) available.
- All professional care workers should be registered (similar to registered childminder status in the UK).
- There should be training for specialist care practitioners, in stroke and dementia for example, as well as a pay premium for specialist care practitioners to enable career progression. This would help raise the status of care workers to that of other healthcare workers, such as healthcare assistants in hospitals.
Although investigating the funding of the care system is not in the remit of the Helpcare project, it is clear that the sector is underfunded and that the funding shortfall underpins many of the problems in commissioning care, recruiting and retaining staff, and training and development.
Until there is a sustainable funding model it is difficult to see these recommendations become reality, and this will affect the recruitment and retention of staff in the care sector.