How can we improve quality of life at work for the social care workforce?
ENRICHEnabling Research in Care Homes
How can we improve quality of life at work for the social care workforce?
Ann-Marie Towers is a Reader in Social Care at the University of Kent and leads an international programme of research to develop and test the Adult Social Care Outcomes Toolkit (ASCOT), an outcomes measure used internationally in research and evaluation. She is a collaborator for the NIHR Research Design Service South East (RDS-SE), a funding panel member for the NIHR Research for Social Care programme and is on the editorial board for the journal of Primary Health Care Research and Development.
This blog post discusses the important issue of quality of life at work for the social care workforce. It draws on an NIHR study to begin developing a scale of work-related quality of life for adult social care staff and refers to a Sector Guide, co-produced with members of the public with lived-experience of adult social care and representatives of the social care sector.
Advice and tips for improving your ‘quality of life’ are everywhere. Everyone from policy makers, researchers, fitness gurus and social media influencers have something to say about how we can improve our quality of life; be happier, be healthier, have better wellbeing. We are told to build our resilience, get more sleep, find time to exercise, get outside and experience nature, have less screen time, eat more vegetables, drink less alcohol, have better work-life balance, practice mindfulness, and so the list goes on. All of these strategies are no doubt helpful and worthy in their own right but what they all have in common is that they place the responsibility for improving quality of life squarely on the shoulders of individuals. The focus of ‘self-help’ is necessarily on what we can control: our actions, attitudes and behaviours. Regarding quality of life, this often translates to improving our ability to cope with stressors, rather than addressing the root causes.
Given that about one third of our lives are spent working, it is unsurprising that in recent years there has been an explosion of research, literature and training resources on how organisations can improve their employees’ quality of life at work. However, yet again, we often see the emphasis being placed on improving employees’ personal resources, through resilience training and coping strategies; or by supporting employees to ‘self-help’ via assistance schemes (e.g. confidential helplines, signposting, counselling) and perks designed to promote generic health and wellbeing (e.g. discounted gym memberships). These are defined as being ‘secondary’ (focusing on managing workplace stressors) or ‘tertiary’ (remedial in nature) interventions (Cooper & Cartwright, 1997). They are popular because they focus on strategies that are within the ‘gift’ of the employer or organisation.
According to recent estimations, the health and social care sector employs one in ten of the working age population in the UK (The King’s Fund, n.d.), with adult social care employing around 1.54m people in England alone (Skills for Care, 2021). During the COVID-19 pandemic, this predominantly female and ethnically diverse workforce, were on the frontline, delivering essential care and support to those at most risk from death and serious illness. It was during this time that we undertook a study focused on care workers’ quality of life at work (Hussein et al., 2022), working with the sector to find out how employers were currently supporting their staff and make recommendations for actions (Towers et al., 2022). Understanding and supporting care workers’ quality of life at work is critical if we want to retain skilled staff and ensure the best outcomes for those they care for.
Unsurprisingly, we found that care workers’ quality of life at work is affected by their employer’s organisational and financial resources (e.g. rates of pay, working schedules, training opportunities), working conditions (e.g. models of care, teamwork) and the quality of the leadership (e.g. compassion, advice and support). As with most workplace interventions, formal strategies tended to be secondary or tertiary in nature. Some of the most valued interventions were informal, ‘soft’ interventions, put in place by particular mangers going ‘over and above’ to support their staff (e.g. phone calls to check in, even when the manager was not working). Although welcomed by staff, such informal interventions are unlikely to be sustainable and may even lead to staff in teams with less proactive managers feeling unsupported and resentful.
Currently, decades of underfunding in the sector, along with rising costs and the pressure of COVID-19, mean that transformative change is beyond the gift of many social care employers, especially those who rely on publicly funded contracts. As such, we worked with representatives in the sector to think beyond these limitations and reflect upon what the sector told us they really need to support care workers’ quality of life at work.
There is an urgent need for investment in the social care workforce to cover the real costs of care. This means better pay and working conditions, including the time and equipment people need to do their job well.
The care worker role needs to be recognised and valued through professional registration, national qualifications and an agreed career trajectory on a national pay scale.
Care is not delivered in a vacuum. At its core are people and relationships between people. To deliver high quality care, care workers need to work in a way that facilitates relationships within the triangle of care: those using services, their families and the social care workforce.
Representative and compassionate leadership
Leadership really matters in adult social care. Team leaders and managers need the time and resources to be ‘available’ to their staff. The workforce looks to its leaders to set the culture and tone of the workplace. Compassionate, communicative, available leaders were highly valued by those we interviewed.
Cooper, C. L., & Cartwright, S. (1997). An intervention strategy for workplace stress. Journal of Psychosomatic Research, 43(1), 7–16. https://doi.org/10.1016/S0022-3999(96)00392-3
Hussein, S., Towers, A. M., Palmer, S., Brookes, N., Silarova, B., & Mäkelä, P. (2022). Developing a Scale of Care Work-Related Quality of Life (CWRQoL) for Long-Term Care Workers in England. International Journal of Environmental Research and Public Health 2022, Vol. 19, Page 945, 19(2), 945. https://doi.org/10.3390/IJERPH19020945
Skills for Care. (2021). The state of the adult social care sector and workforce in England. www.skillsforcare.org.uk
The King’s Fund. (n.d.). Overview of the health and social care workforce. Retrieved March 16, 2022, from https://www.kingsfund.org.uk/projects/time-think-differently/trends-workforce-overview
Towers, A.-M., Palmer, S., Brookes, N., Markham, S., Salisbury, H., Silarova, B., Mäkelä, P., & Hussein, S. (2022). Quality of life at work: what it means for the adult social care workforce in England and recommendations for actions. www.pssru.ac.uk/ascotforstaff/homepage/
This project was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR200070). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.