Health and social care secretary, Matt Hancock, launched the government’s COVID-19 ‘action plan’ for adult social care on 15 April 2020 – the same week that excess deaths in care homes peaked during the first wave of the pandemic. Unveiling the plan, Hancock said that ‘Our goal throughout has been to […] support our 1.5 million colleagues who work in social care’. In reality, there had been very little national support for social care staff up to that point.
At the Health Foundation, we’ve assessed central government policy to protect and support people who use and provide care services in England during the pandemic. Although our latest analysis shows that parts of the response have improved over time, there have been delays and persistent gaps in national policy support, including for social care staff.
Around 1.5 million people work in 1.6 million jobs in adult social care in England. 82% of staff are women, 27% are aged 55 and older, and 21% are from black and minority ethnic backgrounds. There are 865,000 care workers, 135,000 personal assistants, 87,000 senior care workers, 36,000 registered nurses and 22,500 registered managers. Most roles provide direct care and support, but others are responsible for coordinating services and managing resources. Social care staff provide care services to adults of all ages in many different settings, including people’s own homes (domiciliary care), residential or nursing care homes, supported housing and day care settings.
Unlike in the NHS, social care staff are employed by 18,200 (mostly private) organisations or directly employed by individuals with care needs. Pay, terms and conditions vary by role, region and employer. Three quarters of care workers earn less than the Real Living Wage, a quarter of all jobs are on zero-hours contracts and 1 in 10 roles has no fixed hours. Vacancy and turnover rates are high.
A slow start
The national pandemic response in social care has been slow, including on action to boost the care workforce. There weren’t enough people working in social care before the pandemic hit, with around 112,000 vacancies in 2019/20. COVID-19 has put further strain on staffing, with staff getting sick, having to self-isolate or only working in one location to limit spread. The government began a recruitment campaign for social care staff at the end of April 2020, more than a month after the NHS began its recruitment drive to help cope with pandemic pressures.
Government paused its social care staff recruitment campaign after the first wave. But providers continued to experience staffing challenges over the course of the pandemic. In mid-January 2021 (just after COVID-19 cases in care homes peaked during the second wave), social care leaders warned of ‘alarming gaps’ and ‘sheer fatigue’ among the workforce. Soon after, government announced £120m extra funding for local authority spending on social care staffing. It was not until February 2021 that government began a second round of television, digital and radio advertising for the national recruitment campaign.
Targeted support for social care staff at higher risk from COVID-19 (including those from minority ethnic backgrounds) also appeared an afterthought. National policy advising social care providers to carry out risk assessments to provide additional protection for their most vulnerable employees was not introduced until June 2020. This was at the tail end of the first wave and nearly 2 months after the NHS introduced similar risk assessments for its staff. The government’s social care taskforce found that minority ethnic staff ‘felt delays in risk assessments exposed them to unnecessary risks’. Even after the introduction of risk assessments, concerns remained that they were sometimes implemented as ‘tick boxes’ or for employers to ‘cover themselves’.
Some important gaps in support remain. Poor pay and employment conditions in social care have consistently affected access to financial support for staff who need to self-isolate. Unlike NHS employees, social care workers are not guaranteed sick pay above the statutory requirement. Low and precarious incomes mean some people working in social care are not even eligible for statutory sick pay. Government introduced funding for infection control in social care in May 2020 (later extended to the end of June 2021), partly to help care providers pay staff while self-isolating. But even at the end of May 2021, 16% of care home providers paid self-isolating staff less than full pay (there are no data for other settings). The prospect of losing earnings is a likely barrier to getting tested and self-isolating.
Migrant workers in the social care sector have not had equal support in the policy response to those in the NHS. During the pandemic, government has offered free visa extensions for ‘overseas health and care workers’ whose visas are due to expire. But this does not apply to most of the social care workforce (only to health care professionals eligible for work visas). In April 2020, when asked about extending coverage of the free visa extension policy to social care workers, Home Secretary Priti Patel said that ‘we are absolutely working on that’ but the ‘disparate nature’ of the sector made it challenging.
In some areas, government support for the social care workforce improved after the first wave – for example, staff have had much better access to COVID-19 tests and personal protective equipment (PPE). And social care staff were included in the two highest priority groups for COVID-19 vaccines. But it has taken longer to vaccinate social care staff than the people they care for and NHS workers. The government confirmed yesterday that it will introduce legislation requiring people working in care homes to be vaccinated from October. But the many factors impacting vaccine uptake among care staff are complex: again, underlying structural factors in the sector play a part. There is no national register of most front-line social care workers (unlike for NHS staff), and the lack of oversight and scale of the sector appears to have presented challenges in identifying social care workers for vaccinations.
As a priority, the government must take action to ensure there are enough staff to provide care and protect staff as the pandemic continues. All staff who have to self-isolate should receive full pay. Wellbeing support is vital as social care staff may be at risk of burnout. Policymakers could also consider short-term measures to help retain and recognise staff – England is now the only UK nation not to give bonus payments to social care staff during the pandemic.
Then there are more deep-rooted problems. Social care services are chronically underfunded, understaffed, and undervalued. The social care workforce had been neglected by policymakers for decades before the pandemic. Although there are other factors at play, this legacy of neglect has impacted support and protection for social care staff during the pandemic. Fundamental reform to adult social care in England is now long overdue. Reform must include measures to increase wages and improve terms and conditions for the workforce. We don’t just need a better social care system for people with care needs and their unpaid carers, but also for the millions working in care.